Innovative Teaching Method on the Patient Safety for Nursing Students: Escape Room
Phase: NA
Conditions: Patient Safety, Nursing Education
Sponsor: Fenerbahce University

1 
 
Study Protocol with Statistical Analysis Plan 
Title: 
Innovative Teaching Method on the Patient Safety for Nursing Students: Escape Room 
NCT Number: 
NCTXXXXXXXX  
Document Type: 
Study Protocol with Statistical Analysis Plan 
Document Date: 
April 18, 2024 
Sponsor/Institution: 
Sağlık Bilimleri University 
Hamidiye Faculty of Nursing 
Nursing Simulation Laboratory 
Istanbul, Turkey 
Principal Investigator (PI): 
Associate Professor Dr. Demet İnangil 
Sağlık Bilimleri University, Hamidiye Faculty of Nursing 
Email: demet.inangil@sbu.edu.tr 
Phone: 0530 302 11 60 
 
 
 
 

2 
 
Innovative Teaching Method on the Patient Safety for Nursing Students: Escape Room 
Abstract  
Objectives 
Ensuring patient safety is a cornerstone of nursing practice, and its foundation is established 
during nursing education. This study aims to empower senior nursing students to develop self-
efficacy in patient safety practices through the "Escape Room" teaching method. 
Methods 
The study was conducted with senior nursing students from February to May 2024. Data were 
collected using the Student Information Form, Patient Safety Self-Efficacy Questionnaire, and 
Satisfaction with Training Methods Scale. The escape room was structured in three phases—
prebriefing, simulation, and debriefing—following INACSL standards.  
Results  
The average age of the participants was 23.5, and 43.5% had previously completed an elective 
course on patient safety. Analyses revealed that students spent the most time, averaging 2.59 
minutes, in the room dedicated to information questions. The average self-efficacy score before 
the intervention was 61.26, which increased to 71.32 after the intervention, and participants 
reported a high level of satisfaction. 
Conclusion 
Our study's findings indicate that patient safety-themed escape room training significantly 
enhances students' self-efficacy in patient safety, as well as their overall satisfaction and 
motivation. 
Keywords  
Patient safety, escape room, nursing education, teaching methods. 
 
 

3 
 
Introduction  
Everyone has the fundamental right to live in a healthy and safe environment (WHO, 2007). 
However, safety issues that arise within healthcare settings can compromise this right, posing 
significant risks to patient well-being. The US National Patient Safety Foundation (NPSF) 
underscores the critical nature of patient safety, defining it as "the prevention of errors related 
to healthcare and the reduction of patient harm caused by such errors" (NPSF, 2011). Ensuring 
patient safety is a cornerstone of nursing practice, and its foundation is established during 
nursing education (Mansour et al., 2018; WHO, 2011). Patient safety education has traditionally 
been delivered primarily through theoretical instruction, focusing on cognitive aspects. 
However, the integration of psychomotor skills and patient safety into laboratory applications 
has often been insufficient, leading to a potential gap in students' awareness and application of 
patient safety principles in clinical practice (DeBourgh & Prion, 2011). 
In response to these challenges, Joint Commission International (JCI) (2011) has established 
"International Patient Safety Goals," which include correct patient identification, enhanced 
communication, improved safety of high-risk medications, correct-site and correct-procedure 
surgery, reduction of healthcare-associated infections, and minimization of patient harm from 
falls. To achieve these goals, JCI advocates for the adoption of active teaching methods that 
holistically address the cognitive, affective, and psychomotor dimensions of patient safety in 
health education (JCI, 2011; Aktaş & Göçmen Baykara, 2023).  
Innovative teaching methods that actively engage students and cater to diverse learning styles 
are increasingly recognized as essential in nursing education (San Martin et al., 2021). Among 
these methods, gamification—transforming educational content into interactive and engaging 
experiences—has gained prominence. Gamification, such as the "Escape Room" approach, 
enhances learning by transforming passive students into active participants, thereby making the 
educational process more dynamic and effective (Aktaş & Göçmen Baykara, 2023; Culha, 

