The Effectiveness of Serious Game-Based Training for Nursing Students in Postpartum Haemorrhage Management

The Effectiveness of Serious Game-Based Training for Nursing Students in Postpartum Haemorrhage Management: A Randomised Controlled Trial

This randomized controlled trial evaluated the incremental effect of adding a web-based serious game to standard theoretical instruction on third-year nursing students' postpartum hemorrhage management knowledge, task-specific self-efficacy, and self-regulated learning. Using census recruitment, all 159 eligible students were invited, and 120 students consented and were randomly allocated in a 1:1 ratio to the intervention or control group (60 participants per group) using randomly permuted blocks of four. Both groups received the same three 40-minute theoretical sessions. The intervention group additionally completed an individual, self-paced, 30-50-minute browser-based serious game featuring a single branching postpartum hemorrhage scenario, clinical decision-making, and immediate physiological feedback. The control group received no additional educational activity before the immediate posttest assessment. Outcomes were assessed at baseline before randomization and immediately after the intervention or control condition. Outcome data were analyzed by an independent analyst blinded to group coding.Data will be collected using the PPK Management Knowledge and Skills Assessment Form and the PPK Management Self-Confidence Scale.

Study Overview

• Status: Completed
• Conditions: Postpartum Hemorrhage; Self-Efficacy; Nursing Students; Nursing Care; Game-Based Learning; Nurse Education
• Intervention / Treatment: Other: Web-Based Serious Game

• Study Type: Interventional
• Enrollment (Actual): 120
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Sakarya
    • Adapazarı, Sakarya, Turkey (Türkiye)
      • Sakarya University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child; Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

1. Enrollment as a third-year nursing student in the Obstetrics and Gynecology Nursing course.
2. Voluntary agreement to participate and provision of electronic informed consent.
3. Access to an internet-enabled smartphone, tablet, or laptop for using the web-based serious game.

Exclusion Criteria:

Absence during the scheduled intervention session. Incomplete submission of the data collection forms.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Web-Based Serious Game; Participants received three 40-minute standard theoretical sessions on postpartum hemorrhage management and additionally completed an individual, self-paced, 30-50-minute browser-based serious game containing a single branching clinical scenario with clinical decision-making and immediate physiological feedback.	Other: Web-Based Serious Game; A browser-based serious game (Version 1.0) comprising a single branching clinical scenario on the recognition and management of primary postpartum hemorrhage. Participants made clinical decisions, observed the physiological consequences of their choices, and received immediate formative feedback. The game was completed individually in a single continuous attempt lasting approximately 30-50 minutes.
No Intervention: Standard Theoretical Instruction Group; Participants received the same three 40-minute standard theoretical sessions on postpartum hemorrhage management as the intervention group. They received no additional educational content or time- and attention-matched activity before the immediate posttest assessment. Access to the serious game was offered after all post-intervention outcome assessments had been completed.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Postpartum Hemorrhage Management Knowledge Assessment Form (PHM-KAF)	The researcher-developed PHM-KAF is a 15-item multiple-choice assessment of knowledge and clinical decision-making accuracy related to postpartum hemorrhage risk assessment, etiology (the 4Ts), and evidence-based management. Each correct response is scored as 1 and each incorrect response as 0, yielding a total score ranging from 0 to 15. Higher scores indicate greater postpartum hemorrhage management knowledge. Content validity was evaluated by nine academic experts specializing in women's health and obstetric nursing (S-CVI/Ave = 0.96).	At baseline before randomization and immediately after the intervention or control condition.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Postpartum Hemorrhage Management Self-Efficacy Assessment Form (PHM-SEAF)	The researcher-developed PHM-SEAF is a 10-item, task-specific assessment form measuring nursing students' perceived self-efficacy in postpartum hemorrhage management. Items are rated on a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree), yielding a total score ranging from 10 to 50. Higher scores indicate greater task-specific self-efficacy. Content validity was evaluated by nine academic experts specializing in women's health and obstetric nursing (S-CVI/Ave = 0.94).	At baseline before randomization and immediately after the intervention or control condition.
Self-Regulated Learning Scale for Clinical Nursing Practice	The Self-Regulated Learning Scale for Clinical Nursing Practice is a 16-item, 5-point Likert-type instrument comprising two subdimensions: Motivation and Learning Strategies. Total scores range from 16 to 80, with higher scores indicating stronger self-regulated learning.	At baseline before randomization and immediately after the intervention or control condition.

Collaborators and Investigators

• Sponsor: Sakarya University

Study record dates

Study Major Dates

• Study Start (Actual): November 5, 2025
• Primary Completion (Actual): November 30, 2025
• Study Completion (Actual): December 30, 2025

Study Registration Dates

• First Submitted: November 13, 2025
• First Submitted That Met QC Criteria: November 13, 2025
• First Posted (Actual): November 17, 2025

Study Record Updates

• Last Update Posted (Actual): September 1, 2026
• Last Update Submitted That Met QC Criteria: August 28, 2026
• Last Verified: November 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Urogenital Diseases; Pathologic Processes; Female Urogenital Diseases and Pregnancy Complications; Obstetric Labor Complications; Pregnancy Complications; Hemorrhage; Puerperal Disorders; Uterine Hemorrhage; Pathological Conditions, Signs and Symptoms; Postpartum Hemorrhage
• Other Study ID Numbers: 06.10.2025

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No