Background: Key challenges for clinical education during the COVID-19 pandemic include how to continue teaching and learning, how to teach core clinical skills, and how to demonstrate professional and practical skills in various clinical situations. Therefore, nursing students need to learn how to assist with in-patient intubation, eliminate accumulated sputum overflow, and the basic techniques of sputum suction. Objectives: We proposed and investigated an approach to integrating online game-based learning with the watch-summarize-question strategy to improve nursing students' learning achievement, self-efficacy, learning engagement, and learning satisfaction in sputum suction skill training. Design: A quasi-experimental study with pretest and posttest design. Settings and participants: We randomly allocated 45 first-year nursing students to an experimental group (n = 21) or a control group (n = 24) at a school of nursing in a university. Methods: The experimental group adopted the online game-based learning and watch-summarize-question strategy, while the control group used video-based learning. Participants were assessed on learning achievement of sputum suction skills, self-efficacy, learning engagement, and learning satisfaction before and after the intervention. Results: The experimental group, which used the proposed approach, achieved statistically significant higher learning achievement, self-efficacy, learning engagement, and learning satisfaction than the control group. Conclusions: The integration of online game-based learning with the watch-summarize-question strategy demonstrated a positive impact on nursing students' sputum suction skill training. Nurse educators and researchers should consider integrating computer technology and teaching strategies to facilitate nursing education.
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