4 
 
2019; Wynn, 2021). In an escape room scenario, teams of 2-10 members work together to solve 
puzzles and complete tasks, progressing through multiple rooms with time constraints and 
optional hints for time management (Sánchez-Martín et al., 2020; Mullen & Seiler, 2019; 
Guckian et al., 2020). This method has been shown to improve students' cooperation, 
communication, critical thinking, and active learning, while also enhancing their motivation, 
knowledge acquisition, and team-building skills (Davis, 2022; Gómez-Urquiza et al., 2022). 
The escape room approach is increasingly being utilized across various healthcare disciplines, 
including nursing, medicine, pharmacy, physiotherapy, and pharmacology (Satır et al., 2022). 
Research on its application in nursing education has demonstrated that simulation-based escape 
rooms help identify patient safety hazards, boost students’ self-confidence, and provide 
valuable opportunities for inter-professional education by highlighting the shared responsibility 
of maintaining a culture of safety (Diemer et al., 2019). Moreover, studies have shown that 
nursing students not only increase their awareness of patient safety through active participation 
in escape rooms but also find the experience enjoyable and motivating (Garwood, 2020). For 
instance, Dacanay et al. (2021) reported that an escape room themed around sepsis care 
enhanced students' ability to retain and apply critical thinking skills, leading to positive 
outcomes in both knowledge retention and skill development. Similarly, Gracia et al. (2021) 
found that nursing students had fun and effectively acquired professional competencies while 
playing an escape room game during a community health course, validating the use of 
gamification as a teaching strategy. 
This study aims to empower senior nursing students to develop self-efficacy in patient safety 
practices through the "Escape Room" teaching method. 
Method  
Design 

5 
 
The research was conducted in a quasi-experimental type with a one-group pretest-posttest 
design. The study complied with the TREND Checklist guidelines, and the research flow 
diagram created by the researchers was based on TREND (Figure 1). 
Sample  
The study population included senior students at XX Faculty of Nursing, University of XX, 
between February 2024 and May 2024 (N=95). Students who volunteered to participate were 
included in the sample without sample calculation. The inclusion criteria were (a) being 18 
years of age or older, (b) being a fourth-year nursing student, (c) completing the data collection 
forms in full, and (d) volunteering to participate in the study. Being in the escape room for more 
than 6 minutes in each room was set as an exclusion criterion. 
Hypothesis 
H11: Patient safety-themed escape room teaching method increases students’ self-efficacy in 
patient safety practices in nursing students.  
H12: Patient safety-themed escape room teaching method increases nursing students’ 
satisfaction. 
Data Collection Tools 
As data collection tools in this research student Information Form, Patient Safety Self-Efficacy 
Questionnaire and Satisfaction with Training Methods were used. Informed consent was 
obtained from the students in the study, which was conducted on a voluntary basis. 
Student Information Form 
The form was developed by the researchers in line with the literature and consists of 5 questions 
to determine participants’ demographic information, including age, gender, type of school they 
graduated from, and whether they have attended the elective course on patient safety.  
Patient Safety Self-Efficacy Questionnaire  

6 
 
The structural content of the patient safety self-efficacy questionnaire created by the researchers 
was created with reference to Eskici et al. (Eskici at al., 2021). It includes a degree of 
competence between 0-75 (0=insufficient, 5=sufficient) for each goal. Fifteen headings were 
determined by matching the keywords in the ‘International Patient Safety Goals’ set by JCI 
(Table 1). These headings were finalised by consulting five experts in the field. A minimum 
score of 0 and a maximum score of 75 can be obtained from the questionnaire. High scores will 
indicate high self-efficacy for patient safety. Low scores would indicate low self-efficacy for 
patient safety. 
Table 1. Patient Safety Self-Efficacy Headings 
1. I can establish safe communication that can ensure patient safety.  
2. I can cooperate with other disciplines for patient safety.  
3. I can use reporting systems for patient safety.  
4. I can make safe patient transfers.  
5. I can determine the safe site when practicing giving injections to the patient.  
6. I can calculate the safe dose range in drug applications.  
7. I can take the necessary security measures to verify patient identity. 
8. I can use colour codes (red-white-blue-pink) in the hospital. 
9. I can ensure patient privacy safely. 
10. I can take precautions for falls in patient safety. 
11. I can recognise the safe connections of medical materials given to the patient. 
12. I can recognise applications that may infect the patient. 
13. I can ensure the safety of medical supplies given to the patient in terms of infection. 
14.  I can recognise situations that may threaten patient safety related to the patient’s environment.  
15. I can take precautions for pressure injuries in patient safety.  
 
