Background
The fundamentals of nursing constitute the foundational and pivotal components in the nursing curriculum, encompassing theoretical knowledge and practical skills, with the latter being indispensable core competencies for future clinical nursing practice [1]. However, undergraduate nursing graduates in China exhibit a relatively low level of proficiency in clinical practice skills [2]. A previous study revealed that judgment thinking ability scores of Chinese graduates regarding clinical problems were significantly lower than those of South Korean graduates [3]. Surveys [4] indicate that traditional teacher-centred approaches still prevail within China’s current education system, with assessments being primarily focused on individual procedural abilities. Consequently, there is an absence of comprehensive evaluations pertaining to specific nursing students’ capabilities, such as teamwork and critical thinking. During the evaluation of skills, there is a predominant focus on “technique” rather than “ability”. Assessments primarily emphasize the standardization and proficiency of skill operations, requiring students to dedicate a substantial amount of time to repetitive practices. However, this approach can induce fatigue and does not significantly contribute to the development of comprehensive abilities. This underscores the need for Chinese educators to actively explore novel teaching methods that enhance student motivation and engagement, ultimately leading to improved learning outcomes. Furthermore, in line with these concerns, the National Standards for Teaching Quality in Nursing Education issued by the Chinese Ministry of Education in 2018 also advocated for diverse approaches towards comprehensively evaluating the professional competence and clinical thinking of students [5].
Serious gaming is an educational concept that integrates gaming with teaching, enabling students to efficiently acquire theoretical knowledge, practical skills, and professional competence through immersive scenario-based games. These games not only stimulate interest in learning but also enhance learning efficiency [6]. In recent years, researchers from various countries have successfully introduced serious games into medical education [7]. A former study focused on nursing undergraduates found that the use of serious games as educational tools contributed to learning and to the development of collaborative problem-solving [8].
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Escape rooms (ER) represent a type of serious game that offers a high level of enjoyment and challenge. Escape room-style teaching revolves around designing educational objectives within the game’s framework. Participants must solve a series of puzzles related to educational goals within a specified period in order to ultimately escape from the fictional environment created by the game. It has been demonstrated that escape room teaching can effectively motivate students and increase their engagement [9]. The escape room game teaching model was initially promoted in nursing education of specific Western and European countries, including intensive care learning [10], obstetrics and gynaecology nursing [11], community nursing [12], critical and emergency care nursing [13], paediatric nursing [14], and cardiac patient care [14]. In China, research on the application of escape room games in nursing education is still at an early stage, and has only been applied to the practical teaching of cardiovascular internal medicine [16], and oral surgery [17].
In 2020, researchers [18] introduced the escape room teaching method as an assessment tool for medical skills, suggesting its successful integration based on diverse learning styles and positive feedback from students. Moreover, educators have found this evaluation approach to effectively transform routine skill examinations into captivating immersive learning experiences.
Most research on the escape room teaching method has primarily focused on European and American countries. In China, education is heavily influenced by traditional teaching methods, characterized by teachers delivering lectures as the primary mode of instruction. As a result, there is a lack of Chinese researchers utilizing escape rooms as an assessment method in nursing education. Hence, our research team integrated the characteristics of basic nursing skill assessments and undergraduate students’ circumstances to develop an escape room-style assessment of nursing fundamentals. Through in-depth interviews, we aimed to gain insights into students’ subjective experiences, summarize their learning encounters, and discuss the feasibility and effectiveness of this evaluation approach. Our objective was to provide a reference framework for the design and implementation of optimized assessment plans for future use.
Methods
Study design and setting
This study was conducted at a university in the Zhejiang Province, where a basic nursing course is offered during sophomore year following a traditional teaching model that combines theory and practice. Midterm and final exams were administered to assess students’ theoretical knowledge and nursing skills operation. Previously, the examination format consisted of written tests and individual practical assessments. Building upon the traditional midterm examination method for nursing undergraduates, this study devised an innovative “escape room” approach for the final nursing skills assessment.
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Research Team: One supervising professor was responsible for setting teaching objectives, reviewing and revising the plan, and controlling the difficulty of puzzles. Two graduate students were tasked with designing the operational projects and levels, setting up the scene, and collecting and analysing interview data. Four teachers from the Nursing Skills Centre participated in the evaluation assessment.
