Effectiveness of Kahoot Game-based Learning and Satisfaction of Newly Graduated Nurses: A Pilot Randomized Controlled Trial

Minping Deng; Jiasu Yan; Chan Li; Manli Liu; Yanfei Li

doi:doi:10.11648/j.ajnhs.20260701.12

Research Article |

| Peer-Reviewed

Effectiveness of Kahoot Game-based Learning and Satisfaction of Newly Graduated Nurses: A Pilot Randomized Controlled Trial

Minping Deng

, Jiasu Yan

, Chan Li

, Manli Liu

, Yanfei Li^*

Published in American Journal of Nursing and Health Sciences (Volume 7, Issue 1)

Received: 3 March 2026 Accepted: 1 April 2026 Published: 16 April 2026

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Abstract

Purpose: Teachers often face the challenges in maintaining the student attention in class. This study aimed to evaluate the effectiveness of the Kahoot! game-based learning (KGBL) platform in enhancing attention span, theoretical knowledge acquisition, and satisfaction among newly graduated nurses in a hospital setting. Methods: This study employed a randomized controlled trial design. Newly graduated nurses from a tertiary hospital in China were recruited in September 2023. Participants were randomly assigned to either the experimental group (n=44) or the control group (n=43). The experimental group underwent a 5-day training program incorporating pre-class quizzes via the KGBL platform, while the control group received traditional classroom-based training without the gamified component. The training content followed the 2016 “Newly Employed Nurse Training Outline,” covering essential theoretical knowledge and practical guidelines. The concentration indicator was used to assess the nurses classroom attention; the acquisition of theoretical knowledge was measured using a closed-book exam. A 9-item questionnaire was used to survey the intervention group's satisfaction and attitude toward KGBL Results: The results showed that the KGBL group's concentration scores (eye contact, body language, classroom behaviour, and total score) were significantly higher than those of the control group at 5, 15, and 25 minutes (P < 0.001). At 35 minutes, the KGBLgroup continued to show significantly higher scores in eye contact, body language, and overall attention was a statistically significant difference (P < 0.001). Test of theoretical knowledge: the KGBL group had an average score of 91.1±4.1, while the control group had an average score of 77.3±5.5 was a statistically significant difference (P<0.001). The majority of nurses reported KGBL reinforced the content learning in class and they enjoyed the learning process (95.3%). Almost all participants (95.3%) expressed a desire that the KGBL could be integrated into their future learning or education. Conclusions: This pilot study demonstrated the feasibility of KGBL in the nursing training program in hospital situations and suggested its potential effectiveness in enhancing attention, test scores, and satisfaction. Despite limitations such as the short study duration and lack of long-term follow-up, these preliminary findings suggest that gamified learning tools like KGBL could play a valuable role in enhancing nurse training. Further research is needed to explore the long-term impact of KGBL on learning outcomes and its broader applicability in nursing education.

Published in	American Journal of Nursing and Health Sciences (Volume 7, Issue 1)
DOI	10.11648/j.ajnhs.20260701.12
Page(s)	12-21
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2026. Published by Science Publishing Group

Keywords

Kahoot, Game-based Learning, Attention, Theoretical Knowledge Acquisition, Nurse Training

1. Introduction

New-entry nurse training plays a key role in facilitating the transition of nursing students into qualified nursing roles. The 2016 New Entry Nurse Training Outline in China clearly outlines the connotations and requirements for the learning of new nurses, stipulating that the training should cover four essential aspects: basic theoretical knowledge, basic skills, professional theories, and practical competencies

[1]

. The proficient acquisition of fundamental theoretical knowledge by novice nurses serves as a crucial readiness for clinical practice and fosters the establishment of appropriate values and mindsets. However, modules on laws, rules, policies, procedures, and legislation may seem boring and uninteresting in a course. Additionally, the conventional pedagogical approach of relying heavily on lectures lacks interactivity, resulting in disengaged, unmotivated, and uninterested students. Studies show that when a lecturer uses a PowerPoint to teach material that the students find "dull" or "too information dense," the students become distracted and lose focus

[2]

Maintaining students' engagement, focus, and motivation in the classroom is a significant challenge for most educators. The lack of motivation could negatively impact learning outcomes and disrupt classroom dynamics. Research indicates that incorporating game mechanics and principles into the learning process, known as gamified learning, can increase students' interest and motivation

[3]

and attention in class

[2]

Gamified learning, rooted in gaming concepts, has become a popular pedagogical approach as educational technology continues to advance. KGBL is a free, interactive online platform that has gained popularity in recent years. KGBL stimulates learners' intrinsic motivation through secure, collaborative environments by providing educational content in the form of fun quiz games. Real-time feedback and positive reinforcement further enhance instruction and acquisition

[4]

, resulting in better teaching effectiveness

[5]

and increased classroom attentiveness among students

[6]

. KGBL has been widely used in education since its debut in 2013, resulting in numerous studies on its implementation across a variety of disciplines, including higher education, K–12 education, languages, STEM fields, and healthcare sciences

[7]

KGBL was shown to significantly raise medical students' motivation levels in a Pakistani study

[8]

. Further investigation showed that KGBL enhanced the conceptual understanding and learning efficacy of nursing students

[9]

, and that first-year nursing students at a Turkish university who utilised the game enhanced their skills and knowledge

[10]

. KGBL is a useful tool for enhancing classroom dynamics, academic performance, and test anxiety reduction for both teachers and students, according to additional research

[11]

. Therefore, using the game as a teaching tool is advised by educational experts

[6]

Nowaday most research has been done on its use in colleges and nursing schools

[9, 12, 13]

, with a few studies done in continuing education and hospitals as well. Research on KGBL use in RN preceptor education is extremely limited. The purpose of this study is to assess the KGBL impact on novice nurses' attention span, theoretical knowledge acquisition, attitudes, and satisfaction with this modality in order to offer recommendations for new nurse education.

