Escape room and high-fidelity clinical simulation in neonatal nursing education: A randomized clinical trial

Background: The increasing complexity of health care environments requires nursing graduates to develop strong technical and decision-making skills.High-fidelity simulation is recognized as an effective strategy for improving clinical competence, while gamified approaches such as escape rooms have gained attention for enhancing engagement and motivation.This study aimed to evaluate whether integrating an escape room within high-fidelity simulation improves learning outcomes and student satisfaction compared with traditional simulation in neonatal resuscitation training.Methods: A randomized clinical trial was conducted with second-year undergraduate nursing students ( n = 40), assigned to either an intervention group (escape room-formatted high-fidelity simulation) or a control group (traditional simulation).Learning outcomes were assessed with a multiple-choice questionnaire, and perceptions were measured using a Likert-scale survey.Results: The intervention group achieved slightly higher knowledge scores (7.29 1.61 vs. 6.88 1.75; p = .48;Cohen's d = 0.25).Satisfaction was high across groups, with the escape room group reporting greater perceived applicability and educational relevance.Conclusions: Incorporating gamified elements may enhance engagement and collaborative learning within simulation-based nursing education.