From Design to Implementation: NursingUP® Board Game for Positive Nursing Practice Environments

Positive nursing practice environments are fundamental to patient safety, care quality, and nurses' well-being. However, few structured and evidence-based interventions have been developed to actively strengthen these environments and foster collaboration among nursing teams. This study describes the systematic development, validation, implementation, and preliminary evaluation of NursingUP®, an innovative board game designed to stimulate reflection on positive nursing practice environments. A multi-method, multi-phase design guided the study. The development phase integrated theoretical and empirical evidence on healthy work environments to define the game's objectives and structure. Content validity was established through a structured e-Delphi process involving 17 nursing experts who evaluated clarity, relevance, and representativeness of the game's content and mechanics. Implementation was conducted with 48 primary health care nurses, followed by evaluation using standardized satisfaction and usability instruments and two open-ended qualitative questions on usefulness and improvement suggestions. Experts reached consensus regarding the clarity, relevance, and pertinence of the game's content and mechanics. Nurses reported high satisfaction, and perceived the game as useful for stimulating reflection on practice environment determinants, improving communication, and strengthening teamwork. Usability assessment demonstrated strong acceptance, with clear rules and ease of use being particularly valued. NursingUP® demonstrated content validity, high user satisfaction, and good usability, establishing feasibility as a potential educational tool for nursing teams. Future studies should test its impact on behavioral and organizational outcomes using controlled designs.