2. Methods

2.1. Study Design

A randomised controlled trial was used in this study to compare the KGBLgroup to the control group. The Fifth Affiliated Hospital of Jinan University's ethics committee approved the study. All participants provided written informed consent in compliance with the Declaration of Helsinki before any information was collected. During the lectures, the researchers observed the participants' behaviour and took photos. Following the completion of all lectures, both groups received a final paper test and the members of the KGBL group were surveyed to gauge their attitudes and degree of satisfaction.

2.2. Participants

The eligible participants in this study were newly graduated nurses with less than 2 months of experience, specifically from June and August 2023. Participants who did not meet these requirements were excluded from the study. All participants provided written informed consent and received a clear description of the study plan. The purpose of the trial was explained to the participants. The theoretical training sessions began after we received informed consent. Age and gender were among the baseline data that was gathered from the hospital database.

2.3. Allocation

All participants provided written, informed, and orally witnessed consent to participate in the research study. A random allocation sequence was created based on the recruits' work numbers. Participants with job numbers ending in an odd number were assigned to the traditional group, while those with job numbers ending in an even number were assigned to the KGBL group. All participants were randomly assigned to one of the two groups. The control group (n = 43) received only traditional instruction, while the KGBLgroup (n = 44) learned hospital policies and procedures through both traditional instruction and the KGBL online game. The instructors were proficient in utilizing the KGBL online gaming platform and had experience with the Kahoot application. Skilled nurses with no affiliation to this project served as the observers, keeping a careful eye on the students' engagement and behaviors in the classroom. We gave the observers a brief training session to make sure the observation was rigorous. The training went over the standards and marking guidelines, as well as the roles and behaviors that were expected of the observers. In order to confirm whether the observers' rating method was correct, the observers were asked to perform a concentration assessment exercise in a class after the training.

2.4. Interventions

Eighty-seven newly graduated nurses from a tertiary hospital were randomly assigned to either the KGBL group (n = 44) or the traditional group (n = 43). Both groups followed the same curriculum based on the 2016 "Guiding Opinions on Basic Theoretical Training for New Nurses."

[1]

The training took place from 8 a.m. to 12 a.m., with three one-hour classes each morning and a 10-minute break between classes. The teachers and teaching materials were consistent across both groups, with the key difference being the use of KGBL in the experimental group. In the KGBL group, participants completed a short, dynamic quiz at the beginning of each class using the KGBL platform. The 2-6 minutes quizzes featured 10–15 multiple-choice questions dessigned to reinforce the course content. Participants accessed the platform via personal devices, and their responses were scored in real-time, fostering a competitive and engaging learning environment. In contrast, the traditional group received lectures through standard formats such as PowerPoint presentations and videos. The training for both groups spanned five consecutive days in late August 2023.

The KGBL platform, an interactive learning aid, was employed in this study with the aim of improving participant engagement

[14]

and knowledge retention

[16]

. With a user-friendly interface, the platform enabled instructors to create personalised tests that were in line with the training curriculum's specific subjects. Using their personal mobile devices, such as smartphones or tablets, participants in the KGBL group accessed the platform. By signing into the platform and taking the interactive quizzes, they were able to participate in the Kahoot sessions. Dynamic 2-6-minutes KGBL segments with 10–15 multiple-choice questions that directly tied to the course material were a part of every session. KGBL live interaction, response analysis, and scoring system work in tandem to create a dynamic and competitive atmosphere that fosters student motivation and engagement. Participants were given a time limit to select the correct response, and their performance was displayed on an interactive leaderboard to foster a competitive environment and allow them to track their progress in comparison to their peers.

2.5. Assessment and Measurements

2.5.1. Attention Quantitative Evaluation

The concentration indicator can be used to evaluate students' learning efficiency as well as the effectiveness of classroom instruction. Over the years, attention has been measured in a variety of ways, including focus, which can be interpreted as students' level of attention in the classroom

[16]

. Conventional techniques for assessing students' attention spans include manual methods

[17]

such as examining student gaze

[18]

, after-school response methods

[19]

, some studies have using high-definition image stream data encoded in video format supplied by cameras, analyse students' facial and body expressions, such as body gesture classification, eye fixation estimation, and head posture estimation, to estimate students' attention state during lectures

[20]

, and more advanced methods such as brainwave detection

[21]

, each of which has its own advantages and disadvantages. Based on the validated attention assessment dimensions (i.e., eye contact and body language) reported in existing literature

[16, 18, 20]

, the observation indicators and predefined scoring standards for this study were determined through face-to-face discussions and consensus among the research team members. This study assessed attention by observing particular indicators like eye contact, body language, and classroom behavior using a photographic combined field observation method. Trained researcher observed, documented, took pictures of, and graded the classroom behaviors, eye contact, and body posture of the students at particular intervals throughout the lesson, namely 5, 15, 25, 35, and 45 minutes. These indicators were evaluated and given a score based on predefined standards consistent with the above-discussed literature-based dimensions. The detailed explanations and scoring standards for every assessment indicator are displayed in Table 1. The concentration is measured on a scale of 1 to 5, where a higher score indicates greater concentration.

