Publication Date

Spring 2022

Degree Type

Doctoral Project

Degree Name

Doctor of Nursing Practice (DNP)



First Advisor

Arlene Spilker


neonatal resuscitation, positive pressure ventilation, game, game-based learning, refresher training


Based on evidence suggesting resuscitation provider knowledge and skill decay can occur as soon as four weeks post-training, the American Heart Association (AHA) recommends more frequent resuscitation refresher training. While current resuscitation training and education practices center on simulation training, its cost in terms of supplies, equipment, and personnel may be creating barriers to increasing the frequency of refresher training. This quality improvement project implemented a game-based, refresher training for registered nurse providers of neonatal resuscitation with a focus on improving the time to initiation of positive pressure ventilation (PPV) per Neonatal Resuscitation Program (NRP) guidelines. Using commonly available free or low-cost software programs, three self-directed, online games were developed which aimed to stabilize or improve neonatal resuscitation knowledge and skill. Participant knowledge and skill were assessed pre- and post-game play using a standardized simulation scenario. Participant levels of motivation and engagement with the learning materials were assessed with the Instructional Materials Motivation Scale (IMMS). Statistically significant improvements in knowledge and skill and time to PPV initiation were noted at six weeks post-game play, with an overall mean improvement of almost thirteen seconds in the start time of PPV. Participants found the learning materials to be motivating, engaging, and relevant to their current practice. Project results suggest that a low-cost, game-based, refresher training can stabilize or improve neonatal resuscitation provider knowledge and skill, leading to better outcomes for newborns requiring resuscitation after birth.


To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.