Through collaboration during the play of a game, learners may discuss prior experiences to aid in discovery of the correct answer. Gaming activities also permit peer feedback to be given to students based on their previous experiences. The millennial student desires immediate feedback and integrates their experiences into their learning (Tapscott, 1998). Again, through group discussion and collaboration, learners share previous experiences with others to confirm or not the correct answer. By not tapping into the experience of adult learners, negative effects may result (Knowles, 2005). The adult learner identifies their experiences as who they are. In other words, their experiences help to define them as a person. Adult learners, who perceive their experiences as being ignored or devalued, perceive the instructor as rejecting them as persons (Knowles). By devaluing or ignoring the millennial learner's experiences, the mutual respect they desire with the instructor is hampered because they are no longer seen as adults (Aviles, Phillips, Rosenblatt, & Vargas, 2005).

Fourth, the adult learner's readiness to learn is dependent on one's evolving social roles (Knowles, 2005). Knowles stated adult learners become ready to learn in order to effectively cope with their real-life or upcoming situations. Baccalaureate nursing students become ready to learn when they become aware of potential real-life or upcoming events they will be facing as a nurse. Interaction that occurs when learners participate in gaming may promote social role development and readiness to learn (Knowles, 2005).

Fifth, adult learning orientation shifts from subject-centered to problem-centered (Knowles, 2005). Adults learn best if new material is presented in a problem format in which the learner can immediately apply what is being learned. According to Knowles, the adult learner seeks to apply tomorrow what they learned today. In this regard, gaming activities allow students to immediately apply their knowledge from classroom lecture to situations that promote application. Oblinger and Oblinger (2005) state the millennial learner thrives on immediate gratification through application of new knowledge. Through immediate application of content learned, the link between nursing theory and practice is strengthened (Henderson, 2005).

Lastly, Knowles's theory (2005) stated that adults are both internally and externally motivated to learn. The most powerful motivators are internal factors such as a desire, a perceived need, or a wanting to learn. "Adults are motivated to learn to the extent that they perceive that learning will help them perform tasks or deal with problems that they confront in their life situations" (p. 67).

Given the explosive growth in the number of adult learners in recent years, it is not surprising that the methods developed by Knowles and others have received an increasing amount of attention, particularly as they relate to what actually helps motivate adult learners to learn. In this regard, Griffin and his associates report that, "Malcolm Knowles' theory of andragogy originated the contract idea. Experiential learning also lies at the heart of much current theory and practice, and this too involves a degree of self-directed learning. As a result, self-directed learning and learning contracts are increasingly used for purposes of assessment and accreditation both in higher education and in professional continuing education and development" (p. 90). These trends have been fueled by some external forces as well that make the identification of what motivates adults to learn effectively all the more pressing and an extensive body of literature on the subject of self-directed learning has developed, reflecting research, adult learning theory and practice (Griffin et al., 2003), and these issues are discussed further below.

Application of Adult Learning Theory

There has been a profusion of new educational strategies in adult education in recent years that have provided educators with some viable alternatives to conventional teaching methods (Braithwaite & Westbrook, 2001), and one such approach is used in this study. The card game entitled "ABG Go Fish" will be played by undergraduate baccalaureate nursing students (Appendix a). Students seeking a career in nursing have a need to know about arterial blood gas content. "ABG Go Fish" seeks to reinforce arterial blood gas parameters, analysis, and clinical manifestations of respiratory and metabolic acidosis or alkalosis. The game will provide participants with a sense of progress towards identifying and interpreting normal and abnormal arterial blood gas parameters, and recognizing abnormal clinical manifestations of acid-base imbalances.

Gaming also allows the adult learner to have active control of learning and promotes independence. The "ABG Go Fish" card game allows students to participate actively by interpreting and analyzing arterial blood gas parameters and clinical manifestations. The card game also allows the student to have active control of learning at their own pace.

The "ABG Go Fish" game allows learners the ability...

The card game engages the learner and permits peer feedback of previous experiences with acid-base imbalances.
Gaming can promote an adult learner's readiness to learn and social role development. Interaction between players during the "ABG Go Fish" card game permits social development and promotes a readiness to learn. Nursing students become ready to learn arterial blood gas content when they are aware of this need to know in order to cope effectively in patient care.

According to Knowles (1998), adults are problem-centered in their route to learning. Therefore, the "ABG Go Fish" card game supports this principle of learning. The card game presents arterial blood gas information in a hands-on, problem format which allows immediate application of content. Gaming makes learning more effective when presented in the context of application (Knowles, 1998). In fact, there is a profound motivation among adult students to learn (Knowles, 1998). Consequently, it is reasonable to suggest that adult students, in particular adult nursing students, will be motivated when they recognize learning will help them perform the responsibilities necessary to deal with the problems they will confront when performing patient care (Knowles, 1998). The "ABG Go Fish" card game motivates nursing student's learning of arterial blood gas content.

Definition of Terms

Gaming is an instructional strategy, directed by rules and levels of chance, which uses an established format to involve one or more players who compete (with self, one another, or a computer) in an effort to achieve an outcome (De Tornyay & Thompson, 1987). In this study, the card game "ABG Go Fish" is the format used amongst teams consisting of two players who compete to correctly interpret and analyze arterial blood gas parameters and clinical manifestations cards.

Knowledge is an understanding of information gained by experience (Merriam-Webster, 1999).

Immediate knowledge is knowledge gained at once after content to be learned is presented. Immediate knowledge will be measured by a difference in a 15-item multiple choice pretest and posttest score (Appendix B, C).

Knowledge retention is information that is retained or held onto. In this study, knowledge retention will be measured by a difference between the immediate posttest score and a 15-item multiple choice posttest score in four weeks (Appendix D).

Lecture is a passive form of instructive talk in which students passively receive verbal information, facts, or ideas by teachers (DeYoung, 2003). In this study, lecture will include a 30-minute presentation/discussion by the researcher on arterial blood gas components and analysis of lab results.

Nursing student includes any male or female, 18 years of age or older, an academically passing junior or senior level baccalaureate, enrolled part-time or full-time, in a National League of Nursing Accredited Commission (NLNAC) or Commission of Collegiate Nursing Education (CCNE) accredited university or college. Nursing student also includes only those who can read and write English.

Attitude towards Gaming is the opinion that nursing students have about gaming as a teaching method. In this study, attitude towards gaming will be measured by the total score on the Attitude Toward Gaming Semantic Differential Instrument (ATG-SDI) (Appendix E).

Assumptions of the Study

This study is based on the following assumptions:

1. Baccalaureate nursing students' meet Knowles principles of adult learning.

2. Baccalaureate nursing students' in the experimental group will actively participate in the proposed game intervention in good faith.

3. Baccalaureate nursing students' in both groups will answer the research questionnaires honestly and in good faith.

Significance of the Study

Nursing Research

The significance of this study in nursing education, science, and research, is noteworthy for several reasons. Currently, there is a limited amount of research available on the evaluation of gaming in adult education and in particular, nursing education (Jarvis, 2004). A review of the literature revealed that much has been written supporting the value of gaming in nursing education; however, most of the literature consisted only of opinion. A minimal amount of empirical evidence exists that demonstrates gaming to be more effective than traditional instructional strategies, such as lecture, for enhancing students' knowledge in nursing education. In addition, little empirical research exists in assessing a game's impact on knowledge retention. Using an instructional strategy like gaming may facilitate students' immediate learning and retention of information better than a traditional method of instruction. In order to validate a game's use and outcomes, research is needed. This study will begin to fill the current void existing in research-based evidence that supports the use of gaming in nursing education to enhance knowledge. Research is an essential component…