Content area
Aim
To evaluate the effects of escape rooms and role-playing methods on nursing students’ ability to recognise and assess violence against women and their attitudes toward violence.
BackgroundInnovative and practical strategies are essential to enhance nursing students’ capacity to identify and address violence. Gamification offers a promising approach to the development of these skills.
DesignA pre-test and post-test factorial group randomised controlled trial was conducted.
MethodsA total of 120 nursing students were randomised into three groups: escape room game (n = 40), role-playing (n = 40) and control (n = 40). Data were collected using the Knowledge Test on Violence Against Women, Scale for Attitudes Toward Violence and Scale for Nurses’ and Midwives’ Recognition of the Symptoms of Violence Against Women. Assessments were conducted one week and one month after the intervention.
ResultsBoth the escape room game and role-playing groups demonstrated significantly higher knowledge test scores and more contemporary, non-approving attitudes toward violence than the control group at both time points. The escape room group, in particular, achieved notable improvements in recognising signs of violence against women.
ConclusionsEscape room games and role-playing are effective educational methods to improve nursing students’ knowledge, attitudes and assessment skills related to violence prevention. Incorporating these methods into nursing education programs is recommended to enhance the learning outcomes.
Violence, defined as the exertion of physical, psychological, social, sexual, emotional, or economic power by one individual over another, is a pervasive global issue with profound consequences for its victims ( Maier and Bergen, 2018). It manifests in various forms, including violence against women, children, the elderly, individuals with disabilities, persons of diverse sexual orientations and immigrants ( Marshall et al., 2020). Intimate partner violence against women—this study’s focus—is described by the World Health Organization as “any behaviour within an intimate relationship that causes physical, sexual, or psychological harm” ( WHO, 2013). This form of violence has no boundaries and affects women across all age groups and sociocultural backgrounds ( Natan et al., 2016).
The World Health Organization states that “globally, almost one-third (27 %) of women aged 15–49 years have been subjected to either physical and/or sexual intimate partner violence in their lifetime” ( World Health Organization, 2024). Although intimate partner violence against women is widespread, it is a preventable problem. Healthcare professionals play a crucial role in the prevention and detection of violence against women. However, the nursing response to this issue remains insufficient to date ( Patrick and Jackson, 2021). Beyond the visible physical injuries that healthcare professionals can readily identify, violence against women often induces complex psychological and social effects, including psychosomatic symptoms that are difficult to detect and frequently overlooked ( Maier and Bergen, 2018; Yılmaz and Oz, 2018). Such complexities present substantial challenges for nurses who must navigate identifying, assessing and preventing violence in healthcare environments ( Alhalal, 2020). Research indicates that nurses frequently feel unprepared to address violence, may become desensitised to these cases, do not consider them part of their professional responsibilities, or lack the necessary skills to provide appropriate care, factors that collectively hinder effective interventions ( Dichter et al., 2015; Rahmqvist et al., 2019; Shaqiqi et al., 2022; Waalen et al., 2000).
In this context, it is critical to equip nursing students with the requisite knowledge, skills and experience to recognise, assess and address violence early in their training. However, many nursing programs in Türkiye fall short in this area, leaving students ill-prepared and lacking confidence in handling such situations ( Gürkan and Kömürcü, 2017). The literature further reveals that nursing students often lack proficiency in conducting violence screenings, identifying the signs and symptoms of violence and understanding the legal aspects of interventions ( Bradbury-Jones and Broadhurst, 2015; Shaqiqi et al., 2022). Consequently, nursing education needs to go beyond theoretical knowledge and instil the effective communication skills, diagnostic capabilities and practical competencies needed to manage cases of violence ( Correa et al., 2020).
1.1 BackgroundIn nursing education, theoretical courses, clinical experiences and simulation exercises related to violence have been shown to improve students’ knowledge and understanding of this complex topic. Such methods also encourage students to screen patients for exposure to violence ( Boursnell and Prosser, 2010; Oztürk, 2021). A scoping review of nursing students’ knowledge, attitudes, preparedness and practices regarding intimate partner violence against women found that those who received training on the topic exhibited more positive attitudes, greater knowledge and improved preparedness ( Shaqiqi et al., 2022). Additionally, various studies have evaluated educational interventions aimed at enhancing students’ knowledge, attitudes and skills in addressing violence through diverse approaches ( Gürkan and Kömürcü, 2017; Turan, 2022). However, these studies also reveal that students often struggle to apply theoretical knowledge in practice, particularly in recognising the signs and symptoms of violence ( Gürkan and Kömürcü, 2017; Shaqiqi et al., 2022). One study highlighted that the lack of practical application in violence-related training leaves students feeling unprepared to assess violence effectively ( Hutchinson et al., 2020). This underscores the need for innovative, hands-on methods to enhance nursing students’ violence assessment and management skills.