Table 1. Classroom Attention Evaluation indicators and Criteria.

Evaluation Indicator	Scoring Points (1: poor, 5: good)	Scoring Description
Eye Contact	5	Students consistently make eye contact with the teacher or gaze at classroom presentation content
	4	Students occasionally make eye contact with the teacher or gaze at classroom content
	3	Student rarely makes eye contact with the teacher or looks at classroom content
	2	Student occasionally looks out the window or elsewhere not related to instruction, but only temporarily.
	1	Student looks out the window or other non-instructional areas most of the time.
Body Language	5	Students maintain an upright body posture and sit upright without frequent movement or twisting movements.
	4	The student's body posture is more upright, and occasionally may lean forward slightly or make subtle movements or adjustments to the posture
	3	The student's body posture remains generally normal, and there may be some small movements while sitting, such as slight rocking or fine tuning of body position.
	2	The student's body posture shows signs of distraction, such as leaning back, slouching, or leaning in a chair, moving from position to position, or frequently adjusting the sitting position
	1	The student's body posture clearly shows a complete lack of concentration, such as extreme leaning back, slouching, or instability, and may sit in an unnatural position, or stand up and move around frequently
Classroom Behavior	5	The student actively engages in taking notes during the lecture.
	4	The student demonstrates attentive listening without any disruptive behavior.
	3	The student is observed looking at their cell phone, indicating a potential distraction.
	2	The student's attention appears to be diverted as they look down or show signs of drowsiness.
	1	The student talks frequently with others in the classroom, potentially distracting or interrupting other students.

2.5.2. Test of Theoretical Knowledge

The assessment assessed the students' understanding of theoretical concepts through a 50-item, closed-book exam that included multiple-choice and multiple-selection questions. There was a 100-point maximum possible score. This evaluation was carried out at the end of the fifteen lessons.

2.5.3. An Assessment of Kahoot Users' Satisfaction

The researchers developed a questionnaire based on the work of Andrés etal

[22]

. The final nine-item questionnaire included two additional items added by our study. Before the questionnaire was distributed, the KGBL group completed 12 KGBL exams in a classroom setting. This allowed them to express their opinions about using KGBL as a teaching tool. The questions and answers are shown in Table 2.

Table 2. Kahoot Satisfaction Questionnaire and answer distribution (n=44).

Question	Response	n	%
1. Have you used KGBL before?	No	39	90.6
1. Have you used KGBL before?	Yes	4	0.94
2. When I play Kahoot	I have fun and I learn	41	95.3
	I have fun but I don’t learn	0	0.0
	I don’t have fun but I learn	1	2.3
	I don’t have fun or learn	1	2.3
3. Making Kahoots helps me reinforce what I learned in class	It doesn’t help me at all	0	0.0
	It helps me a little	3	7.0
	It helps me	19	44.2
	It helps me a lot	21	48.8
4. Making Kahoots motivates me to learn the subject	Nothing	1	2.3
	Little	15	34.9
	Quite a lot	16	37.2
	A lot	11	25.6
5. I prefer to do the Kahoot	As soon as class starts	10	23.3
	In the middle of class	4	9.3
	At the end of class	9	20.9
	Before and after class	20	46.5
6. I would like the Kahoot’s length to be	Short (<5 min)	9	20.9
	Medium (between 5 to 10 min)	31	72.1
	Long (>10 min)	3	7.0
7. I prefer the teacher to use to explain the theory	Exclusively his explanation	2	4.7
	His explanation combined with Kahoot	17	39.5
	His explanation combined with practical exercises	10	23.3
	His explanation combined with Kahoot and practical exercises	14	32.6
8. In general, I consider Kahoot to be	Unnecessary	0	0.0
	Unimportant	4	9.3
	Necessary	28	65.1
	Essential	11	25.6
9. I hope Kahoot! will be used in future classes	Yes	41	95.3
	Indifferent	2	4.7
	No	0	0.0%

2.6. Ethical Consideration

The necessary approvals were obtained from the relevant institutions to conduct the research. The researchers obtained written informed consent from the nurses involved in the research before conducting the study, explaining the purpose and benefits of the study.

2.7. Statistical Analysis

SPSS 27 software was used to analyze the data. Age, sex, and level of education were compared as baseline characteristics between the experimental and control groups. The Chi-square test was used to compare gender and education level, and the means were used to compare age. For normally distributed data, the t test was used to gauge student attention in the classroom. For non-normal distribution data, the median M (P25, P75) was used to describe the data, and the non-parametric rank sum test Kruskal-Wallis H test (F-value) and Mann-Whitney U test (Z-value) were used for comparison between groups. An independent double-tail t test was used to ascertain the difference in post-training theoretical test scores between the two groups of nurses. Descriptive statistics of frequency and percentage were used to assess nurses' satisfaction with the Kahoot teaching method. p<0.05 was the level of significance.

