Impact of self-directed learning strategy, an innovative method in nursing undergraduates: A randomized controlled trial

Background Nursing education is adapting to advancing healthcare technologies and changing patient needs. Self-directed learning (SDL) is essential for fostering lifelong learning among nursing students. Game-based learning (GBL) has emerged as a novel approach to improve engagement and SDL skills, yet its effectiveness against traditional methods in nursing undergraduates is still not well studied. Methods This study is a prospective, randomized, controlled trial aimed at evaluating the effectiveness of game-based learning (GBL) as an innovative self-directed learning strategy compared to conventional self-directed learning (SDL) in nursing education. Conducted at Smt. Radhikabai Meghe Memorial College of Nursing in India, it involved 140 nursing undergraduates who were randomly assigned to either an experimental group using an antimicrobial stewardship game or a control group utilizing traditional learning materials. Each participant attended a 90-minute orientation session before beginning a 12-week intervention period. The study focused on measuring SDL abilities through the Self-Directed Learning Instrument (SDLI) and knowledge acquisition with a questionnaire specifically targeting antimicrobial resistance and stewardship. Secondary outcomes included assessments of perceived cognitive, affective, and psychomotor learning via the CAP Perceived learning scale. Statistical analyses employed R software, utilizing nonparametric tests and ANCOVA models to adjust for baseline differences and covariates, with a significance level set at p < 0.05. Results At the 12-week follow-up, the experimental group showed significantly higher median knowledge scores (12.0 vs. 9.0, p < 0.001) and SDLI scores (72.0 vs. 59.0, p < 0.001) compared to the control group. ANCOVA analysis indicated a significant adjusted mean difference for knowledge (-3.1, p < 0.001) and SDLI (-12.3, p < 0.001). All secondary outcomes also demonstrated significant improvements in the experimental group (all p < 0.001), with sensitivity analyses affirming the robustness of these findings across various statistical models. Conclusion Game-based learning significantly improves knowledge acquisition and self-directed learning in undergraduate nursing students over traditional methods, and its incorporation into nursing curricula is advised to develop essential lifelong learning skills for the evolving healthcare sector. Trial registration number: Trial Registered Prospectively at Clinical Trials Registry - India [CTRI/2024/01/061599 (Registered on: 18/01/2024)] ; URL: https://ctri.nic.in/Clinicaltrials/rmaindet.php?trialid=92950&EncHid=87481.96317&modid=1&compid=19