Gamification methods, such as role-playing and escape-room activities, hold promise as practical and engaging strategies to help students develop their skills in identifying and assessing violence. In an educational context, gamification fosters problem-solving skills, critical thinking and student motivation through an interactive, engaging learning experience ( Sánchez-Martín et al., 2020). By integrating excitement and curiosity into the educational process, gamification not only increases student motivation but also helps them develop unique skills ( Adams et al., 2018) and maintain their attention ( Hsu et al., 2023). Although role-playing is a more traditional approach, escape-room games represent a novel and innovative gamification method.
Role-playing involves assigning students specific roles in simulated clinical settings, enabling them to practice real-life scenarios ( Delnavaz et al., 2018). This approach enhances social communication, active listening, empathy and practical skills by offering students a safe environment to apply theoretical knowledge ( Vizeshfar et al., 2019). Used as teaching tools for violence, role-playing and similar simulation methods bridge the gap between theory and practice, providing hands-on opportunities to manage sensitive situations ( Natan et al., 2016; Wood, 2016).
In contrast, escape room games are problem-based learning activities where participants must collaborate to solve puzzles and “escape” within a set time frame. By presenting a series of challenges, these games require students to think critically, work as a team and apply their knowledge creatively ( López-Belmonte et al., 2020; Nicholson, 2015; Morrell and Ball, 2020; Aktaş et al., 2024). A systematic review by Quek et al. (2024), which included 52 studies, reported that escape rooms are widely used in nursing education and can deliver high-quality learning experiences within a short time frame, often within an hour ( Guckian et al., 2020).
Both role-playing and escape room activities are promising approaches for improving students’ understanding and management of violence. These methods allow learners to translate theoretical knowledge into practical skills, including critical thinking, decision-making, effective communication and teamwork. Previous research has demonstrated the effectiveness of escape rooms in improving new nurses’ de-escalation skills, violence knowledge and learning satisfaction, although these studies were not randomised controlled trials ( Hsu et al., 2023). By using escape room games and role-playing in a realistic laboratory environment and applying a randomised controlled study design, our research aims to fill this gap in the existing literature. As noted by Quek et al. (2024), randomised controlled trials are needed to confirm the efficacy of escape rooms in educational settings. Moreover, our study uniquely combined escape rooms and role-playing methods, positioning it as the first randomised controlled trial to evaluate the joint use of these gamification techniques in teaching violence assessment and applying them in practice.
1.2 Research aimThis study aimed to determine the impact of violence recognition and assessment training delivered through escape-room games and role-playing methods on nursing students’ skills in recognising and assessing violence against women and their attitudes toward violence.
Research Hypotheses
H 1a: The mean scores on the Knowledge Test on Violence Against Women differ among students in the escape room, role-playing and control groups.
H 1b: There is a difference in the mean scores of The Scale for Attitudes toward Violence among students in the escape room, role-playing and control groups.
H 1c: There is a difference in the mean scores of the Scale for Nurses’ and Midwives’ Recognition of the Symptoms of Violence Against Women among students in the escape room, role-playing and control groups.
2 Materials and methods2.1 Study design
This single-centre study was designed as a pre-test, post-test and factorial group randomised controlled trial. This study was registered at ClinicalTrials.gov (NCTxxxxxxxx).
2.2 Settings and participantsThe study involved 150 students enrolled in the obstetrics and gynaecology nursing course at a university’s Faculty of Health Sciences, Nursing Department in eastern Turkey during the Fall Semester of the 2023–2024 academic year. The first author recruited students in person.
The sample size was determined using a two-tailed repeated-measures F-test with three groups and three measurements. With a type I error of 0.05, a statistical power of 0.80 and a medium effect size (d = 0.25), the calculation indicated that at least 108 participants were necessary. To account for potential dropouts and ensure a robust analysis, this study included 120 first-time enrollees in an obstetrics and gynaecology nursing course who volunteered to participate. Students who were retaking the course or unwilling to participate were excluded. Although students who withdrew, failed to attend sessions or did not complete data collection forms correctly were excluded, no such exclusions occurred (see Fig. 1). CONSORT Flowchart).