Assessment Plan Design: In accordance with the assessment objectives, theoretical knowledge and nursing skills were integrated by utilizing elements of escape room games. The specific design plan is shown in Table 1. The escape room was prepared in a nursing training lab, where the necessary experimental materials, high-fidelity simulators, and clue cards were prepared as game props. Two graduate students and four teachers from the Nursing Skills Centre underwent the experience to confirm the rationality and appropriateness of the content and levels, as well as its difficulty. After summarizing their opinions, any concerns were addressed.
Assessment Implementation Process: Game rules were presented to students. Each escape room was equipped with 3–4 levels, and the students were required to complete the corresponding operations based on hints to obtain a pass card to enter the next level. Assessments were conducted by one teacher based on self-compiled basic nursing skills scoring standards. The score for a single operation was 100 points, and a score of 75 points or above was necessary to progress to the next level. A score below 75 points was regarded as unsatisfactory, and the operation required restarting. The entire game was limited to 30 min, and the team that finished the game in the shortest period of time was deemed the winner. All students participating in the assessment were free to form teams, with each team consisting of 6–7 people. Five escape rooms were set up simultaneously for the assessment, and one batch was completed quickly after the other. The room was promptly rearranged, and the next batch of assessments was conducted immediately. To avoid interference and exchange of information between teams, the students who had completed the assessment were instructed to wait in a separate classroom, and were informed that top-ranking teams would receive rewards. Each team preformed in a competitive manner.
Table 1
A skill assessment plan inspired by the principles of escape room design
Setting the Scene | Assessment Content | |
|---|---|---|
Room 1 | An initial task card is strategically positioned within the confines of the classroom, prompting students to locate and commence the assigned task. For instance, the inaugural task card presents a clinical scenario: “Mr. Zhang, a 50-year-old individual, has been experiencing an unexplained fever for three consecutive days. His peak temperature reached 39.5℃ while concurrently exhibiting symptoms such as coughing with yellow and viscous sputum production, generalized weakness, and decreased appetite. Notably absent were chest tightness or pain, as well as any breathing difficulties.” Students are required to meticulously adhere to medical guidelines in order to assess the patient’s vital signs accurately. Upon successful completion of each operation, students are guided by clues leading them towards subsequent task cards arranged sequentially throughout the designated area. Progression to the next task is contingent upon satisfactory completion of its predecessor; consequently, earning a key to an allocated cabinet containing a letter essential to construct a complete word denoting triumph. Each group may request one hint from their instructor; however, additional requests will incur a two-minute extension on the team’s time. | Classification of care levels; Assessment of fever severity; Identification of various types of fever charts; Measurement of vital signs. |
Interview outline
An interview outline considering previous literature reviews was developed [19], and included the following questions: (1) Have you ever played an escape room game before? (2) Can you share your experience participating in this assessment? (3) Compared with regular assessments, what were the differences between the two? Which one do you prefer? (4) What are the advantages and disadvantages of the escape room teaching method? (5) Do you have any suggestions or improvements to offer?
Participants
The study participants included second-year nursing undergraduates from a university in the Zhejiang Province. In the context of this study, they had completed the first semester of the basic nursing course and participated in a mid-semester examination of basic nursing skills. A purposeful sampling method was used to select participants from 72 nursing undergraduates who participated in the escape room-style basic nursing skills assessment. The inclusion criteria for the study subjects were participation in the escape room-style assessment, willingness to participate in the interview, and good language expression ability to clearly and accurately express their thoughts. The study excluded students who had not participated in traditional basic nursing skills assessments. The number of participates was determined by saturation of the interview content, i.e., when no new themes emerged, and repetitive information was found [20]. Saturation was reached at the tenth interview, and to confirm this, two additional interviews were conducted. All students included in the study agreed to participate, and no student dropped out during the study. This study included a total of 12 participants, comprising 9 females and 3 males. This was potentially attributed to the higher representation of women in the nursing profession. Further details are indicated in Table 2, where participants were assigned numerical identifiers (e.g., Participant 1) to ensure anonymity during the study.
