Investigation of nursing students' addiction to digital game play and associated factors

Due to technological advancements, urbanization, and decreased physical play areas, the current generation increasingly turns to indoor activities and digital gaming, utilizing computers, game consoles, and online games. The phenomenon of digital gaming addiction has evolved significantly across different generations. The Silent Generation and Baby Boomers experienced the early days of gaming with arcade games and rudimentary home consoles, where addiction was rare due to limited access. Gen X witnessed the advent of more advanced gaming systems like Atari and Nintendo, leading to increased engagement, though gaming addiction was still not widely recognized. Millennials grew up with the rapid expansion of digital technology and the internet, facing the first wave of widespread gaming addiction as games became more immersive and socially connected. Gen Z has been immersed in a digital world from birth, with higher instances of gaming addiction due to the rise of eSports, streaming platforms, and mobile gaming. Gen Alpha is growing up in an era of ubiquitous digital technology, with gaming integrated into early childhood experiences, making the long-term effects of early exposure to digital gaming and potential addiction an ongoing concern. Over time, digital gaming addiction has progressed from a rare phenomenon to a widespread issue, particularly affecting Millennials and Gen Z, with implications for future generations like Gen Alpha [1]. This shift towards virtual environments is prevalent and expanding among children and adolescents, with a significant daily increase in digital game players. The popularity of these games continues to grow even among younger children [1‐4]. The uncontrolled urge to engage in digital gaming can lead to significant changes in social life, emotions, and thoughts, potentially culminating in gaming addiction [5‐7]. International studies have shown that the incidence of gaming addiction varies between 2 and 15% [3, 8], and according to the American Medical Association, 90% of adolescents engage in digital gaming, with 15% demonstrating addictive behaviors [9].

Digital games offer a virtual realm where users can fulfill their fantasies, creating a world that doesn’t exist in reality [3, 6, 10]. Within university settings, where interpersonal interactions and communication are emphasized, young adults frequently engage in digital gaming to connect with friends [8, 10, 11]. Research by Shuvo and Biswas has indicated a significant association between the time spent on screen-based devices and playing digital games with overweight and obesity among university students [12]. Moreover, findings by Polat and Topal suggest that digital game addiction is significantly predicted by factors such as gender, academic achievement, and hours spent gaming on computers and smartphones each week rather than by body mass index or types of players [13].

The research on digital gaming addiction among nursing students is essential due to its impact on the cognitive and emotional skills critical for patient care, such as attention, decision-making, and stress management. This focus is crucial in nursing education to prepare students for the demanding healthcare environment. These consequences are not exclusive to nursing students; however, they are particularly significant for this group due to their direct implications on patient care and safety. While other university students might experience reduced academic performance and social interaction from gaming addiction, these issues do not typically present immediate life-or-death consequences. In contrast, in nursing, digital addiction directly impacts public health and safety. This study underscores the need for proactive measures in nursing education to equip students with the skills to tackle digital addiction effectively, enhancing patient safety and overall care quality. This approach benefits the nursing professionals and the broader healthcare system, establishing the study's relevance and necessity in training nurses to handle complex health challenges, including addictions, in their careers. The central research questions were as follows:

Students may engage with digital games for various reasons during their university education, potentially leading to digital game addiction if not properly managed [16, 17]. This study found that digital game addiction among nursing students, as measured by DGAS-7, was generally low. This observation aligns with previous research by Aktan [18] and Aktaş with Bostancı-Daştan [3], which also noted low levels of game addiction among nursing students. Despite the challenges posed by the pandemic, nursing students appear to be aware of potential digital gaming issues and manage their gaming habits accordingly.

Regarding motivation for playing digital games, DGPMS revealed that curiosity and social acceptance were significant factors. These external motivations drive gaming behavior, which include the desire for rewards such as trophies and status and the sensory appeal of game sounds and effects [19]. Further studies have confirmed that curiosity and social acceptance are predominant, followed by motives like uncertainty, success, and survival in gaming scenarios [20]. This indicates that external factors are strong determinants of gaming behavior among nursing students, primarily motivated by curiosity, as is common among their peers in different fields.

The subdimension of uncertainty in gaming desire, which ranks second for motivational factors in digital gaming, suggests that students engage in gaming without fully considering the consequences or causes of their gaming habits [21]. This aspect is crucial as it contrasts with the critical thinking and evidence-based practices emphasized in nursing education, grounded in real-world experiences.

Interestingly, the study also highlights that intrinsic motivations such as achievement and revitalization, which include elements like ambition and happiness, are less influential among nursing students [22, 23]. This finding, corroborated by Güler and Çakır [21], suggests a lesser inclination towards gaming driven by these intrinsic factors, challenging some prior studies [1, 2].

Correlations were observed between various motivational subdimensions—achievement, revival, curiosity, and social acceptance—and digital game addiction [24, 25]. These correlations suggest that while motivations can vary, they significantly influence the likelihood of addiction, particularly through social motivations [7].

Examining demographic factors, we found that male nursing students scored higher on the DGAS-7 than their female counterparts, potentially due to cultural and social dynamics that encourage men more towards gaming [3, 10, 11, 25]. The influence of gender on game addiction is also seen in different responses to the motivational factors within the DGPMS, where success, revival, curiosity, and social acceptance scores were notably higher among males [20, 21].

Age also plays a critical role; older students (21 years and above) reported higher addiction scores, possibly exacerbated by the remote learning conditions imposed during the pandemic [6, 25]. This was a deviation from the trends observed in younger age groups, where the pandemic seemed to reduce the interactive aspects of their education, leading to increased gaming.

Marital status and physical health also influenced gaming behavior. Single students and those classified as overweight according to BMI had higher scores on the DGAS-7 [26, 27]. This could be attributed to more free time and less engagement in physical activities, respectively.

Lastly, the type of device used for gaming was a significant factor, with students using tablets showing higher addiction scores than those using smartphones [4, 28]. The ease of use and the immersive experience provided by tablets might contribute to higher levels of engagement and, consequently, higher motivation and addiction scores.

This analysis demonstrates that digital game addiction and motivation among nursing students are influenced by a complex interplay of demographic, psychological, and environmental factors. Understanding these factors can help in developing targeted interventions to manage potential addiction issues effectively [29].

This study had some limitations. A self-report scale was used to gather information about all the variables that might have the potential for bias. Another limitation was that causality could be explained to a limited extent due to the descriptive and correlational design of the study. The study's non-experimental design was limited to nursing students from three specific universities: two state universities and one foundation university. Consequently, the findings are applicable only to these institutions.

This study investigated the levels of digital game addiction and digital game playing motivation among nursing students and the factors influencing these aspects. The findings indicate that digital game addiction is generally low among nursing students, yet certain factors such as gender, age, BMI, and the type of device used for gaming (particularly tablets) significantly affect both addiction levels and motivational subdimensions.

Male students, those aged 21 and older, overweight students, and those who prefer tablets for gaming are more likely to have higher digital game addiction scores. These demographic and device preference factors also enhance motivational aspects related to digital gaming, particularly in Success and Revival, Curiosity, and Social Acceptance. While overall addiction levels are low, they are influenced by specific demographic and behavioral factors, which are crucial for developing interventions aimed at reducing game addiction risks and promoting healthier gaming habits among nursing students.

This study shows that evaluating nursing students in terms of digital addictions is critical in preventing future health problems. In line with these results, it can be suggested that digital games can be transferred to the nursing curriculum to be used in cognitive and psychomotor areas and that more comprehensive studies on the effects and management of these games on individuals should be suggested.