Content area
Aim
The aim of the study is to evaluate the effectiveness of the escape room approach, one of the game-based learning methods used in nursing education and to systematically examine its effects on learning outcomes.
Background
The escape room method stands out as an innovative game-based learning strategy that encourages active participation among students and improves problem-solving, teamwork and communication skills. There are a limited number of systematic reviews on the effects of this method on theoretical knowledge acquisition, clinical skills and learning motivation in nursing education.
Design
This study was designed as a systematic review on game-based learning and the escape room approach in nursing education.
Method
The study was conducted in accordance with PRISMA guidelines. Studies published between 2015 and 2025 examining the effects of the escape room method in nursing education were systematically reviewed. A total of 7 studies (1 randomised controlled and 6 quasi-experimental) were included. Relevant databases were used for the review. PROSPERO: CRD42025627709
Results
Escape room activities effectively enhanced nursing students’ theoretical knowledge, clinical skills and learning motivation. The method is recommended for nursing education, with a need for further comprehensive studies.
Conclusion
This study revealed that the escape room approach was an effective tool for game-based learning in nursing education. It is recommended to conduct more comprehensive and experimental studies to increase the applicability of this method in the future.
1 Introduction
The objectives of nursing education are to equip students with knowledge, skills and attitudes ( Ordu and Çalışkan, 2021). Furthermore, it has been aimed to enrich students with critical thinking ability, problem-solving skills and skills such as empathic care, communication and a multidisciplinary approach ( Uysal, Bölükbaş, and Sağlam, 2021; Göriş et al., 2014). Therefore, there is a need for learning strategies that will enable students to actively participate in the educational stages and clarify the problems they may come across in their professional lives ( Göriş et al., 2014). Skills such as lifelong learning, innovation and digital literacy are referred to as 21st-century skills. This necessitates curriculum development and modification to expose students to different teaching methods. Since today’s Generation Z students are able to multitask ( Erden, 2017), it is recommended that students should be trained using innovative teaching methods ( Erden, 2017; Culha, 2019). Students prefer to participate actively in the learning process, where the majority of nursing students constitute Generation Z and they need innovative ways ( Şahin and Başak, 2019; Johnsen et al., 2018). One of the active teaching methods that should be examined by educators and is needed is “gamification” ( Sarker et al., 2021; Figueroa, 2016). Games are known to be fun and motivating, as well as to improve knowledge and skills and bring out competitiveness among individuals ( Petitte and Farris, 2020). Furthermore, it is emphasised that games increase sociability among students, allow them to make mistakes, provide instant feedback and uncover their creativity ( Cadavid and Corcho, 2018). Therefore, “escape rooms” have become popular ( Zhang et al., 2018). The escape room method has also been used to train students in other health departments such as medicine and pharmacy. It has been observed that escape room practices are particularly effective for patient safety and training of communication skills ( Davis et al., 2022).
Escape rooms, originally conceived as a niche entertainment format, have evolved into a valuable pedagogical tool in educational settings. The emergence of escape rooms as structured educational experiences can be traced back to the influence of gamification, wherein educational strategies integrate game principles to enhance learner engagement and motivation. This transformation began in earnest around the early 2010s when educators recognized the potential of escape rooms to foster collaboration, critical thinking and active problem-solving abilities among students ( Veldkamp et al., 2020). Initially popularized in recreational settings, escape rooms offered immersive experiences where participants were tasked with solving puzzles to "escape" from a themed area within a set timeline. This concept resonated with educators who saw the parallels between the engagement generated in escape rooms and the learning dynamics sought in academic environments. Around 2013, educators began experimenting with escape room formats, leveraging their interactive nature to construct active learning environments across various disciplines ( Guckian et al., 2020). These pedagogical adaptations focused on designing escape rooms that not only entertained but also effectively delivered educational content, enhancing the overall learning experience ( Morrell and Eukel, 2020). By the late 2010s, the integration of escape rooms into formal educational frameworks gained traction. Various studies showcased their effectiveness in different academic fields, from nursing and pharmacy to mathematics and computer programming. For instance, the development of escape rooms targeted at teaching nursing concepts, such as "Escape the Generational Gap: A Cardiovascular Escape Room," highlighted how such methodologies promote teamwork, problem-solving and critical thinking ( Eukel et al., 2017; Morrell and Eukel, 2020). In parallel, pharmacy education incorporated escape rooms to bolster knowledge retention and practical skills, demonstrating the versatility of this teaching tool across disciplines ( Palasik et al., 2022).
