Effectiveness of escape rooms in nursing education: A systematic review

Aim: This study examines the effect of escape room-based learning on critical thinking, problem-solving and clinical decision-making skills in nursing education. Background: Educational escape rooms have emerged as an innovative and interactive teaching method in nursing education. They offer a dynamic approach that enhances critical thinking, problem-solving, teamwork, and applying theoretical knowledge in a safe and engaging environment. Design: Systematic review. Method: A structured search was performed in Pubmed, Scopus, Cochrane Library, Google Scholar, Web of Science, Science Direct, and ULAKBIM. The databases were searched with the keywords "nursing students," "escape game," and "escape room" and were combined with Boolean connectors (and, or). In this systematic review, only studies conducted with nursing students or nurses with a randomized controlled trial (RCT) or quasi-experimental research design were published in English or Turkish, and whose full text was accessible were included. The Joanna Briggs Institute, MetaAnalysis of Statistics Assessment and Review Instruments (JBIMAStARI), was used to assess the quality of studies. Two independent reviewers conducted selection and critical appraisal. Results: N = 14 interventional studies up to November 2024 were included (n = 2 Randomized Clinical Trials and n = 12 quasi-experimental designs). The samples of 12 of the reviewed studies consisted entirely of nursing students. The sample of 1 study consisted of nurses, and 1 study consisted of nursing and pharmacy students. In most of the reviewed studies, escape room interventions significantly improved nursing students' clinical decision-making, critical thinking, and problem-solving skills. It was also found to positively affect students' motivation to learn, satisfaction, and retention of information. Conclusion: After implementing the escape rooms method, the students' average scores significantly increased. This method effectively improves students' knowledge, skills, critical thinking, motivation, satisfaction, selfefficacy, problem-solving, and clinical judgment skills. Integrating the escape room method with digital technologies such as virtual reality (VR) and augmented reality (AR) is suggested to extend interactive learning experiences.