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KeithRN Clinical Reasoning Escape Rooms Develop Student Clinical Judgment by Integrating Educational Best Practices

By February 9, 2023February 14th, 2023No Comments

As professional nurse educators, we are frequently challenged to transform dry, tedious classroom content into something memorable and exciting. However, this challenge goes beyond providing an entertaining classroom.

We want our students to have a deep understanding of the content, then be able to apply that knowledge to patient situations and develop a patient-specific plan of care, continuing to evaluate the plan’s success.

Using that process as the foundation of learning leads students to develop the clinical judgment necessary for successful practice, improved patient outcomes and NextGen NCLEX success.

So how can we create learning experiences that increase student engagement and prepare them for practice and clinical decision-making?

Using Educational Best Practices

Based on a wide array of educational research, two top teaching strategies that encourage student participation and engagement in learning are:

  • Unfolding case studies
  • Educational escape rooms

This article describes how nurse educators can improve their teaching using an innovative teaching tool that combines the strengths of both.

NextGen NCLEX is only a few months away, so nurse educators must continue using case-based resources to prepare students for the complex, multiple-step exam items in an unfolding case study that replicates the clinical judgment processes essential for competent clinical practice.

Why use an unfolding case study rather than focus on NCLEX question format?

When a surgical patient complains of shortness of breath, they do not provide the nurse with a choice of four possibilities for their change in condition. Instead, the nurse must gather information from the medical record, carefully assess the patient, interpret and prioritize a large amount of data, and finally decide on a course of action.

This decision-making process requires practice, and nurse educators must continually offer students numerous opportunities to master clinical reasoning before they graduate to pass licensure and successfully transition to professional practice.

Clinical Reasoning Case Studies

Case studies are one of the most effective tools to bridge the gap between theory and practice. They immerse students in clinical realities and allow the student to apply knowledge to real-world patient scenarios that simulate practice (McLean, 2016).

The development of clinical judgment is strengthened when the instructor can bring clinical context into the classroom while emphasizing clinical reasoning. Nurse educators should use open-ended questions in a case study highlighting the context of clinical judgment in practice (Benner, Sutphen, Leonard, & Day, 2010).

KeithRN Clinical Reasoning Case Studies replicate nursing practice using this open-ended format and a consistent framework using the nursing process and Tanner’s Clinical Judgment Model, a clinical reasoning framework informed by research and practice.

Educational Escape Rooms

An educational escape room is a physical or virtual space where students use clinical knowledge to solve puzzles to “escape” a room. It is a variation on an unfolding case study, where each puzzle unlocks a clue, leads to additional information, or opens another patient care activity.

Unlike a typical escape room, the goal of an educational escape room is not entertainment. Instead, the experience is designed around learning outcomes that provide knowledge, give an opportunity to practice skills, or train and reinforce certain behaviors. Interest in using escape rooms as a teaching tool has been growing rapidly in educational research. There have been a variety of documented benefits to using an educational escape room, including:

  • Improves communication and teamwork.
  • Students engage and are motivated around learning.
  • Improves student confidence.
  • Supports active interdisciplinary communication and collaboration.
  • Bridges the theory-practice gap.
  • Promote learner-centered teaching.
  • Improves exam scores.

As in case-based learning, educational escape rooms also use narrative story elements. As humans, our brains are hard-wired to connect with stories. We remember great stories, pass information through stories, and use stories as a bridge between our experiences.

Learning through a storyline helps students build foundational knowledge blocks and a scaffolding framework that they can use to apply new information, store data in long-term memory, and impact future practice.

Engaging in an educational escape room combined with an unfolding case study establishes a shared goal that allows students to practice these skills in a safe, non-threatening environment.

What is a KeithRN Clinical Reasoning Escape Room?

A KeithRN Clinical Reasoning Escape Room combines an unfolding case study with an educational escape room to create a unique and engaging teaching tool. It is an online simulation that integrates knowledge and skill development with game-playing elements that focus on high-level application within a case-based learning activity.

As a student moves through the online escape room, each puzzle unlocks a clue, unfolding to the next aspect of patient care.

