Game-based learning in undergraduate nursing education: A systematic review and meta-analysis

Game-based learning is increasingly being utilized in nursing education to enhance student engagement, motivation, and overall learning outcomes. This approach encompasses a wide range of pedagogical strategies, including gamification (the integration of game elements into non-game contexts), serious games, and other structured educational games designed to meet specific learning objectives. While there is growing evidence that game-based learning can positively influence cognitive, affective, and psychomotor outcomes, the findings are often inconsistent, influenced by methodological differences and variations in instructional design. This systematic review and meta-analysis aim to evaluate the effectiveness of game-based learning strategies compared with traditional instruction in undergraduate nursing education. A meta-analysis conducted in accordance with PRISMA 2020 guidelines. A search of five databases identified randomized trials and quasi-experimental studies on Game-based learning in nursing education from January 2015 to December 2025. The effectiveness relative to traditional methods was analyzed using standardized mean differences and random-effects models, with assessment of heterogeneity and publication bias. Risk of bias was evaluated with the OHAT tool. Thirty-five studies involving undergraduate nursing students met the inclusion criteria, revealing that game-based learning improved various educational outcomes compared to traditional methods. Pooled analyses indicated positive effects across multiple learning domains; however, effect magnitudes varied considerably, and substantial heterogeneity was observed across outcomes. Game-based learning appears to improve cognitive, affective, and psychomotor outcomes; however, the size of these effects varies considerably and warrants cautious interpretation. To further reinforce the evidence base, it is advisable to conduct high-quality, multi-site randomized trials with standardized outcomes and extended follow-up periods. • Game-based learning improves cognitive, affective, and psychomotor outcomes in nursing. • Large pooled effects were observed for knowledge, skills, and self-confidence. • Substantial heterogeneity reflects variability in designs, outcomes, and measures. • Evidence supports cautious integration of game-based learning into nursing curricula.