Improving Pediatric Nursing Undergraduate Education: An Escape Room on Dehydration in Children

Overview

Nursing education aims to equip students with the knowledge, skills, attitudes, and behaviors required for safe and effective professional practice. However, traditional teacher-centered approaches are often insufficient for developing competencies such as critical thinking, problem-solving, decision-making, communication, and teamwork.Consequently, innovative student-centered teaching strategies are increasingly being integrated into nursing education.Game-based learning is one such strategy that enhances engagement, motivation, active participation, and collaborative learning. Among GBL approaches, the educational escape room combines gamification with problem-solving by requiring students to work collaboratively under time constraints to solve realistic clinical scenarios. This method promotes active learning while strengthening communication, teamwork, leadership, and clinical reasoning skills. Educational escape rooms have been successfully implemented in several areas of nursing education, including women's health, pediatric care, geriatric nursing, cardiovascular diseases, clinical skills, teamwork, and leadership. Despite these developments, evidence regarding their use in pediatric nursing education remains limited.Dehydration is one of the most common pediatric health problems and requires nurses to accurately assess hydration status, recognize clinical findings, and implement appropriate nursing interventions. Competence in dehydration management is therefore essential for pediatric nursing students. To date, no published study has evaluated an educational escape room designed specifically to teach pediatric dehydration management. This study aims to examine the effectiveness of an educational escape room implemented during a pediatric nursing laboratory simulation on nursing students' hydration knowledge, teamwork, and anxiety levels. It is expected that this innovative educational approach will enhance students' knowledge acquisition and teamwork skills while reducing anxiety during learning.

Detailed description

Pediatric nursing education aims to train nurses who can respond safely and effectively to the complex and rapidly changing healthcare needs of children. Accordingly, nursing students are expected to possess not only theoretical knowledge but also clinical reasoning, rapid decision-making, effective communication, teamwork, and psychomotor skills. Therefore, it is recommended that undergraduate nursing education be supported by active and student-centered learning approaches that develop students' critical thinking, problem-solving, clinical decision-making, and teamwork skills. While traditional teaching methods are effective in transferring basic knowledge, they may be limited in developing students' ability to integrate and utilize their clinical knowledge and skills. In contrast, active learning approaches are reported to increase knowledge transfer, clinical performance, and learning retention.Game-based learning, which is among the active learning methods, has been widely used in nursing education in recent years. Process, is reported to increase student participation and motivation in learning, support critical thinking, problem-solving, and knowledge retention, and reduce anxiety related to learning. Furthermore, game-based learning contributes to the development of professional skills necessary for pediatric care, such as communication, leadership, and teamwork.

Educational escape rooms, one of the innovative applications of game-based learning, are a student-centered teaching approach that integrates gamification principles with problem-solving-based learning. In these applications, structured around realistic clinical scenarios, students complete tasks as a team by analyzing clinical clues within a specific time frame; during this process, they simultaneously use communication, clinical reasoning, and decision-making skills. Structured feedback sessions allow students to evaluate their experiences and reinforce their learning.

Recent studies have shown that educational escape rooms have positive effects on nursing students' knowledge level, clinical reasoning, teamwork, and learning satisfaction. Systematic reviews also reveal that this method facilitates the transfer of theoretical knowledge to clinical practice and improves problem-solving and clinical decision-making skills. Although educational escape rooms have been implemented in various nursing fields such as women's health, child health, geriatrics, cardiovascular care, clinical skills, teamwork, and leadership, evidence regarding applications focusing on dehydration management in children is quite limited. Dehydration is a common and significant clinical problem in childhood that can lead to serious morbidity and mortality if not managed properly (source). Therefore, nurses need to have sufficient knowledge and skills to recognize early signs of dehydration, assess the degree of fluid loss, and plan appropriate nursing interventions. However, nursing students have limited opportunities for clinical experience to develop these skills. The literature lacks a study that develops and evaluates the effectiveness of an educational escape room application focusing on the assessment and management of dehydration in children for nursing students. This study, planned to address this research gap, aims to evaluate the effect of an educational escape room, developed within the scope of pediatric nursing laboratory practice, on nursing students' hydration knowledge level, teamwork, and situational anxiety levels.

Interventions

• Other Escape room educational training
  The escape room educational training consisted of a game-based learning activity designed around a pediatric dehydration management scenario. Working in small teams, nursing students completed a series of sequential clinical tasks and puzzles requiring assessment of hydration status, identification of dehydration severity, selection of appropriate nursing interventions, and clinical decision-making within a predetermined time limit. A structured debriefing session followed the activity to reinfo

Primary outcome measures

• Hydration Knowledge Quiz [Time frame: Baseline (immediately before the intervention) and immediately after completion of the educational escape room (approximately 60 minutes later).]
• State Anxiety Scale [Time frame: Baseline (immediately before the intervention) and immediately after completion of the educational escape room (approximately 60 minutes later).]
• Collaboration Scale [Time frame: Baseline (immediately before the intervention) and immediately after completion of the educational escape room (approximately 60 minutes later).]
• Gameful Experience (GAMEX) Gaming Experience Scale [Time frame: Immediately after completion of the educational escape room (same day)]

Eligibility criteria

Inclusion criteria

• • Being a 3rd-year nursing student,
• • Having a GPA above 2,
• • Completing theoretical courses,
• • Completing practical courses,
• • Agreeing to participate in the study,
• • Completing the escape room practice.

Exclusion criteria

• • Retaking the Pediatric Nursing course,
• • Having a high school, associate's, or bachelor's degree in a health-related field,
• • Having prior escape room experience.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: Yes

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Single blind

Primary purpose

Other

Study locations

Center list to be confirmed — check the primary protocol.

Identifiers

NCT: NCT07752537 · 2026-2026

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