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AIM: To evaluate the effectiveness of escape room-based learning on nursing students' knowledge, clinical skills and critical thinking through a systematic review and meta-analysis. BACKGROUND: Traditional nursing education faces limitations in promoting active learning and higher-order cognitive skills. Escape rooms, as gamified interventions, offer immersive scenarios to enhance engagement and competency development. However, robust evidence regarding the effectiveness specifically for nursing students remains limited. DESIGN: Systematic review and meta-analysis. METHODS: A systematic literature review encompassed ten databases, covering publications up to May 2025. Methodological quality and bias risk for eligible studies were evaluated using the Cochrane RoB 2.0 tool alongside JBI critical appraisal instruments. Statistical analyses, performed in R, employed meta-analysis with standardized mean differences (SMD) and 95 % confidence intervals (CI) as the primary summary measure. RESULTS: Twenty studies involving 2215 nursing students were included. Meta-analysis demonstrated that escape rooms significantly improved knowledge acquisition (SMD: 0.88, 95 % CI: 0.62-1.13, p < 0.001), clinical skills (SMD: 1.33, 95 % CI: 0.71-1.95, p < 0.001) and critical thinking (SMD: 0.91, 95 % CI: 0.50-1.33, p < 0.001). Subgroup analysis for knowledge outcomes indicated significant differences in effect sizes by country and academic level. CONCLUSIONS: Escape rooms effectively enhance nursing students' knowledge, clinical skills and critical thinking. However, significant methodological limitations and high heterogeneity require cautious interpretation. Future high-quality studies are needed to confirm these effects and explore heterogeneity sources and develop theory-driven escape room interventions.
Yang et al. (Fri,) studied this question.