Effects of a Digital Pressure Injury Educational Game (PI-DGAME) on Nursing Students' Knowledge and Staging Accuracy: A Quasi-Experimental Study With 4-Week Follow-Up

Abstract

Accurate classification and staging of pressure injuries (PIs) are essential competencies for nursing students, yet traditional teaching methods may not sufficiently support retention and clinical decision-making. Digital game-based learning has emerged as an innovative strategy to enhance engagement and knowledge acquisition in health professions education. This study aimed to examine the effect of the Pressure Injury Digital Game (PI-DGAME) mobile application on nursing students' knowledge of PI classification and staging, their staging accuracy and short-term knowledge retention and to evaluate usability and learner satisfaction. A quasi-experimental single-group pre-test–post-test design with a 4-week follow-up. The study was conducted with 60 undergraduate nursing students between May and July 2025. Following baseline assessment using the Pressure Injury Test (PI-TEST), participants accessed the PI-DGAME mobile application and completed at least one full gameplay session during a one-week self-directed intervention period. Repeated gameplay was permitted. Game engagement and performance indicators were automatically logged. The PI-TEST was re-administered immediately after the intervention and at 4-week follow-up. Data were analysed using non-parametric tests. PI-TEST scores increased significantly from pre-test to post-test and were maintained at the 4-week follow-up (p < 0.001). Pairwise comparisons showed significant improvements from pre-test to post-test and from pre-test to follow-up, with no significant decline between post-test and follow-up. In-game performance improved with repeated gameplay; total scores and correct responses increased, while incorrect responses and completion time decreased (p < 0.05). Achievement level and gameplay frequency did not differ by academic year. Students evaluated the game positively; over 90% reported ease of use and clarity of content. PI-DGAME was associated with improved knowledge, staging accuracy and short-term retention among nursing students. Digital game-based learning may provide a complementary educational strategy to support learning related to PI classification and staging in nursing education.