First Advisor

Aldridge, Michael

Document Type


Date Created



Registered nurses (RNs) working in today’s healthcare environment must consistently learn new knowledge and skills, keep abreast of practice changes, and implement strategies to improve patient outcomes. However, healthcare organizations face significant challenges as they attempt to facilitate efficient training. Nursing professional development practitioners miss opportunities to leverage learner motivation, which drives investment, knowledge retention, and practice application. Gamification, which strategically embeds game elements and mechanics into an educational design to boost motivation, offers a potential solution. It aims to increase learner engagement by presenting learners with challenges, tracking their progress, and offering feedback, ultimately leading to knowledge retention and application. The purpose of this quantitative study was to examine whether gamification leads to increases in motivation to learn and knowledge levels for RNs. Specifically, the study focused on RNs who did not have previous cardiac monitoring experience. The study used flow theory and self-determination theory to optimally incorporate gamification. A quasi-experimental posttest-only design with a comparison group allowed for comparisons among RNs who completed a traditional ECG course with those who completed a gamified ECG course. The comparison group contained 66 eligible participants who completed the survey and the experimental group contained 64 participants. Post-course surveys were electronically distributed to registered nurses who completed either the traditional or the gamified version of the ECG course. Research instruments included a demographic survey, the Flow Perceptions Questionnaire (a self-reporting motivational survey), and an ECG knowledge test. Additionally, RNs who completed the gamified version were administered a short survey measuring the motivational effects of included game elements and mechanics. Two hierarchical multiple regressions were conducted to identify differences between the comparison and experimental groups when controlling for age and current patient care environment. The first indicated the addition of the variable class type to the prediction of ECG test scores was statistically significant (ΔR2 = .116, p <.001). Therefore, the experimental group scored statistically significantly higher than the comparison group. The second hierarchical multiple regression suggested the addition of the variable class type to the prediction of Flow Perceptions Questionnaire scores was not statistically significant (ΔR2 = .006, p = .397). Thus, no significant differences were discovered between the two groups specific to learner motivation. In fact, the comparison group reported higher motivation levels than the experimental group. The proposed theoretical framework effectively guided the ECG course’s gamification design; however, since anticipated learner motivation scores were not achieved, minor adjustments might be warranted. Game mechanics and game elements, specifically selected for the gamified ECG course based on learner personas, were mostly rated as promoting higher motivation levels. Future research must be conducted to improve sample diversity, control, and motivation measurement, in addition to exploring qualitative data, longitudinal outcomes, and gamification’s various technological sophistication levels.


210 pages

Local Identifiers


Rights Statement

Copyright is held by the author.