Using Escape Rooms for Nurse Education

2021.05.26.

Even though they might not be the best means of engaging with students, much of our higher learning education revolves around learning via lectures. The problem here is that it's probably not the most effective means of getting knowledge across.  The National Association of Colleges and Employers (NACE) reports that nearly half of all surveyed Americans believed that hands-on instruction to be much more useful and capable of transmitting knowledge in a much better format. For Generation Z (millennials) students, who famously have very short attention spans, this is especially true.  
 
Today's students are looking for newer and more exciting methods to create a productive learning environment. And so it was only a matter of time before escape room games made their way into the picture. With its focus on problem-solving, albeit in the context of a time-limited game, the medical field was one of the first to express interest in how this gameplay structure could be adapted for their own use. Academic programs such as Duquesne Universityís Nurse Education & Faculty Role MSN set about making creative and interactive tools to aid learning and introduce some fun into the proceedings. 

How It Works

S. Richelle Monaghan, PhD and Scott Nicholson, PhD have written an interesting article on the use of escape room principles in an educational setting called, ìBringing Escape Room Concepts to Pathophysiology Case Studies.î According to their research, an escape room game has three phases:

Scenario Overview

Before the game or challenge begins, there's a talk through that sets the narrative scene for the situation they're about to face. During this phase, the players are assigned their ultimate goal and informed that there awaits any number of problems that'll need solving in order to reach it. They are told that each time they solve a puzzle or set of clues, they will then receive additional information as they progress. 

One such age involved creating an escape room scenario whereby a patient arrives at ER with unspecified but potentially fatal symptoms. The players have to find the clues which will allow for a correct diagnosis. The time limit ends with the patient dying or if they solve the puzzles within the allotted time, the patient living. Another storyline finds a scientist who accidentally exposes himself to a biological agent he's working on. With the clock running, the players need to find out exactly what the agent is and what the cure would be. 

The Challenge

This is essentially the game part of the process. There's a fixed amount of time for the participants to complete a number of tasks. Depending on the design of the challenge, they may or may not be able to ask for hints. 

Debriefing

This is one of the most important aspects of the whole exercise, with the host asking a series of pre-planned questions. it's a group session that gives the individual players a chance to share their thoughts and perspectives. It helps them perceive the whole point of the game and how its results can be implemented in the real world. Now within these phases, an educator can develop whatever story takes their fancy. Issues with patient management, medical crisis and the problems of a clear diagnosis can all be somehow incorporated into a gaming situation. 

Educational Benefits

So the real question on everyone's lips is, do these games actually help the players to learn more. So far, all the evidence points to a "yes." The Penn Medicine Sepsis Alliance staged an escape room style game which involved a narrative featuring a sepsis patient who needs treatment. All the medicines must e in the right quantity, the right combination, and the right order. The Alliance later published a paper concerning this hybrid style of teaching. Their general findings are as follows:

Cross-Discipline Collaboration

The novel approach in this exercise led to attracting healthcare workers from a huge number of related but differing fields. They included physicians, infection team specialist, nursing students, physical therapists and social workers. For the first time, all these different professions were "forced" to work together, something that would rarely happen in a real-world scenario. As a result of this collaboration, the participants experienced and built new connections and received a new perspective on the subject at hand, as well as gaining a huge amount of insightful knowledge.

Variety of Learning Methods

The game made use of three different learning styles: audio, visual, and kinesthetic. In other words, all the game's participants could see, hear, and feel the clues, which gave a possibility for all types of learners to benefit from the exercise.

Performance Under Pressure

Thanks to performing under the pressure of a clock, for the first time, many of the players were forced to make important decisions on their feet. In the day to day of their regular work, in a more traditional scientific and academic setting, things are generally more laid back. ut this exercise helped foster the idea of fast decision making on the go.

The Novelty Factor

The game made a lasting impression on those who played. This was due to the novelty of the whole situation and the fact that everything was new in terms of approach to the typical educational needs. Simply by having a more memorable experience, the organizers boosted the retention factor. 

Other Factors

After looking at all the potential benefits, the authors suggested that there were some other factors to be taken into account if you're thinking of utilizing escape room gameplay for nursing training. There are as follows: 

The Role of The Narrative

This story provides the context for the whole exercise and it can otherwise get lost in the classroom setting. Having a strong, and consistent story will keep all the players immersed and interested as they engage with their tasks.

Timing

What might prove more taxing is that the escape room scenario needs to be able to play out during a single class period. This will include the narrative, the gameplay, and the de-briefing. This might be a squeeze, but it's essential that the exercise is completed together, not broken up into separate parts. So, keep in mind any time constraints.

Flow And Complexity

The general idea is that the escape room starts in a simpler fashion and, as the game progresses, becomes more complex. This way the participants can get "warmed up" at the beginning.

Play Testing And Feedback

It's important that the game has several "dry runs" before you offer it to the students in earnest. Have a group of non-medical personal play the escape room game to find any basic faults and to revise the parts that need changing.

Class Size

Think about the number of students who will be taking part. maybe a smaller group can perform the game as a single group, but a larger classroom will need to play in shifts. 

If you keep these considerations in mind, then it should be possible to design an escape room game highlighting many issues and meeting the needs of the students. These games will provide a dynamic and creative teaching tool with the possibility of helping everyone achieve a good educational outcome.

Further Reading Links: 
https://scottnicholson.com/pubs/escaperoompatho.pdf
http://blog.diversitynursing.com/blog/escape-rooms-are-a-new-way-to-practice-nursing-skills
https://www.healthleadersmedia.com/nursing/nurses-create-escape-room-increase-sepsis-awareness
https://www.naceweb.org/career-readiness/competencies/using-an-escape-room-as-gameful-training-with-students/
 

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