2.2.1 RandomisationTo minimise allocation bias, the students were stratified into two groups based on their scores on the Violence Knowledge Test: those scoring ≤ 50 and those scoring ≥ 51. After stratification, a simple randomisation method was used. An independent statistician used Excel software to randomly allocate students in a 1:1 ratio to the experimental groups (Escape Room Game group, n = 40; role-play group, n = 40) and control group (n = 40) ( Fig. 1). Although blinding the researchers or participants to the interventions was not possible, the assignment process was blinded to ensure an unbiased group allocation.
2.3 Data collection toolsData were collected using a Descriptive Information Form, Knowledge Test on Violence Against Women, Scale for Attitudes Toward Violence ( Gömbül, 2000) and Scale for Nurses’ and Midwives’ Recognition of the Symptoms of Violence Against Women ( Arabacı and Karadağlı, 2006). These instruments were chosen based on a comprehensive review of the literature and deemed appropriate for the study’s aims, with validity and reliability established in previous research.
2.3.1 Descriptive information formThe researchers developed a Descriptive Information Form to capture demographic information, including variables such as age and gender.
2.3.2 Knowledge test on violence against womenThis 10-item test was created by the researchers with reference to course content and evaluated knowledge of various aspects of violence against women. The test included questions on the types of violence, characteristics of the victims, available services, recommended approaches for healthcare personnel and legal considerations. The scores ranged from 0 to 100.
Five experts reviewed the test and evaluated its measurements and content to establish validity. The questionnaire was piloted with 120 fourth-year nursing students who had taken the course previously. Item analyses were performed to assess the difficulty and discrimination and the KR-20 reliability coefficient was calculated for each item. The test was found to have moderate difficulty (mean difficulty index = 0.63) and good reliability (KR-20 = 0.74), confirming that it is a reliable tool for measuring the knowledge of violence against women.
2.3.3 The scale for attitudes toward violenceThis scale, developed by Gömbül (2000), measures healthcare personnel’s attitudes toward intimate partner violence against women. It comprises 19 attitude statements categorised into four domains: economic violence (seven items), emotional/psychological/sexual violence (six items), legitimising myths (three items) and explanatory myths (three items). The scale uses a 5-point Likert format ranging from “1” (strongly disagree) to “5” (strongly agree). The total attitude scores ranged from 19 to 95, with higher scores reflecting more traditional views on violence and lower scores indicating more contemporary, non-approving attitudes. The original Cronbach’s alpha was 0.82 ( Gömbül, 2000) and in this study, the Cronbach’s alpha was 0.78 for both the pre- and post-tests.
2.3.4 Scale for nurses’ and midwives’ recognition of the symptoms of violence against womenDeveloped by Arabacı and Karadağlı (2006), this scale assesses nurses’ and midwives’ abilities to identify symptoms of violence against women. It contained 31 true/false items encompassing both physical violence symptoms (13 items) and emotional violence symptoms (18 items). Scores ranged from 0 to 31, with higher scores indicating greater competency in recognising signs of violence. The original Cronbach’s alpha was 0.76 ( Arabacı and Karadağlı, 2006) and in this study, the Cronbach’s alpha was 0.75 for pre-tests and post-tests.
2.4 ProcedureBefore the pre-test, all students attended a two-hour theoretical lecture on violence and the assessment was delivered by the same researcher to ensure consistency. Following this session, the participants completed the Descriptive Information Form, Knowledge Test on Violence Against Women, Scale for Attitudes Toward Violence and Scale for Nurses’ and Midwives’ Recognition of the Symptoms of Violence Against Women.
Students were then randomised into three groups: the Escape Room game group, the Role-Play group and the control group, stratified by their pre-test knowledge scores. Prior to the intervention, participants in the experimental groups received additional training in drama, empathy, communication skills and escape room games. These interventions were conducted the day after the initial theoretical session.
The Knowledge Test, Attitudes Scale and Recognition Scale were re-administered one week and one month after the intervention. All data collection was conducted in person by one of the researchers, with participants completing the forms in approximately 10–15 min each time.
