Nurse Education in Practice 32 (2018) 1–8

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Nurse Education in Practice

journal homepage: www.elsevier.com/locate/nepr

Original research

The use of digital badges by undergraduate nursing students: A three-year T

study
Timna Garnetta,∗, Didy Buttonb
a
Centre for Innovation in Learning and Teaching, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia
b
School of Nursing and Midwifery, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia

A R T I C LE I N FO A B S T R A C T

Keywords: During a three-year study, 32% (n = 67) in 2015, 16% (n = 44) in 2016 and 55% (n = 161) of students in 2017
Digital badges expressed an interest in using digital badges to enhance their learning. But who are these students? This paper
Game elements explores the features of students who are interested in using digital badges as a motivational reward to prepare
Nursing bioscience for weekly face-to-face classes through engaging with online activities and resources. This paper uses a first-year
undergraduate Bachelor of Nursing bioscience topic at an Australian university to report nursing students' in-
terests around playing games, their digital badge history during the topic, and their self-reported attitudinal
interest in using digital badges to enhance and personalise their learning. Overall, the results indicate that some
students chose to enhance their learning potential in class by earning digital badges prior to class. The results of
this paper are relevant for nursing educators and educational designers seeking to integrate digital badges into
motivational teaching practices, by evaluating the role digital badges play as a motivational game-based learning
design element.

1. Introduction 1.1. The current state of digital badges in education

Digital badges have a history entrenched in physical badges, such as Digital forms of badges, or digital badges, have been inter-
those established by Baden-Powell with cub scouts, where individual changeably referred to as badges, open badges, educational badges,
cub scouts would work towards different cloth badges by performing a micro-credentials and digital badges. While there are obvious differ-
task or displaying a skill. Each badge would be displayed on their ences between the assigned nomenclature for those who set up the
uniform to help communicate their success amongst peers. More re- badging process, the current literature seems to agree that the digital
cently, digital badges have been integrated into mobile games and badge is a visual symbol of an accomplishment, skill or recognisable
wearable fitness monitors like Apple Watch™ and FitBit™, and trait that deserves acknowledgement; contains metadata to explain the
achievement structures built into gaming consoles such as the Microsoft context of the award; can be shared digitally across social communities
XBox™. Relatively unexplored is the individual who is motivated to (Fanfarelli et al., 2015; Gibson et al., 2015; Goligoski, 2012); and
earn what is essentially a digital image and attached metadata, which should be broadly identified as a digital badge (Elliott et al., 2014; Foli
can only be displayed in an online environment. et al., 2016; Gibson et al., 2015). In the context of this case study, the
In the educational sector, digital badges are considered by many as digital badge is used for an educational purpose in a university-re-
an alternative (micro) credentialing tool. However, this paper argues stricted digital environment. Therefore, it is not able to be shared with
that digital badges have a motivational power associated with the type others unless the student decides to share and use an external backpack
of learner who is motivated to learn new skills or knowledge which is system, a specialised online folder for storing and presenting digital
recognised informally (Foli et al., 2016). This article highlights the badges in social media tools (Elliott et al., 2014).
potential value of digital badges to help personalise learning when they This paper describes the use of a digital badge system embedded in
are purposefully integrated into a nursing university teaching topic, the university's learning platform (Moodle). What is generally ac-
adding to recent published work (White and Shellenbarger, 2018). knowledged about digital badges is that they have been implemented in
many educational settings to varying levels of success. A study by Davis
and Klein (2015) with high school students found that digital badges

∗
Corresponding author.
E-mail addresses: timna.garnett@flinders.edu.au (T. Garnett), didy.button@flinders.edu.au (D. Button).

https://doi.org/10.1016/j.nepr.2018.06.013
Received 1 March 2017; Received in revised form 20 May 2018; Accepted 28 June 2018
1471-5953/ © 2018 Elsevier Ltd. All rights reserved.
T. Garnett, D. Button Nurse Education in Practice 32 (2018) 1–8

