Exploring the Impact of Home-Based Serious Smartphone Resuscitation Gaming on Stress Among Nursing Students Practicing Simulated Adult Basic Life Support: Randomized Waitlist Controlled Trial.

Abstract

Background: Simulation-based training is widely used in resuscitation education, yet limited research exists on how serious smartphone games-especially when used independently at home-impact stress levels during simulated adult basic life support (BLS). Understanding this relationship may offer new approaches to preparing health care students for high-stress clinical situations.

Objective: This study aimed to evaluate the impact of a home-based serious resuscitation game, MOBICPR, on physiological stress markers among nursing students performing simulated adult BLS.

Methods: In this single-center, randomized, waitlist controlled trial, 43 first-year nursing students were assigned to either an intervention group (IG) or a waitlist control group (WL-CG). Stress was measured at baseline and 2-week and 4-week follow-ups using electrodermal activity (EDA), blood volume pulse (BVP), heart rate (HR), and body temperature (BT) collected via the Empatica E4 wearable (Empatica Inc., USA). Each data collection point included 3 phases: mandala coloring before and after simulated adult BLS performance, and the adult BLS scenario itself. The MOBICPR game-a serious mobile game designed per the 2021 European Resuscitation Council adult BLS guidelines-was played at home over 2 weeks by IG (weeks 0-2) and WL-CG (weeks 2-4). A random forest classifier, trained on the AffectiveRoad dataset, predicted stress levels (none, moderate, and high) based on physiological signals.

Results: Of 124 students invited, 43 participated (22 in IG, 21 in WL-CG; 38/43, 88% female; mean age of 19, SD 0.6 years). EDA, BVP, and BT significantly changed across measurement phases in both groups (P<.05), while HR did not show consistent differences (P>.05). Stress classification showed a significant decrease in stress after simulated adult BLS in the IG at the 2-week follow-up (P=.04), but not in the WL-CG. After 2 weeks of gameplay, 12 of 22 participants in the IG had lower stress levels after performing simulated adult BLS compared to before, suggesting an adaptive stress response. No significant group-level stress reductions were observed over time.

Conclusions: Short-term, home-based gameplay using a serious resuscitation game modestly influenced physiological indicators of stress during simulated adult BLS among nursing students. While overall group stress levels remained stable, individualized responses suggested improved coping for some. Incorporating serious games into curricula could offer learners safe, gamified environments to rehearse stressful clinical scenarios. Future research should explore optimal game frequency and content depth to maximize educational and emotional resilience outcomes.