Effectiveness of gamified interventions on clinical reasoning-related cognitive skills, knowledge, teamwork skills, and problem-solving skills among nursing students: A systematic review and meta-analysis.

BACKGROUND

Existing systematic reviews and meta-analyses have reported inconsistent findings regarding the effects of gamified interventions on clinical reasoning-related cognitive skills in nursing education. In addition, prior meta-analyses were based on a limited number of studies with small, pooled sample sizes, highlighting the need for a more focused and comprehensive synthesis of evidence on this outcome.

OBJECTIVES

To systematically evaluate the effects of gamified interventions on clinical reasoning-related cognitive skills, knowledge, teamwork skills, and problem-solving skills in nursing students.

DESIGN

A systematic review and meta-analysis.

METHODS

Eight databases were searched from inception to December 2025. Randomized controlled trials and quasi-experimental studies involving nursing students, using gamified interventions, and reporting clinical reasoning-related outcomes were included. Primary outcomes were clinical reasoning-related cognitive skills, and secondary outcomes were knowledge, teamwork skills, and problem-solving skills. Hedges' g with 95% confidence intervals (CIs) was calculated using random-effects models. Moderator analyses were conducted to explore sources of heterogeneity.

RESULTS

Of 20 eligible studies, 18 provided sufficient data for a meta-analysis. Those studies included 1930 undergraduate nursing students. Gamified interventions showed a large immediate post-intervention effect on clinical reasoning-related cognitive skills (g = 0.98, 95% CI = 0.53-1.43), whereas no significant effect was observed at the 1-month follow-up (g = 0.08, 95% CI = -0.16-0.32). Gamified interventions also showed potential benefits on knowledge (g = 1.30, 95% CI = 0.01-2.60), teamwork skills (g = 1.11, 95% CI = 0.84-1.38), and problem-solving skills (g = 0.74, 95% CI = 0.22-1.25). The certainty of evidence ranged from moderate to very low across outcomes.

CONCLUSIONS

Gamified interventions may have positive immediate effects on clinical reasoning-related cognitive skills, knowledge outcomes, teamwork skills, and problem-solving skills among nursing students. However, the evidence for knowledge outcomes should be interpreted cautiously because of substantial heterogeneity and borderline precision. In addition, evidence regarding teamwork skills and the sustained effects of gamified interventions on clinical reasoning-related cognitive skills remains limited because these findings were derived from only a small number of studies.