were recognised as an opportunity for personal empowerment but the Digital badges were integrated throughout the design of the ten-
students had concerns about the sharing of digital badges online. In the week topic to motivate and focus students on the importance of being
higher education sector, digital badges have been explored as an al- prepared for laboratory and clinical practicals. Being prepared for face-
ternative to grades (micro-credentialing) (Elliott et al., 2014); sup- to-face classes, especially laboratory practical classes where there are
porting the process of progressing through research degrees (Mewburn high costs to run certain classes, is important for science-based learning.
et al., 2014); assessing individual students in collaborative assignments Chittleborough et al. (2007) stated that “pre-laboratory preparation is
(Moccozet et al., 2013); and as an introduction to navigating a physical crucial considering that what students already know determines what
campus through a scavenger hunt exploration (Koutropoulos, 2012). they will learn” (p. 884). There is also a concern that the technical
This wide range of activities identifies that there are highly creative language often used in bioscience and laboratory manuals puts addi-
uses of digital badges in the higher education sector. However, the use tional requirements on the short-term memory of a student during the
of digital badges in nursing education is just commencing with ex- practical. By motivating students to come to class prepared through
plorations in micro-credentials (Elliott et al., 2014); motivating stu- using digital badges, nurse educators are ultimately enhancing their
dents in an online nursing course (Foli et al., 2016); clinical perfor- students' learning potential in class.
mance and GPA recognition (Hannas, 2016); and recording
achievement for future employers (Thomas, 2014). White and
Shellenbarger (2018) supports the process of adopting digital badges by 1.4. Using digital badges to motivate students to be prepared for class
summarising key educational design considerations for faculty nursing
academics who decide to incorporate digital badges. Targeted research Being motivated to be prepared for class is a personal experience.
to motivate students in a first-year bioscience nursing topic to be pre- However, the steps taken can be the same for many students, including
pared for practical classes (without being linked to formative assess- using motivational achievements. Glover (2013) defined motivational
ment) remains unexplored. achievements, such as digital badges, as icons which “highlight activ-
ities completed by the person, and allow an individual to keep track of
1.2. Bioscience in nursing education what they have done and potentially ‘shown off’ to third parties” (p.
2001). More recent research on the role of digital badges in motivating
Registered nurses require accurate bioscience knowledge in order to students by Reid et al. (2015) indicates that students' level of ex-
provide safe evidence-based practice. Undergraduate nursing students pectation of their studies influences the motivational appeal of digital
have for many reasons had difficulty successfully negotiating the large badges. Yet according to Hartnett (2012), measuring students' motiva-
volume of content and the complex concepts in bioscience topics (Choi- tion in an online environment needs to be done cautiously, as the online
Kwon et al., 2002; Gresty and Cotton, 2003; McKee, 2002; Smales, activity is only part of the “gauge for assessing student motivation in
2010). Practical classes are an important component in nursing topics online contexts” (p. 28). This applies to an online, blended or flipped
for developing clinical skills and applying theoretical content knowl- classroom, where students complete either all or a component of their
edge, thereby encouraging students to develop an understanding of the studies using digital resources and online activities, which include vi-
content and complex concepts in bioscience. deos, discussion forums and quizzes.
In a recent systematic review of pre-registration bioscience curri- In a study by Abramovich et al. (2013), high school children were