Satisfaction with Training Methods Scale 
The scale was developed by Gürpınar (Cronbach’s alpha: 0.84) and used in their studies. It 
contains 16 propositions, with each proposition scored on a 5-point Likert scale (1=strongly 
disagree, 2=disagree, 3=undecided, 4=agree, 5=strongly agree). High average scores indicate 
that students' satisfaction with the education method is high. Low average scores indicate that 

7 
 
students' satisfaction with the education method is low. Students can rate their satisfaction with 
the training methods with a minimum of 16 and a maximum of 80 points. 
Interventions 
All participants who volunteered for the study were thoroughly briefed on the duration, flow, 
and expectations of the interventions. Both verbal and written consent were obtained from each 
participant. The date and time for the escape room activity were scheduled, and students were 
notified accordingly. Participants were required to assemble into teams of four to six members 
and report to the Nursing Simulation Laboratory within the designated time frame. 
The Patient Safety Self-Efficacy Questionnaire was administered as a pre-test prior to the 
commencement of the escape room activity. The design and implementation of the escape room 
adhered to the ‘Best Practice Standards’ established by the International Nursing Association 
for Clinical Simulation and Learning (INACSL) Standards Committee and the INACSL Board 
of Directors (INACSL, 2016). 
The intervention was structured in three phases: prebriefing, simulation training (Escape 
Room), and debriefing. Following the debriefing session, participants completed the Patient 
Safety Self-Efficacy Questionnaire and the Satisfaction with Training Methods Questionnaire. 
Escape Room Design 
The escape room was created in three stages: prebriefing, simulation and debriefing, under 
INACSL standards (INACSL, 2016). 
A- Prebriefing 
Prior to the commencement of the escape room simulation, students underwent a 
comprehensive orientation session. This session included: 
• 
Introduction to the simulation environment and management procedures within the 
simulation laboratory. 

8 
 
• 
Provision of foundational information regarding patient safety principles that would be 
integrated into the escape room experience. 
• 
Explanation of the objectives and expected outcomes for the students. 
• 
Obtaining consent for video and photo documentation of the simulation. 
• 
Emphasis on the importance of confidentiality concerning the escape room's design and 
content to prevent information leakage. 
• 
Detailed description of the escape room setup: the laboratory was divided into three 
distinct rooms.  
The first room featured four knowledge-based questions and one skill-based question, 
the second room addressed medication dosage calculations and patient safety issues 
related to mother-infant care, and the third room focused on patient safety concerns 
within an intensive care setting. Students were informed that they would have a 
maximum of six minutes in each room. Correct responses to the questions were assigned 
letters, and the completion of five correct answers would form the word "T-A-M-A-M" 
(Turkish for "OKAY"), which served as the key to proceed to the next room. Successful 
completion of all three rooms would be followed by evaluation based on the time spent 
in each room. A facilitator was available to provide hints if students exceeded the time 
limit of five minutes per room. 
B- Simulation - Escape Room  
First Room (Patient Safety - Knowledge Notes): 
Upon entering the room, the timer was activated. Students were tasked with answering 
five patient safety-related questions: 
1. List three practices that ensure safe communication in patient safety. 
2. Identify three practices for effective inter-disciplinary collaboration in patient 
safety. 

9 
 
3. Name three reporting systems used for patient safety. 
4. Describe three practices that ensure safe patient transfer. 
5. Demonstrate the safe injection site in the gluteal area (ventrogluteal area) using 
a skill model. 
Second Room (Mother-Infant Room): 
In this room, students were required to perform a medication dosage calculation relevant 
to patient safety and identify four patient safety threats: 
1. Calculation of a safe drug dose range. 
2. Identification of different mother-infant patient wristbands. 
3. Utilization of color codes (red, white, blue, pink) in the hospital setting. 
4. Ensuring maternal privacy. 
5. Addressing safety concerns with open incubator edges. 
Third Room (Adult Intensive Care Unit): 
• 
Students were asked to identify five practices that pose threats to patient safety: 
1. Incorrect connection of medical equipment (e.g., intravenous treatment 
administered through a nasogastric catheter). 
2. Presence of bloody and dirty peripheral catheter dressing. 
3. Oxygen mask tip exposed and in contact with the floor. 
4. Sharp objects present on the patient’s bed. 
5. Patient cables and connections passing under the patient, risking pressure 
injuries. 
C- Debriefing 
• 
The debriefing phase utilized the Promoting Excellence and Reflective Learning in 
Simulation (PEARLS) method (Eppich & Cheng, 2015). This method encompasses 
four stages: reaction, definition, analysis, and summarization. 

