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Game Modification Project Discovering the Surgical Instrument Game by Transforming the Catan Marisa Tapia IT 5830 University of Colorado Denver March 8, 2012

Introduction: Introduction:   Can a game be changed to teach something? Yes. Through game modification techniques a game can be transformed into a purposeful subject specific learning opportunity. The purpose of this assignment is to transform or modify a current game-The Settlers of Catan-to teach a subject in my discipline or domain. Through simple or complex changes one can create and deliver a robust teaching tool that promotes fun, engagement, purpose and identified learning outcomes.

By embedding values such as collaboration, ownership, accountability and critical thinking the game is now being transformed into a usable tool to promote teaching and learning principles. The newly created game using the basic principles of The Settlers of Catan can be transferred and molded to promote surgical instrument identification and utilization in the surgical setting.  

The Mind Map Story: Establishing Ideas and Game Design Beginnings: Getting started on this project was quite the tedious process. First, my fears about this class were coming true as I am not a game person therefore my first challenge was overcoming my obstacle of not liking games. Secondly, I had to re-program myself to step outside of my comfort zone and dive into breaking down a game that I was not fond of. Lastly, I had to modify the game as well as identify the game content that would be best suited to mold into the Settlers of Catan. This was quite the challenge. I had numerous ideas with no significant direction. I was indifferent to several options as far as content to mold into The Settlers of Catan. I initially thought of a word game to assist with medical terminology but what fun is that? My second attempt at modifying, designing or developing a game was the medication game but that would be too vast and ever-changing as medications change rapidly for their intended purpose or for the true realistic utilization of the medication. I then realized that I was wasting time by overthinking the assignment and I needed to put thoughts into actions and develop a plan, below is the mind map that assisted me in the modifications needed to develop the Surgical Instrument Game.



Modification of the Settlers of Catan: The Surgical Instrument Game

1. I realized quickly that the most important step in playing a game is building confidence among the players to entice participation and competitiveness with the ultimate goal of learning something. My initial challenge was how do I create this with the content I have? Do I keep the Catan structure? Do I stay true to the game rules or do I base the game on the premise of building onto something? Do I start from scratch or do I modify it to build skills that will transfer into the learning criteria through the analysis and synthesis of the current player’s knowledge base to the expected player’s achievable outcomes?

3. Initially, I was going to use the original hexagonal diagram as the playing field for the game but decided to modify this element into a pyramid the player climbs. I created a stair like approach to reaching the top of the pyramid to encourage participation, skill acquisition and ultimately competency in achieving the peak of each achievement. The game is simple as it builds on the player’s knowledge in surgical instrumentation knowhow. Must be played with a minimum of 2 players with the maximum of 4. The game takes the player from a novice to expert approach in mastering one set of skills from one level to the next by climbing the pyramid with the ultimate achievement of reaching “competency” in all components of surgical instrumentation skills and knowledge  acquisition.



Why is the instrument game the content to use? The most important and critical knowledge to fully integrate nursing skills in the operating room is to understand, identify, utilize and recognize what surgical instrumentation is needed for a specific surgical intervention. Critical instrumentation needs in the operating room are essential to facilitate the surgical intervention in a timely manner to promote and insure patient safety needs. Such safety factors include but are not limited to the reduction of blood loss and the surgeon’s ability to attain visualization at the surgical site for the surgical intervention at hand. The progression in learning instruments is quite grueling often tiresome and requires accuracy. First, the student must learn the classifications of instruments, followed by what each instrument’s function and purpose. Next, the student must correctly identify which surgical tray or grouping the instrument belongs to. Finally, the student must identify which surgical tray correlates to which surgical intervention. As you can see, the learning is a series of steps in order for knowledge acquisition and ultimate competency.


Transforming the Board Game

Incorporating a theory and a model into the game in   shape of a pyramid the


Through the use of a theoretical framework and a nursing model I derived the board game, which was the first step in the modification process. The theoretical framework I chose was Maslow’s Hierarchy of Needs and the nursing model I chose is Patricia Benner’s From Novice to Expert. Below are the two pyramids depicting the concepts of the theory and model and how they can both be utilized into deriving teaching and learning constructs to build on the player’s knowledge base.

Expert:   Intuitive   Judgment   Proficient:   Experienced   Competent  Conscious   Planning       Advanced  Beginner:  Guided   Behavior   Novice:  Learn  rule  and  no  experience    



The Game Board: I initially wanted the game board to stay as is, but after careful consideration I decided on the pyramid.


Both the theory and model identify that reaching the peak only establishes more learning to be accomplished as well as growth. In order to be a nurse in the operating room setting, basic skills must be met prior to integrating other aspects of instrumentation knowhow. Building on the knowledge from one level to the next promotes a successful transition from novice to expert.