2.4.1 Escape Room game groupFor the Escape Room game, the researchers developed scenarios involving four female patients who had experienced violence and sought help at different clinics. These scenarios were validated by a panel of five experts. The nursing skills laboratory in the faculty was then transformed into an escape room with the necessary tools, materials and stations prepared for students to assess female patients.
Four stations were set up in the laboratory, each designed to allow students to practice key violence assessment skills. These stations focused on obtaining patient histories, conducting physical examinations and identifying signs of violence. Ten teams, each comprising four students, participated in this study. At each station, a facilitator, one of the researchers of the study, was presented to verify the students’ knowledge and skills, offer guidance when needed and serve as the patients’ voices.
Each group was given 60 min to complete all stations and a visible countdown timer helped the students keep track of their remaining time. The students worked together to solve various tasks: a crossword puzzle at the first station, a word search at the second, a matching exercise at the third and a set of question cards at the fourth station. Completing each activity earned team puzzle pieces, which eventually revealed the code to unlock the final box. Once the correct code was entered and the box opened, students found a note reading, “You can escape.” Completion times were recorded on a whiteboard for all teams.
The facilitator was debriefed after the game. This provided students with the opportunity to reflect on their performance, share their experiences and discuss how the skills they used could be applied in clinical settings. The team with the most remaining time was declared the winner and received a reward for their efforts.
2.4.2 Role-play groupIn the role-play activity, students worked in groups of 4–5, selecting one of the four scenarios featuring female victims of violence seeking care at different clinics. Without prior knowledge of the roles or scenarios, they were provided with relevant materials such as costumes, props and clinical settings at the start of the session. Each group conducted a 40-min improvisational role-play based on their assigned scenario. Following the role-play, the students engaged in discussion and evaluation sessions within and between groups. The entire process, including both role-play and discussion, was completed in approximately 60 min.
2.4.3 Control groupThe control group participated only in the theoretical lecture, which included information on the definition of violence, types of violence, symptoms observed in women exposed to violence and relevant assessment methods. The lecture was delivered as a PowerPoint-supported verbal presentation. In addition, these students received the same scenarios used in the escape room and role-play groups and were asked to conduct individual case analyses. Individual case analysis of the control group was completed within the same time frame allotted to the activities of the other groups.
2.5 Statistical analysisStatistical analyses were conducted using the Statistical Package for the Social Sciences (SPSS) version 26.0. Descriptive statistics were used to summarise participants’ characteristics. The Shapiro-Wilk test and skewness-kurtosis values (range: −1.5–1.5) were applied to assess the normality of the data distribution (
Tabachnick and Fidell, 2013). The relationships between the two categorical variables were examined using χ² cross-tabulations. For normally distributed data, ANOVA (F-test) was used to compare three or more independent groups, whereas the Repeated Measures test (
F-test) was used for within-group comparisons over time. Effect sizes between groups were determined using ANOVA f (0.10 < small<0.25, 0.25
Ethical approval was obtained from the Karabük University Ethics Committee (Approval No: 2023/1543). Institutional Permission No was secured from the institution where the study was conducted (Institutional Permission No: 75898436-900-116580). Before commencing the study, all students received detailed information about the research and written and verbal informed consent was obtained from those who chose to participate.
Efforts were made to prevent the power dynamics that could influence participation. Two researchers were independent of the institution where the research was conducted. Although one researcher was affiliated with the institution as an academic staff member, she did not teach the students’ classes during the research period because she worked in a different department. This arrangement ensured voluntary participation.
No personal information was collected to ensure anonymity. Students were asked to create and consistently use pseudonyms throughout the data-collection process. This study was conducted in compliance with the ethical principles outlined in the Declaration of Helsinki.
3 Results3.1 Baseline characteristics of students
Table 1 presents the demographic characteristics of students in the experimental and control groups. The average age was 21.02 (SD 1.32) in the control group, 21.50 (SD 1.86) in the role-play group and 21.25 (SD 1.50) in the Escape Room Game group. The proportion of female students was 75 % (n = 30) in the control group, 72.5 % (n = 29) in the role-play group and 70 % (n = 28) in the escape-room game group. There were no statistically significant differences between the groups in terms of age or gender (p > 0.05). Table 2 compares the groups’ mean scores on the Knowledge Test on Violence, the Scale for Attitudes toward Violence and the Scale for Nurses’ and Midwives’ Recognition of the Symptoms of Violence against Women.