3. Results

3.1. Baseline Characteristics

A comparison of the participants in both groups according to age, gender, educational status, play KGBL experience, revealed no educationally relevant or significant differences (Table 3).

Table 3. Baseline characteristics (n=87).

Characteristics		Control group n=43	Kahoot group n=44	significance value
Age (years), mean (SD)		22.17±1.14	22.38±1.05	0.4134
Gender, n (%)	Female	34 (79.1)	38 (86.4)	0.569
Gender, n (%)	Male	9 (20.9)	6 (13.6)	0.569
educational status, n (%)	Associate Bachelor	38 (88.4)	40 (93.0)	0.645
educational status, n (%)	Associate Bachelor	5 (11.6)	4 (7.0)	0.645
KGBL experience, n (%)	Yes	5 (11.5)	4 (7/0)	0.511
KGBL experience, n (%)	No	38 (88.4)	40 (93.0)	0.511

3.2. Comparison of Attention Scores Between Two Groups in Different Time Periods

Between August 21 and September 1, 2023, 87 participants were assessed for in-class attention (eye contact, body language, and classroom behavior) via photographic and field observation, with assessments conducted using the Classroom Attention Evaluation Indicators and Criteria (Table 1). Table 4 shows that the KGBL group had statistically significantly higher concentration scores (eyes, body language, classroom behaviour, total score) than the control group at 5, 15, and 25 minutes (P<.001). At 35 minutes, the KGBL group still had significantly higher eye contact, body language and total scores (P<.001), with no significant intergroup difference in classroom behavior scores. No significant intergroup score differences were observed at 45 minutes.

Table 4. Comparison of attention scores between two groups in different time periods (U test).

Time (Minute)	Group	Eye Contact	Body language	Behavior	Total score
5	control group	4 (3-5)	4 (3-5)	4 (3-4)	12 (10-13)
	KGBL group	4 (4-5)	4 (4-5)	4 (4-5)	12 (11-14)
	Z	-3.115	-3.595	-4.071	-5.272
	P	0.002	0.000	0.000	0.000
15	control group	4 (3-5)	4 (3-4)	4 (2-4)	11 (9-13)
	KGBL group	4 (4-5)	4 (4-4)	4 (4-4)	12 (11-13)
	Z	-3.463	-5.093	-5.691	-6.443
	P	0.001	0.000	0.000	0.000
25	control group	4 (3-5)	4 (3-4)	3 (2-4)	10 (9-12)
	KGBL group	4 (4-5)	4 (4-5)	4 (3-4)	12 (10-13)
	Z	-5.404	-6.963	-2.869	-6.724
	P	0.000	0.000	0.004	0.000
35	control group	4 (3-5)	3 (2-4)	3 (2-4)	10 (8-12)
	KGBL group	4 (4-5)	4 (4-4)	3 (2-4)	11 (9-12)
	Z	-4.795	-5.792	-0.332	-4.523
	P	0.000	0.000	0.740	0.000
45	control group	4 (3-4)	3 (2-4)	3 (2-4)	10 (8-11)
	KGBL group	4 (2-4)	3 (2-4)	3 (2-4)	9 (8-11)
	Z	-0.269	-0.139	-0.179	-1.251
	P	0.788	0.890	0.858	0.211

Table 5. Comparison of attention scores between time points within the Control and Kahoot group (K-W test).

Time (minute)	Control group (n=43)				KGBL group (n=44)
Time (minute)	Eye Contact	Body language	Behavior	Total score	Eye Contact	Body language	Behavior	Total score
5	4 (3-5)	4 (3-5)	4 (3-4)	12 (10-13)	4 (3-5)	4 (3-5)	4 (3-4)	12 (10-13)
15	4 (3-5)	4 (3-4)	4 (2-4)	11 (9-13)	4 (3-5)	4 (3-4)	4 (2-4)	11 (9-13)
25	4 (3-5)	4 (3-4)	3 (2-4)	10 (9-12)	4 (3-5)	4 (3-4)	3 (2-4)	10 (9-12)
35	4 (3-5)	3 (2-4)	3 (2-4)	10 (8-12)	4 (3-5)	3 (2-4)	3 (2-4)	10 (8-12)
45	4 (3-4)	3 (2-4)	3 (2-4)	10 (8-11)	4 (3-4)	3 (2-4)	3 (2-4)	10 (8-11)
H	14.003	29.464	45.329	58.349	73.882	132.111	158.642	208.244
P	0.007	0.000	0.000	0.000	0.000	0.000	0.000	0.000

3.3. Comparison of the Test Scores Between Two Groups

Independent sample t-tests revealed a statistically significant difference in theoretical knowledge test scores between the KGBL group and the control group (Table 6), with the KGBL group achieving a significantly higher mean score and a 17.86% improvement in test performance compared to the control group.

Table 6. Comparison of the test scores between two groups (n=87).

