A serious gaming approach to experiencing the effects of unsolicited help and loss of autonomy (Preprint)

Abstract

BACKGROUND Maintaining self-direction and experiencing autonomy is an important basic human need. In healthcare, it is imperative that people with care needs maintain control over their own lives. Respecting autonomy and providing ethically sound care is an ethical obligation for healthcare providers. Many existing interventions focus on promoting (medical) treatments and physical conditions. This serious gaming intervention focuses on experiencing the loss of situational autonomy during nursing education and the impact of paternalistic behaviour on self-efficacy. OBJECTIVE The aim of the study was to explore, through an iterative design process, prototypes that provide nursing students and their teachers with a perspective on the loss of autonomy through unsolicited help. The design process aimed, on the one hand, to develop a serious game to confront nursing students with the effects of unsolicited help through experiential learning and to gain a perspective on the loss of autonomy. On the other hand, the aim was to make nursing students think about their role in the care process and which link they represent to prevent loss of autonomy METHODS This research uses a design-based research framework to develop a serious game through an iterative process. In the first phase of the research, examples of loss of autonomy through unsolicited help were collected through closed Facebook groups. In the second phase, several prototypes were developed and tested with nursing students and teachers. The impact of this experience was supported and documented through dialogue using the Circle of Feelings. RESULTS A total of 94 examples of loss of autonomy due to unsolicited help were collected and divided into seven different categories. Over a period of 10 weeks, four prototypes were developed to simulate loss of autonomy due to unsolicited help. By testing several prototypes, insights were gained and used to refine the design. As the study progressed, resonant game mechanics were integrated into a convergent prototype. CONCLUSIONS This article presents an iterative design process to offer nursing students and teachers the perspective of loss of autonomy through unsolicited help with a serious game. The conceptual structure of the intervention contributes to the discomfort of making one's own choices and executing according to one's own plan while being capable. The iterative design process was helpful in finding constructive and resonant game mechanics to further promote discomfort. This contributed to the design of a serious game as a boundary object that playfully initiates dialogue and encourages nursing students and teachers to reflect on the role of autonomy in the nursing process.