culum, McVicar et al. (2014) found that while there have been in- motivated by digital badges in relation to their background, including
novative changes to support student learning, the effectiveness of these prior knowledge and ability, and the type of accomplishment provided
changes has not been evaluated. Indeed, nurse academics are also by the badge's system. For example, participatory badges, defined as
aware of the challenges of teaching bioscience to large student groups external motivators, had minimal connection to individual measures of
and have expressed concern regarding the lack of time provided for skill. Skill badges that were awarded for a student's performance were
students to be adequately educated and assessed in current curriculums defined as an internal motivator. This finding is reiterated by the work
(Taylor et al., 2015). This paper provides nurse academics with evi- of Foli et al. (2016) who found that online nursing students were en-
dence about which type of nursing student is motivated to learn foun- couraged to learn with the aid of educational digital badges, but success
dational bioscience concepts in a first-year topic using weekly digital was dependent on the type of learner and the individual's performance
badges to acknowledge individual preparedness for practical classes. and expectations (p. 641). In a study by Royse and Newton (2007), the
innovative approach of gamification for nursing students is an affirmed
1.3. Digital badges and preparation for classroom learning technique to enhance students' ability to retain knowledge and motivate
them to learn. This finding is supported by McCurry and Martins (2010)
The paper focuses explicitly on using digital badges in an educa- who acknowledge that nursing academics should consider innovative
tional setting, via the university's Moodle learning platform. Moodle is a approaches to teaching undergraduate nursing students in ways which
widely used learning management platform that provides students with appeal to millennial learners. For the purpose of this article, millennial
access to learning materials (readings and media) and activities leaners belong to the generation born between 1978 and 2001 (DiLullo
(forums, quizzes, assessments) in a secure online environment. The et al., 2011).
results of this research help to build our current understanding of how As the research presented in our study used a combined type of
digital badges can be used successfully to enhance students' learning digital badge, one that measured preparatory knowledge along with
potential in the classroom by encouraging them to come to class pre- participation, the level of motivation was not determined on a mea-
pared. Digital badges were earned through an automated process fol- surable scale. No formal assessment was connected to the digital
lowing the successful completion of key learning activities that do not badges, so they provided a measure of motivation to complete online
have summative reward but that were important for building knowl- preparation activities thereby enhancing students' learning potential by
edge. Interestingly, the digital badges employed a narrative technique, being prepared in class. This informal use of digital badges in a nursing
referred to as a ‘build a body’ approach, which encouraged students to degree will assist educators to empirically discover who is interested in
collect all ten body system parts associated with the main themes in the earning digital badges and therefore which students are likely to be
topic. When all badges had been collected, students were awarded a better prepared to participate in face-to-face learning activities and
‘super prepared body badge’. This approach intrinsically encouraged assessable tasks. By using the students' demographic characteristics and
students to engage with the expected learning process and to come to self-reported attitudes, this paper explores if digital badges can be used
class with a foundational understanding before being asked to apply as a motivational tool for class preparation in nursing education.
their knowledge in a practical setting.

