A Systematic Review and Meta-Analysis of the Effect of Gamified Clinical Skill Learning on Learning Outcomes in Undergraduate Nursing Education.

backgroundNursing education requires innovative approaches to develop core competencies in knowledge, skills, and attitudes. Gamified learning interventions offer promising alternatives to traditional teaching methods for enhancing outcomes in undergraduate nursing education. PURPOSE: This systematic review and meta-analysis was conducted to evaluate the effectiveness of gamified learning interventions on knowledge acquisition, skill performance, and attitude enhancement among undergraduate nursing students and to investigate the differences in effects achieved across different gamification categories.

methodsFollowing PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines, a comprehensive search was conducted across six databases (A+ Education, CINAHL, Embase, ERIC, PubMed, and Web of Science) on March 18, 2025. This search targeted randomized controlled trials designed to compare gamified learning with traditional teaching methods in undergraduate nursing education. Study quality was assessed using the Cochrane Risk of Bias 2.0 tool, and evidence certainty was evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) methodology.

resultsThe findings of randomized controlled trials involving a total of 1,698 participants demonstrated significantly positive effects favoring gamified learning across all key domains, including knowledge acquisition (standardized mean difference [SMD]=0.81, 95% CI [0.55, 1.07]), skill performance (SMD=1.64, 95% CI [0.96, 2.32]), and attitude enhancement (SMD=0.54, 95% CI [0.07, 1.00]). The subgroup analysis revealed differential effectiveness across gamification categories, with serious games demonstrating large and consistent effects on knowledge acquisition (SMD=0.84, 95% CI [0.43, 1.25], I2=61%), while gamified web and mobile learning interventions showed moderate effects with greater variability (SMD=0.55, 95% CI [0.23, 0.87], I2=70%). Skill performance exhibited the largest overall effect sizes, although substantial heterogeneity was observed across all outcome domains (I2=82-95%). The results of the GRADE assessment support moderate-certainty evidence for all learning outcomes.

conclusionsThe results of this systematic review and meta-analysis provide robust evidence that gamified learning interventions significantly enhance undergraduate nursing education across the knowledge, skills, and attitudes domains. Serious games demonstrated superior consistency for knowledge acquisition, while the strongest overall effects were identified for skill performance. The substantial heterogeneity observed underscores the critical importance of selecting appropriate gamification approaches based on specific educational objectives, institutional technological capabilities, and implementation contexts. These findings support the strategic integration of evidence-based gamified learning into nursing curricula as an effective supplement to traditional teaching methods. Future research should focus on assessing long-term competency retention and developing standardized implementation frameworks to guide the widespread adoption of effective gamified learning approaches in nursing education.