Escape Room Simulation vs Case-Based Learning for Vital Sign Measurement in Nursing Students

Selecting the Correct Anatomical Site for Vital Sign Measurement in Different Clinical Conditions: A Mixed-Methods Study Based on Escape Room Simulation Experience

This study compares two teaching methods for helping first-year nursing students learn how to select the correct anatomical site for vital sign measurement in different clinical conditions. Students will be randomly assigned to one of two groups: an escape room simulation group or a case-based learning group. Both groups will receive the same clinical content. Knowledge levels and anxiety will be measured before and after the intervention. Students in the escape room group will also complete scales measuring their gaming experience and satisfaction with learning. Additionally, focus group interviews will be conducted with escape room participants to explore their learning experiences in depth. The study uses a sequential explanatory mixed-methods design.

Study Overview

• Status: Active, not recruiting
• Conditions: Nursing Education; Vital Signs; Simulation Based Learning
• Intervention / Treatment: Behavioral: Escape Room Simulation; Behavioral: Case-Based Learning

Detailed Description

This sequential explanatory mixed-methods study aims to compare the effects of an escape room simulation and case-based learning on first-year nursing students' knowledge and anxiety regarding the selection of the correct anatomical site for vital sign measurement across different clinical conditions.

The study will be conducted at Acibadem Mehmet Ali Aydinlar University, Department of Nursing and the CASE Advanced Simulation and Education Center during the 2025-2026 academic year fall semester.

Eligible participants are first-year nursing students enrolled in the "Health Assessment" course (N≈101). Participants will be randomly assigned using a computer-generated random number table to either the intervention group (escape room simulation) or the control group (case-based learning). Both groups will work through identical clinical case content involving conditions such as post-mastectomy status, arteriovenous fistula, hemiplegia, oxygen therapy, obesity, and nail polish presence.

In the intervention group, students will solve clinical scenarios through an escape room format in teams of 4-5, followed by a 30-minute structured debriefing session. In the control group, students will discuss the same cases in educator-guided sessions lasting 30-35 minutes.

Data will be collected using a Descriptive Characteristics Form, a Knowledge Test (10-item multiple choice, pre- and post-test), the Gameful Experience Scale (GAMEX), the Student Satisfaction and Self-Confidence in Learning Scale, and the State-Trait Anxiety Inventory (STAI). Qualitative data will be collected via semi-structured focus group interviews with escape room participants and analyzed using content analysis.

Sample size was calculated using G*Power 3.1 (α=0.05, power=0.80, Cohen's d=0.60), indicating a minimum of 45 participants per group (total n=90). The study will be conducted in accordance with the CONSORT guidelines and ethical principles of the Declaration of Helsinki.

• Study Type: Interventional
• Enrollment (Estimated): 45
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Kayışdağı Caddesi
    • Istanbul, Kayışdağı Caddesi, Turkey (Türkiye), 34752
      • Acibadem Mehmet Ali Aydinlar University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Enrolled as a first-year nursing student in the "Health Assessment" course at Acibadem Mehmet Ali Aydinlar University in the 2025-2026 academic year
• Having attended the vital signs lecture and laboratory session
• Not having graduated from a vocational health high school
• Willing to participate voluntarily

Exclusion Criteria:

• Incomplete data collection forms
• Absence from the post-test measurement (T2)
• Voluntary withdrawal from the study

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Escape Room Simulation Group; First-year nursing students assigned to this group will participate in an escape room simulation in teams of 4-5 students. They will solve clinical scenarios related to vital sign measurement site selection. The session lasts approximately 15 minutes, followed by a 30-minute structured debriefing.	Behavioral: Escape Room Simulation; A vital sign-themed escape room simulation in which students work in teams to solve clinical scenarios requiring selection of the correct anatomical measurement site. Followed by structured debriefing.
Active Comparator: Case-Based Learning Group; Students assigned to this group will discuss the same clinical cases in educator-guided case-based learning sessions lasting 30-35 minutes. The instructor will facilitate discussion using guiding questions.	Behavioral: Case-Based Learning; Educator-guided group discussion of identical clinical cases involving vital sign measurement site selection under various clinical conditions.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Knowledge Test Score	A 10-item multiple choice test assessing students' ability to select the correct anatomical site for vital sign measurement in different clinical conditions. Each correct answer scores 1 point (total: 0-10).	Baseline (pre-intervention) and immediately after intervention (approximately 1 hour)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
State Anxiety Level	Measured with the State-Trait Anxiety Inventory (STAI) State Anxiety subscale (20 items, score range 20-80).	Baseline and immediately after intervention

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Gameful Experience	Measured with the Gameful Experience Scale (GAMEX); 27 items, 6 subscales, 5-point Likert scale. Applied to intervention group only.	Immediately after escape room simulation
Student Satisfaction and Self-Confidence in Learning	Measured with the Student Satisfaction and Self-Confidence in Learning Scale (12 items, two subscales: satisfaction and self-confidence, 5-point Likert scale). Applied to intervention group only.	Immediately after escape room simulation

Collaborators and Investigators

• Sponsor: Acibadem University

Publications and helpful links

General Publications

• Rafi A,Habibi A,Kalantarion M
• Ghiamikeshtgar N,Ghaljaei F,Ghaljeh M,Taherizade B,Mahmoodi N,Sharifi S

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2026
• Primary Completion (Estimated): March 30, 2026
• Study Completion (Estimated): December 30, 2026

Study Registration Dates

• First Submitted: March 18, 2026
• First Submitted That Met QC Criteria: March 18, 2026
• First Posted (Actual): March 23, 2026

Study Record Updates

• Last Update Posted (Actual): March 23, 2026
• Last Update Submitted That Met QC Criteria: March 18, 2026
• Last Verified: January 1, 2026

More Information

Terms related to this study

• Keywords: vital signs; nursing student; escape room; simulation based learning experience
• Other Study ID Numbers: ATADEK-2025-16/620

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO
• IPD Plan Description: Individual participant data will not be shared in order to protect the privacy and confidentiality of student participants, in accordance with the ethical principles outlined in the study protocol.

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No