Creating an Escape Room to Engage Students in Active Learning to Achieve QSEN KSA's

Background: Teaching the generation Y (millennial) students the complex skills to practice nursing can present challenges to faculty. One challenge is to create engaging and innovative activities which can engage affective, cognitive and psychomotor domains of learning (Hermanns et al., 2018). Measuring the cognitive, affective and psychomotor skills can be also present challenges, especially in the clinical setting (Baumlein, 2015). According to Nick (2015), students are more likely to learn if they are enthusiastic about participating in the learning activity. Research has demonstrated that the use of serious gaming (escape rooms) can promote student engagement and persistence on task, both which can foster deep, rather than superficial learning (Cain & Piascik, 2015). Escape rooms can offer an innovative solution to engage students with creative scenarios and promote excitement about learning new concepts and problem solving.

Escape rooms have become a global phenomenon since this form of entertainment gaming was introduced in Japan in 2007 (Nicholson, 2015). According to Wise, Lowe, Hill, Barnett & Barton (2018), escape rooms can provide an avenue for “moving away from ‘information transmission’ models of induction and towards a student-centered approach, resisting the temptation to tell students everything we want them to know” (p.88). The rooms can engage students, promote critical thinking and team cooperation by solving real-life puzzles (Hermanns et al., 2018). Puzzles are solved by finding clues to combinations which can be used to unlock a series of locks which then can solve the puzzle. Escape rooms are gaining popularity worldwide and can now be found internationally as a form of entertainment. However, review of the literature reveals a gap in how this gaming can be used in education.

Method-Most escape rooms have a central theme in which the puzzles and clues are built around. This escape room was created as part of a learning activity in a mental health course. The learning outcomes were the correctly solved puzzles which were created and based on the Quality and Safety Education for Nurse Knowledge, Skills and Attributes (KSA’s) that are required by a registered nurse (QSEN.org, 2018). The three of the six competencies of KSA's are linked to this activity: Collaboration, Evidence-based practice (EBP) and Safety. The theme is constructed around a story of a older adult residing in an assisted living residence. The puzzles require use of cognitive and psychomotor skills, many of which are essential nursing student skills (dosage calculations, identification of the main classes of medications, and selecting the correct antidote for the client’s deteriorating condition). The challenge of this innovative gaming strategy is to solve all of the puzzles correctly, use the clues provided to decipher codes and ultimately unlock the final box with a key. The key unlocks a box with potential antidotes to reverse the resident’s symptoms. In this case, the final box contains a vial of sterile water which is labeled “Naloxone” (the correct choice), as well as three other options.

Escape rooms require collaboration and communication with the team members, but ideally, the number of participants should be limited to six-eight students to avoid too much crowding and confusion while attempting to solve the inter-linked puzzles. Students are provided game rules, a narrative script, and a time limit of 60 minutes. It is important to explain to students that are unfamiliar with the concept of an escape room an important detail; The room is not ‘locked’ and students are able to leave the room at any time. The students are also reminded to pay attention to the remote controlled IPAD in the room which utilizes the application for Apple devices known as "Double". "Double" is a telepresence robot that enables the user to move around a remote location by use of the internet. The "Double" robotics application provides the ability to remotely monitor the students if they get stuck on a puzzle and can provide some vital clues to avoid unnecessary frustration. The IPAD also serves as a timer so students can easily see how much they have left. The learners will also complete a pre and a post survey to gather quantitative data on the student’s perception of this learning activity.The survey identified for this project was used by Eukel, Frenzel, and Cernusca (2017), in a similar study for pharmacy students.

Results

A 60-minute learning activity was created which contains ten, inter-linked puzzles based on a narrative with a mental health theme. Three of the puzzles are related to QSEN KSA’s of Collaboration, Evidence-based practice and Safety student learning outcomes. Each puzzle is dependent upon solving other puzzles within the room to reach the final, locked box which is opened by a key. Once students are able to open the final locked box and identify the correct medication for the resident, the students are able to ‘escape’, before the paramedics have to be called in to revive the resident. An important step after the completion of this activity is a debriefing session which can provide important qualitative data for future implementation of this activity.

Conclusions

Creating an escape room can allow an educator to use a popular gaming trend as an appealing and innovative method to engage the millennial learner (Eukel, Frenzel, Cernusca, 2017). The creator can develop puzzles which are directly related to vital student learning outcomes and QSEN competencies so students can learn key concepts while using collaborative and team building skills.