10 
 
• 
During this phase, students engaged in reflective discussion about their experiences, 
including their practices, decision-making processes, and the outcomes of the 
simulation exercise. The aim was to facilitate a thorough understanding and learning 
from their simulation experience. 
Legal and Ethical Aspects of the Research 
Permission dated 18.04.2024 and numbered 27424 was obtained from XX University, XX 
Scientific Research Ethics Committee, as well as from the institution where the research was 
conducted. Informed Consent Forms were obtained from the participants. Permission to use the 
scale was granted. 
Statistical Methods  
The data obtained in the study were evaluated by using IBM SPSS Statistics for Windows, 
Version 22.0 (SPSS INC., Chicago, IL, USA) statistical software. Frequency and percentage 
analyses were used to determine the descriptive characteristics of the participants. Kurtosis and 
Skewness values were analysed to determine whether the research variables were normally 
distributed. Since the variables showed normal distribution, parametric methods were used in 
the analysis. Dependent groups t-test was used for the comparison of intragroup measurements. 
Independent groups t-test was used to compare quantitative continuous data between two 
independent groups.  
Results 
According to participant information, the average age of the students was 23.5 years, with 
69.6% being female. 84.8% graduated from Anatolian high schools, 8.7% from science high 
schools, and 6.5% from health vocational high schools. 43.5% had previously taken a patient 
safety course. 
It was observed that students spent the most time in the escape room with information 
questions, averaging 2.59 minutes. They spent an average of 1.18 minutes in the second room 

11 
 
and 1.12 minutes in the third room. The average time for students to complete the escape 
room was 5.29 minutes (Table 2). 
Table 2. Duration of Stay in Rooms  
Rooms 
Mean ± SD 
First room 
2.59 ± .85 
Second room 
1.18 ± .21 
Third room 
1.12 ± .32 
Total time 
5.29 ± 1.4 
Note. SD: Standard Deviation 
The mean score of the Patient Safety Self-Efficacy Questionnaire before the application was 
61.26. After the application, the score was 71.32, showing an increase of 10.06 points. The 
increase in score after the application was significant (p < .05). Students reported high 
satisfaction with the escape room training method, with a satisfaction score of 73.71 (Table 3). 
Table 3. Comparison of Score Averages from Patient Safety Self-Efficacy Questionnaire 
Before and After the Escape Room 
Groups   
Mean ± SD 
t* 
p 
PSSE pre-test 
61.26 ± 13.43 
-5.176 
< .001 
PSSE post-test 
71.32 ± 4.7 
Note. *: Paired sample t-test, PSSE: Patient Safety Self-Efficacy n: Number of participants, SD: Standard 
Deviation  
When analyzing the effect of taking a patient safety course on self-efficacy evaluations in the 
patient safety-themed escape room training method, it was found that whether or not students 
had taken the patient safety course did not create a significant difference in self-efficacy pre-
test and post-test scores (p > .05). In intragroup comparisons, a significant increase of 12.05 
points was observed in students who had taken the patient safety course (p < .05). Similarly, a 
significant increase of 8.54 points was observed in students who had not taken the patient safety 
course (p < .05) (Table 4). 

