The Effect of Escape Room Method in Nursing Process Teaching

To improve and maintain the quality of nursing care, practices should be based on theoretical knowledge and carried out using the Nursing Process, which is a systematic scientific method. In line with the Nursing Process, the nurse plans, implements, and evaluates nursing interventions for the nursing diagnoses identified through the analysis and evaluation of the data collected regarding the health care needs of the healthy or ill individual. In addition to ensuring individualized and holistic care, the Nursing Process offers many benefits such as promoting critical thinking skills among nurses, enabling efficient use of time and energy in care delivery, distinguishing nursing practices from those of other health care professionals, and making nursing practice more visible. However, national and international studies emphasize that there are both individual and institutional barriers to the use of the Nursing Process in practice. In fact, related studies indicate that nurses experience difficulties in the diagnostic phase of the Nursing Process, particularly in making accurate nursing diagnoses and identifying etiological/related factors.

Therefore, it is important for nurses to acquire the necessary knowledge and skills for implementing nursing care in line with the Nursing Process during their nursing education. Nevertheless, studies have reported that students face challenges in understanding, planning, and applying the Nursing Process due to deficiencies in theoretical knowledge, practice, and experience, as well as inadequate problem-solving skills and difficulties in communication with health care professionals. In this context, it is recommended to incorporate active learning methods that complement traditional teaching methods in nursing education to ensure that nursing students understand and apply the importance of providing appropriate nursing care in accordance with the Nursing Process.

One of the active learning methods that has gained popularity in recent years is the educational escape room method. Educational escape rooms are designed to enable students to achieve specific learning outcomes by finding clues, solving puzzles, completing tasks within a limited time, and working collaboratively. The aim of this collaborative game is usually to escape from the room or to find a specific object. Escape rooms have been shown to significantly improve students' critical thinking and decision-making skills by encouraging them to analyze, evaluate, and solve problems, as well as contributing to the development of problem-solving skills and team collaboration. Among the skills that determine and strengthen problem-solving ability is self-efficacy; however, no study has been found that examines the effect of educational escape rooms on self-efficacy. Furthermore, the literature notes that the time limitation in this method may cause stress and anxiety among participants, yet some studies indicate that it can also reduce students' anxiety. Therefore, further research is needed to investigate the effects of educational escape rooms on self-efficacy and anxiety.

Although the literature on teaching the Nursing Process includes studies using active teaching methods such as virtual games, simulation, and web-based instruction, no study has been identified regarding the escape room method. It is believed that the use of the educational escape room method, an innovative active learning approach that complements traditional methods in teaching the Nursing Process, may be an effective strategy. Indeed, in line with the objectives of undergraduate education, nursing students are expected to graduate as professionals capable of implementing nursing care through the Nursing Process. In this regard, it is of critical importance to repeat interventions and trainings related to the teaching of the Nursing Process before students graduate. Within this scope, the present study will be conducted to determine the effectiveness of education provided through the educational escape room method in nursing process teaching and to examine its effects on 4th-year nursing students' self-efficacy, teamwork, and anxiety. This research will be conducted in a randomized experimental design with pretest-posttest experimental and control groups.The study sample will consist of senior nursing students who meet the inclusion criteria and agree to participate in the study. The students included in the sample will be randomly assigned to either the experimental or control group. The sample size of the study was calculated using a power analysis. Based on the data of a referenced study, the analysis indicated that with an effect size of 1.03, a power of 99%, and a significance level of 0.05 with a confidence interval, the required sample size was determined to be 62 fourth-year nursing students (a minimum of n=31 students per group). In order to increase the reliability of the study and to allow the use of parametric tests, the total sample size was determined as n=70, with 35 students in the experimental group and 35 students in the control group, taking into account possible data losses (such as dropouts). Randomization will be achieved through simple random sequencing using a randomization method. Participants will be randomly assigned to the experimental and control groups.Data will be analyzed using the SPSS (Statistical Package for Social Sciences) version 25.0 software. Data will be collected through the "Student Information Form," "Nursing Process Knowledge Test," "Self-Efficacy for Clinical Performance Scale," "Collaboration Scale," "State-Trait Anxiety Inventory," and the "Quality Measurement Tool for Nursing Diagnoses, Interventions, and Outcomes."