Table 2
Demographic data describing the study participants
No. | Sex | Previous research experience | Assessment duration by each team (min’s) | Team score (out of 100 points) |
|---|---|---|---|---|
P1 | Female | No | 23’45 | 87 |
P2 | Female | No | 25’12 | 83 |
P3 | Male | No | 23’45 | 87 |
P4 | Female | No | 24’36 | 85 |
P5 | Female | No | 27’44 | 81 |
P6 | Female | No | 24’35 | 85 |
P7 | Male | No | 22’39 | 91 |
P8 | Female | No | 27’44 | 81 |
P9 | Female | No | 26’33 | 82 |
P10 | Female | Yes | 22’39 | 91 |
P11 | Female | No | 24’36 | 85 |
P12 | Female | Yes | 23’55 | 87 |
Data collection
All researchers were registered nurses with qualifications and experience in qualitative research. They received training on methods of qualitative research and communication skills. A female researcher trained in qualitative interview techniques conducted 12 semi-structured, in-depth interviews where participants shared their learning experiences during escape room-style assessments. During interviews, a quiet environment was chosen, and the research objectives and content were explained to all participants before data collection began. Confidentiality principles were strictly adhered to throughout the process. Participants provided written informed consent to participate, and the same researcher recorded the interview content to observe relevant non-verbal cues, such as facial expressions and body movements that cannot be captured by tape recorder. Each interview lasted approximately 30–40 min.
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Ethical approval
The relevant ethics committee granted approval for this study. Prior to commencement, the researchers provided a comprehensive explanation of the study’s objectives to all participants. Each participant was required to sign a consent form and furnish basic personal information before engaging in formal interviews. Participants were given full autonomy to withdraw from the study at any point, and their involvement was solely driven by personal interest, devoid of any affiliation with the research team. To safeguard participant privacy, deidentified codes were employed during data analysis, and individual interviews were conducted in a tranquil setting.
Data analysis
Interview transcripts were transcribed verbatim within 24 h of the interviews, adhering to a strict timeline. The Colaizzi’s seven-step method [21] was used to organize and analyse the interview data: (1) thorough reading of the interview transcript multiple times to gain familiarity with its content; (2) identification and initial coding of significant statements to establish meaningful units; (3) grouping and re-coding of similar themes accompanied by detailed descriptions; (4) validation of information through participant verification leading to final thematic formation. Two researchers meticulously listened to all recordings while carefully reviewing written transcripts, thereby maximizing the analysis potential of capturing participants’ narratives, and further enhancing result reliability and validity. Any questionable content was subsequently confirmed with participants. In cases where disagreements or unclear concepts arose, analysis outcomes were submitted for additional review and confirmation by experienced qualitative experts.
Findings
Through analysis of the interview data, researchers identified two overarching themes and five corresponding subthemes. Table 3 presents the generated themes and subcategories of these results.
Table 3
Themes and subcategories of this study
Theme | Subtheme |
|---|---|
Learning Experience | A conducive atmosphere that fosters motivation |
Enhance collaboration and establish a knowledge-sharing community | |
Reconcile theoretical knowledge with practical applications to foster the development of critical thinking skills | |
Learning Feedback | The design plan for the evaluation requires enhancement |
Reinforce the segment of teacher evaluation |
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Learning experience
This theme primarily investigated the learning experience of participants in escape room-style assessments, wherein all participants provided affirmative evaluations for this innovative assessment format and acknowledged its positive and substantial impact on stimulating participant motivation, fostering team collaboration, and cultivating effective learning strategies.
A conducive atmosphere that fosters motivation
According to the interview results of participants, a relaxed environment was empirically demonstrated to be a positive factor. The escape room-style assessment, conducted in a game-based format, not only effectively alleviated the initially tense exam atmosphere but also infused it with elements of enjoyment and novelty. Throughout the participation process, students’ heightened emotions were lessened, leading to a significant improvement in their learning motivation. Moreover, this innovative assessment method exhibited high interactivity and practicality, aligning more closely with the contemporary learning needs of students, and further igniting their enthusiasm for knowledge acquisition.
“Escape room challenges are much more interesting than regular exams. I don’t feel like I’m even taking a test.“(P1, female, no research experience).
“I’m always super nervous during regular exams, and the more nervous I am, the more pressure I feel. But this time, I felt really relaxed and had no pressure at all.“(P4, female, no research experience).
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The implementation of gamified learning methods was found to significantly enhance participants’ learning motivation and competitive drive. Due to the inherent challenges and enjoyable nature of games, individuals exhibited a greater willingness to invest time and effort into the educational process.
“I’m really loving this format, it’s like playing an exciting puzzle game.“(P3, male, no research experience).
“Because I want to win, it pushes me to go over important points and to prepare more thoroughly.“(P6, female, no research experience).