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T. Garnett, D. Button Nurse Education in Practice 32 (2018) 1–8

2. Methods 2.4. Data collection and validation

2.1. Background context The researchers designed and used an online gamification survey at
the beginning and end of the topic delivery (pre-topic and post-topic)
This paper reflects one part of a whole study using gamification that anonymously identified the students' interest in playing games
techniques to motivate first-year nursing students to prepare for (online, console, mobile, board and cards) and identified if digital
bioscience practical classes, specifically practical laboratories and badges (as a game element) were a best fit for enhancing their learning.
health assessment tutorials. The teaching topic used for this study in- Additional demographic data, including gender and age, was collected
corporated digital badges into the online learning platform (Moodle) to at this time. As the survey information was collected anonymously,
be offered as a reward for completing pre-class activities. Following the there was no connection between the individual completing a survey
redesign of the topic, a pre/post-topic survey was developed and pi- and their final badge count and grade. However, following the dis-
loted in 2014 before being revised and delivered for three consecutive tribution of final grades to students, the number of digital badges
years (2015–2017). This study wanted to determine which first-year earned by a student was matched against their final academic result.
students self-reported an interest in digital badges as motivational The online gamification survey was designed and validated in 2014
achievement for engaging with online preparation activities prior to by the researchers, and statistically tested for reliability using the re-
face-to-face class. sponses from a pilot group of students (n = 386) in 2014. An internal
consistency test was completed to validate the pre-topic survey using
Cronbach's alpha, resulting at 0.760. A content validity index test was
2.2. Participants and ethics completed using a scale-level content validity index average (S-CVI/
Ave), resulting at 0.93.
A large (2015 n = 408; 2016 n = 420; 2017 n = 418), first-year
nursing bioscience topic was selected for this study. The topic employs 3. Results
a flipped classroom approach, requiring students to watch pre-recorded
lectures online, complete assigned readings, and participate in a range 3.1. Earning digital badges within a Moodle learning platform
of online activities such as quizzes and collaborative glossary building,
all delivered through the university's learning platform. These activities The total number of individuals purposefully earning digital badges
are required as preparation learning prior to attending 4 h of face-to- through the Moodle automated badge system in 2015 was 245 (60% of
face practical class time each week over the topic duration (10 weeks). the cohort). In 2016 this increased to 305 (73% of the cohort), and in
All participants for the survey were volunteers and the research project 2017 it increased again to 318 (76% of the cohort). Fig. 2 presents the
has been approved by the Flinders University Social and Behavioural trend for the total number of digital badges earned by students per
Research Ethics Committee. module/week of the topic. As students could only earn digital badges if
they opted into the weekly feature, involving a ‘click here’ to trigger
collection in the automated system, these numbers are an accurate in-
2.3. Gamifying the topic: a design challenge dicator of how many individuals were interested in earning digital
badges for being prepared for class across the ten-week topic.
During late 2013, the first-year bioscience topic underwent a major As Fig. 2 shows, the interest in earning digital badges each week
redesign process, where an educational designer and nurse academic generally decreased as the topic continued. When compared to the
worked together to redesign the topic within the university's Moodle cohort differences, in 2015 (n = 408) digital badge interest began at
learning platform. Once the content and learning activities were set up 40% (165 earned the Intro to body badge) and declined to 8% (39
and the activity completion setting turned on for all activities, the earned the Respiratory system badge) by the end of the topic. The co-
Moodle digital badges feature was turned on and linked to the identi- hort in 2016 (n = 420) went from an interest of 66% (275 earned the
fied preparation activities, using the activity set conditions for auto- Intro to body badge) and declined to 15% (64 earned the Respiratory
matically determining successful completion of an activity. system badge) by the end of the topic. In 2017 (n = 418), the interest
Each of the 10 modules requested five items to be accessed/com- went from 58% who earned the Intro to body badge (241) to 17% who
pleted to a pre-set expectation using the activity completion feature, earned the Respiratory system badge (72).
which needed to be completed before the end of each week. The pre-
paration learning activities were typically to download two laboratory 3.2. Self-reported interest in digital badges for learning
practical reports, successfully complete a five-question revision quiz
and/or participate in a collaborative glossary-building task. To com- To narrow the focus of digital badges earned by an individual stu-
plete the activities successfully, students were encouraged to read re- dent by year of study (cohort) reported in section 3.1, we can report
levant textbook chapter(s) and watch the lecture video to gather the results from individuals who self-reported an interest in earning digital
content knowledge required for the practical classes. In addition, stu- badges to enhance their learning. In 2015, 208 students self-reported an
dents clicked a weekly trigger link to indicate they wished to earn the interest in game elements generally, but only 67 (32%) of these stu-
digital badge. This feature meant digital badges were not accidentally dents self-reported an interest specifically in digital badges as a learning
earned by students who had no interest in earning one just because they enhancing tool. All 67 students nominated that they play games, se-
had completed the preparation activities. lecting from the list provided (online, console, mobile, board and
The physical appearance of the digital badges was an important cards). Importantly, these same 67 students also report positively
motivating feature. A series of digital badges were designed and created (agree-strongly agree) about the potential of digital badges to help them
using Adobe Illustrator to showcase the ten different human systems prepare for class. In the 2016 pre-topic survey, of the 269 students who
covered in the topic, one for each week. The selection of these digital nominated a strong interest in using game elements to enhance their
badge images added a narrative encouragement and was a purposeful learning, 44 (16%) reported an interest in earning digital badges as a
motivator for students to collect all body parts to build an entire body, learning enhancing tool. All 44 students reported that they play games
represented by the final body badge awarded if all digital badges were (online, console, mobile, board and cards). In 2017, 323 students no-
collected. These digital badges are displayed in Fig. 1 below in grey- minated an interest in using game elements as a learning enhancing
scale. tool, of which 161 (50%) reported an interest in earning digital badges.
All 161 students reported that they played games such as online,

