The use of an escape room simulation in undergraduate community health nursing course: a single group pre-post evaluation

Community health nursing (CHN) clinical practice is essential for pre-licensure nursing students to develop the competence and confidence needed to deliver safe and effective care in patients’ homes. However, clinical placements are often hindered by limited site availability, preceptor shortages, and inconsistent quality. Escape room simulation (ERS) has emerged as an innovative strategy to address these challenges and provide meaningful learning experiences. Despite its growing use, there is limited evidence on the impact of ERS in enhancing nursing students’ readiness for home-based community settings. To address this gap, this study evaluated the effects of ERS on students’ competence and confidence in CHN. A quasi-experimental, single-group pre/post design was used with 56 full-time undergraduate nursing students. Data were collected at three time points: before ERS (T1), immediately after (T2), and ten weeks later (T3). Instruments included the CHN Competency Checklist, CHN Confidence Scale, and ERS Perception Scale. A linear mixed-effects model showed statistically significant increases in both competency (t = 6.413, p  < .001) and confidence (t = 8.142, p  < .001) from T1 to T2, with sustained or slightly improved scores at T3. Spaghetti plots revealed reduced variation in competence over time, suggesting consistent benefit across participants, while confidence growth showed greater variability, indicating individual differences in response. Students with lower baseline scores exhibited the most notable gains. Most had no prior ERS experience but reported high satisfaction. Findings support the integration of ERS into CHN curricula to enhance student preparedness, especially when clinical placements are limited.