The integration of escape rooms into nursing education represents a new pedagogical approach that uses gamification to foster student engagement, teamwork and critical thinking skills. Escape rooms, characterised by their engrossing environment where participants solve puzzles and complete tasks to “escape” within a limited time frame, have drawn interest in a diverse range of educational settings, including nursing. The related studies have indicated that escape rooms can significantly improve the learning experience for nursing students by fostering active learning and collaboration. For example, Goodman and Landgren emphasise that escape room activities not only boost excitement about a nursing career but also introduce prospective students to the active learning strategies they will encounter in nursing programmes, thereby alleviating anxiety associated with their start to education ( Goodman and Landgren, 2021). Likewise, Dimeo et al., have emphasised that escape rooms have been successfully implemented in medical education to promote interaction and motivation among students, demonstrating their versatility as an educational tool ( Dimeo et al., 2022). Moreover, studies have shown that escape rooms can lead to statistically significant improvements in knowledge retention and test scores in several health disciplines, including nursing ( Frederick and Reed, 2020). The design and implementation of escape rooms in nursing education also facilitate the development of critical competencies such as teamwork, communication and problem-solving. Neetoo et al., argue that these skills are essential for nursing practice and escape rooms provide a unique platform for students to practice these skills in a simulated setting ( Neetoo et al., 2021). Gómez-Urquiza et al., found that nursing students reported improved teamwork and ability to function under pressure when they participated in escape room activities, suggesting that this method effectively prepares them for real-world clinical scenarios ( Gómez-Urquiza et al., 2019). Moreover, the interactive nature of escape rooms further reinforces learning experiences for students by encouraging them to collaborate and engage in meaningful discussions ( Morrell and Eukel, 2020). As the use of escape rooms continues to expand, it is crucial to explore their potential in various nursing contexts, including clinical skills training, patient safety education and interdisciplinary collaboration ( Daniels et al., 2022). One of the promising aspects of escape rooms in nursing education is their ability to promote active learning through scenario-based interactions. Evidence suggests that experiential learning, where students actively engage in their learning processes, leads to higher retention rates and improved clinical skills ( Kuesakul et al., 2024; Paul et al., 2024; Rajaguru and Park, 2021). Recently, the incorporation of virtual reality (VR) and artificial intelligence (AI) in education has emerged as a promising strategy to enhance the realism and adaptability of simulation-based learning. VR can replicate complex clinical scenarios that may be difficult to recreate in traditional settings, enriching the learner's experience ( Karaduman and Başak, 2022; Putri et al., 2023; Um, 2023). Furthermore, implementing escape rooms at scale poses challenges related to resource allocation, faculty preparedness and standardization ( Gu and Sok, 2020). Institutions may face difficulties in scenario development, training of educators and ensuring consistent application across programs.
Despite promising findings, the literature on the effectiveness of escape rooms in nursing education remains limited and many studies call for further research to standardise methodologies and evaluate long-term outcomes ( González-de la Torre et al., 2024). Recent systematic reviews have highlighted the need for more meticulous studies to comprehensively evaluate the impact of escape rooms on nursing education ( González-de la Torre et al., 2024). However, to date, there is no comprehensive systematic review that synthesizes the existing evidence on the effectiveness of escape rooms specifically in nursing education, highlighting a clear gap in the literature. This lack of a consolidated synthesis limits the ability of educators and curriculum developers to fully understand the potential benefits and challenges of implementing escape rooms as an educational strategy. Therefore, this systematic review aims to fill this gap by rigorously evaluating and summarizing the current research on the use of escape rooms in nursing education, as well as assessing their role as a pedagogical approach and examining their impact on student learning outcomes, engagement levels and the development of essential nursing competencies.
2 Methodology
This systematic review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, an internationally recognised method for systematic reviews and meta-analyses, to formulate research strategies such as literature search, inclusion and exclusion criteria and data extraction (
Page et al., 2021).