12 
 
Table 4. Comparison of Score Averages from Patient Safety Self-Efficacy Test Before 
and After the Escape Room According to Patient Safety Course 
Groups   
Course taken (n=20) 
Course not taken (n=26) 
ta 
p 
Mean ± SD 
Mean ± SD 
PSSE pre-test 
59.80 ± 16.96 
62.38 ± 10.16 
-.642 .524 
PSSE post-test 
71.85 ± 3.26 
70.92 ± 5.64 
.654 
.516 
tb 
-3.412 
-4.01 
 
 
p 
.003 
< .001 
 
 
Note. a T-Test in Independent Groups; b T-Test in Dependent Groups, PSSE: Patient Safety Self-Efficacy, n: 
Number of participants, SD: Standard Deviation 
 
Discussion 
In contemporary healthcare services, the cultivation and application of critical thinking, 
problem-solving, and clinical decision-making skills are crucial for ensuring patient safety 
(Noviyanti et al., 2021). The implementation of innovative teaching strategies, such as the 
escape room approach in nursing education, has been shown to significantly enhance these 
essential skills, thereby promoting optimal and safe patient care. Additionally, this method 
encourages collaborative learning among students (Barker et al., 2020; Vestal et al., 2021; 
Edwards et al., 2019). Our study sought to evaluate the effectiveness of a patient safety-themed 
escape room applied to senior nursing students, and the results were compelling. 
The findings indicate that the approach increased students' knowledge levels and provided 
clinical experience. This approach reduces the risk of patient harm by engaging with clinical 
scenarios in a controlled environment. As a result, students have improved their clinical 
decision-making abilities, enhanced their practical skills, and increased their awareness of 
patient safety. Previous studies have reported similar positive outcomes, such as increased 
confidence and shifts in perspective among nursing and medical students engaged in patient 
safety-themed escape room activities (Zhang et al., 2019; Diemer et al., 2019; San Martin et al., 
2021). 

13 
 
Our study demonstrated a statistically significant increase in the mean scores of the Patient 
Safety Self-Efficacy Test following the escape room intervention. Notably, the most 
challenging aspect for students was the task of sorting anatomical structures, with all groups 
spending the most time in the first room, where they answered questions related to patient safety 
and identified the ventrogluteal injection site. This finding aligns with the results of Molina-
Torres et al. (2022), where students described the escape room as a game-based approach that 
offered a realistic and effective resource for anatomy learning. 
Studies have observed that nursing students who participated in escape room activities reported 
higher retention of information, increased motivation, and greater satisfaction (Darby et al., 
2020; Gomez-Urquiza et al., 2019; Kinio et al., 2018; Gutiérrez-Puertas et al., 2020; Smith & 
Paul, 2021). Similarly, our study found that student satisfaction levels were high. 
Moreover, research has established that innovative educational approaches—including active 
learning, simulation, concept mapping, reflective learning, inverted classrooms, and escape 
rooms—are effective in developing critical thinking, communication, problem-solving, 
teamwork, and creative thinking skills (Gutiérrez-Puertas et al., 2020; Hursman et al., 2022; 
Soares et al., 2023; Antón-Solanas et al., 2022; Shatto et al., 2019). Anguas-Gracia et al. (2021) 
found that students enjoyed game-based learning, were motivated to study more, and believed 
that such games should be more widely incorporated into nursing education. They also reported 
that these games helped them retain theoretical knowledge and apply it in practice (Antón-
Solanas et al., 2022). In line with these findings, our research revealed that students valued the 
escape room method for its emphasis on teamwork and communication skills. They reported 
that the activity was enjoyable, informative, and memorable, with potential for practical 
application. 
This study substantiates that the escape room approach effectively enhances students' 
knowledge and skills related to patient safety practices. Furthermore, based on student 

14 
 
feedback, the game was not only engaging and motivating but also contributed to the 
development of critical thinking and communication skills. We conclude that the escape room 
can be a valuable tool for identifying and addressing patient safety concerns, providing students 
with an enjoyable and motivating learning experience. 
Conclusion 
In the 21st century, lifelong learning, innovation, and digital literacy are essential competencies 
for educators. As such, it is imperative to employ diverse teaching and learning strategies, along 
with continual curriculum development, to prepare students to excel in creativity, problem-
solving, clinical decision-making, communication, and critical thinking (Taraldsen et al., 2020). 
The escape room approach is an innovative pedagogical tool that not only heightens learners’ 
motivation but also enhances the engagement with the subject matter. 
Our study demonstrated that integrating patient safety-themed escape room training into the 
curriculum significantly enhances nursing students’ self-efficacy in patient safety, while also 
boosting their satisfaction and motivation. The adoption of such innovative educational 
practices has the potential to not only improve the competency of nursing graduates but also to 
instill a heightened awareness of patient safety, ultimately contributing to safer healthcare 
environments 
Acknowledgments 
We thank all participants who agreed to take part in the study. 
Funding 
No funding has been granted for this paper. 
References 
Antón-Solanas, I., Rodríguez-Roca, B., Urcola-Pardo, F., Anguas-Gracia, A., 
Satústegui-Dordá, P. J., Echániz-Serrano, E., & Subirón-Valera, A. B. (2022). An 
evaluation of undergraduate student nurses' gameful experience whilst playing a digital 