Benefits of Using a KeithRN Clinical Reasoning Escape Room

In addition to the documented benefits of escape rooms listed earlier, KeithRN Clinical Reasoning Escape Rooms offer students and educators the opportunity to practice with complex, alternative format questions such as those on the NextGen NCLEX. Additionally, KeithRN Clinical Reasoning Escape Rooms use open-ended questions that ask students to provide the rationale for their decisions, further developing their clinical reasoning skills.

Using questions derived from Tanner’s Clinical Judgment Model students notice data, interpret its meaning, determine a priority, and evaluate their care in the same cyclical nature that occurs in professional practice. Through repetition of this type of thinking, students gain confidence and can translate what they are learning to patient care.

When to use a KeithRN Clinical Reasoning Escape Room

KeithRN Clinical Reasoning Escape Rooms will take students about 45-60 minutes to complete. Once a student finishes, a report is sent to the instructor. This activity can be an excellent graded assignment for course content or for an online discussion board assignment. It can also be used in class as pre-work or during small group discussions. Additionally, this process can also be used in pre- or post-conference or as a make-up assignment if a student misses a day.

Take the Next Step

There are currently three KeithRN Clinical Reasoning Escape Rooms available:

  • Pediatric DKA
  • Heart failure
  • Pneumonia/sepsis

These are foundational topics that students will encounter in professional practice, and working through these escape rooms will allow students to practice making clinical decisions.

Take the next step to engage students and develop clinical reasoning by using these Clinical Reasoning Escape Rooms.


Case-based learning in an unfolding case study combined with an educational escape room integrates two educational best practices that have been proven to promote student engagement and develop clinical judgment.


How frequently are you using an active learning activity that requires application of knowledge in the context of clinical practice?

What content areas that you teach would benefit from integrating a KeithRN Clinical Reasoning Escape Room?

Closing Thoughts

Fostering the development of clinical judgment in nursing students through engaging and meaningful classroom content continues to challenge nurse educators. Data suggests that most graduate nurses, even if they pass NCLEX, do not possess clinical judgment skills for safe practice (Kavanagh & Sharpnack, 2021).

KeithRN Clinical Reasoning Escape Rooms provide educators with a creative, active learning activity that prepares students for NextGen NCLEX and professional practice!


Benner, P., Sutphen, M., Leonard, V., & Day, L. (2010). Educating nurses: A call for radical transformation. San Francisco, CA: Jossey-Bass.

Kavanagh, J.M., Sharpnack, P.A., (January 31, 2021) “Crisis in Competency: A Defining Moment in Nursing Education” OJIN: The Online Journal of Issues in Nursing, Vol. 26, No. 1, Manuscript 2.

McLean, S. (2016). Case-based learning and its application in medical and health-care fields: A review of worldwide literature. Journal of Medical Education and Curricular Development, 39. doi: 10.4137/JMECD.S20377

Molina-Torres, G., Cardona, D., Requena, M. Rodriguez-Arrastia, M., Roman, P. & Ropero-Padilla, C. (2022). The impact of using an “anatomy escape room” on nursing students: A comparative study. Nurse Education Today, Volume 109.

Reinkemeyer, E.A., Chrisman, M. & Patel, S.E. (2022) Escape rooms in nursing education: An integrative review of their use, outcomes, and barriers to implementation. Nurse Education Today, Volume 119.

Martha Johnson, MSN, RN, CEN, the author of this article, is the founder of Breakout RN, a company she created to empower nurse educators to successfully transition from lecture to active learning. She believes active learning does not have to be hard or overwhelming, educators should just take it one activity at a time.

The Ultimate Solution to Develop Clinical Judgment Skills

KeithRN’s Think Like a Nurse Membership

Access exclusive active learning resources for faculty and students, including KeithRN Case Studies, making it your go-to resource.

Sign up to receive a free KeithRN NextGen Case Study!

Develop clinical judgment skills with this innovative new case study on asthma to prepare your students for NextGen NCLEX and practice!

The Ultimate Solution to Develop Clinical Judgment Skills

KeithRN’s Think Like a Nurse Membership

Access exclusive active learning resources for faculty and students, including KeithRN Case Studies, making it your go-to resource.

Sign up to receive a free KeithRN NextGen Case Study!

Develop clinical judgment skills with this innovative new case study on asthma to prepare your students for NextGen NCLEX and practice!