Education has traditionally been developed and delivered via conventional didactic methods such as lecture. However, with the evolution of education and learning, nursing professional development (NPD) practitioners are challenged to design and implement interactive learning strategies that engage learners, thereby stimulating critical thinking and creating a more enjoyable learning experience (Steelman, 2014). An escape room is one such interactive learning strategy described as an experience where teams are provided with a simulated scenario and must then solve puzzles and use clues to complete all tasks within a designated time frame to escape the room (Adams et al., 2018). Furthermore, the literature confirms the benefits of escape rooms in education. For example, Kinio et al. (2019) notes that escape room modalities, a form of game-based learning, can be used effectively to help promote active learning, reinforce knowledge, and engage as well as motivate learners. Therefore, designing and implementing an escape room is one avenue by which the NPD practitioner not only can support learners as they hone their knowledge and skills related to specific clinical topics, but also can support and foster critical thinking, teamwork, and collaboration.
Purpose, Method, and Discussion
The NPD Scope and Standards of Practice denotes one of the essential roles of the NPD practitioner is that of a learning facilitator, which includes “employ[ing] strategies to facilitate positive learning and practice environments” (Harper & Maloney, 2016, p. 38). Related competencies for this role challenge NPD practitioners to select appropriate psychomotor, cognitive and affective educational content, materials, techniques and strategies to establish a positive learning environment, and various educational strategies to meet the needs of learners (Harper & Maloney, 2016).
FirstHealth Moore Regional Hospital, a 402-bed, acute care, not-for-profit hospital located in Pinehurst, North Carolina, sought to increase interactivity in its RN residency program to better align with the American Nurses Credentialing Center's (ANCC) Practice Transition Accreditation Program® criteria regarding the incorporation of multimodal teaching–learning strategies (ANCC, 2020). Therefore, the NPD practitioner, in collaboration with the operating room leadership team, designed and implemented an escape room as an avenue to offer a nontraditional interactive learning opportunity to promote and foster an increase in knowledge and skill related to the principles of sterile technique.
First, the NPD practitioner crafted a project charter and submitted the proposed project to the local institutional review board for approval. Additionally, in an effort to ensure support from administration, the NPD practitioner ensured to align the active learning project with the following facility's strategic priorities and related goals of securing top decile performance in clinical quality, patient safety and service, as well as attracting, retaining, and developing a workforce dedication to top performance for quality, patient safety, and succession planning.
After its design, the escape room (Figure 1) was set up in an unoccupied operating room. First, participants were prebriefed with instructions, rules, and the following case scenario (Figure 2):
You are about to embark on a quest to ensure you have a sound knowledge base of the principles of sterile technique, which will allow you to play an integral role in the prevention of surgical site infections and optimal care for your patients.
Escape room setup.
Rules of the escape room.
Next, teams of two to four people collaborated and used critical thinking skills to complete a mission to learn about the concepts of sterile technique, as well as reinforce any previous knowledge. While completing their mission, participants successfully moved through a series of tasks and puzzles within a 45-minute time frame to ultimately escape the room. After each team escaped, participants completed surveys and evaluations while also participating in a debriefing session with the facilitator to allow for reflection on the various concepts addressed. The debriefing helped participants determine what was done successfully in the escape room, recognize opportunities for improvement, and identify challenges that may need to be addressed organizationally to optimize the implementation of sterile technique principles.
The development and implementation of an escape room proved to be a creative and innovative way to engage perioperative RN residents and positively influence their learning experience. Survey results, using a 5-point Likert scale, demonstrated that 100% of participants agreed or strongly agreed that the escape room was an effective learning strategy, increased their knowledge of the concept of sterile technique, and encouraged collaboration and teamwork. Anecdotal comments were positive and reflected that participants found this method of learning enjoyable and beneficial to learning (Figure 3). It was also further anecdotally noted that the incorporation of an escape room should be expanded to other perioperative concepts as well as other specialties.
Escape room survey results.
Barriers and Limitations
When developing and implementing an escape room, NPD practitioners and the administration should assess for and address any related barriers or challenges. Table 1 highlights some of the potential challenges associated with developing and implementing an escape room to include a heightened awareness to the need of ensuring adequate social distancing amid a pandemic.
Potential Challenges Associated With Developing and Implementing an Escape Room
It is also noteworthy to mention some of the various limitations associated with the development and implementation of this escape room. Limitations associated with this project include a lack of a comparison and control group, the inability to confirm long-term retention of knowledge, and that only group knowledge was tested—not individual knowledge.
Implications and Conclusion
The active learning experience of an escape room can serve as an effective and innovative avenue for the application of critical thinking, teamwork, and communication. For example, using this interactive teaching strategy, participants were able to increase knowledge related to the principles of sterile technique, thereby contributing to positive patient outcomes. So, NPD practitioners should explore escape rooms as a tool to create active learning environments, which are effective and enjoyable adjuncts to conventional didactic teaching methods. NPD practitioners should also consider expanding the use of the escape room in all nursing specialties to create an active learning environment to better enhance nurses' knowledge and skill.
One role of the NPD practitioner is to create an optimal learning environment, with one component of that environment being ensuring learners are actively engaged in continuing professional development activities. Use of an escape room is one example of an active engagement strategy that can effectively support and facilitate learning while also facilitating the implementation of, and adherence to, ANCC accreditation criteria and NPD standards of practice.
- Adams, V., Burger, S., Crawford, K. & Setter, R. (2018). Can you escape? Creating an escape room to facilitate active learning. Journal for Nurses in Professional Development, 34(2), E1–E5 doi:10.1097/NND.0000000000000433 [CrossRef] PMID:29481471
- American Nurses Credentialing Center. (2020). 2020 ANCC primary accreditation provider application manual.
- Harper, M. G. & Maloney, P. (Eds). (2016). Nursing professional development: Scope and standards of practice (3rd ed.). Association for Nursing Professional Development.
- Kinio, A. E., Dufresne, L., Brandys, T. & Jetty, P. (2019). Break out of the classroom: The use of escape rooms as an alternative teaching strategy in surgical education. Journal of Surgical Education, 76(1), 134–139 doi:10.1016/j.jsurg.2018.06.030 [CrossRef] PMID:30126728
- Steelman, V. M. (2014). Pursuing excellence through creative education. AORN Journal, 100(3), 235–237 doi:10.1016/j.aorn.2014.06.008 [CrossRef] PMID:25172558
Potential Challenges Associated With Developing and Implementing an Escape Room
Time and cost associated with planning and designing; ill preparation
Threatening view of competitive aspect associated with the gaming experience
Learners who may prefer a more passive role to learning
Interpersonal conflict within teams
Lack of interest, motivation, buy-in, perceived benefit, confidence, or administrative support
Learning curve; feelings of vulnerability
Environmental challenges (e.g., pandemic)