Escape Room in Pressure Ulcer Education

Effect of a Game-Based Escape Room Teaching Method on Intern Nursing Students' Knowledge Levels Regarding Pressure Ulcers: A Randomized Controlled Trial

This randomized controlled trial (RCT) with a pretest-posttest design aimed to determine the effect of a game-based escape room teaching method on intern nursing students' knowledge levels regarding pressure ulcers. The study was conducted at the Faculty of Nursing, Aydın Adnan Menderes University between March and December 2025. A total of 56 senior nursing students were randomly assigned to either the intervention group (n = 28) or the control group (n = 28).

The intervention group received both theoretical instruction and escape room-based learning activities, while the control group received only traditional lecture-based theoretical instruction. Data were collected using the Student Information Form, the Pressure Ulcer Knowledge Assessment Tool 2.0 (PUKAT 2.0-T), and the Gameful Experience Scale (GAMEX).

The primary outcome was the change in pressure ulcer knowledge levels measured using the Pressure Ulcer Knowledge Assessment Tool 2.0 (PUKAT 2.0-T) across three time points: baseline, immediately after theoretical instruction, and 1 month after the intervention.

Study Overview

• Status: Completed
• Conditions: Nursing Education; Game-Based Learning; Pressure Ulcer Knowledge
• Intervention / Treatment: Behavioral: Escape Room-Based Learning; Behavioral: Theoretical Instruction

Detailed Description

This study was designed as a randomized controlled trial (RCT) with repeated measures (pretest-posttest design). After completion of theoretical instruction on pressure ulcers, participants in the intervention group engaged in structured escape room activities, including crossword puzzles, word search tasks, matching exercises, and puzzle-based problem-solving activities. The control group received only traditional lecture-based instruction.

Data were collected at three time points: baseline, immediately after theoretical instruction, and one month after the intervention. Statistical analyses included descriptive statistics, chi-square tests, independent samples t-tests, and two-way repeated measures analysis of variance (ANOVA).

• Study Type: Interventional
• Enrollment (Actual): 51
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Turkey (Türkiye)
  • Aydin, Turkey (Türkiye)
    • Aydın Adnan Menderes University

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

• Being a senior nursing student
• Enrolled in the Nursing Care Management course
• Aged between 18-45 years
• Attendance in theoretical and practical sessions
• Voluntary participation

Exclusion Criteria:

• Failure to participate in intervention procedures
• Absenteeism during the relevant course sessions
• Prior experience with escape room games

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-Based Learning + Theoretical Instruction; Participants in this group received standard theoretical instruction on pressure ulcers, followed by a structured game-based escape room intervention. The escape room intervention consisted of interactive learning activities, including crossword puzzles, word search tasks, matching exercises, and puzzle-based problem-solving activities. Participants worked in small groups under facilitator supervision and completed sequential tasks designed to achieve learning objectives related to pressure ulcer prevention and management.	Behavioral: Escape Room-Based Learning; A structured, game-based educational intervention designed to enhance engagement and reinforce knowledge of pressure ulcers. The intervention consisted of multiple interactive learning activities, including crossword puzzles, word search tasks, matching exercises, and puzzle completion activities. These activities were facilitated in a simulated clinical learning environment under instructor supervision. The session was followed by a structured debriefing phase.; Behavioral: Theoretical Instruction; Participants in this group received standard lecture-based theoretical instruction on pressure ulcers delivered in a classroom setting. The instruction included face-to-face teaching using presentation, explanation, discussion, and question-answer techniques. No additional educational intervention or game-based learning activities were applied.
Active Comparator: Theoretical Instruction; Participants in this group received standard lecture-based theoretical instruction on pressure ulcers delivered in a classroom setting. No additional educational intervention was provided.	Behavioral: Theoretical Instruction; Participants in this group received standard lecture-based theoretical instruction on pressure ulcers delivered in a classroom setting. The instruction included face-to-face teaching using presentation, explanation, discussion, and question-answer techniques. No additional educational intervention or game-based learning activities were applied.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Pressure Ulcer Knowledge Level	Assessed using the Pressure Ulcer Knowledge Assessment Tool 2.0 (PUKAT 2.0-T). The tool is a 25-item questionnaire with scores ranging from 0 to 25. Higher scores indicate a higher level of knowledge regarding pressure ulcer prevention and management.	Day 0 (Baseline, October 24, 2025), Day 0 (Immediately post theoretical instruction, October 24, 2025), and Day 33 (1-month follow-up, November 26, 2025)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Gameful Experience Level [assessed using the Gameful Experience Scale (GAMEX)]	The outcome was assessed using the Gameful Experience Scale (GAMEX) developed by Eppmann, Bekk, and Klein (2018). The original scale consists of 27 items covering six dimensions: enjoyment (6 items), absorption (6 items), creative thinking (4 items), activation (4 items), absence of negative affect (3 items), and dominance (4 items). The total score increases with a more positive gameful experience. The Turkish adaptation of the scale was performed by Hatipoğlu and Türker (2018), who conducted validity and reliability analyses. The adapted version consists of 42 items; however, items after item 38 are specific to the marketing field and were excluded in non-marketing studies, including the present study. The Turkish version demonstrated high internal consistency with a Cronbach's alpha coefficient of 0.931. Higher scores indicate a more positive gameful experience during the gamified learning intervention.	Day 33 (1-month follow-up, November 26, 2025, post-intervention assessment)

Collaborators and Investigators

• Sponsor: Aydin Adnan Menderes University

Study record dates

Study Major Dates

• Study Start (Actual): March 5, 2025
• Primary Completion (Actual): November 26, 2025
• Study Completion (Actual): December 5, 2025

Study Registration Dates

• First Submitted: April 20, 2026
• First Submitted That Met QC Criteria: April 29, 2026
• First Posted (Actual): May 4, 2026

Study Record Updates

• Last Update Posted (Actual): May 4, 2026
• Last Update Submitted That Met QC Criteria: April 29, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: Randomized Controlled Trial; Pressure Ulcer; Nursing Education; Escape Room; Game-Based Learning
• Additional Relevant MeSH Terms: Skin Diseases; Skin Ulcer; Skin and Connective Tissue Diseases; Pressure Ulcer
• Other Study ID Numbers: 2121-Pressure Ulcer

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

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