The Effect of Digital Games on Ethical Sensitivity and Decision Making in Nursing Students

The Effect of Digital Game-Based Teaching Methods on the Development of Ethical Sensitivity and Ethical Decision-Making Processes in Nursing Students

The study was planned using a randomised controlled experimental design to determine the effectiveness of digital game-based teaching in the development of ethical sensitivity and ethical decision-making processes among nursing students.

Study Overview

• Status: Not yet recruiting
• Conditions: Decision Making; Ethics
• Intervention / Treatment: Other: Digital game; Other: In-class group work

Detailed Description

The most significant contribution this study will make to the literature is its systematic demonstration of the effects of a digital game-based teaching method on the development of ethical sensitivity and ethical decision-making processes in the context of nursing education. Currently, ethics education is mostly conducted using traditional methods, and it is known that students experience difficulties in transferring what they learn in theoretical education to practice. This study makes a unique contribution by demonstrating that digital games can support students' ethical thinking and decision-making skills by offering interactive and experience-based learning opportunities. Furthermore, the study aims to expand the limited literature on the use of digital game-based teaching in ethics education in nursing and to provide evidence-based data on the integration of technological innovations in ethics education. In this respect, the research is of a nature that will strengthen the pedagogical foundations of nursing education and pioneer the development of student-centred and innovative teaching strategies.

• Study Type: Interventional
• Enrollment (Estimated): 60
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Furkan Keles, PhD Student; Phone Number: +90 507 491 77 96; Email: FurkanS_1996@hotmail.com
• Study Contact Backup: Name: Funda Büyükyılmaz, Prof. Dr.; Phone Number: +90 505 454 92 16; Email: funda.buyukyilmaz@iuc.edu.tr

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

Students must:

• Have taken and successfully completed the Nursing Ethics course,
• Be a fourth-year nursing student who has successfully completed all professional courses and is undertaking the 'Professional Training in the Workplace' placement.

Exclusion Criteria:

• Students who have not taken the Nursing Ethics course or have failed the course before taking the Professional Training in the Workplace course.
• Having a conditional grade point average (CGPA <2.00) up to the period when the data was collected.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Experimental group; Both the experimental and comparison groups will receive a reminder lecture from the researcher on ethical principles and codes prior to the applications. Participants in the experimental group will simultaneously play digital games and participate in classroom group work after the reminder lesson.	Other: Digital game; Digital Game: The developed digital game aims to enhance medical students' ethical awareness and decision-making skills. The digital game first provides students with reminders about ethical principles. The game covers a four-week process, focusing on a specific ethical principle each week. Each weekly module presents two cases supported by animated visuals written by the researcher, reviewed by experts, and created by the software company. After watching and reading the cases, students answer related questions. The modules and principles covered are as follows: Week 1 (Do No Harm/Beneficence): Cases related to treatment refusal and palliative care compliance. Week 2 (Autonomy/Respect): Cases related to organ donation decisions and chemotherapy refusal. Week 3 (Justice/Equity): Cases related to resource (air mattress) allocation and patient prioritisation. Week 4 (Confidentiality/Privacy): Cases related to HIV diagnosis confidentiality and psychiatric service confidentiality.; Other: In-class group work; Face-to-face case analysis will be conducted over 4 weeks. These sessions are scheduled outside the course programme, once a week for 40 minutes. A total of 4 cases, each relating to an ethical principle, will be given to students in printed form at the beginning of each session, and they will be asked to analyse them simultaneously. Before the exercises, students will be explained how to analyse the cases.
Other: Comparison; They will only participate in in-class group work.	Other: In-class group work; Face-to-face case analysis will be conducted over 4 weeks. These sessions are scheduled outside the course programme, once a week for 40 minutes. A total of 4 cases, each relating to an ethical principle, will be given to students in printed form at the beginning of each session, and they will be asked to analyse them simultaneously. Before the exercises, students will be explained how to analyse the cases.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Adapted Ethical Sensitivity Scale for Nursing Students	This scale determines the ethical sensitivity levels of nursing students. The 7-point Likert-type scale (1=Strongly disagree, 7=Strongly agree) consists of 30 items and six subscales. Items 8, 24, and 29 are reverse-scored. The total score ranges from 30 to 210; a high score indicates high ethical sensitivity. Item averages are evaluated as 7-5.9 (very important), 5.8-5 (important), 4.9-3.1 (neutral), and below 3.1 (unimportant).	3 times; a week before implementation, a week after implementation, 2 months after implementation
The Ethical Dilemma Test in Nursing	The scale developed under the name 'Nursing Dilemma Test' aims to identify ethical issues in nursing and consists of six scenarios. Each scenario has three sections (A, B, C): Section A (Action): Measures the decision to be made in the face of an ethical dilemma (to act/not to act/to be undecided). Section B (Thinking Style): Determines the 'Principled Thinking' (NPT - importance given to ethical principles) and 'Practical Thinking' (PT - importance given to environmental factors) scores by ranking six statements based on Kohlberg's theory. Section C (Familiarity): Calculates the 'familiarity' score by questioning the case experience. Scoring: NPT Score: ranges from 18 to 66. PT Score: ranges from 6 to 36. Familiarity Score: 6-17 (familiar), 18-30 (unfamiliar). Reliability (Turkish Version): Cronbach's Alpha: NPT (0.59), PT (0.50). Test-Retest: NPT (0.77), PT (0.73).	3 times; a week before implementation, a week after implementation, 2 months after implementation

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Student Satisfaction and Self-Confidence in Learning Scale	This scale assesses students' satisfaction with education and their attitudes towards self-confidence in learning. The 5-point Likert-type scale (1=Strongly disagree, 5=Strongly agree), consisting of 13 items in total, has two subscales: Satisfaction with Learning (5 items) Self-Confidence (8 items) Items are reverse-coded. The total score ranges from 13 to 65; a high score indicates high satisfaction and self-confidence. The Cronbach's alpha coefficients of the original scale were found to be Satisfaction (0.94) and Self-Confidence (0.87). The Cronbach's alpha values for the Turkish form were found to be Satisfaction (0.89), Self-Confidence (0.83), and Scale Total (0.90).	Once; a week after implementation

Collaborators and Investigators

• Sponsor: Istanbul Medeniyet University
• Investigators: Principal Investigator: Furkan Keles, PhD Student, Istanbul University - Cerrahpasa; Principal Investigator: Funda Büyükyılmaz, Prof. Dr., Istanbul University - Cerrahpasa

Study record dates

Study Major Dates

• Study Start (Estimated): March 1, 2026
• Primary Completion (Estimated): April 1, 2026
• Study Completion (Estimated): June 1, 2026

Study Registration Dates

• First Submitted: November 13, 2025
• First Submitted That Met QC Criteria: November 17, 2025
• First Posted (Actual): November 19, 2025

Study Record Updates

• Last Update Posted (Actual): November 19, 2025
• Last Update Submitted That Met QC Criteria: November 17, 2025
• Last Verified: November 1, 2025

More Information

Terms related to this study

• Keywords: Decision Making; Nursing Students; Ethics; Digital Game
• Other Study ID Numbers: IMU17

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