3.2 Comparison of knowledge test on violence scoresFollowing the theoretical lecture (pre-test), there was no significant difference in the mean Knowledge Test scores among the three groups (p > 0.05). However, in both the first-week and first-month assessments, the Role-Play and Escape Room Game groups scored significantly higher than the control group (p < 0.05). The effect size of the between-group difference was moderate (F = 0.237) at the first-week follow-up and low (F = 0.138) at the first-month follow-up. These findings indicate that the students in the role-play and escape-room game groups retained more knowledge over time than those in the control group ( Table 2).
3.3 Comparison of the scale for attitudes toward violence scoresThere were no significant differences in the mean scores on the Scale for Attitudes toward Violence in the pre-test or first-week assessment (p > 0.05). However, a significant difference was observed at the one-month follow-up (p < 0.05). Post-hoc comparisons revealed that the mean scores in the control group were significantly higher, indicating more traditional views of violence than those in the Role Play and Escape Room Game groups. The effect size was very low (F =0.076) ( Table 2).
3.4 Comparison of scores on the scale for nurses’ and midwives’ recognition of the symptoms of violence against womenNo significant differences were observed in the pre-test scores among the three groups (p > 0.05). However, significant differences emerged in both the first week (post-test 1) and first month (post-test 2) assessments (p < 0.05). In post-test 1, the Escape Room Game group scored significantly higher than the control group. In post-test 2, the Escape Room Game group scored significantly higher than the role-play and control groups. The effect size of the between-group difference was very low (F = 0.070) at the first-week follow-up and low (F = 0.118) at the first-month follow-up. Thus, the Escape Room Game group demonstrated a notable improvement in recognising the symptoms of violence compared with the other groups ( Table 2).
3.5 Comparison of intragroup scoresWithin-group comparisons revealed no statistically significant changes in the Knowledge Test on Violence or the Scale for Attitudes Toward Violence scores for any of the three groups (p > 0.05). However, the Escape Room Game group showed a statistically significant increase in their scores on the Scale for Nurses’ and Midwives’ Recognition of the Symptoms of Violence Against Women between the pre-test and both post-tests 1 and 2 (p < 0.05). The difference between Post-test 1 and Post-test 2 was also significant, with a large effect size (η²=0.398). These findings indicate that students in the Escape Room Game group continued to improve their ability to recognise the symptoms of violence over time ( Table 2).
4 DiscussionInnovative pedagogical strategies are essential to bridge the gap between theoretical learning and practical applications in recognising and assessing violence against women ( Gürkan and Kömürcü, 2017; Hutchinson et al., 2020; Shaqiqi et al., 2022). Gamification techniques such as escape rooms, role-playing and case studies show promise in enhancing students’ competence in evaluating violence ( Hsu et al., 2023; Natan et al., 2016; Wood, 2016). This randomised controlled study investigated the impact of two such methods, escape room games and role-playing, on third-year nursing students’ ability to identify violence against women and their attitudes toward it.
4.1 Discussion of “The Knowledge Test on Violence” Mean ScoresOur findings showed that the mean scores on the Knowledge Test on Violence were higher in the Role-Play and Escape Room Game groups than in the control group at both one week and one-month post-intervention ( Table 2). This outcome suggests that both escape rooms and role-play methods effectively enhanced students’ knowledge of violence. To date, only one study has focused on how escape rooms affect nurses’ skills and knowledge related to violence prevention, reporting that their knowledge levels were maintained for over a month ( Hsu et al., 2023). Consistent with these findings, our results indicate that escape room intervention promotes knowledge retention, potentially because it is interactive, enjoyable and supported by a facilitator’s debriefing session ( Hsu et al., 2023). Moreover, our randomised controlled design helps address the gap highlighted in a systematic review by Quek et al. (2024), who pointed to a shortage of rigorous studies examining the effectiveness of escape rooms in education.
Similarly, the consistently high knowledge scores of the role-play group suggest that role-play is an effective technique to reinforce theoretical information through active participation. Role-play immerses students in scenarios that simulate nurse-patient encounters, thereby motivating them to apply the knowledge gained in class ( Vizeshfar et al., 2019). Research shows that simulation-based approaches—whether using role-playing, standardised patients, or other interactive methods—significantly enhance students’ competencies in identifying and intervening in cases of intimate partner violence ( Blumling et al., 2018; Marken et al., 2010; Sadeghi et al., 2023).