The player(s) will climb the pyramid during each level of the process of: 1.

Instrument identification and classification


Instrument sterilization


Instrument utilization


Instrument tray recognition


Type of tray for specific

Doyan   Retractor  

surgery 6.

Sterile technique skills


Putting it all together: scenario based question


1. The  instrument  classification  is  a  retractor   The  identification  is  the  name  of  the  retractor  (Doyan  Retractor).   2. Sterilization  methods  include:  autoclave  steam,  Ethylene  Oxide   Gas  (ETO)  as  well  as  Hydrogen  Peroxide  Gas  Plasma   3. Utilization:  used  for  visualization  of  organs  during  surgery   4. The  above  set  is  a  plastic  surgery  set  which  includes  this   instrument     5. This  tray  would  be  used  in  a  minor  abdominal  or  breast  surgery.       6. Sterile  technique  related  question  to  surgical  table  set-­‐up   7. Scenario  based  question  to  promote  expertise  and  p eak   performance  


Adaptation  of  the  New  Game   Settler’s  of  Catan  Original  Tiles  

Original  Game   Board   Configuration   Hills:  Bricks  

Tiles  and  Resources  Cards  

Each  resource  card  is  color  

New  Tiles  

Blue:   Instrument   Class  and  ID     Pasture:  Woods   Green:   Sterilization   Method   Mountains:  Ore   Purple:  How     the   instrument  is   used   Fields:  Grain   Brown:  ID  of   instrument   tray   Forest:    Lumber   Orange:     Types  of   surgical   procedure   that  would   use  this   surgical   instrument   tray   Desert:  Nothing   Yellow:  Sterile   Technique   question     Red:  Scenario   Based   Question    

coded  to  determine  the  learning   level  in  a  novice  to  expert  with   the:   Blue  and  Green:    Novice   Purple  and  Brown:  Advanced   Beginner   Orange:      Competent   Yellow:  Proficient   Red:    Expert      

Cards:    Development  Cards,   Resource  Cards,  Special  Cards   and  Victory  Point  Cards                In  the  Surgical  Instrument   Game  the  Development  Cards   stay  the  same  as  the  original   game  in  which  they  provide   progression.    As  the  player  climbs   the  pyramid  starting  with  the  blue   level  and  progressing  to  the  top  or   the  red  level  they  automatically   will  be  allowed  a  “re-­‐do”  or  a   second  chance  to  progress  when   they  draw  this  card.    The  Resource   cards  are  an  opportunity  to  use  a   resource  to  look  up  information.     Special  cards  are  “chance”  cards   that  allow  the  player  to  go   straight  to  the  top  and  risk   everything.    Victory  Points  Cards   allow  the  player  to  double  their   score  regardless  of  level.      


Scoring: Through the use of a dice, the number displayed on the dice determines which level you start on in a blue to red progression BONUS: Additionally, if a player is awarded the QA Card they have the opportunity to ask the opponent a question regarding sterile technique.



Reflection:   Design  Process  

Step 1: Establishing ideas and generating a plan of action for this game was the most frustrating process as I lack the gaming experience and ingenuity to create a game-and as a friend told me, that “if you can think it, it has probably already been done”, which was disappointing to hear since he is a devoted gamer and my partner in crime with all the games with Friends that I play. Next, I drew out the sketch to a possible game, and then another and another, with no success. Finally, I decided on using a mind map. Through the use of a mind map, I was able to identify the direction and the goals of the game that would be relevant in my domain/discipline as well as the applicability to the teaching and learning perspective. Step 2: I did an internet search on “healthcare games”, “nursing games” and “surgical instrument games”. None of these games captured my attention nor did they capture “a true method to learning something”. These games only identified a method to perform item recognition while using the word “game” to depict this. I felt that in order for my game to be effective I had to bring it back to theories and models to figure it all out. I chose Maslow’s Hierarchy of Needs and Patricia Benner’s model, From Novice to Expert (1984) to mold something that could take a player’s knowledge base and build on this to effectively provide the care necessary and safely to the patient undergoing an operative or invasive surgical intervention. I thought to also use Bloom’s Taxonomy but it did not mold quite as well as Benner’s nursing model, which most nurses are familiar with.  


Reflection:   Modification  and  Learning  Outcomes   Step 3: When creating this game, I had no idea I would change it so much from its original state, but it made sense, as I wanted to create a purposeful game for nurses learning surgical instrumentation and its many layers of information that the nurse should know. As nurses we collectively lack expertise in other disciplines such as education, training and technology. Through the use of theoretical frameworks and nursing models the most effective learning into practice is developed and achieved. Maslow’s Hierarchy of Needs depicts levels of a pyramid in which needs are met ranging from the most basic to the more complex (bottom to top). An individual will seek out the most basic needs first prior to progressing to the next level. Upon reaching self-actualization, the individual will attain this level for a brief moment and the progression begins anew starting from the bottom and working oneself towards the peak of self-actualization.