2.1 Design
This study was designed as a systematic review to evaluate the effectiveness of the escape room method, one of the game-based learning strategies, in nursing education. The review focused on its impact on learning outcomes such as clinical reasoning, teamwork, academic achievement and student satisfaction. The protocol was developed following PRISMA guidelines. The review was registered with PROSPERO under the ID CRD42025627709.
2.2 Eligibility Criteria and Exclusion Criteria
The studies to be included in this systematic review were selected in accordance with the (PICOS) model recommended by the Joanna Briggs Institute: P: Population (type of participants); I: Intervention (types of interventions); C: Comparator (types of comparisons); O: Outcome (types of outcomes); S: Study designs (types of studies).
P: The sample consisted of individuals who were 18 years old and older and were studying at the nursing faculty of the university, regardless of gender, race and socio-economic status.
I: The review focused on the escape room game and escape room practices developed for students enrolled in the “Nursing” department of the university.
C: The review compared the effectiveness of the education provided through the escape room on students.
O: The review evaluated changes in improving students’ clinical reasoning, teamwork, communication skills, academic achievement and overall student satisfaction based on escape room training.
S: The review included randomised controlled experimental and quasi-experimental trials.
The reasons for exclusion at the full-text screening stage were as follows: (1) Studies where the population did not consist of nursing students, (2) Studies that did not employ an escape room methodology but instead used other forms of gamification, (3) Studies for which the full text could not be accessed despite efforts to contact the authors, (4) Articles published in languages other than English, (5) Studies where participants were from mixed disciplines and not exclusively nursing.
2.3 Information sources
The search strategy was adapted to the specific syntax requirements of each database and applied in the following information sources: PubMed, Scopus, Web of Science, MEDLINE, ScienceDirect, EBSCOhost and the Cochrane Library. The number of studies identified from each database was recorded accordingly. The study selection process is illustrated in the PRISMA flow diagram ( Fig. 1).
2.4 Search strategy
We developed a rigorous and systematic search strategy to accurately and comprehensively identify literature on the effects of escape rooms in nursing education. The search was conducted using the key terms “escape room,” “nursing students,” “game-based learning,” and “randomised controlled” between September 1, 2024 and January 30, 2025, covering studies published from 2015 to 2025. For the concept of “escape room,” alternative terms such as “quest room,” “puzzle room,” “exit room,” and “interactive game simulation” were also considered. Boolean operators (AND/OR) were used to combine these terms as follows: ("escape room" OR "puzzle room" OR "quest room" OR "exit room") AND ("nursing student*" OR "nursing education") AND ("game-based learning" OR "gamification" OR "simulation").
2.5 Study selection and data collection process
We used EndNote software to remove duplicates. Two authors independently searched and reviewed titles and abstracts and then extracted the full text of all potentially eligible articles for further searches. The extracted information covered the author, year of publication, country/region of publication, research design, sample type, intervention group (N), control group (C), intervention duration and conclusions. During the study selection and data extraction phases, two reviewers independently screened titles, abstracts and full texts according to the eligibility criteria. In cases where discrepancies arose between the reviewers, discussions were held to reach a consensus. If agreement could not be reached through discussion, a third reviewer was consulted to resolve the disagreement. This process ensured consistency and minimized potential bias in study inclusion and data interpretation.
2.6 Study risk of bias assessment
In this review, the methodological quality of the included studies was assessed using two validated tools, depending on the study design. The single randomized controlled trial (RCT) included in the review was evaluated using the Cochrane Risk of Bias 2.0 (RoB 2.0) tool. The six quasi-experimental (non-randomized) studies were assessed using the ROBINS-I (Risk Of Bias In Non-randomized Studies of Interventions) Version 2 tool.
The RoB 2.0 tool evaluates five domains of potential bias: the randomization process, deviations from intended interventions, missing outcome data, measurement of the outcome and selection of the reported result. The results of this evaluation are presented in
The ROBINS-I tool assesses risk of bias across seven domains: confounding, selection of participants, classification of interventions, deviations from intended interventions, missing data, measurement of outcomes and selection of reported results. Based on these domains, studies were rated as having a risk of bias categorized as “Low”, “Moderate”, “Serious”, or “Critical”. The outcomes of this analysis are detailed in
2.7 Data synthesis process
Given the qualitative nature and methodological diversity of the included studies, a narrative synthesis approach was adopted. The extracted findings were systematically organized and grouped into key thematic domains, including clinical reasoning, teamwork, academic achievement and student satisfaction. These themes structured the presentation of results and guided the interpretation of evidence in the discussion section. The synthesis aimed to explore both commonalities and variations in the reported effectiveness of escape room activities in nursing education. Due to considerable heterogeneity in study designs, intervention protocols and outcome measures, a quantitative synthesis (meta-analysis) could not be performed. Instead, a narrative synthesis was conducted to summarize and interpret the findings across the studies.
