Participants received a multimodal intervention (intervention order: interactive fiction activities and role-play simulation).

Participants received a multimodal intervention (intervention order: role-play simulation and interactive fiction activities).

Participants received a conventional practical teaching based on lectures.

The case studies were prepared using interactive fiction through Twine. Each case simulated a nursing consultation with a patient requiring dietary advice, and the patient's evolution depended on the students' choices. All cases created had similar structures, durations, and difficulties to avoid complexity-related bias. For each circumstance, three possible dietary advice options were offered to the patient: one option that would be ideal, one suitable option, and one unsuitable option.

The assessment of the learning level during the intervention was measured by correcting the three unpublished case studies created using the interactive fiction methodology. Each case study consisted of 6 questions with 3 possible answers (1 point for the ideal answer, 0.5 points for the adequate answer and 0 points for the inadequate answer). For readability, the final scores were reconverted proportionally out of 10 before statistical analysis.

Measurement instrument: Clinical Decision-Making in Nursing Scale (CDMNS). It comprises the search for options or alternatives, information seeking and unbiased assimilation of new information, evaluation and re-evaluation of consequences, and probing of goals and values.

Measurement instrument: Simulation Design Scale (SDS). This scale measures students' perceptions of 5 dimensions related to simulation design: information, support, problem-solving, guided feedback and fidelity.

Measurement instrument: Gameful Experience Gamification (GAMEX) scale. It measures 6 dimensions of students' experience in gamified experiences or environments involving interactive enjoyment mechanisms.