Transcendence occurs throughout the learning process for nurses and is thought to be critical in the caring for self and others and often takes place during selfactualization.



Step 4: In looking into what works in nursing education Benner’s Model: From Novice to Expert always comes to mind. This model identifies the progression of learning among nurses-or better said, how nurses learn to be nurses. This model is based on Dreyfus’ model of skill acquisition. This model provides the foundation for the learning to occur and the plan for the player’s success in the game and in learning something through the use of progressing or climbing the pyramid.

Play  Testing:            During  the  playtesting  component  of  this  project  and  through  the  use  of  the  internet  I  dabbled  in  the   games  out  there  related  to  surgical  instruments  as  well  as  contrasting  it  with  the  Settlers  of  Catan.    The   games  available  were  quite  non-­‐descript  and  only  emphasized  name  recognition  of  instruments  and   lacked  the  critical  thinking  component  that  I  wanted  to  generate  with  my  game.                  As  with  the  Settlers’  of  Catan  there  was  a  thought  process  involved  in  which  an  individual  player   strategically  planned  thing  out  in  order  to  progress  and  attain  land.    In  my  game  I  wanted  the   progression  to  mean  something  and  to  have  not  only  a  sense  of  accomplishment  in  reaching  the  top  but   to  ultimately  learn  and  practice  safely.                  When  would  I  introduce  this  game  to  student?    The  most  assumed  schedule  would  be  during  the  time   they  are  introduced  to  surgical  instruments  however,  I  would  introduce  the  game  after  each  lesson   related  to  the  given  topic  in  an  effort  to  promote  learning  progression  and  as  a  method  for  the  player  or   student  to  determine  their  own  distinct  learning  needs.        

Reflection:   Reflect  on  the  modification  process  as  a   means  of  better  understanding  content     Q:    How  did  the  modification  exercise   assist  in  learning  more  about  the  learning   domain?                   During  this  treacherous  process  to  take  apart  a  game  and  modify  it  to  meet  the  needs  of  my   discipline  in  the  context  of  a  learning  domain  was  grueling,  however,  as  the  adult  pessimist  that  I  have   become,  I  did  not  see  the  use  of  a  game  in  an  effort  to  learn  something  beyond  medical  terminology.     This  project  was  useful  in  identifying  goals  and  outcomes  for  learning  through  the  use  of  a  game,   whether  it  was  modified  or  not.         Nursing  practice,  nursing  theory  and  nursing  education  is  not  something  that  is  uncommon  to  me,   however,  best  practices  in  learning,  training  and  technology  are  novice  topics  in  my  current  professional   circles.    Utilization  of  a  game  to  learn  something  was  an  unforeseen  outcome  based  on  my  past   experience  in  nursing  education  and  nursing  best  practices  related  to  learning.    This  project  allowed  me   to  mold  or  modify  a  game  to  an  identified  topic  related  to  the  discipline  I  practice.    This  project  also   provided  me  the  opportunity  to  step  out  of  my  comfort  zone  and  take  a  “deep  dive”  approach  to   creating  a  game  that  was  useful,  hopefully  fun,  increases  a  player’s  /student’s  knowledge  base  and  build   up  their  confidence  to  competency  and  achieve  expertise.    






Resources: Photographs: All photographs were obtained from the internet via Snagit during March 1-10, 2012. Benner’s Model retrieved March 10, 2012. Maslow’s Pyramid 1990’s version. Retrieved March 7, 2012.

Settlers of Catan retrieved March 1, 2012 image and board game m=isch&tbnid=nrplnA1uHl7pFM:&imgrefurl= VgOGtCw&zoom=1&iact=hc&vpx=654&vpy=181&dur=1675&hovh=225&hovw=225&tx=109&ty=1 68&sig=100759130507373249911&page=1&tbnh=157&tbnw=157&start=0&ndsp=15&ved=1t:429 ,r:2,s:0 Tapia, M. Personal photographs of instruments. The Thinker retrieved March 9, 2012. sch&tbnid=Cr_tu8KoPV4Z8M:&imgrefurl= 0&ei=gcRdT63hHpHRiAKQmOWLCw&zoom=1&iact=hc&vpx=727&vpy=169&dur=27&hovh=257 &hovw=196&tx=128&ty=107&sig=100759130507373249911&sqi=2&page=1&tbnh=164&tbnw=1 25&start=0&ndsp=23&ved=1t:429,r:4,s:0




Marisa Tapia Game Modification