3 Results
3.1 Preliminary literature search results
A total of 2024 potential articles were initially retrieved from seven databases from 1 September 2015–30 January 2025. After removing duplicates using EndNote software, 119 articles remained. The remaining articles were excluded after the title and abstract search since the topics were irrelevant (n = 32), the participants were not nursing students (n = 18), the article was not original but was a literature review and it was not published in English (n = 30). Following full-text articles assessed for eligibility, five articles were excluded since full-text articles were inaccessible, no escape room studies were available, or participants included not only nursing students but also those from other fields of study. To give an example, this review excluded the study “Saving Patient X: A Quasi-Experimental Research on Teamwork and Performance after an Interprofessional Escape Room Simulation” by
Foltz-Ramos et al. (2025) since it was conducted with students in the pharmacy department. Finally, seven studies were included in this systematic review.
3.2 Research design and methods in the included articles
We analysed the research methodology used in the included articles, including study design, sampling and intervention design.
Six out of seven included studies were quasi-experimental trials (N-RCT) and one was a randomised controlled trial (RCT). Participants were primarily undergraduate students of different grades ( Rodríguez-Ferrer et al., 2022; Gutierrez-Puertas et al., 2020). The studies specified the sampling method. However, some studies did not specify the intervention and control group ( Ghiamikeshtgar et al., 2022; Zhou et al., 2024). The studies that considered intervention and control groups ( Liang et al., 2024; Rushdan et al., 2025; Rodriguez-Ferrer et al., 2022; Gutierrez-Puertas et al., 2020; Yang et al., 2023) comparatively evaluated the effects of escape room-based learning methods. In such studies, the intervention group was introduced to escape room activities, while the control group was usually introduced to traditional teaching methods or nothing was applied. The results aimed to show the differences between the two groups for problem-solving skills, teamwork, critical thinking abilities, creative thinking skills, learning motivation and academic achievement. These comparisons provided important findings in determining whether or not the escape room method is an effective learning tool in nursing education ( Liang et al., 2024; Gutierrez-Puertas et al., 2020).
4 Discussion
The integration of game-based learning, particularly with the escape room approach, has emerged as a transformative pedagogical strategy in nursing education. This discussion synthesises findings from several studies to explain the effectiveness of this innovative method in improving clinical reasoning, teamwork, communication skills, academic achievement and overall student satisfaction among nursing students. The development of clinical reasoning abilities is one of the most important benefits associated with the escape room approach. In their study, Rushdan et al. (2025) observed that both digital and physical escape room practices significantly improved nursing students’ clinical reasoning abilities and the p-value was less than 0.001. This finding was confirmed by Liang et al. (2024), who reported a significant rise in critical thinking scores among students who took part in an Objective Structured Clinical Examination (OSCE)-based escape room method (p = 0.010). Escape room scenarios effectively simulate complex clinical cases and provide students with opportunities to engage in problem-based learning that improves their analytical skills. This aligns with the findings of ( Bae et al., 2023), who emphasised the importance of metacognition in clinical decision-making and suggested that the escape room method supports metacognitive strategies that are crucial for effective problem-solving in nursing practice. Moreover, the escape room approach not only improves clinical reasoning but also contributes significantly to the development of teamwork and communication skills among nursing students. Rushdan et al. (2025) noted a significant improvement in teamwork skills in the experimental group (p < 0001), indicating that escape room scenarios provided a practical ground for implementing collaboration and effective communication. This is particularly important in simulation-based education, where students need to collaborate to solve complex tasks, thereby preparing them for real-world clinical settings. The findings of Menegon et al. (2019) further support this idea, emphasising the importance of teamwork in emergency care nursing and reinforcing the idea that collaborative learning settings, such as escape rooms are essential for developing critical-reflective professionals. Besides improving clinical reasoning and teamwork, the escape room method has been associated with improved academic achievement and raised awareness of critical health problems. Rodríguez-Ferrer et al. (2022) found that escape room practices aimed at raising awareness of mental illness significantly attenuated negative attitudes and improved the understanding among students (p < 0.001). Likewise, Yang et al. (2023) reported that escape room-based childbirth education activities had a profound impact on academic performance (p < 0.001). These results highlight the potential of escape rooms to not only enhance cognitive learning but also promote professional awareness and ethical sensitivity among nursing students, which are essential for holistic patient care. This is compatible with