Abstract:

Introduction:
One of the nursing activities in Primary Health Care is the nurse home visit, with the objective of establishing a follow-up of the various individuals and families whose health is at risk or affected. In addition, they should monitor the physical environment at home for elements beneficial or detrimental to health. Difficulties are observed in nursing students to be able to mentally stage the different theoretical clinical cases, being the nurse home visit one of these situations that covers this problem.
The main objective is to improve nursing students' knowledge, skills and attitudes about nurse home visit using clinical cases with tabletop role-playing game mechanics.

The specific objectives are the following:
(1) to assess the usefulness and playable experience through the aforementioned mechanics in this context,
(2) to evaluate the students' performance based on the role played in the clinical case through the virtual tabletop role-playing game.

Methods:
The teaching methodologies used were gamification and case-based learning. In the days prior to the simulation of three virtual clinical cases, 3-4 nursing students were assigned as family members and patients for each one, sending them their corresponding house plan (produced using the Sweet Home 3D software) and a genogram of the family.
For virtual simulation, Google Meet was used with Google Meet Dice Roller extension, allowing random events or factors to be added to the clinical cases by means of a virtual ten-sided dice (1: worst event, 10: best event). In each clinical case, a student volunteered to act as a nurse in the case, at which time the patient's clinical history was provided. Once prepared, the story of each clinical case was developed from the street of the patient's home until the end of the nurse home visit, with a maximum duration of 30 minutes. Teachers acted as game masters.
A pre-test questionnaire of nursing home visit was distributed. At the end of the simulation, participants completed the GAMEX scale, while the assistants evaluated the organisational, communicative and improvisational skills of the student who acted as nurse. All students completed a post-test knowledge questionnaire together with items related to their role.

Results:
Prior to the simulation, 66.7% (32) of the nursing students were familiar with role-playing games and 37.5% (18) had previously played tabletop role-playing games. Participants highlighted that the tabletop role-playing game mechanics were very useful for the development of the virtual clinical cases (9.23 +- 1.14 points), highlighting high scores on positive emotions and low scores on negative emotions about their gaming experience. Attendees felt that the students who acted as nurses did not plan the nurse home visit well and sometimes did not pay attention to the physical aspects of the home. However, after the simulation, knowledge of the most important phase of the nurse home visit (planning) was significantly improved (Z=-3; p=0.003).

Conclusions:
The use of tabletop role-playing game mechanics in the simulation of virtual clinical cases has been positive for the improvement of some knowledge and skills about nurse home visit in nursing students. The gaming experience was rewarding for the participants, while the attendees were able to detect and observe the difficulties of nursing in the home environment.

Keywords:

Tabletop role-playing game, Distance learning, Google Meet, Nurse home visit, Simulation, Nursing.