Group	n	Mean	SD	t	P
Control group	44	77.3	5.5	-13.26	0.000
KGBL group	43	91.1	4.1	-13.26	0.000

3.4. Participants' Satisfaction and Attitudes with KGBL

Following the 12th theoretical session, 44 nurses from the KGBL group took part in the survey. (Table 2) shows that the majority of nurses (95%) find playing KGBL enjoyable and educating, indicating a clear positive motivation. When asked if KGBL helps them remember what they have learned in class, more than 93% of the nurses gave a positive answer, with 48.8% saying it helps them a lot and 44.2% saying it helps them. 62.8% of nurses said KGBL inspires them to learn the material, with 37.2% saying it does so "quite a lot" and 25.6% saying it does so "a lot." When it comes to when KGBL is best played, nurses prefer to play twice in a single class: once at the start and once at the conclusion of each session (46.5%). 72% of nurses say that five to ten minutes is the ideal KGBL duration. It is clear from the survey that a majority of nurses, 88% consider KGBL to be a necessary part of their classroom experience. Furthermore, 21% of the respondents believed that Kahoot game is an essential tool for classroom teaching. The survey also revealed that an overwhelming 95.3% of nurses expressed the desire to continue using Kahoot in the future.

4. Discussion

New nurse training is crucial for novice nurses to acquire fundamental theoretical knowledge and develop clinical practice skills. However, traditional teaching methods can lead to disengaged and unmotivated students. Maintaining students' engagement, focus, and motivation in the classroom is a significant challenge for most educators. The lack of motivation could negatively impact learning outcomes and disrupt classroom dynamics. Research indicates that incorporating game mechanics and principles into the learning process, known as gamified learning, can increase students' interest and motivation

[3]

and attention in class

[2]

As technology in education continues to advance, educators are integrating various online gaming platforms into their classrooms to increase student engagement and participation

[14]

. As a popular gamification tool KGBL can effectively tackle several problems encountered in traditional classroom instruction. When compared to conventional learning and other educational tools and techniques, as well as various contexts and fields, relevant studies have shown that KGBL can have a favourable effect on learning

[7]

. It primarily enhances students' interest in learning, stimulates their active participation, improves concentration and enhances academic achievement

[7, 15]

. It also sparks their intrinsic motivation for learning

[23]

. KGBL has been shown to improve interest, active participation, concentration, and academic achievement across various educational contexts

[7, 15]

. Despite its success in other fields, KGBL has been underutilized in vocational training, particularly in nursing education.

Our findings indicate that KGBL significantly enhances attention in the classroom. Previous research suggests that student attention is highest in the initial minutes of class, with a gradual decline thereafter

[2, 14]

. In our study, nurses in the KGBL group demonstrated notably higher attention levels at the 15-minute, 25-minute, and 35-minute marks compared to the control group (P<0.001). This suggests that KGBL effectively sustains student focus for longer periods. The enhanced attention, reflected in increased eye contact and positive body language in the KGBL group, highlights how KGBL interactive and game-based design contributes to sustained engagement. These results corroborate even strengthen the previous studies previous studies on KGBL effectiveness in increasing student engagement and attention

[7, 15]

. Consistent with the findings of previous studies on KGBL in nursing and medical education

[7, 15]

, the present study further verifies that KGBL can significantly improve learners’ academic performance and in-class attentiveness, which confirms the universal effectiveness of KGBL’s core advantages—such as real-time feedback, positive reinforcement and gamified interaction—in healthcare education. However, unlike most existing KGBL research that has focused on application in colleges and nursing schools for nursing students

[9, 10, 12, 13]

, this study extends its practice and research to the vocational training of newly graduated nurses in a clinical hospital setting, a research context rarely involved in prior studies. Most previous studies have also evaluated KGBL’s effectiveness from a single perspective of academic performance or learning motivation

[8-11]

, while the current study comprehensively assesses its impact on novice nurses from multiple dimensions including in-class attention span, theoretical knowledge acquisition, and learning satisfaction. More importantly, this study specifically explores the application value of KGBL in new nurse vocational training, a research direction that is extremely limited in existing literature, and thus adds empirical evidence to the application of KGBL in clinical nursing education, making the research findings more targeted to the actual needs of hospital-based new nurse training.

This improvement in attention may be attributed to several key features of KGBL, such as its interactive and game-based design. KGBL utilizes immediate feedback and competitive elements, which can enhance engagement and motivation. The interactive nature of KGBL keeps students actively involved and reduces cognitive overload by breaking down information into manageable, engaging segments. These mechanisms help maintain students' attention over longer periods, as opposed to traditional lecture formats which may not offer the same level of engagement and stimulation.

In addition to improving attention, our study found that KGBL significantly boosts theoretical knowledge retention. KGBL interactive quizzes not only maintain students’ attention but also facilitate deeper learning by converting theoretical content into engaging, gamified formats. This dual benefit—enhancing attention while improving knowledge retention—demonstrates the comprehensive advantages of KGBL for educational settings. The experimental group achieved an average KGBL assessment score of 91.1 points, significantly higher than the control group’s average of 13.8 points, reflecting a substantial 17.86% improvement in achievement. These findings are consistent with prior research showing that KGBL improves learning outcomes and test scores KGBL

[7, 24]

. The gamified nature of KGBL transforms dry theoretical content into interactive learning experiences, which helps reinforce understanding and improve retention. The immediate feedback provided by KGBL also allows students to correct mistakes and solidify their knowledge

[25]

. This engaging approach not only boosts concentration but also supports better memorization and consolidation of material, making KGBL an effective tool for enhancing learning outcomes.