the findings of ( Mwale, 2024), which state that a convenient clinical environment is vital to foster the acquisition of clinical reasoning abilities and innovative pedagogical approaches such as escape rooms can create such settings. Student satisfaction and engagement are also critical outcomes associated with the escape room method. Gutierrez-Puertas et al. (2020) found that the escape room approach significantly improved student satisfaction and led to a more effective learning experience compared with traditional methods. Likewise, Liang et al. (2024) found that OSCE-based escape room practices improved learning engagement (p = 0.010). The interactive nature of escape rooms makes education more enjoyable and effective by actively engaging students in the learning process. This is compatible with the findings of ( Hagrass et al., 2020), which emphasised the importance of creating attractive learning settings in nursing education to improve student satisfaction and retention. The communicative nature of escape rooms contributes to their practical development by encouraging active performance in demonstrations. Ghiamikeshtgar et al. (2022) emphasised that escape rooms were effective in teaching complex topics that were traditionally difficult to comprehend. These findings are compatible with the results of the study by Delport and Weber (2021). Furthermore, the theoretical components of these environments allow for practice in simulated scenarios and provide a better understanding of critical concepts.
Development of escape room algorithm, teamwork and communication technologies. Ghiamikeshtgar et al. (2022) stated that the presentation of these activities improved collaboration. Hudson et al. (2023) and Gordillo and López-Fernández (2024) also emphasised that this was a positive approach in interprofessional education. Escape rooms have been associated with improved student presentation and satisfaction. Ghiamikeshtgar et al. (2022) reported substantial differences from these methods. Likewise, Gutierrez-Puertas et al. (2020) and Liang et al. (2024) showed that escape rooms made learning more attractive. However, limitations must be taken into account. Ghiamikeshtgar et al. (2022) stated that semi-dispersed designs were generally borderline. Yang et al. (2023) highlighted the need for stronger research designs in this field.
Despite the promising results associated with the escape room method, it is important to acknowledge the methodological limitations found in the existing literature. Numerous studies, including those conducted by have highlighted limitations such as small sample sizes and incomplete randomisation, which restrict the generalisability of findings. There is also a significant dearth of research that examines the long-term effects of escape room methodologies on nursing education. Future studies should aim to bridge these gaps by using larger sample sizes and longer follow-up periods to assess the sustainable impact of escape room interventions on nursing students’ competencies. This is especially important given the findings of ( Drasiku et al., 2020). Nurse educators should be more involved in clinical teaching to ensure that students are adequately prepared for practice. Consequently, the escape room approach represents a valuable and innovative strategy in nursing education and effectively improves clinical reasoning, teamwork, communication skills, academic achievement and student satisfaction. The integration of VR and AI technologies into escape rooms offers a significant opportunity to enhance simulation-based nursing education. VR environments can simulate a wide range of clinical settings, while AI can provide real-time adaptive feedback and individualized learning pathways ( Gu and Sok, 2020; Putri et al., 2023; Karaduman and Başak, 2022; Um, 2023). These technologies may promote deeper engagement and improved learning outcomes, particularly in developing clinical reasoning and decision-making skills. Nevertheless, several challenges in scalability and standardization must be addressed to implement escape rooms widely. Developing meaningful escape room scenarios requires substantial investment in time, material resources and trained faculty ( Gu and Sok, 2020). A lack of consistent frameworks and evaluation tools limits the comparability of outcomes across institutions. As innovative methods become more common in nursing education, it is essential to establish continuous feedback and evaluation mechanisms to assess their effectiveness and identify areas for improvement ( Solheim and Flo, 2021). Standardized design templates and robust pedagogical models can ensure consistent and meaningful integration into curricula. Looking ahead, aligning escape room-based learning activities with established nursing competencies and accreditation standards can elevate their educational legitimacy ( Lalani, 2023; Yeo and Jang, 2022). This alignment will better prepare nursing students for complex healthcare environments while fostering interprofessional collaboration. The integration of game-based learning into the nursing curriculum not only improves critical thinking and problem-solving skills but also prepares students for the complexities of real-world clinical practice. As the field of nursing education continues to evolve, the adoption of interactive and engaging teaching methodologies such as escape rooms will be crucial in training skilled and confident nursing professionals. The evidence presented in this discussion highlights the need for further research to optimise the implementation of escape room methodologies and explore their long-term impacts on nursing education.