Enhance collaboration and establish a knowledge-sharing community
During in-depth exchanges with participants, researchers received widespread and detailed feedback: the innovative assessment form of escape room games undoubtedly provided a unique showcase for teamwork. In this tense and stimulating environment that required quick responses and decision-making, every participant deeply appreciated the importance of teamwork. This assessment method not only amplified the collaborative effects between teams, but also subtly trained students’ coordination and cooperation skills. Moreover, everyone was closely connected because they shared a clear learning goal, forming a tight-knit learning community. In this community, each person could share their insights and experiences, and draw inspiration from others’ perspectives, thereby enhancing their learning effectiveness. This atmosphere of mutual learning and inspiration not only improved students’ learning efficiency but also allowed them to experience more joy and a sense of accomplishment in their learning process.
“During the evaluation process, it’s important for each team member to work closely together and not feel isolated.“(P2, female, no research experience).
“We would practice operations together, observe each other, and point out any issues. This proved to be very helpful as we all progressed more quickly by learning together.“(P4, female, no research experience).
“We shared study materials and discussed procedures or standards when questions arose. Through brainstorming sessions, we found optimal solutions that saved us from unnecessary detours.“(P7, male, no research experience).
“Throughout the entire process, every team member was fully engaged, supporting and learning from one another.“(P9, female, no research experience).
Reconcile theoretical knowledge with practical application to foster the development of critical thinking skills
In the escape room-style skill assessment, theoretical knowledge was ingeniously integrated with practical applications through meticulously designed scenarios, thereby enhancing the comprehensiveness and depth of the assessment content. Moreover, this method effectively evaluated participants’ overall abilities. By simulating clinical scenarios, not only did it enable participants to gain a profound understanding of the intricate relationship between theoretical knowledge and practical implementation, but it also fostered their critical thinking skills.
“In a regular exam, we only test one operation, but in an escape room, there are multiple levels within one scenario, which helps to better integrate theoretical knowledge and practical skills.“(P1, female, no research experience).
“During both the preparation and the actual exam, I often make mistakes and learn from them. The escape room experience makes me more proactive in reflecting on my errors and understanding why they occurred.“(P8, female, no research experience).
“I think this format is great. The exam content is comprehensive, encompassing not just practical skills but also a significant amount of theoretical knowledge. It also incorporates complete scenarios to assess our clinical judgment and critical thinking abilities.“(P10, female, research experience).
Learning feedback
This theme primarily explored participants’ perspectives and recommendations regarding utilization of the escape room-style assessment methodology.
The design plan for the evaluation requires enhancement
When discussing optimization suggestions for the escape room-style skills assessment, some interviewees expressed their concerns regarding participant limitations. The presence of either too many or too few participants may have impeded a fair evaluation of individual performance. Excessive participants can dilute an individual’s role within the team, making it challenging to accurately discern each person’s contribution during evaluation. Conversely, insufficient participants may result in subpar teamwork and subsequently affect individual evaluations. Furthermore, certain participants voiced their expectations for enhanced scenario settings that would increase the challenge and authenticity of assessments, enabling individuals to showcase and enhance their skills within a more realistic work environment.
“Some parts of the scene setup were missing, which was a bit distracting. If there are similar evaluations in the future, I hope the scene setup can feel more realistic.“(P6, female, no research experience).
“In group collaborations, there might be more people involved, so it could be challenging to observe each person’s performance and the tasks may also not be evenly distributed.“(P7, female, no research experience).
“Even though the setup has been changed, we still feel very familiar with the laboratory environment and lack a sense of tension.“(P10, female, research experience).
Reinforce the segment of teacher evaluation
Several participants expressed the desire to engage in post-assessment discussions with their teacher, aiming to critically examine and evaluate different facets of the assessment process. This collaborative reflection would enable them to identify any shortcomings or weaknesses, facilitating targeted improvements and advancements in their future learning endeavours and practical applications.
“Even though we’ll have a group debrief after the project, what we say might not be entirely accurate, and we don’t want to bother the teacher. So, it would be great if the grades could also highlight each group’s issues, allowing us to later reflect and learn together within our team!“(P5, male, no research experience).
“If the teacher provides a comprehensive evaluation post-assessment, we’ll get insights into our understanding and performance problems.“(P11, female, no research experience).
