Six Design Keys for Escape Rooms in Nursing

Escape rooms are team-based games where participants locate hidden clues to complete a series of puzzles and finish a quest within a specified time to win the game. They are a clinical teaching strategy that fosters active learning through friendly competition to evaluate critical thinking, teamwork, communication, and skill demonstration in the classroom setting.¹ The use of escape rooms increases student motivation, engagement, and content mastery by incorporating adult learning principles that allow participants to have control over the learning environment through discussion, collaborative problem solving, and application of previous experiences.^2,3 This type of simulation requires a thoughtful and systematic approach to design and evaluate the education session. This article will review the six key design elements and offer a worksheet to organize your next escape room. 

Design Elements 

The six design elements include participant characteristics, learning objectives and outcomes, theme, puzzles and equipment, debriefing, and evaluation. Participant characteristics for consideration include target staff roles, difficulty level, amount of time available, number of participants per group, involvement of the moderator, and space available. Available space will determine the scale and number of the puzzles that can be incorporated in the game scenario. Learning objectives and outcomes will be used to describe the goals of the education and the knowledge and skills that will be demonstrated by the participants.   

The theme encompasses the case study or scenario and the game format. Escape rooms can be designed as open, linear, multilinear, or virtual simulations. Open designs allow participants to solve puzzles in any order or allow multiple puzzles to be solved simultaneously. Linear designs unlock puzzles sequentially through the release of clues at each stage. Multilinear designs combine multiple elements (open, sequential, or path-based) to produce a hybrid puzzle structure.⁴  

Puzzle designs are diverse and only limited by the imagination. Some examples of puzzles include cryptograms, locked boxes, riddles, use of black light markers, or completion of tasks and skills. The available budget should be considered when designing puzzles and selecting supplies or equipment.  

During the debriefing, students can share their feelings and reactions to the simulation while the moderator can provide feedback and reinforce knowledge, skills, or processes in the learning outcomes. Finally, evaluations of the simulation should be designed to capture reactions to the simulation and increases in knowledge or demonstration of skills commensurate with the learning outcomes. Knowledge may be assessed using a pre- and post- assessment while skills can be assessed with a standardized checklist. 

Conclusion 

Escape rooms are a valuable education tool to facilitate active learning in accordance with adult learning principles. Systematic planning and testing are necessary to design escape rooms because of the complexity of the simulation. Checklists and planning tools can be used to simplify the process for escape room design.  

Example Escape Room Documents

A blank escape room worksheet and an example escape room worksheet* for preoperative patient assessment, safe patient transfers, skin antisepsis, and time-out protocol for novice nurses can be downloaded below. 

Download Blank Escape Room Planning Worksheet

Download Example Escape Room Planning Worksheet

Additional escape room resources can be found at: Simulation Escape Room Resources. 

*The escape room for preoperative patient assessment, safe patient transfers, skin antisepsis, and time-out protocol was created by the perioperative education team at Allegheny Health Network. Team members contributing to this escape room include Kellie Burnett, Jennifer Conroy, April Dzik, Jody Garich, Michael Jackanic, and Sara Angelilli. 

References:

1. Tassemeyer D, Rowland S, Barnason S. Building a nursing escape room: an innovative active learning strategy. Nurse Educ. 2021;46(5):271-272. 
2. Carroll JA, Morse K. Engaging learners in productive struggle: escape rooms as a teaching tool. J Nurs Educ. 2022;61(9):545-548.
3. Eukel H, Morrell B. Ensuring educational escape-room success: the process of designing, piloting, evaluating, redesigning, and re-evaluating educational escape rooms. Simul Gaming. 2021;52(1):18-23.
4. Veldkamp A, van de Grint L, Knippels M, Christine PJ, van Joolingen WR. Escape education: a systematic review on escape rooms in education. Educ Res Rev. 2020;31:100364.

AORN Resources

AORN members can access:

• Perioperative Staff Development - AORN Simulation Scenarios
• AORN Educator Resources
• Engaging Perioperative Learners Using Online Game‐Based Education - AORN Journal
• Strategies to Implement a Competency Assessment Verification Program - AORN Journal
• Using Virtual Reality to Improve Perioperative Skills - AORN Journal