5 Conclusion
Escape room-based learning methods were evaluated as an effective tool to improve nursing students’ problem-solving skills, teamwork, learning motivation and academic achievement. The findings of the study suggest that this method is an innovative and effective pedagogical approach to nursing education and offers a valuable alternative to traditional methods. In the future, it is recommended that the method be evaluated more comprehensively with studies including larger sample groups and examining long-term effects. Additionally, integrating escape rooms with VR and AI technologies and addressing challenges of scalability and standardization, holds great promise for the future of nursing education.
Author Contributions
Idea/Concept: Samine Esmailzadeh; Design: Samine Esmailzadeh, Mehmet Aygün; Supervision/Consultancy: Samine Esmailzadeh; Data Collection and/or Processing: Samine Esmailzadeh; Analysis and/or Comments: Samine Esmailzadeh; Literature Review: Samine Esmailzadeh, Mehmet Aygün; Article Writing: Samine Esmaeilzadeh; Critical Review: Samine Esmailzadeh, Mehmet Aygün
CRediT authorship contribution statement
Samineh Esmaeilzadeh: Writing – review & editing, Writing – original draft, Validation, Project administration, Methodology, Investigation, Formal analysis, Data curation, Conceptualization. Mehmet Aygün: Writing – original draft, Supervision, Software, Resources, Project administration, Methodology, Formal analysis, Conceptualization.
Ethical Considerations
The authors declare that the study is based on publicly available data, theoretical models and open-source data and therefore the nature of the study requires no examination by an ethics committee.
Ethics Committee Approval
Since the design of the study was a systematic review of literature, ethics committee permission was not applied for.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Declaration of Competing Interest
I have nothing to declare.
Table 1
| Liang et al., (2024) | |
| Bias arising from the randomization process | Some concerns |
| Bias due to deviations from intended interventions | Low risk |
| Bias due to missing outcome data | Low risk |
| Bias in measurement of the outcome | Low risk |
| Bias in selection of the reported result | Some concerns |
| Overall Risk of Bias | Some concerns |
Table 2
| Study | Confounding | Classification of Interventions | Selection of Participants | Deviations from Intended Interventions | Missing Data | Measure ment of Outcomes | Selective Reporting | Overal Risk |
| Rodríguez-Ferrer et al. (2022) | Moderate | Low | Low | Low | Low | Low | Low | Low |
| Gutierrez-Puertas et al. (2020) | Serious | Low | Moderate | Low | Low | Low | Low | Moderate |
| Ghiamikeshtgar et al. (2022) | Critical | Moderate | Moderate | Moderate | Moderate | Moderate | Unclear | Moderate |
| Zhou et al. (2024) | Low | Low | Low | Low | Low | Moderate | Unclear | Low |
| Rushdan et al. (2025) | Moderate | Low | Low | Low | Low | Low | Low | Low |
| Yang et al. (2023) | Low | Moderate | Moderate | Moderate | Low | Low | Low | Low |
Table 3
| Assessment Questions | Rushdan, Mohamed, Abdelhalim, El-Ashryand Ali (2025) | Rodríguez-Ferrer et al. (2022) | Gutierrez-Puertas et al. (2020) | Yang et al. (2023) | Ghiamikeshtgar et al. (2022) | Zhou et al. (2024) |
| Does the study clearly identify what the “cause” and “effect” are? | + | + | + | + | + | + |
| Have participants been included in similar comparisons? | + | + | + | + | + | + |
| Have participants been included in receiving similar treatment/care except for the intervention in the study? | + | + | + | + | + | + |
| Is there a control group? | + | + | + | + | - | - |
| Have multiple assessments been done for pre- and post-intervention
outcomes? |
+ | + | + | + | + | + |
| Has the completion of follow-up or, if not, the cause of the difference between the groups been clearly identified and analyzed? | + | + | + | + | + | + |
