Design and protocol of a randomized assessor-blinded controlled trial evaluating an educational escape room for individual and team cardiopulmonary resuscitation skills among nursing students
- 1Research Center for Nursing and Midwifery Care, Comprehensive Research Institute for Maternal and Child Health, School of Nursing and Midwifery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
- 2Department of Nursing, School of Nursing and Midwifery, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
- 3Department of Medical Education, Medical Education and Development Center, Shahid Sadoughi University of Medical Sciences, Bouali Ave., Safaeyeh, Yazd, 8916877443 Iran
Abstract
Background: High-quality cardiopulmonary resuscitation (CPR) depends not only on technical competence but also on effective communication, role clarity, leadership, and coordinated team performance under pressure. However, conventional CPR instruction may not adequately reproduce the collaborative and time-sensitive demands of real resuscitation. Educational escape rooms (EERs), as simulation-based gamified learning strategies, may provide a more immersive and learner-centered approach to strengthening both cognitive and teamwork-related aspects of CPR training. This study protocol was developed to evaluate the effect of a team-based CPR educational escape room (CPR-EER) integrated into advanced life support (ALS) training for undergraduate nursing students.
Methods: This study was designed as a two-arm, parallel-group, assessor-blinded randomized controlled trial with a 1:1 allocation ratio. Participants were seventh-semester undergraduate nursing students at Shahid Sadoughi University of Medical Sciences, Yazd, Iran. All participants first received a standardized 8-hour CPR refresher workshop to establish a common educational baseline. The intervention group then participated in a structured CPR-EER delivered in fixed six-member teams in a simulated in-hospital cardiac arrest environment, whereas the control group continued with the routine curriculum during the primary comparison phase and received the intervention after post-test assessment. The primary outcome was team coordination during CPR, assessed using a Team Objective Structured Clinical Examination (TOSCE). Secondary outcomes included role-specific performance, CPR knowledge, and learner satisfaction. Outcomes were assessed at baseline and one month after the intervention. Data analysis was prespecified using a per-protocol framework and distribution-appropriate statistical tests.
Discussion: This protocol provides a methodologically explicit and pedagogically grounded model for evaluating a gamified, team-based CPR-EER training strategy in undergraduate nursing education. By aligning intervention design, educational objectives, and outcome assessment, it may contribute to the development of more immersive, competency-oriented, and reproducible approaches to resuscitation training.
Trial registration: Iranian Registry of Clinical Trials (IRCT), registered on 16 October 2024, IRCT20240815062770N1. Available at: https://irct.behdasht.gov.ir/.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12912-026-05151-4.
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BibTeX
@article{bakhshi2026design,
title = {{Design and protocol of a randomized assessor-blinded controlled trial evaluating an educational escape room for individual and team cardiopulmonary resuscitation skills among nursing students}},
author = {Fatemeh Bakhshi and Amir Dehghani Ashkezari and Sara Heydari},
journal = {BMC Nursing},
year = {2026},
month = jul,
doi = {10.1186/s12912-026-05151-4},
url = {https://doi.org/10.1186/s12912-026-05151-4},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Design and protocol of a randomized assessor-blinded controlled trial evaluating an educational escape room for individual and team cardiopulmonary resuscitation skills among nursing students
AU - Fatemeh Bakhshi
AU - Amir Dehghani Ashkezari
AU - Sara Heydari
PY - 2026
DA - 2026/07/29
JO - BMC Nursing
DO - 10.1186/s12912-026-05151-4
UR - https://doi.org/10.1186/s12912-026-05151-4
AB - Background: High-quality cardiopulmonary resuscitation (CPR) depends not only on technical competence but also on effective communication, role clarity, leadership, and coordinated team performance under pressure. However, conventional CPR instruction may not adequately reproduce the collaborative and time-sensitive demands of real resuscitation. Educational escape rooms (EERs), as simulation-based gamified learning strategies, may provide a more immersive and learner-centered approach to strengthening both cognitive and teamwork-related aspects of CPR training. This study protocol was developed to evaluate the effect of a team-based CPR educational escape room (CPR-EER) integrated into advanced life support (ALS) training for undergraduate nursing students. Methods: This study was designed as a two-arm, parallel-group, assessor-blinded randomized controlled trial with a 1:1 allocation ratio. Participants were seventh-semester undergraduate nursing students at Shahid Sadoughi University of Medical Sciences, Yazd, Iran. All participants first received a standardized 8-hour CPR refresher workshop to establish a common educational baseline. The intervention group then participated in a structured CPR-EER delivered in fixed six-member teams in a simulated in-hospital cardiac arrest environment, whereas the control group continued with the routine curriculum during the primary comparison phase and received the intervention after post-test assessment. The primary outcome was team coordination during CPR, assessed using a Team Objective Structured Clinical Examination (TOSCE). Secondary outcomes included role-specific performance, CPR knowledge, and learner satisfaction. Outcomes were assessed at baseline and one month after the intervention. Data analysis was prespecified using a per-protocol framework and distribution-appropriate statistical tests. Discussion: This protocol provides a methodologically explicit and pedagogically grounded model for evaluating a gamified, team-based CPR-EER training strategy in undergraduate nursing education. By aligning intervention design, educational objectives, and outcome assessment, it may contribute to the development of more immersive, competency-oriented, and reproducible approaches to resuscitation training. Trial registration: Iranian Registry of Clinical Trials (IRCT), registered on 16 October 2024, IRCT20240815062770N1. Available at: https://irct.behdasht.gov.ir/. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12912-026-05151-4.
SN - 1472-6955
ER -