15 
 
escape room as part of a FIRST year module: A cross-sectional study. Nurse Education 
Today, 118, 105527. https://doi.org/10.1016/j.nedt.2022.105527  
Aktaş, N., & Göçmen Baykara, Z. (2023). Escape Rooms As An Innovatıve 
Teachıng Strategy In Nursıng Educatıon. Journal of Gazi University Health Sciences 
Institute 8(1): 62-69. https://doi.org/10.52881/gsbdergi.1188475 
Anguas-Gracia, A., Subiron-Valera, A.B., Anton-Solanas, I., Rodríguez-Roca, B., 
Satustegui-Dord, P.J., & Urcola-Pardo, F. (2021). An evaluation of undergraduate student 
nurses gameful experience while playing an escape room game as part of a community 
health 
nursing 
course. 
Nurse 
Education 
Today, 
103,104948. 
https://doi.org/10.1016/j.nedt.2021.104948 
Barker, N., Kaulback, M.& Yocom, D. (2020).  Fluid and electrolyte escape room. 
Journal of Nursing Education, 59:298–298. https://doi.org/10.3928/01484834-20200422-
14 
Culha, İ. (2019).  Active learning methods used in nursing education. Journal of 
Pedagogical Research, 3(2). http://dx.doi.org/10.33902/JPR.2019254174 
DeBourgh, G.A., & Prion, S.K. (2011). Using simulation to teach prelicensure 
nursing students to minimize patient risk and harm. Clinical Simulation in Nursing, 7(2), 
e47-e56. DOI:10.1016/j.ecns.2009.12.009 
Davis, K., Lo, H.Y., Lichliter, R., Wallin, K., Elegores, G., Jacobson, S.& 
Doughty, C. (2022).  Twelve tips for creating an escape room activity for medical 
education. Medical Teach, 44: 366-371. https://doi.org/10.1080/0142159X.2021.1909715 

16 
 
Dacanay, A.P., Sibrian, J., Wyllie, C., Sorrentino, E. & Dunbar, G. (2021).  can you 
escape sepsis? using a healthcare escape room as an innovative approach to nursing 
education. Clinical Nurse Specialist, 35(2):65-72. DOI: 10.1097/NUR.0000000000000578 
Darby, W., Bergeron, P., Brown, N., DeFoor, M., & Jones, B. (2020). Escape room 
relay race: "go for the gold" in formative assessment. The Journal of Nursing 
Education, 59(11), 646–650. https://doi.org/10.3928/01484834-20201020-09 
Diemer, G., Jaffe, R., Papanagnou, D., Zhang, X. C., & Zavodnick, J. (2019). Patient 
safety escape room: a graduate medical education simulation for event reporting. The 
Journal 
Of 
Teaching 
And 
Learning 
Resources, 15, 
10868. 
https://doi.org/10.15766/mep_2374-8265.10868 
Edwards, T., Boothby, J. & Succheralli, L. (2019). Escape room: using an innovative 
teaching strategy for nursing students enrolled in a maternity clinical course. Teaching And 
Learning İn Nursing, 14(4), 251-253. DOI:10.1016/j.teln.2019.05.001 
Eppich, W., & Cheng, A. (2015). Promoting excellence and reflective learning in 
simulation (PEARLS): Development and rationale for a blended approach to health care 
simulation 
debriefing. 
Simulation 
in 
Healthcare, 
10(2), 
106-115. 
DOI: 
10.1097/SIH.0000000000000072 
Eskici, G. T., Kanig, M., Ugur, E., & Seren, A. K. H. (2021). The Turkish version 
of the patient safety competency self-evaluation tool: a validity and reliability study. Nurse 
Education in Practice, 57, 103229. https://doi.org/10.1016/j.nepr.2021.103229 
Guckian, J., Eveson, L. & May, H. (2020).  The great escape? the rise of the 
escape room in medical education. Future Healthcare Journal, 7:112–115. DOI: 
10.7861/fhj.2020-0032 