| Have participants been included in the comparison group with their results assessed in the same way? | + | + | + | + | + | + |
| Have the results been assessed by a reliable method? | + | + | + | + | + | + |
| Have appropriate statistical analyses been used? | + | + | + | + | + | + |
Table 4
| Author / Year | Country of Study | Aim | Research Type | Number of Participants in the Experimental and Control Groups | Study Group | Method | Type of Educational Materials Used | Findings | Conclusion |
| Rushdan, Mohamed, Abdelhalim, El-Ashryand Ali, (2025) | Egypt | This study aims to evaluate the effect of the escape room method on clinical reasoning and teamwork skills among nursing students. | N-RCT | E: 80
C: 80 |
4th-year nursing students | The “Teamwork Skills Questionnaire” and the “Nurses Clinical Reasoning Scale” were used in the study to evaluate the clinical reasoning and teamwork skills of nursing students. The escape room was implemented both digitally using Google Forms and in a physical setting. | Digital escape room scenarios, mathematical problems, videos, visuals, and physical clues |
Clinical Reasoning
E: Pretest mean score: 52.65 Posttest mean score: 63.0 p < 0.001 C: Pretest mean score: 55.55 Posttest mean score: 54.58 p > 0.05 Teamwork Skills E: Pretest mean score: 104.6 (SD: 6.83) Posttest mean score: 125.89 (SD: 16.92 ) p < 0.001 C: Pretest: 103.75 Posttest: 105.34 p-Value p > 0.05 |
The escape room method was evaluated as an effective learning tool in nursing education, and it was concluded that it made a valuable contribution to traditional teaching methods to support clinical practice. |
| Rodríguez-Ferrer, Manzano-León, Fernández-Jiménez, Aguilar-Parra, Cangas, andLuque de la Rosa, (2022) | Spain | This study aims to improve nursing students’ attitudes towards mental illness, raise their awareness, and evaluate the long-term effects of escape room-based training. | N-RCT | E: 197
C: 109 |
Nursing students | The experimental group interacted in teams with one hour-long tasks and puzzles, while the control group used standard course materials. | An online, scenario-based escape room game |
Pretest:
E: = 47.57 C: = 49.56 Posttest: E: 30.83 C: 49.55 p-Value p < 0.001 (ANOVA) |
The escape room was found to be effective in raising students’ awareness of mental illnesses and alleviating their negative attitudes towards these illnesses. |
| Gutierrez-Puertas et al. (2020) | Spain | This study aims to understand the gaming experience and satisfaction of nursing students in the evaluation of their clinical skills using an escape room. | N-RCT | E: 117
C: 120 |
Nursing students | E: A 30-minute escape room in a simulation lab in teams of five
C: Objective structured clinical examination (OSCE) method |
Escape room scenarios (life support, clinical safety, wound healing) |
Satisfaction
Final score of the experimental group: 9.59 ± 0.36 Final score of the control group: 7.46 ± 1.36 p-Value p < 0.05 |
The escape room method was found to significantly improve students’ performance compared to the traditional OSCE method. |
| Yang et al. (2023) | Taiwan | This study aims to identify the efficiency of escape room activities in enhancing nursing students’ retention of maternity-related knowledge and their overall learning performance. | N-RCT | E: 21
C: 21 |
Nursing students |
Experimental Group: Participated in a maternity escape room activity involving problem-solving tasks based on maternity care and assessment.
Control Group: Followed a traditional online learning approach without gamified elements. |
Experimental Group: An interactive online game-based escape room designed for maternity care learning (OGBER).
Control Group: Traditional teaching materials and assessments. |
Learning Success: Experimental group performed significantly better with p < 0.001p < 0.001p< 0.001.