An interesting observation from our study is that none of the three groups showed a statistically significant within-group increase in Knowledge Test scores from pre-to post-tests. The two active-learning interventions helped students retain the knowledge gained during the theoretical lesson more effectively than substantially increasing their total knowledge levels. In contrast, the control group’s knowledge scores declined over time, underscoring the benefits of engaging and reinforcing learning strategies such as escape rooms and role-playing. Consequently, although these interventions did not dramatically boost baseline knowledge, they helped preserve and apply the knowledge gained from the theoretical lectures in the long term.
4.2 Discussion of “The Scale for Attitudes toward Violence” mean scoresThe primary aim of violence assessment training is to cultivate a non-approving attitude toward violence against women ( Gürkan and Kömürcü, 2017). Our findings show that one month after the intervention, the control group’s mean score for Attitudes Toward Violence was significantly higher than that of the Role-Play and Escape Room Game groups. These results suggest that students in the intervention groups adopted more contemporary, non-approving attitudes, whereas the control group held more traditional views.
Research indicates that nurses and nursing students often have inadequate attitudes toward violence against women, underscoring the need for additional training to improve their intervention skills ( Alshammari et al., 2018; Doran et al., 2019). Moreover, innovative methods are recommended to transform students’ perspectives on violence ( Gürkan and Kömürcü, 2017). In this regard, our study contributes to the literature by demonstrating the effectiveness of both escape rooms and role-playing in attitude changes. Consistent with our findings, other studies have shown that creative drama in the classroom positively influences attitudes toward violence against women and heightens student awareness ( Tokur Kesgin and Hançer Tok, 2023). Similarly, forms of violence prevention education, such as peer education and structured courses, have been linked to non-approving attitudes toward violence ( Gürkan and Kömürcü, 2017; Sis Çelik and Aydın, 2019).
Our findings also revealed that changes in attitude did not appear immediately but became evident one month after the intervention. This delayed effect implies that attitudes toward violence evolve over time rather than instantly. Notably, no prior research has specifically investigated the impact of escape rooms on students’ attitudes toward violence, making this randomised controlled study a pioneering effort in this area. However, further studies are needed to confirm and expand these results, particularly regarding the long-term effects of escape room interventions on attitudes toward violence.
4.3 Discussion of “The Scale for Nurses’ and Midwives’ Recognition of the Symptoms of Violence Against Women” Mean ScoresEffectively assessing violence in clinical settings requires healthcare professionals to recognise their signs and symptoms ( Simsek and Ardahan, 2020). However, previous research indicates that nursing students often lack these recognition skills, highlighting the need for improved educational strategies ( Simsek and Ardahan, 2020; Sis Çelik and Aydın, 2019; Tambağ and Turan, 2015).
Our study showed significant post-intervention differences in the scores on the Scale for Nurses’ and Midwives’ Recognition of the Symptoms of Violence against Women (p < 0.05). Students in the Escape Room Game group demonstrated a notably larger increase in their scores one week and one month after the intervention, outperforming the control group at one week and both the role-play and control groups at one month. These findings suggest that the innovative, engaging and interactive escape room format supports sustained learning and skill development in violence recognition.
To our knowledge, no prior research has specifically examined how escape-room games influence students’ ability to recognise signs of violence, indicating a need for further investigation. Nonetheless, existing studies suggest that various educational methods, including peer education and structured courses on violence against women, can improve students’ capacity to detect the indicators of violence (Çelik and Aydın, 2019; Turan, 2022). These findings underscore the importance of integrating violence recognition and assessment content into nursing curricula to bolster future nurses’ competencies in identifying and managing cases of violence against women.
4.4 Limitations and strengths of the studyThis study had several strengths and limitations that should be considered when interpreting the results. Strengths include the relatively large sample size, robust randomised controlled design (with pre- and post-intervention comparisons) and use of validated and reliable measurement tools. Additionally, incorporating a one-month follow-up period provided insights into the long-term effects of the intervention. The balanced gender distribution among the participants further supported the reliability of the findings. The CONSORT checklist was used to maintain methodological rigour.
However, this study had some limitations. First, no specific measures were taken to minimise the interaction (or potential “contamination”) between the experimental and control groups, which may have influenced the outcomes. Second, the study was restricted to third-year nursing students at a single university, limiting the findings’ generalizability. Future research should include students from various years of experience and healthcare disciplines to enhance the external validity of these results.
