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NCT Number: NCT07752537

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

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.

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Key information

Age range

20 year–32 year

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

About this study

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.

Who can participate

Healthy volunteers accepted: Yes

Only the study team can determine whether someone qualifies for participation.

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.

Treatment and study plan

Escape room educational training

Other

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 reinforce learning objectives and facilitate reflective learning.

Primary outcomes

  1. Hydration Knowledge Quiz

    Time frame: Baseline (immediately before the intervention) and immediately after completion of the educational escape room (approximately 60 minutes later).

    Developed by researchers using literature to assess hydration status in the pediatric age group (source). The questions are in a 5-option multiple-choice format. There are a total of 10 questions. The questions will be sent to 10 academic experts in the field to evaluate content validity. After the test, Kuder-Richardson 20 (KR-20) value, item difficulty, and discrimination will be analyzed to test its reliability.

  2. State Anxiety Scale

    Time frame: Baseline (immediately before the intervention) and immediately after completion of the educational escape room (approximately 60 minutes later).

    State anxiety will be assessed using the State Anxiety Scale (SAS), which measures participants' current level of anxiety in response to a specific situation. The scale consists of 20 items rated on a 4-point Likert scale, with higher total scores indicating higher levels of state anxiety. The scale will be administered immediately before and after the educational escape room intervention to evaluate changes in students' situational anxiety associated with the learning activity.

  3. Collaboration Scale

    Time frame: Baseline (immediately before the intervention) and immediately after completion of the educational escape room (approximately 60 minutes later).

    Adapted into Turkish by Yerlikaya and Doğruyol (2020) based on the Cooperation and Competitiveness Scale, this is an 11-item, 5-point Likert-type scale. Scores on the scale range from 11 to 55, with higher scores indicating stronger cooperative tendencies. The scale is divided into three sub-dimensions: emotions, behaviors, and beliefs. The original 16-item scale underwent validity and reliability testing during its adaptation into Turkish (Yılmaz and Bayram, 2025; Yerlikaya and Doğruyol, 2020).

  4. Gameful Experience (GAMEX) Gaming Experience Scale

    Time frame: Immediately after completion of the educational escape room (same day)

    The scale developed by Eppman et al. (2018) is used to evaluate the gaming experience. This five-point Likert-type scale, which can be completed by students or researchers, consists of six sub-dimensions (enjoyment, engagement, creative thinking, influence, absence of adverse effects, and dominance) and 27 items. Each item is scored between 1 and 5, with a minimum score of 27 and a maximum score of 135 for the entire scale. In the original version of the scale, the Cronbach's alpha value for the entire scale is 0.89, while the Cronbach's alpha values for the sub-dimensions range from 0.84 to 0.96. In the Turkish validity and reliability study, the total Cronbach's alpha value was 0.93, and the Cronbach's alpha values for the sub-dimensions ranged from 0.67 to 0.92 (Dönmez, Çalık, Kabal and Kapucu, 2024; Eppmann, Bekk and Klein, 2018).

Sponsors and collaborators

Lead sponsor

Gazi University

Other

Registry information

Important dates

Study start
2026
Primary completion
2026
Study completion
2026
First posted
Aug 7, 2026
Registry last updated
Aug 7, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

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This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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