Problem-Solving Skills: Experimental group outperformed the control group with p < 0.001p < 0.001p< 0.001. Critical Thinking Abilities: Experimental group outperformed the control group with p < 0.001p < 0.001p< 0.001. |
The OGBER approach effectively improved nursing students’ learning success, problem-solving skills, and critical thinking abilities compared to the traditional method. It provided an attractive and practical resource for nursing education. |
| Ghiamikeshtgar et al., (2022) | Iran | This study aims examine the effect of the escape room clinical evaluation method and PEARLS-based feedback provision on satisfaction, learning, and preparedness to practice as interns among pre-internship nursing students. | N-RCT | The study included a total of 42 participants. (No explicit division into experimental and control groups was mentioned; all students underwent the intervention) | Sixth-semester undergraduate nursing students at Zahedan University of Medical Sciences. | Participants were evaluated using escape rooms designed as hospital wards.
Students were divided into five groups (8–9 students per group). Performance was observed and evaluated using a camera, followed by PEARLS-based feedback sessions. Pre- and Posttests were conducted to assess clinical skills, satisfaction, and preparedness. |
Simulated clinical scenarios in escape rooms equipped with relevant hospital equipment (e.g., patient beds, manikins) and tasks designed to assess critical nursing skills. |
Self-assessment score
Mean and standard deviation Pretest 40.26 ± 4.04 Posttest 51.69 ± 3.51 p-Value 0.000 |
Considering the satisfaction of nursing students with the clinical evaluation using the escape room game and its impact on student learning, it is recommended that this method be implemented in all medical education departments. |
| Zhou et al., (2024) | China | This study was conducted to examine the effects of an Escape Room teaching approach based on the CGTD model with clinical cases as guides (C) and task drivers (G) on undergraduate nursing students’ humanistic care abilities and their creative thinking. | N-RCT | A total of 108 undergraduate nursing students participated in this study. Participants may have been divided into experimental and control groups, but this was not clarified in the file. | The study group consisted of undergraduate nursing students from a university in 2020 in Sichuan Province, China. | The participants in the study attended 11 innovative escape room teaching activities, and their scores on humanistic care and creative thinking were compared before and after the intervention. | The educational materials included real clinical cases and problem-based puzzles integrated into an escape room game. Furthermore, simulation materials and equipment were used (e.g., electrocardiographs, monitors, simulators). |
Creative Thinking:
Pretest: 106.34 ± 10.63 Posttest: 110.48 ± 12.36 p-Value: p-value 0.006 Humanistic Care Skills Before: 132.50 ± 15.21 After: 139.52 ± 18.92 p-Value: p < 0.05 |
This method offers an alternative approach to traditional nursing education by providing an innovative and interactive learning setting. However, further optimisation of the method with a larger sample size and improved game designs is recommended. |
| Liang et al., (2024) | China | This study aims assess the impact of the OSCE-based Escape Room Approach on nursing interns’ critical thinking, learning engagement, self-regulated learning ability, and improvement of clinical knowledge and skills. | RCT | E: 80
C: 80 |
Nursing students doing internship in the Gastroenterology Department of the hospital under Xuzhou Medical University. | The experimental group used the Escape Room Approach based on OSCE. This approach included multi-stage tasks based on the key assessment points of OSCE, while the control group followed traditional teaching methods. Critical thinking, learning engagement, self-regulated learning, and academic achievement were assessed before and after the intervention. | Clinical scenarios based on OSCE principles
Simulation equipment (e.g., laptops, phenolphthalein solution, IV infusion tools) Tasks based on puzzles about gastrointestinal haemorrhages and pancreatitis |
Critical Thinking Ability (Total Scores):
C: Before 295.32 ± 60.41, After 299.64 ± 60.01 E: Before 293.24 ± 58.64, After 323.53 ± 51.50 p-Value: p = 0.010 Learning Engagement (Total Scores): C: Before 69.49 ± 15.349, After 71.17 ± 8.124 E: Before 70.78 ± 11,625, After 78.86 ± 15.314 p-Value: p = 0.010 Self-Regulated Learning Capacity: C: Before 69.61 ± 11.521, After 70.61 ± 10.436 E: Before 67.62 ± 11.375, After 73.88 ± 8604 p-Value: p = 0.039 |
The OSCE-based Escape Room Approach incorporated the multi-centric setting elements of the OSCE system into the Escape Room teaching scenario, linked the puzzle settings with the key points of OSCE evaluation, provided relevant medical theoretical support for the Escape Room Approach, and effectively improved nursing students’ critical thinking, learning engagement, and self-regulated learning, which is worth promoting in clinical nursing teaching. |
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