17 
 
Gómez-Urquiza, J.L., Hueso-Montoro, C., Correa-Rodríguez, M., Suleiman-
Martos, N., Martos-Cabrera, M.B., Gómez-Salgado, J. & Albendín- García, L. (2022).  
Nursing students' experience using an escape room for training clinical skills and 
competencies on emergency care: a qualitative observational study.  Medicine 
(Baltimore), 101(30): e30004.doi: 10.1097/MD.0000000000030004 
Garwood, J. (2020). Escape to learn! an innovative approach to engage students in 
learning. Journal of Nursing Education, 59:278–282. DOI: 10.3928/01484834-20200422-
08 
Gracia, A., Valera, A., Solanas, I., Roca, B., Dordá, P.& Pardo, F. (2021).  An 
evaluation of undergraduate student nurses' gameful experience while playing an escape 
room game as part of a community health nursing course. Nurse Education Today,103, 
104948. https://doi.org/10.1016/j.nedt.2022.105527 
Gomez-Urquiza, J. L., Gomez-Salgado, J., Albend_ın-Garcıa, L., Correa-
Rodr_ıguez, M., Gonzalez-Jim_enez, E., & Canadas-Dela Fuente, G. A. (2019). The impact 
on nursing students’ opinions and motivation of using a ‘‘nursing escape room’’ as a 
teaching 
game: 
a 
descriptive 
study. 
Nurse 
Education 
Today, 
72; 
73-76. 
https://doi.org/10.1016/j.nedt.2018.10.018.  
Gutiérrez-Puertas, L., Márquez-Hernández, V.V., Román-López, P., Rodríguez-
Arrastia, M.J.,  Ropero-Padilla, C., & Molina-Torres, G. (2020). Escape rooms as a 
clinical evaluation method for nursing students. Clinical Simulation in Nursing, 49, 73-80. 
https://doi.org/10.1016/j.ecns.2020.05.010 

18 
 
Gurpinar, E. (2007). Instructional Technologies in Medical Education: Integration 
of E-Learning and Problem Based Learning. Unpublished Master's Thesis, Akdeniz 
University, Health Sciences Institute, Antalya.  
Gurpinar, E., Zayim, N., Basarici, I., Gunduz, F., Asar, M., & Oguz, N. (2009). 
Integration of e-learning and problem based learning in cardiology education. Anatolian 
Cardiology Journal, 9, 158-164. 
Hursman, A., Richter, L. M., Frenzel, J., Viets Nice, J., & Monson, E. (2022). An 
online escape room used to support the growth of teamwork in health professions 
students. Journal 
Of 
İnterprofessional 
Education 
& 
Practice, 29, 
100545. 
https://doi.org/10.1016/j.xjep.2022.100545 
INACSL Standards Committee (2016). INACSL standards of best practice: 
simulation outcomes and objectives. Clinical Simulation in Nursing, 12(S), 13-15. 
http://dx.doi.org/ 10.1016/j.ecns.2016.09.006.  
Joint Commission International (2011). Accreditation Standards for Hospitals, 
U.S.A. 
Access 
Date: 
29.05.2024 
https://www.jointcommissioninternational.org/standards/international-patient-safety-
goals/ 
Kinio, A., Dufresne, L., Brandys, T., & Jetty, P. (2018). Break out of the classroom: 
the use of escape rooms as an alternative learning strategy for surgical education. Journal 
Of Vascular Surgery, 66(3), E76. Https://Doi.Org/10.1016/J.Jvs.2017.07.034. 
Mansour, M.J., Shadafan, S.F.A., Abu-Sneineh, F.T., & AlAmer, M.M. (2018). 
Integrating patient safety education in the undergraduate nursing curriculum: a discussion 
paper. The Open Nursing Journal, 12, 125-132. doi: 10.2174/1874434601812010125 
Molina-Torres, G., Cardona, D., Requena, M., Rodriguez-Arrastia, M., Roman, P., 
& Ropero-Padilla, C. (2022). The impact of using an "anatomy escape room" on nursing 