5 ConclusionsIn this randomised controlled trial examining the impact of escape rooms and role-play methods on nursing students’ knowledge and attitudes toward violence against women, three key conclusions emerged. First, the escape room and role-playing interventions significantly improved students’ knowledge of violence compared to theoretical instruction alone. Second, these interactive methods helped foster a more contemporary, non-approving attitude toward violence, although further studies are needed to confirm and expand this effect. Third, the escape room game proved particularly effective in improving students’ ability to recognise signs of violence in the short and long term.
Based on these findings, it is recommended that interactive strategies, such as escape room games and role play, be integrated into nursing curricula, especially in areas requiring advanced cognitive skills where students may struggle to apply theoretical knowledge in practice. Future research could involve multidisciplinary studies that incorporate various active learning methods and include practising healthcare professionals, thereby facilitating a comprehensive approach to complex cases involving violence and abuse.
FundingThis study did not receive any specific grants from funding agencies in the public, commercial, or not-for-profit sectors.
CRediT authorship contribution statementNurhan Aktaş: Writing – original draft, Visualization, Validation, Methodology, Investigation, Conceptualization. Sultan Özkan Şat: Writing – review & editing, Writing – original draft, Visualization, Validation, Methodology, Formal analysis, Data curation, Conceptualization. Pınar Akbaş: Writing – original draft, Visualization, Validation, Methodology, Investigation, Conceptualization.
Declaration of Competing InterestThe authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
AcknowledgementsThe authors express their gratitude to the students who actively participated in the study.
| | | | | | |||
| | | | |||||
| | 21.02 ± 1.32 | 21.50 ± 1.86 | 21.25 ± 1.50 | F = 0.999
P = 0.371 | |||
| | | | | | | ||
| | |||||||
| Female
Male | 30
10 | 75.0
25.0 | 29
11 | 72.5
27.5 | 28
12 | 70.0
30.0 | χ2 = 0.251
P = 0.882 |
| | | | | |
| | ||||
| Immediately After Theoretical Lecture (Pre-test) 1 | 58.00 ± 9.66 | 58.25 ± 11.29 | 62.75 ± 10.12 | F = 2.651
p = 0.075 |
| One Week After Training (Post-test 1) 2 | 50.25 ± 13.86 | 60.50 ± 10.36 | 66.00 ± 11.04 | F = 18.181
[1−2,3] F = 0.237 |
| One Month After Training (Post-test 2) 3 | 50.75 ± 25.25 | 63.50 ± 12.51 | 66.25 ± 8.96 | F = 9.380
[1−2,3] F = 0.138 |
| Statistics* | F = 3.011
p = 0.077 | F = 2.184
p = 0.119 | F = 1.661
p = 0.197 | |
| | ||||
| Immediately After Theoretical Lecture (Pre-test) 1 | 31.65 ± 9.39 | 30.92 ± 7.37 | 30.72 ± 6.44 | F = 0.154
p = 0.857 |
| One Week After Training (Post-test 1) 2 | 31.12 ± 9.27 | 30.17 ± 7.37 | 29.65 ± 6.91 | F = 0.356
p = 0.701 |
| One Month After Training (Post-test 2) 3 | 33.97 ± 8.76 | 29.52 ± 7.59 | 28.85 ± 7.61 | F = 4.833
[1−2,3] F = 0.076 |
| Statistics* | F = 2.004
p = 0.158 | F = 0.527
p = 0.592 | F = 1.970
p = 0.146 | |
| | ||||
| Immediately After Theoretical Lecture (Pre-test) 1 | 17.12 ± 2.53 | 17.42 ± 2.97 | 17.00 ± 2.55 | F = 0.263
p = 0.769 |
| One Week After Training (Post-test 1) 2 | 17.80 ± 2.37 | 18.25 ± 1.72 | 19.00 ± 1.15 | F = 4.434
[1–3] F = 0.070 |
| One Month After Training (Post-test 2) 3 | 18.10 ± 2.44 | 18.22 ± 1.70 | 19.62 ± 1.46 | F = 7.803
[3−1,2] F = 0.118 |
| Statistics* | F = 2.483
p = 0.090 | F = 1.953
p = 0.156 | F = 25.776
η2 = 0.398 | |
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