Survey data revealed that students found traditional PowerPoint presentations to be "boring"

[2]

and overwhelming, whereas they reported higher levels of engagement and focus during KGBL sessions. This feedback underscores the critical role of instructional methods in shaping student engagement. Our study found that 95% of participants felt that KGBL made learning enjoyable, a rate significantly higher than the 60-80% reported in studies from other countries

[22, 26-28]

. This discrepancy may reflect a cultural shift among younger generations in China towards more interactive, participatory learning methods compared to passive, didactic instruction. Despite KGBL not being specifically customized for the Chinese market, its effective integration with China’s advanced digital infrastructure has made it a highly popular educational tool. The high usability and positive reception of KGBL among Chinese nursing students suggest that its engaging design and interactive features align well with contemporary learning preferences. The overall satisfaction with KGBL in our study supports its potential as a valuable tool for enhancing educational experiences in nursing.

Limitations of This Study

This study had several limitations that must be acknowledged. First, the relatively small sample size within a single hospital, while sufficient for preliminary investigation, may limit the broader scope of the results to a wider population of nurses. Furthermore, the study sample was limited to hospitals within a single region, potentially under-representing the variety of nursing training settings found in other institutions or areas. The absence of long-term follow-up was another noteworthy drawback, which prevented an analysis of KGBL long-term effects on attention and memory retention. Despite these limitations, this study provides valuable initial insights into the application of KGBL in nursing education, and the findings may serve as a foundation for future research. Larger studies with more diverse samples and extended follow-up assessments are needed to further explore the sustainability of the observed benefits.

5. Conclusions

This study demonstrated the feasibility and effectiveness of integrating the KGBL platform into new nurse induction training. Despite some limitations, such as a relatively small sample size and the lack of long-term follow-up, the results are promising. KGBL significantly improved classroom attention and theoretical knowledge retention, with participants reporting high levels of engagement and satisfaction. The platform’s interactive and gamified design, combined with its ability to provide immediate feedback, facilitated deeper learning and sustained focus during training sessions. These findings suggest that KGBL can serve as a valuable tool for enhancing nurse education. Future studies should expand the sample size, include more diverse populations, and evaluate the long-term impacts of gamified learning in this context. Additionally, adapting KGBL for broader applications in vocational and healthcare education could further enhance its effectiveness and reach.

Abbreviations

KGBL	Kahoot! Game-Based Learning

Acknowledgments

The author would like to thank all individuals who willingly participated in and provided support for this study.

Author Contributions

Minping Deng: Conceptualization, Formal Analysis, Investigation, Methodology, Visualization, Writing – original draft

Jiasu Yan: Data curation, Investigation, Validation, Writing – review & editing

Chan Li: Resources, Data curation, Writing – review & editing

Manli Liu: Investigation, Project administration, Writing – review & editing

Yanfei Li: Conceptualization, Methodology, Project administration, Supervision, Writing – review & editing

Conflicts of Interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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Deng, M., Yan, J., Li, C., Liu, M., Li, Y. (2026). Effectiveness of Kahoot Game-based Learning and Satisfaction of Newly Graduated Nurses: A Pilot Randomized Controlled Trial. American Journal of Nursing and Health Sciences, 7(1), 12-21. https://doi.org/10.11648/j.ajnhs.20260701.12

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ACS Style

Deng, M.; Yan, J.; Li, C.; Liu, M.; Li, Y. Effectiveness of Kahoot Game-based Learning and Satisfaction of Newly Graduated Nurses: A Pilot Randomized Controlled Trial. Am. J. Nurs. Health Sci. 2026, 7(1), 12-21. doi: 10.11648/j.ajnhs.20260701.12

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AMA Style

Deng M, Yan J, Li C, Liu M, Li Y. Effectiveness of Kahoot Game-based Learning and Satisfaction of Newly Graduated Nurses: A Pilot Randomized Controlled Trial. Am J Nurs Health Sci. 2026;7(1):12-21. doi: 10.11648/j.ajnhs.20260701.12

