Adapting the Escape Room to Engage Learners Two Ways During COVID-19

When creating the project, “An Escape Room Simulation Focused on Renal-Impairment for Prelicensure Nursing Students” [1] the author’s goal was to increase positive health outcomes for patients with acute kidney injury (AKI). AKI is complicated, but nurses who can help identify those at risk for the disorder and help initiate early treatment can improve patients’ results [2-5]. This paper focuses on how the original escape room idea, created out of a need to engage learners and grow their clinical judgment, evolved to support nursing education needs during the COVID pandemic of 2020.


Introduction
When creating the project, "An Escape Room Simulation Focused on Renal-Impairment for Prelicensure Nursing Students" [1] the author's goal was to increase positive health outcomes for patients with acute kidney injury (AKI). AKI is complicated, but nurses who can help identify those at risk for the disorder and help initiate early treatment can improve patients' results [2][3][4][5]. This paper focuses on how the original escape room idea, created out of a need to engage learners and grow their clinical judgment, evolved to support nursing education needs during the COVID pandemic of 2020.
One needs only to turn on the television, open a social media account, or travel to the store to experience the effects of COVID-19. The pandemic has instituted a new way of living for the globe. The novel virus has impacted nurses and nursing education. In response to COVID-19, nursing education has transitioned many activities online to support social distancing and quarantine efforts [6]. Additionally, Haas [7] describes many stressors bedside nurses have experienced during the pandemic, including long work hours and extra responsibilities. In this unprecedented time, innovative strategies that assist the development of competent nurses without increasing their stress are more important than ever.
Wynn's [1] article cited literature in support of gaming as one of those strategies nurse leaders can utilize to transform learners into critical thinkers [8][9][10][11][12]. Another recent study by Blanié [13] noted that gaming as a teaching strategy produced increased satisfaction over traditional approaches. Satisfaction is something a pandemic era craves to promote resilience during stressful times. Before the pandemic, the escape room showed promise as an innovative approach because enjoyment in learning enhances the process.
Using a game as a teaching strategy was the premise for the article "An Escape Room Simulation Focused on Renal-Impairment for Prelicensure Nursing Students" [1]. The escape room game from the article proved to be successful because it engaged the learner to foster deep learning while providing a less stressful approach to simulation [1]. Current literature explains that the method is useful to teach a variety of concepts and, like other gaming strategies, participants enjoy escape rooms [14][15][16][17][18][19][20]. Learner satisfaction and versatility were the impetus for adopting the escape room approach to assist two diverse learner groups, prelicensure students and registered nurses.
The first adaptation of the escape room activity benefited nursing students. Following the original escape room, necessity mandated the author transform the actual escape room into a virtual escape room for online nursing students who could not attend classes on campus. Students soon to enter the workforce still needed to learn how to care for patients with AKI competently. However, social distancing and quarantining mandates made an in-person simulation unwise. To help students, the author transformed clues from the escape room into computer documents that were passcode protected.
During a video conference, students viewed a series of Google docs screen-shared by the host who narrated the scene, provided instructions, and started a timer. Students had to answer a series of questions to retrieve codes to open new documents with more clues and escape the virtual room. The host incorporated memes and graphics into the documents to visually enhance the student experience and create a game atmosphere. Students were required to think critically to answer the questions and use J Diabetes Clin Res. 2021 Volume 3, Issue 1 teamwork to complete the assignment. This adaptation of an escape room was a successful alternative to the inperson simulation, providing engagement and developing clinical judgment skills while helping students abide by social distancing and quarantining requirements needed to stop the spread of COVID-19.
COVID -19 has created increased stress for nurses working in acute care settings in 2020. Another reason to utilize the escape room approach is to promote learning using a well-received modality that fosters socialization and motivation [21]. The second adaptation of the escape room promoted learning for acute care nurses using fun and teamwork to decrease stress and provide motivation to complete required annual competency activities. A nurse educator used the original article as the foundation for a second escape room for registered nurses working on a maternity floor at a hospital in Birmingham, Alabama. The educator desired to decrease nurses' stress and increase their enthusiasm for an annual education fair on the unit (A. Camp, personal communication, December 7, 2020). To provide yearly teaching for RN's on an acute care unit, the escape room method trained nurses on the priority actions to take during a postpartum hemorrhage to encourage friendly competition, bonding, and decrease stress for their annual required hospital education. Teams of four nurses received a simulated patient report and four clues to solve to escape the room. One of the inpatient rooms was utilized for the escape room along with one of the unit's postpartum hemorrhage kits, a manikin, and cranberry sauce filled peri pads and absorbent sheet pads. Several of the groups escaped, and one group completed the activity in only 5 minutes. The nurses' perception of the exercise was positive, and each group actively engaged in the escape room.
The application of the escape room for hospital nurses allowed them to review essential actions to take to care for a postpartum hemorrhage patient while creating a competition with a reward. The team who escaped first won a gift certificate for food and bragging rights for the year until the next annual education fair on the unit. Hosting a fun activity on the unit boosted morale. It decreased stress for nurses who did perceive the escape room as another extraneous work requirement, but as a novel activity that invoked curiosity and anticipation. It was a break from the typical simulation on a postpartum hemorrhage.
The escape room concept is adaptable and relevant, considering the COVID pandemic. It can be used remotely and crosses educational boundaries from prelicensure to licensed nurses as a less stressful learning approach. Once the author learned how to use the escape room strategy, incorporating the method into various circumstances was feasible and beneficial. In today's healthcare environment, learning activities that promote increased clinical judgment and are entertaining are worthwhile teaching strategies.