The Effects of a Healthcare Simulation Escape Room on Clinical Judgment: A Randomized Controlled Trial

Background: The predominant pedagogy of traditional lecture-based learning should include meaningful active content to foster clinical judgment, engagement, and knowledge retention. Innovative active learning strategies must be tested to understand if they can better facilitate nursing learners’ readiness for practice.Aims: This research study investigated the impact of a healthcare simulation escape room as an innovative platform on individual and team clinical judgment to determine whether this active learning strategy can benefit nursing learners’ preparedness and increase clinical judgment. Method: A randomized, double-blinded, waitlist control design was used to examine the effect of a healthcare simulation escape room on clinical judgment. Nursing learners participated in didactic learning, a healthcare simulation escape room, and an obstetric hemorrhage simulation as part of the maternal clinical course. The Lasater Clinical Judgment Rubric (LCJR) evaluated individual clinical judgment, and the modified Critical Behavior Checklist (CBC) evaluated group clinical judgment. A demographic survey with additional questions was collected to determine if any teams had prior knowledge of the experiences. The data from the observation checklists was analyzed using an independent t-test, an analysis of covariance (ANCOVA), and a multivariate analysis of covariance (MANOVA) to examine the difference between clinical judgment scores from the waitlist control and intervention groups. An alpha level of .05 was used in the statistical analysis. The demographic data was analyzed using descriptive statistics. Results: The clinical judgment scores increased for individual and team participants who experienced the healthcare simulation escape room. The ANCOVA comparing group differences of the LCJR total scale score revealed that the intervention group (M = 23.04 SD = 4.06) had significantly higher scores (F(1,76) = 100.44, p < .001) on the LCJR total scale score than the waitlist control group (M = 14.53, SD = 2.48) controlling for age and sex.). The participants who completed the healthcare simulation escape room (M = 22, SD = 2.21) reported significantly higher levels of clinical judgment in the management of an obstetric hemorrhage than the participants who did not experience a healthcare simulation escape room (M = 16.7, SD = 2.75), t(25) = -5.56, p < .001). Discussion: The study demonstrated that healthcare simulation escape rooms as an innovative platform can play a significant role in enhancing both individual and team clinical judgment. Clinical judgment is crucial for nursing students to provide high-quality, safe patient care, which is rooted in effective educational methodologies. Nursing education should intentionally craft teaching strategies that cater to the needs of contemporary learners while fostering the development of clinical judgment. Nurse educators are encouraged to explore and disseminate successful teaching strategies that build the knowledge, skills, and attitudes essential for cultivating clinical judgment. Further research is warranted to explore the relationship between other innovative platforms, such as the healthcare simulation escape rooms, and the advancement of clinical judgment.