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@article{10.11648/j.ajnhs.20260701.12,
  author = {Minping Deng and Jiasu Yan and Chan Li and Manli Liu and Yanfei Li},
  title = {Effectiveness of Kahoot Game-based Learning and Satisfaction of Newly Graduated Nurses: A Pilot Randomized Controlled Trial},
  journal = {American Journal of Nursing and Health Sciences},
  volume = {7},
  number = {1},
  pages = {12-21},
  doi = {10.11648/j.ajnhs.20260701.12},
  url = {https://doi.org/10.11648/j.ajnhs.20260701.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajnhs.20260701.12},
  abstract = {Purpose: Teachers often face the challenges in maintaining the student attention in class. This study aimed to evaluate the effectiveness of the Kahoot! game-based learning (KGBL) platform in enhancing attention span, theoretical knowledge acquisition, and satisfaction among newly graduated nurses in a hospital setting. Methods: This study employed a randomized controlled trial design. Newly graduated nurses from a tertiary hospital in China were recruited in September 2023. Participants were randomly assigned to either the experimental group (n=44) or the control group (n=43). The experimental group underwent a 5-day training program incorporating pre-class quizzes via the KGBL platform, while the control group received traditional classroom-based training without the gamified component. The training content followed the 2016 “Newly Employed Nurse Training Outline,” covering essential theoretical knowledge and practical guidelines. The concentration indicator was used to assess the nurses classroom attention; the acquisition of theoretical knowledge was measured using a closed-book exam. A 9-item questionnaire was used to survey the intervention group's satisfaction and attitude toward KGBL Results: The results showed that the KGBL group's concentration scores (eye contact, body language, classroom behaviour, and total score) were significantly higher than those of the control group at 5, 15, and 25 minutes (P Conclusions: This pilot study demonstrated the feasibility of KGBL in the nursing training program in hospital situations and suggested its potential effectiveness in enhancing attention, test scores, and satisfaction. Despite limitations such as the short study duration and lack of long-term follow-up, these preliminary findings suggest that gamified learning tools like KGBL could play a valuable role in enhancing nurse training. Further research is needed to explore the long-term impact of KGBL on learning outcomes and its broader applicability in nursing education.},
 year = {2026}
}

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TY  - JOUR
T1  - Effectiveness of Kahoot Game-based Learning and Satisfaction of Newly Graduated Nurses: A Pilot Randomized Controlled Trial
AU  - Minping Deng
AU  - Jiasu Yan
AU  - Chan Li
AU  - Manli Liu
AU  - Yanfei Li
Y1  - 2026/04/16
PY  - 2026
N1  - https://doi.org/10.11648/j.ajnhs.20260701.12
DO  - 10.11648/j.ajnhs.20260701.12
T2  - American Journal of Nursing and Health Sciences
JF  - American Journal of Nursing and Health Sciences
JO  - American Journal of Nursing and Health Sciences
SP  - 12
EP  - 21
PB  - Science Publishing Group
SN  - 2994-7227
UR  - https://doi.org/10.11648/j.ajnhs.20260701.12
AB  - Purpose: Teachers often face the challenges in maintaining the student attention in class. This study aimed to evaluate the effectiveness of the Kahoot! game-based learning (KGBL) platform in enhancing attention span, theoretical knowledge acquisition, and satisfaction among newly graduated nurses in a hospital setting. Methods: This study employed a randomized controlled trial design. Newly graduated nurses from a tertiary hospital in China were recruited in September 2023. Participants were randomly assigned to either the experimental group (n=44) or the control group (n=43). The experimental group underwent a 5-day training program incorporating pre-class quizzes via the KGBL platform, while the control group received traditional classroom-based training without the gamified component. The training content followed the 2016 “Newly Employed Nurse Training Outline,” covering essential theoretical knowledge and practical guidelines. The concentration indicator was used to assess the nurses classroom attention; the acquisition of theoretical knowledge was measured using a closed-book exam. A 9-item questionnaire was used to survey the intervention group's satisfaction and attitude toward KGBL Results: The results showed that the KGBL group's concentration scores (eye contact, body language, classroom behaviour, and total score) were significantly higher than those of the control group at 5, 15, and 25 minutes (P Conclusions: This pilot study demonstrated the feasibility of KGBL in the nursing training program in hospital situations and suggested its potential effectiveness in enhancing attention, test scores, and satisfaction. Despite limitations such as the short study duration and lack of long-term follow-up, these preliminary findings suggest that gamified learning tools like KGBL could play a valuable role in enhancing nurse training. Further research is needed to explore the long-term impact of KGBL on learning outcomes and its broader applicability in nursing education.
VL  - 7
IS  - 1
ER  -

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Author Information

Minping Deng

Surgery Department, The First Affiliated Hospital of Jinan University, Guangzhou, China

http://orcid.org/0000-0002-1226-6485
Jiasu Yan

Department of Nursing, The Fifth Affiliated Hospital of Jinan University, Heyuan, China

http://orcid.org/0009-0002-7551-2767
Chan Li

Department of Nursing, The Fifth Affiliated Hospital of Jinan University, Heyuan, China

http://orcid.org/0009-0002-6145-7533
Manli Liu

Surgery Department, The First Affiliated Hospital of Jinan University, Guangzhou, China

http://orcid.org/0009-0008-5729-9214
Yanfei Li

Surgery Department, The First Affiliated Hospital of Jinan University, Guangzhou, China

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APA Style

Deng, M., Yan, J., Li, C., Liu, M., Li, Y. (2026). Effectiveness of Kahoot Game-based Learning and Satisfaction of Newly Graduated Nurses: A Pilot Randomized Controlled Trial. American Journal of Nursing and Health Sciences, 7(1), 12-21. https://doi.org/10.11648/j.ajnhs.20260701.12

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ACS Style

Deng, M.; Yan, J.; Li, C.; Liu, M.; Li, Y. Effectiveness of Kahoot Game-based Learning and Satisfaction of Newly Graduated Nurses: A Pilot Randomized Controlled Trial. Am. J. Nurs. Health Sci. 2026, 7(1), 12-21. doi: 10.11648/j.ajnhs.20260701.12

