Exploring the experiences of serious games in learning from the perspective of undergraduate nursing students: a qualitative systematic review and meta-synthesis

Background Serious games are increasingly used in nursing education to boost undergraduates’ motivation. Despite their potential to integrate cognitive, psychomotor, and affective learning, students’ actual experiences and expectations remain underexplored. Understanding their perspectives is key to deepening learning and sustain engagement and development. Objectives This study explored undergraduate nursing students’ learning experiences and perceptions of serious games, with particular attention to their learning experiences, perceived gains and the challenges encountered. Methods We systematically searched nine databases, including PubMed, Web of Science, Embase, Cochrane Library, Scopus, CINAHL, PsycINFO, SinoMed and China National Knowledge Infrastructure (CNKI) from their inception to September 15, 2026 for qualitative evidence on undergraduate nursing students’ serious game experiences, using relevant search terms. Two independent reviewers assessed methodological quality via CASP, synthesized data thematically, and evaluated confidence in the findings using GRADE-CERQual. Results A total of 13 studies were included, 4 overarching themes emerged. Among them, the overarching themes were: favorable environment-supportive technical infrastructure, internal gains-intertwined cognitive and affective gains, external advancement-perceived clinical competence development, and practical appeals-existing deficiencies and targeted optimization approaches. Serious games offer systematic pedagogical benefits via technical infrastructure support, cognitive–affective synergy, clinical competence enhancement, and continuous optimization pathways within an immersive safe environment. Conclusion Students regarded serious games as a complementary learning strategy that supported their cognitive, affective, and practical development. However, limitations persist in scenario diversity, affective support, and feedback design. Future research should address scenario library and feedback system constraints to better align serious games with complex clinical decision-making training. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420261380457 ; identifier CRD420261380457.