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T. Garnett, D. Button Nurse Education in Practice 32 (2018) 1–8

Fig. 1. The digital badges ‘build a body’ series.

console, mobile, board and cards. The following results focus on iden- Table 1
tifying individuals by their gender and age who expressed an interest in Demographics of topic cohort.
earning digital badges by being prepared for class. Topic cohort statistics

3.2.1. Who are they? 2015 2016 2017

Table 1 summarises the 2015–2017 topic cohort statistics and
n = 408 (%) n = 420 (%) n = 418 (%)
Table 2 summarises the survey and digital badge respondents, as
identified in the pre-topic survey. The difference between the number Gender Male 77 (19) 67 (16) 71 (17)
of students in the topic (Table 1) and those that responded to the survey Female 331 (81) 353 (84) 347 (83)
Age 15–19 142 (35) 177 (42) 166 (40)
and collected badges (Table 2) are presented for three consecutive
20–24 174 (43) 160 (38) 163 (39)
years. 25–29 38 (9) 42 (10) 42 (10)
30 > 54 (13) 41 (10) 47 (11)
3.2.2. Student interest in playing games
To assist in understanding the value of game elements within the
student cohort, the students who expressed an interest in digital badges to 70% of females (mobile) in 2016. As identified in the 2017 cohort,
(identified as ‘badge participants’ in Table 2) were asked to identify board and card games were of higher interest compared to 2015 and
what types of games they play by selecting from a list of provided ca- 2016 cohorts. When gender is considered with this data, we see the
tegories for both digital and traditional games. These types of games use interest in the 2017 cohort is higher for females with board games
similar game elements to those included in the study to motivate (34%) and card games (35%) than males (27% and 12%). This is in
players. The information from Fig. 3 can be explored by cohorts (years) contrast to the 2017 cohort where females have a lower interest in
and compared by gender (Fig. 4) and age (Fig. 5). online games (30%) and console games (16%) than their male peers
In Fig. 3, the games being played by digital badge interested stu- who have a higher interest in online games (51%) and console games
dents indicated that students reported a higher interest (2015: 33%, (30%). These results indicate that male students are more interested in
2016: 44% and 2017: 33%) in mobile games over other games. Inter- digital games, especially online and console games, than female stu-
estingly, the 2015 cohort of students indicated a higher interest in dents, which may influence their interest to earn digital badges for their
online (33%) and console games (21%) compared to the 2016 student study. This divide overall (2015–2017) has a ratio of 2:1 (49 males: 22
cohort who had the highest mobile game interest (44%). As online, females) students interested in console games and 1.5:1 (36 males: 22
console and mobile games commonly use digital badges as motivational females) interested in online games. Mobile games are more equal at
rewards, it was assumed these would be the most commonly played 1:1 (57 males: 60 females). The average ratio of males to females in the
games by students who declared an interest in digital badges when studied nursing program is 1:5 (see Table 1 for 2015–2017 demo-
compared to the non-digital board games and cards (acknowledging graphics). This is different to the expected ratio of practising male to
that cards could be played digitally). The results indicate that board and female nurses in Australia (1:10) (Australian Bureau of Statistics, 2013).
card games are still played by students, sometimes as much as digital When the results of interest in playing games are explored in rela-
games but occasionally slightly less than some digital games. However, tion to the age of the student (Fig. 5) we find that mobile games are a
in 2017, students indicated a higher interest in board (19%) and card highly popular form of gaming amongst all students, regardless of age.
(18%) games than previous student cohorts. However, a closer look indicates that students who are < 19 and 20–24
When the results of interest in playing games is explored by gender have a higher interest in playing mobile games than the 25–29 and
(Fig. 4) we find that 50% of males in 2015 played online and console 30 > age categories, all of which are millennial learners.
games, compared to 26% (online) and 32% (console) of females. In-
terestingly, 71% of males played mobile games in 2015 compared to
53% of females. This is in contrast to 50% of males (mobile) compared

Fig. 2. Graph illustrating total number of digital badges earned by students per module.

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T. Garnett, D. Button Nurse Education in Practice 32 (2018) 1–8

Table 2
Demographics of survey participants.
Survey participants Badge participants

2015 2016 2017 2015 2016 2017

n = 208 (%) n = 269 (%) n = 323 (%) n = 67 n = 44 n = 161

Gender Male 40 (19) 37 (14) 46 (14) 13 6 33

Female 127 (61) 231 (86) 264 (82) 41 38 127
Gender Not provided 0 0 13 (4) 13 0 1
Age 15–19 71 (34) 46 (17) 114 (35) 23 13 70
20–24 83 (40) 75 (28) 110 (34) 27 21 51
25–29 28 (14) 13 (5) 30 (9) 9 4 12
30 > 25 (12) 22 (8) 34 (11) 8 6 19
Age Not provided 71 (34) 46 (17) 35 (11) 0 0 0

