This 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.
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."
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
OTHER
Masking
SINGLE
Enrollment
70
Application of Research:The escape room game scenario prepared by the researchers was designed according to the steps of the Nursing Process. The game consists of five stages, each conducted at different stations, and each stage includes various clues and activities. The stages were organized to cover the steps of the Nursing Process: "Assessment, Nursing Diagnosis, Planning, Implementation, and Evaluation." Before starting the game, the students who will participate will be informed about the expected objectives, the game rules, and the duration. In addition, it will be stated that each group must select a group leader. The students will be given a total of 60 minutes to answer the questions in each stage, assemble puzzle pieces, unlock locked boxes, follow the clues, and find the exit key in order to leave the room. The students will be expected to complete the tasks at the stations prepared in accordance with the Nursing Process stages and to exit the room within the allotted time.
Bezmialem Vakif University
Istanbul, Turkey (Türkiye)
RECRUITINGNursing Process Knowledge Test
The form developed by the researcher in line with the literature regarding the stages of the Nursing Process consists of a total of 25 questions. Each correct answer is worth 4 points, with a maximum possible score of 100. The students' scores, whether low or high, will indicate their level of knowledge on the subject.
Time frame: 3 weeks before the intervention (before the theoretical nursing training) 2 weeks before the intervention (after the theoretical nursing process training) Directly after the intervention
Skill in Applying the Nursing Care Plan
To evaluate the quality and effectiveness of nursing process records, the "Quality Measurement Tool for Nursing Diagnoses, Interventions, and Outcomes" will be used. The scale consists of four sub-dimensions (Nursing Diagnoses as Process, Nursing Diagnoses as Outcomes, Nursing Interventions, and Nursing-Sensitive Patient Outcomes) and a total of 29 items. Higher scores on the scale indicate an increase in the quality of the nursing care plan.
Time frame: 1 week before the intervention (the first Nursing Process case study given after the theoretical nursing training) 2 weeks after the intervention (the second Nursing Process case study given after the intervention)
Self-Efficacy
To determine nursing students' self-efficacy perceptions regarding clinical performance, the "Self-Efficacy Scale in Clinical Performance" will be used. The scale consists of a total of 37 items. It is a Likert-type scale with four sub-dimensions: data collection, diagnosis, implementation, and evaluation. The minimum possible mean item score is 0, and the maximum possible mean item score is 100. A higher score indicates a higher level of self-efficacy in clinical performance, while a lower score indicates a lower level of self-efficacy in clinical performance.
Time frame: 3 weeks before the intervention 2 weeks after the intervention
Team Collaboration
To determine individuals' attitudes toward collaboration and their tendency to collaborate, the "Collaboration Scale" will be used. The scale consists of 11 items. It is a Likert-type scale with three sub-dimensions: emotions, behaviors, and beliefs. The minimum possible total score is 11 and the maximum is 55. Higher total scores on the scale indicate a higher tendency for collaboration.
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Time frame: 3 weeks before the intervention Directly after the intervention
Anxiety
To determine individuals' anxiety levels, the State-Trait Anxiety Inventory (STAI) will be used. The scale consists of a total of 40 items and is a four-point Likert-type instrument composed of two subscales: the State Anxiety Inventory (first 20 items) and the Trait Anxiety Inventory (last 20 items). The State Anxiety subscale measures how an individual feels at a particular time and under specific conditions, whereas the Trait Anxiety subscale assesses how an individual generally feels regardless of the situation and conditions. A score between 0-19 indicates no anxiety, 20-39 indicates mild anxiety, 40-59 indicates moderate anxiety, and 60-79 indicates severe anxiety.
Time frame: 3 weeks before the intervention (Trait Anxiety Inventory) Directly before the intervention (State Anxiety Inventory) Directly after the intervention (State Anxiety Inventory)