19 
 
students: a comparative study. Nurse education today, 109, 105205. 
https://doi.org/10.1016/j.nedt.2021.105205 
Noviyanti, L., Ahsan, A., Sudartya, T.S. (2021).Exploring the relationship between 
nurses’ communication satisfaction and patient safety culture. Journal of Public Health 
Research, 10(10). doi: 10.4081/jphr.2021.2225 
Sánchez-Martín, J., Corrales-Serrano, M., Luque-Sendra, A. & Zamora-Polo, F. 
(2020).  Exit for success. gamifying science and technology for university students using 
escape-room a preliminary approach. Heliyon 6(7), e04340. 
https://doi.org/10.1016/j.heliyon.2020.e04340 
Satır, G., Kaya, G. & Kızılkaya Beji, N. (2022). New methods in nursing 
education: escape room and virtual escape room. Journal of Health Science Yuksek Ihtisas 
University, 3:69-72. https://doi.org/10.51261/yiu.2022.00050 
San Martin, L., Walsh, H., Santerre, M., Fortkiewicz, J., & Nicholson, L. (2021). 
Creation of a "patient" hospital escape room experience to reduce harm and ımprove quality 
of 
care. Journal 
of 
Nursing 
Care 
Quality, 36(1), 
38–42. 
https://doi.org/10.1097/NCQ.0000000000000485 
Soares, R. V., Barel, P. S., Leite, C. C., Letícia Dos Santos, L., Junior, F. C. S., de 
Carvalho, E. R., Gianotto-Oliveira, R., & Cecilio-Fernandes, D. (2023). Implementation of 
escape room as an educational strategy to strengthen the practice of safe surgery. Journal 
of Surgical Education, 80(7), 907–911. https://doi.org/10.1016/j.jsurg.2023.04.016 
Shatto, B., Shagavah, A., Krieger, M., Lutz, L., Duncan, C. E., & Wagner, E. K. 
(2019). Active learning outcomes on NCLEX-RN or standardized predictor examinations: 

20 
 
an 
integrative 
review. 
Journal 
of 
Nursing 
Education, 
58(1), 
42-46. 
https://doi.org/10.3928/01484834-20190103-07.  
Taraldsen, L.H., Haara, F.O., Lysne, M.S., Jensen, P.R.& Jenssen, E.S. (2020).  A 
review on use of escape rooms in education –touching the void. Education Inquiry, 13:169–
184. https://doi.org/10.1080/20004508.2020.1860284 
The National Patient Safety Foundation-NPSF. Agenda for Research and 
Development in Patient Safety. Available from NPSF Announces 2011 Patient Safety 
Awareness Week (prnewswire.com) (Access Date: 29.05.2024). 
Vestal, M.E., Matthias, A.D.& Thompson, C.E. (2021). Engaging students with 
patient safety in an online escape room. Journal of Nursing Education, 60:466–469. 
https://doi. org/10.3928/01484834-20210722-10 
WHO, (2007), The Right To Health Joint Fact Sheet WHO/ OHCHR /323. 
http://www.who.int/mediacentre/factsheets/fs323_en.pdf (Access Date: 29.05.2024). 
World Health Organization (2011). Patient Safety Curriculum Guide: Multi-
Professional Edition. Geneva. https://www.who.int/publications/i/item/9789241501958 
(Access Date: 29.05.2024). 
Wynn, L. (2021).  An escape room simulation focused on renal-impairment for 
prelicensure nursing students. Teaching and Learning in Nursing,16:95–99. https://doi. 
org/10.1016/j.teln.2020.09.006  
Zhang, X. C., Diemer, G., Lee, H., Jaffe, R., & Papanagnou, D. (2019). Finding the 
'qr' to patient safety: applying gamification to ıncorporate patient safety priorities through a 
simulated 
'escape 
room' 
experience. Cureus, 11(2), 
e4014. 
https://doi.org/10.7759/cureus.4014