Discussion
The main aim of this study was to explore and describe the thoughts and experiences of nursing undergraduate students in escape room-based operational assessments. After analysing the results, it was found that similar to previous studies [22, 23], the use of game elements in teaching created a relaxed and positive environment. An escape room-based assessment method, rather than traditional operational assessment methods, helped create a more relaxed atmosphere, with teams working together to minimize the stress and frustration that an exam usually brings to students [24]. This suggested that the supplementary use of serious games can be an effective assessment method that creates a safe environment for students and promotes the development of other skills required for nursing, and should thus form part of the nursing research curriculum [25].
Through interviews, we clarified the advantages of the escape room teaching method. Compared with traditional assessment methods, students showed greater positive attitudes towards the escape room-based assessment method, which is consistent with the research findings of Roman et al. [23]. As a mature commercial game, escape rooms were originally designed with the goal of improving customer loyalty, which explains why the integration of an escape room as an educational game for nursing education greatly improved students’ learning motivation and participation. Even students who had never played escape room games before had a good learning experience and gave high evaluations in this assessment, which is similar to Garwood et al.‘s [26] research findings, indicating that the escape room teaching method does not require students to have escape room game experience and is also suitable for beginners. This is related to the fact that the participants in the escape room-based operation assessment were all millennials, whose growth and educational experiences were accompanied by the rapid development of the internet, so they were willing and open to trying new things. Millennials are more interested in immersive learning with entertainment or fun elements, the design of the escape room’s design combines three types of learning methods: gamification teaching, flipped learning, and problem-based learning [27]. Students improved their ability to actively learn, utilize information resources, and reason logically by discovering, analysing, and solving puzzles. Aubeux et al. [6] surveyed participants and indicated that the entertainment value of the escape room teaching method enhanced their learning motivation, making them more proactive in the learning process. The escape room teaching method uses trendy culture as its starting point, implementing the popular “escape room” as the site for teaching, presenting the teaching content through a combination of physical, symbolic networks, and digital media, closely linking carefully selected and designed teaching tasks to the classroom. This can effectively stimulate students’ interest in new things. Secondly, the game simplifies written knowledge from books into a series of interesting and meaningful active choices. Students participate in the game learning process through real experiences. The simplicity and participation in the game increases a sense of achievement and mastery in learning, stimulating the formation of learning motivation, thus ensuring participation, knowledge mastery, and problem-solving abilities.
Escape rooms are conducted in groups, where members share resources and clues, and collaborate to produce solutions, filling the gap in traditional teaching that lacks team building. This enhances group relationships during the teaching process. Meanwhile, escape rooms contain various puzzles that correspond to different ways of thinking and roles, allowing each member to utilize their strengths and contribute to the team [28]. When team opinions differ, members can debate, absorb, and expand the ideas of others, refining their own knowledge. In a dental escape room designed by Zaug et al. [29], participants unanimously agreed that individual efforts were not enough to complete the task, and that they only successfully escape by relying on the team [30]. Students expressed that they learned the strengths of their teammates during this activity. The dynamic simulation environment and sense of urgency in escape rooms can stimulate students’ team spirit, increase interaction between students, and train and enhance their ability to solve problems collectively. Additionally, research has found [31] that a relaxed environment can encourage teamwork in a specific manner, providing each team member with an opportunity to showcase themselves, and strengthen their sense of support from the team. In summary, escape room training can lower students’ stress levels and feelings of frustration compared to traditional clinical skills testing environments, which make them feel safe, relaxed, and comfortable, rather than being evaluated, with nursing students reportedly preferring the relaxed environment of escape rooms [32]. Furthermore, students analysed both explicit and implicit information, utilized relevant props, assessed the patient’s condition, and performed appropriate and timely nursing skills to solve puzzles and obtain clues. As a result, they completed the level tasks and ultimately escaped the room, integrating clinical reasoning and decision-making abilities into the entire game process. Former studies [23] similarly showed that escape rooms can enhance students’ critical thinking abilities.
