Using a digital interactive narrative as guided self-reflection for beginning nurses to encourage self-care

Background
Burn-out and turnover rates among beginning Dutch nurses are high. One of the main reasons for this is the difficulty in adjusting to the tumultuous working environment or making it work in their favor. This is particularly hard for beginning nurses, as they do not have enough experience to reflect on their ordeals and take appropriate actions.One way to prompt their self-reflection is to provide focused questions within controlled situations that are believable and relatable. The contextualized guidance provides clarity and helps student nurses analyze tough situations in a safe and structured environment. Through this process, they are invited to reflect on what they could do differently, or whom they could reach out to for help.
Methods
Using a User-Centered design research approach, we have developed a digital interactive narrative that helps beginning nurses identify aspects of their job that they find challenging (i.e. it provides contextualized guided self-reflection). In this prototype, the reader plays through an interactive story based on common work floor experiences that require assertive behavior (e.g. a shift throughout which a patient is too demanding). At certain points in the story, the user hasto consciously decide how the protagonist acts by selecting from a set of possible (re)actions. Each action leads to story-appropriate consequences, after which the story continues. After finishing the story, users are provided with more in-depth feedback on their (non-) assertive behaviors, using the related moments in the story as context.In line with our User-Centered approach, testing was aimed at informing future iterations of the prototype with input of the target audience. In its current form, the focus was put on the clarity and realism of the story, the level of control experienced by the user, and the acceptance and perceived usefulness of the feedback. Small-scale tests were conducted with a group of student nurses with internship experience (n=18). A version of the prototype was played and feedback was gathered through the use of interviews and surveys.
Results
Both groups deemed the story very realistic and recognizable; some nurses described that they had had similar experiences during their internships. The group had no issues with the interactive nature of the story and they liked the tough choices they had to make, stating that it made them think of similar situations they had experienced themselves. Although the feedback-aspect was only tested with a part of the participants, this aspect was unanimously seen as clear and useful. However, the prototype lacked a clear follow-up on what to do with the feedback and what to do next.
Discussion
As there is no true surrogate for experience, beginning nurses need more support as they acclimate to the complex demands of the working field. Although the scale of testing was limited, the prototype shows promise as a vehicle for guided self-reflection. Further iterations should refine the feedback element at the end of the story to focus more on supporting the user in taking action to achieve meaningful change.