The goal of escape rooms is to leave, but these nursing students are having too much fun. UNLV Nursing graduate student Jennifer Peltier is helping students break out of the classroom by introducing interactive escape rooms as a means of preparing nursing students for clinical simulations. Working together, students investigate their surroundings and solve puzzles to learn about the tools and techniques required in their labs.

In-and-Out of the Escape Rooms

Operating out of California State University, Stanislaus (with Simulation Program Director and UNLV Nursing alumna Wendy Matthew), Peltier created six different escape rooms, each with their own subject material and challenges.

In the community health escape room, students must locate puzzle pieces by finding potential health risks within the apartment simulation room. Peltier explains the key to leave may be hidden inside unhealthy food or under a baby sleeping on its stomach.

Other escape rooms teach students how to properly treat conditions like obstetrical hemorrhages or diabetic comas. Examples of tasks students would have to complete include reading an ID band, locating a drug book to identify materials around the room, and equipping a blood pressure cuff to a Manikin and taking its vitals.

Using virtual avatars and Google Docs, Peltier created an escape room in place of a syllabi quiz. “I give them an online escape room with the scenario of a professor running down the hall to get to class, and their cards fall to the floor. The puzzle the students have to solve is to find which card is missing and that points to my office hours,” Peltier explained.

Room for Improvement

These escape rooms aren’t just fun and games. Peltier is investing in them for their ability to increase engagement and learning as well. When her students reported they were not oriented to the simulation environment, Peltier and Matthew collaborated to find a way to better introduce the clinical setting.

Matthew noticed that when her students entered their clinicals, their stress levels were so elevated they were not completely focused. “Our students tend to be high performers, but they are so anxious,” Peltier stated.  “I wanted to find some way where it’s not so ‘do or die’, where it’s an opportunity for them to try and fail, then succeed.”

Together, Peltier and Matthew devised an escape room as a fun way to make the lab more memorable.

Peltier intends for her escape rooms to improve clinical judgment and has designed them with learner outcomes in mind. In order to measure the effects, she surveys students on their satisfaction, opinion, and perceived impact of the escape rooms on their clinical experience.

Since developing her escape rooms, Peltier finds her students are less nervous in simulation situations and are accomplishing their tasks proficiently. “When they first come into the SIM area, they have heightened anxiety,” Peltier said. “[But when] they get that puzzle piece, it seems like there’s a calmness, and then they come out laughing and high-fiving.”

Student feedback indicates they are highly satisfied and regard the escape rooms as a strong strategy for learning, Peltier says.

Cracking the Code for Unique Instruction

Peltier believes she could be breaking new ground in nursing education. “The first education escape rooms came out in 2010, but they [were] for chemistry, engineering, and computer science,” Peltier said. “There’s not a lot out there in the research for nursing.” 

Rocky Rockstraw, director of UNLV's Clinical Simulation Center of Las Vegas, says educational escape rooms are a form of gamification (turning something into a game) not typically attempted by institutions.

“The challenge that academics have is getting students to want to learn,” Rockstraw began. “With the escape rooms, students get intrigued by it, but you have to weigh against that how much bang for the buck, how much learning is happening at the end of the day.”

A balance must be struck between entertainment and education, he says. If the gamification is done incorrectly, students will have more fun, but walk away having learned less than they would have in a normal lecture. “I think it’s beneficial, but the ability to replicate and measure it is what’s important,” Rockstraw says. “As long as you can measure learner outcomes, any way to do it, and make it fun, I’m all for it.”

Peltier says that as an active learning activity, where students can apply their skills in a physical environment, it is paramount that escape rooms be presented with a solid knowledge base. “It needs to always be scaffold with didactic learning,” Peltier said. “All simulations have to be met with learning objectives. I have four learning objectives for one escape room. You take your learning objectives and you build your puzzles and escape rooms backwards to meet the objectives.”

Peltier is planning to publish her dissertation on whether or not escape rooms have helped students develop clinical judgment in regards to obstetric hemorrhage. In the future, she hopes to further refine her escape rooms, as she creates new locks, codes, and hints for future content areas.