Abstract:

Introduction:
The gamification in the classroom has had a wide reception in the field of teaching in recent years. Interactive fiction has been widely used in books and comics for several decades. In recent years there has been a greater presence of this genre (“choose your own adventure”) in plain text video games. However, it is not often used in the field of university teaching, and there is no evidence of its application in nursing studies, where "decision-making" competence is widely developed in many subjects.
The main objective is to improve decision-making by nursing students prior to their clinical practice. The specific objectives are as follows: (1) to determine the students' behavior regarding their decision making in daily life, and (2) to know the students' opinion about the usefulness of Twine software for the realization of simulated clinical cases.

Methods:
The teaching methodology used was storytelling, especially in those situations where second-year nursing students can interact with the story to simulate clinical cases prior to their care practices.
Twine 2.3.2 was used in conjunction with the Harlowe 3.0.2 history format for the preparation of the clinical cases. It is free software and cross-platform in PC.
The pre-test questionnaire was distributed at the beginning of the activity, while the post-test questionnaire was distributed after the clinical cases were completed. In addition, the students gave prior feedback on their decision-making skills using the "Melbourne Decision Making Questionnaire", adapted and validated version for the Spanish language.

Results:
Only 40.8% (31) of the students knew about interactive fiction and 34.2% (26) had previously read a book or video game of this genre. Likewise, the students valued very positively that the use of this methodology could improve their decision-making capacity during their future care practices, with an average of 8.67 +- 1.40 points.
Using the Melbourne Decision Making Questionnaire, average scores of 10.21 +- 1.34 (vigilance), 6.01 +- 2.40 (hypervigilance), 5.08 +- 2.84 (buck-passing) and 3.45 +- 2.76 points (procrastination) were obtained. These data indicate greater uncertainty in decision-making among the students studied compared to previous research.
Once the clinical cases were completed, the students felt that they preferred this methodology to traditional formats such as clinical cases written in a document (9.49 +- 0.87 points), and the power of choice allowed them to reflect on their decisions (9.09 +- 1.12 points). Finally, the students positively highlighted that this methodology has helped to improve their decision making prior to their clinical practices (7.72 +- 1.50 points).

Conclusions:
Clinical case studies using interactive fiction have improved decision making for nursing students under study. They initially started with low self-esteem in terms of their decision-making skills and ended with a very positive opinion regarding the effect that interactive fiction has had on developing this competence.

Keywords:

Decision Making, Twine, Melbourne Decision Making Questionnaire, Nursing.