Escape Room Challenge Helps Nurses Master Best Practices in Stroke Care

"Nurses are constantly translating this evolving expertise into improved care at the bedside."

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The room buzzes with activity as a team of nurses races against the clock. But instead of working to manage a medical crisis, they're playing a game that involves tinkering with jigsaw puzzles, black lights and locks to solve medical mysteries.

It's all part of an escape room that researchers designed to help stroke nurses master ever-evolving guidelines and best practices for stroke care. Escape rooms are a type of adventure game in which teams of people are typically locked in a room. They must find clues, solve puzzles or perform other tasks, all of which lead to one goal: to unlock the room in the shortest amount of time possible.

"The body of knowledge about stroke prevention, treatment and recovery is growing every day," said lead researcher Siena Kramer, a clinical instructor at Tufts Medical Center in Boston. "Nurses are constantly translating this evolving expertise into improved care at the bedside."

While online learning modules are often used to provide nurses with continuing education, Kramer and her colleagues tested the more interactive approach. She will present the findings Wednesday at the American Stroke Association's International Stroke Conference in Phoenix.

The researchers developed the escape room in response to two key needs. Nurses at Tufts Medical Center Comprehensive Stroke Center gave feedback in recent years that they were looking for more interactive ways to meet their continuing education requirements through in-person formats. And those educational opportunities must be provided without requiring that nurses spend too much time away from their patients.

In total, 75 stroke specialist nurses at the stroke center participated in the escape room activity. In teams of two to eight, the nurses worked to solve nine puzzles focused on stroke treatment, intensive care, identifying post-stroke complications and more.

In the months following the activity, the stroke center's leadership team audited the quality of the vital signs and neurology checks that nurses performed. This was done by reviewing the charts of their stroke patients to ensure that those checks – which guidance stipulates must be done at specific time intervals – were correctly performed and charted, said Katelyn Skeels. She is nurse manager at Tufts' stroke center and one of the study's investigators. The results showed improvements primarily in the quality of neurological checks, she said.

Survey responses after the escape room also showed the nurses felt more confident in caring for stroke patients and were more familiar with the latest clinical practice guidelines.

The findings are considered preliminary until full results are published in a peer-reviewed journal.

"This was such an innovative and engaging way to foster an increase in nurses' knowledge of the updated (clinical practice guidance) for stroke," said Nicole Bennett, nurse manager of the neuroscience intensive care unit at the University of Wisconsin Hospitals and Clinics in Madison.

"Nurses working in a busy stroke unit are not known for sitting still, so interactive learning activities can be more effective, not to mention more fun, than passive computer-based modules or lectures for retaining new content," said Bennett, who was not involved with the study.

The activity helped foster collaboration among groups of nurses with different levels of experience, the researchers said. Many of the nurses who participated see the same patients at different stages of care but often don't work together directly, Skeels said. "We wanted them to become familiar with each other so that when they're doing those handoffs, there's accountability, they're friends, and they know each other."

The escape room concept "puts a new spin on simulation-based learning that encourages strong teamwork and effective communication," Bennett said. "The team must come together to work their way through an interactive environment. This requires critical thinking, problem-solving and decision-making, which can be translated back to the clinical setting."

When nurses master the latest guidelines and can apply them to caring for stroke patients, there is a huge potential impact on patient care, Kramer said. "By adopting the most recent evidence into our nursing care and monitoring, we are able to improve outcomes for stroke patients receiving an ever-widening range of state-of-the-art treatments."

While the study included just 75 nurses from one medical system, other stroke centers could implement similar programs with minimal monetary investment, Kramer said.

"It's easy to deploy. You don't need a lot of space," she said. "If you can get an extra, small room, invite a couple people in, you don't need a ton of resources to make this work. Just a little creativity."

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