This study represents an inaugural attempt by the research team to design and implement a locked-room escape-style-based assessment method. Through conducting in-depth interviews with participants, the team identified several areas for improvement and refinement within the current assessment approach, which also serves as the challenge and focal point of this teaching method. After reviewing an array of related studies and integrating insights from these interviews, we propose several suggestions to optimize the design of the locked-room escape teaching plan: Firstly, it is crucial that the teaching content is closely aligned with the instructional plan while considering students’ educational background and practical needs so as to ensure targeted instruction that meets their learning expectations. For instance, Morrell et al.‘s [32] design can serve as a reference wherein a locked-room escape game centred around cardiac arrest was devised encompassing multiple stages such as identifying shock types, selecting appropriate medications, interpreting ECGs (electrocardiograms), and describing disease symptoms to comprehensively assess students’ grasp of relevant knowledge. Secondly, it is imperative for the locked room escape game to feature an engaging plotline coupled with a logical structure, enabling students to acquire extensive knowledge throughout its progression. By incorporating diverse stages into this process, students can experience enjoyment while simultaneously enhancing their understanding. Moreover, presenting puzzles in varied and intriguing formats such as puzzles, sudoku [33], decoding locks [34], and safe boxes will heighten student engagement and interest levels. These puzzle forms not only augment pedagogical enjoyment but also enrich instructional design while offering cost-effective solutions that are reusable. In terms of enhancing the realism of the scene, audio, video, and other elements can be applied to create multi-sensory stimulation, including visual, auditory, and tactile stimulation, thus generating a tense atmosphere and a more immersive learning environment. Furthermore, facilitating student reflection on their escape room experience constitutes a crucial aspect of the pedagogical process. This stage serves to prompt students to engage in profound contemplation regarding the activity and comprehend its educational significance. During this phase, educators should concentrate on guiding students’ attention towards nursing teaching objectives while encouraging them to articulate their emotions and experiences. Simultaneously, teachers can assist students in enhancing any overlooked aspects based on their observations of student behaviour and outcomes. Additionally, instructors can steer students towards reflecting upon their encounters by establishing connections between puzzles, theoretical knowledge, and practical content. Lastly, it is imperative to prioritize fostering students’ experiences, engagement levels, as well as the cultivation of soft skills. Our future research will focus on designing captivating and diverse escape room-style teaching games that effectively showcase the intended pedagogical goals.
The escape room teaching method establishes a secure and well-structured learning environment for students, offering simulated scenarios to effectively impart knowledge and skills. In the future, collaboration with computer science professionals may be used to develop diverse online escape room modes. We envision that future teaching processes will incorporate error node recordings within the system, enabling students to reflect upon and analyse their performance. Online modes not only facilitate the individual assessment of students’ comprehension and proficiency but also address the limitation of accommodating fewer participants in a physical escape room, thereby allowing more students to benefit from knowledge acquisition. Despite the advantages of escape rooms in stimulating learning interest and cultivating comprehensive qualities, the focus of teaching should still be on skill enhancement. Hence, this method can be combined with traditional objective structured examinations to consolidate fundamental knowledge, thus avoiding the misalignment of teaching objectives due to excessive gamification. A previous study showed that escape room teaching cannot completely replace traditional lecturing, but it can be an important method to consolidate knowledge and enhance skills. It is therefore suggested that teachers include escape room games for crucial and difficult topics in order to enhance learning.
To summarize, the flexible design of the escape room teaching method empowers educators to explore suitable scenarios and puzzles across various disciplines based on educational advancements while fully capitalizing on gamified education and simulation-based strategies to foster innovative and effective nursing talent cultivation in China.
Conclusion
Escape room teaching achieved favourable results in the examination of basic nursing skills, and was a positive experience for most research subjects. Combining escape room games with a formal examination results in a relaxed, interesting, and interactive experience, while also enabling teaching goals. This includes stimulating students’ learning initiatives and commitments, promoting teamwork, and cultivating critical thinking. In the future, the use of escape room training programs may be further improved as an important method to consolidate knowledge and strengthen nursing skills. The findings of this study offer specific insights and recommendations for the subsequent implementation of escape room-style teaching practices, enabling more researchers and educational institutions to embrace this innovative approach in nursing skills education.
Limitations
It is important to acknowledge the limitations of this study. Currently, there is a lack of extensive utilization and standardized teaching designs in incorporating escape rooms as an assessment method in nursing education-related learning. To enhance the comprehensiveness of future research findings, interviews with subject matter experts or experienced teachers who have integrated escape rooms with skill assessments, as well as randomized controlled trials, may provide a more diverse perspective.
Acknowledgements
The authors thank all nursing students who participated in this study and shared their experiences.
Declarations
Ethics approval and consent to participate
Ethics approval was obtained from the Medical Ethics Committee of Zhejiang Chinese Medical University (code: AF-20231110-1). All authors confirm that written informed consent was obtained from all study participants before interviews were conducted. All methods were performed in accordance with specified relevant guidelines and regulations.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
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