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AMA Style

Deng M, Yan J, Li C, Liu M, Li Y. Effectiveness of Kahoot Game-based Learning and Satisfaction of Newly Graduated Nurses: A Pilot Randomized Controlled Trial. Am J Nurs Health Sci. 2026;7(1):12-21. doi: 10.11648/j.ajnhs.20260701.12

Copy | Download

@article{10.11648/j.ajnhs.20260701.12,
  author = {Minping Deng and Jiasu Yan and Chan Li and Manli Liu and Yanfei Li},
  title = {Effectiveness of Kahoot Game-based Learning and Satisfaction of Newly Graduated Nurses: A Pilot Randomized Controlled Trial},
  journal = {American Journal of Nursing and Health Sciences},
  volume = {7},
  number = {1},
  pages = {12-21},
  doi = {10.11648/j.ajnhs.20260701.12},
  url = {https://doi.org/10.11648/j.ajnhs.20260701.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajnhs.20260701.12},
  abstract = {Purpose: Teachers often face the challenges in maintaining the student attention in class. This study aimed to evaluate the effectiveness of the Kahoot! game-based learning (KGBL) platform in enhancing attention span, theoretical knowledge acquisition, and satisfaction among newly graduated nurses in a hospital setting. Methods: This study employed a randomized controlled trial design. Newly graduated nurses from a tertiary hospital in China were recruited in September 2023. Participants were randomly assigned to either the experimental group (n=44) or the control group (n=43). The experimental group underwent a 5-day training program incorporating pre-class quizzes via the KGBL platform, while the control group received traditional classroom-based training without the gamified component. The training content followed the 2016 “Newly Employed Nurse Training Outline,” covering essential theoretical knowledge and practical guidelines. The concentration indicator was used to assess the nurses classroom attention; the acquisition of theoretical knowledge was measured using a closed-book exam. A 9-item questionnaire was used to survey the intervention group's satisfaction and attitude toward KGBL Results: The results showed that the KGBL group's concentration scores (eye contact, body language, classroom behaviour, and total score) were significantly higher than those of the control group at 5, 15, and 25 minutes (P Conclusions: This pilot study demonstrated the feasibility of KGBL in the nursing training program in hospital situations and suggested its potential effectiveness in enhancing attention, test scores, and satisfaction. Despite limitations such as the short study duration and lack of long-term follow-up, these preliminary findings suggest that gamified learning tools like KGBL could play a valuable role in enhancing nurse training. Further research is needed to explore the long-term impact of KGBL on learning outcomes and its broader applicability in nursing education.},
 year = {2026}
}

Copy | Download

TY  - JOUR
T1  - Effectiveness of Kahoot Game-based Learning and Satisfaction of Newly Graduated Nurses: A Pilot Randomized Controlled Trial
AU  - Minping Deng
AU  - Jiasu Yan
AU  - Chan Li
AU  - Manli Liu
AU  - Yanfei Li
Y1  - 2026/04/16
PY  - 2026
N1  - https://doi.org/10.11648/j.ajnhs.20260701.12
DO  - 10.11648/j.ajnhs.20260701.12
T2  - American Journal of Nursing and Health Sciences
JF  - American Journal of Nursing and Health Sciences
JO  - American Journal of Nursing and Health Sciences
SP  - 12
EP  - 21
PB  - Science Publishing Group
SN  - 2994-7227
UR  - https://doi.org/10.11648/j.ajnhs.20260701.12
AB  - Purpose: Teachers often face the challenges in maintaining the student attention in class. This study aimed to evaluate the effectiveness of the Kahoot! game-based learning (KGBL) platform in enhancing attention span, theoretical knowledge acquisition, and satisfaction among newly graduated nurses in a hospital setting. Methods: This study employed a randomized controlled trial design. Newly graduated nurses from a tertiary hospital in China were recruited in September 2023. Participants were randomly assigned to either the experimental group (n=44) or the control group (n=43). The experimental group underwent a 5-day training program incorporating pre-class quizzes via the KGBL platform, while the control group received traditional classroom-based training without the gamified component. The training content followed the 2016 “Newly Employed Nurse Training Outline,” covering essential theoretical knowledge and practical guidelines. The concentration indicator was used to assess the nurses classroom attention; the acquisition of theoretical knowledge was measured using a closed-book exam. A 9-item questionnaire was used to survey the intervention group's satisfaction and attitude toward KGBL Results: The results showed that the KGBL group's concentration scores (eye contact, body language, classroom behaviour, and total score) were significantly higher than those of the control group at 5, 15, and 25 minutes (P Conclusions: This pilot study demonstrated the feasibility of KGBL in the nursing training program in hospital situations and suggested its potential effectiveness in enhancing attention, test scores, and satisfaction. Despite limitations such as the short study duration and lack of long-term follow-up, these preliminary findings suggest that gamified learning tools like KGBL could play a valuable role in enhancing nurse training. Further research is needed to explore the long-term impact of KGBL on learning outcomes and its broader applicability in nursing education.
VL  - 7
IS  - 1
ER  -

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