3.3. The ‘super prepared students’ because of a novelty effect is theorised. Further studies to target the
direct effect of novelty on learning when using gamification techniques
The last measurable element was to evaluate the individual students is required in the education field. This is an important step, as to use
who collected all 10 body-themed digital badges to earn the Super relevant teaching and learning techniques for the millennial genera-
Prepared Body Badge and were reviewed based on their final (provi- tions requires innovative thinking. This is reinforced by Royse and
sional) grade. The results indicated that digital badge earners in their Newton (2007) who promote the innovative approach of gamification
cohort were also academically motivated achievers (Fig. 6). This level for nursing students as a way to enhance students' ability to retain
of achievement is reinforced by Reid et al. (2015) who stated that knowledge and to motivate them to learn. McCurry and Martins (2010)
students who have a high expectancy of learning are intrinsically mo- additionally support innovative approaches to teaching undergraduate
tivated. To put this into perspective, the class average grade for 2015 nursing students in ways which appeal to millennial learners.
was 61%, for 2016 it was 56%, and in 2017 it was 60%. All grades are Mobile games are a primary area where digital badges specifically
listed as passing grades, whereas the final super prepared body badge are found to motivate players, and may be considered an innovative
students had an average grade of 75% which equates to a distinction and targeted approach for some students who report an interest in
grade. mobile games, the most popular type of game recorded in Figs. 4 and 5.
For example, male students who completed the online gamification
4. Discussion survey reported a stronger interest in playing online and console games
than their female peers. This result is supported by Veltri et al. (2014)
4.1. Characteristics of students who earnt digital badges who found that males engaged with online gaming because of the
competitive aspect, while females who engaged in online games saw it
According to the findings of the three-year study, there was an in- more as a vehicle for social engagement. As online and console games
crease in the number of students who indicated they were interested in employ a range of game elements to motivate their players, such as
earning digital badges to enhance their learning. It was noted, however, levelling up and progress bars, digital badges are just one component
that the frequency of earning digital badges across the 10 weeks of the that may be used in some games. This is in contrast to mobile games
topic continued to decline. This was evident in each year of the study which, in this study were commonly played by both males and females
(Fig. 2). This finding is reinforced by studies in gamification such as respectfully at 71% and 53% in 2015, at 50% and 70% in 2016, and at
Koivisto and Hamari (2014) who found that the use of game elements 49% and 58% in 2017. Further information on specific games students
as a motivation declined with use, suggesting a potential novelty effect. play in these modes would be of interest to future research in order to
Specifically, Hamari (2017) explored badges and theorised that their identify whether there is a correlation between the type of game and
participants showed curiosity towards the badges, reinforcing the no- their interest in digital badges for motivating learning.
velty of the game element in participants' behaviour. However, when
the novelty wore off this affected the participants' behaviour. In our
study, a declining motivation to use digital badges to be prepared

Fig. 3. Game play interest overall.

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T. Garnett, D. Button Nurse Education in Practice 32 (2018) 1–8

Fig. 4. Games played by gender.

4.2. Not all students wanted to earn digital badges applying theoretical content knowledge that is required in their pro-
fession. By learning how to use innovative teaching approaches such as
Results summarised in Table 2 indicate that not all students wanted adding game elements, including digital badges, to motivate some
to earn digital badges. Furdu et al. (2017) and Glover (2016) both students (McCurry and Martins, 2010; White and Shellenbarger, 2018),
agree, if students are not naturally competitive then the use of digital nurse educators can encourage their students to develop an under-
badges will lose their attraction and participation will decrease. How- standing of the content and complex concepts in bioscience during their
ever, the study did find that for other students digital badges can be first year of study. The use of digital badges is one approach to help
meaningful and motivate those who are interested in using game ele- establish good preparation skills that can be carried forward in their
ments to enhance their learning (Abramovich et al., 2013; Foli et al., future years of study, strengthening their learning potential and, ulti-
2016). Reid et al. (2015) suggested that the higher the number of digital mately, their success as practising nurses.
badges earned, greater the value of the digital badge to the student. So
it is no surprise that some high-achieving students are motivated to
5. Future research
learn with digital badges, as displayed in Fig. 5.
Motivating pre-registered nurses to acquire foundational bioscience
Further studies tracking individual students' experience would be a
knowledge in their first year of study is important so they can provide
valuable method to determine what barriers exist in a student's life
safe evidence-based practice as registered nurses. Undergraduate nur-
which may make them less likely to use digital badges in their studies
sing students have an acknowledged difficulty in processing the large
and potentially prevent them from being motivated to prepare for
volume of content and complex concepts in bioscience topics (Choi-
practical classes. Ideally, connecting survey respondents to their digital
Kwon et al., 2002; Gresty and Cotton, 2003; McKee, 2002; Smales,
badge earnings and final grade would strengthen the value of de-
2010). Therefore, being prepared for learning in practical classes is an
termining who is most likely to engage with digital badges as a method
important component in nursing topics for developing clinical skills and
to support their learning. As this level of analysis requires identification

Fig. 5. Games played by age.

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T. Garnett, D. Button Nurse Education in Practice 32 (2018) 1–8

Fig. 6. Final grades for top digital badge earners.

and permission across survey responses, badge history and grades, a Acknowledgements
revised ethics application would be required. Further studies to target
the direct novelty effect badges have on users and explore what games The authors would like to extend special acknowledgement to Greg
students play would be of interest in future research to build on the Faller for the design of the digital badges used throughout this study.
work of previous research.
Appendix A. Supplementary data

6. Conclusions Supplementary data related to this article can be found at http://dx.

doi.org/10.1016/j.nepr.2018.06.013.
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