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KeithRN Clinical Reasoning Escape Rooms

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Connect educational content to practice using an engaging active learning activity that develops student clinical judgment.

What is a Clinical Reasoning Escape Room?

A KeithRN Clinical Reasoning Escape Room is an online simulation that combines knowledge and skills development with game-playing elements that focus on high-level application with a case-based learning activity.

Using a KeithRN Clinical Reasoning Case Study, each puzzle unlocks a clue, unfolding to the next aspect of patient care.

KeithRN Clinical Reasoning Escape Rooms can be used as an effective alternative to lectures, handouts, or quizzes and take students from 45 minutes to an hour to complete.


Oak Valley General Hospital

An 84-year-old female presents to the emergency department with difficulty breathing and a productive cough. Students take charge of this patient’s care through careful physical assessment and lab value analysis as she develops sepsis. Next, they coordinate the medical management and evaluate data as interventions are completed. Finally, students provide patient education on a new diagnosis of COPD.

Heart Failure (CHF)

Lakeland Medical Center

An 89-year-old female arrives to the medical unit after an initial work-up for shortness of breath. Students work through her care, complicated by a history of MI, systolic heart failure, and cardiomyopathy. With careful attention to assessment findings and medical history, students analyze pharmacological therapies and lab values, including ABGs. They review potential complications, initiate medical and nursing interventions, and evaluate the patient’s response. Finally, students complete an SBAR report and an educational handout about managing heart failure at home.

Diabetic Ketoacidosis (DKA)

Southdale Hospital

A 9-year-old male presents to the emergency department because he has been more sleepy and his breathing is “not normal.” Students coordinate this patient’s care through a new onset of type 1 diabetes, including nursing skills such as careful assessment, lab value analysis, medical management, safe medication administration, and evaluation of outcomes. In addition, they will review the pathophysiology and complications related to the onset of DKA. Finally, students will provide education to the family and an update to the provider.

Benefits of Escape Rooms

Research shows that using escape rooms in nursing education can:

  • Improve communication and teamwork.
  • Increase student engagement and motivation to learn.
  • Improve student confidence.
  • Increase interdisciplinary collaboration.
  • Bridge the theory-practice gap.
  • Improve routine class exams and NCLEX scores.

Unique Features of KeithRN Clinical Reasoning Escape Rooms

  • Incorporate Tanner’s Clinical Judgment Model to help students learn to think like a nurse.
  • Uses complex, alternative format questions similar to the Next-Gen NCLEX.
  • Promote high-level clinical reasoning through open-ended responses.
  • Students provide their rationale to answers to show their critical thinking process.
  • Student reports are sent to the instructor to monitor progress.
  • Storytelling, game elements, and a variety of puzzles keep students engaged.

Where to Use Escape Rooms

A KeithRN Clinical Reasoning Escape Room activity can be used in the classroom, clinical, or off-site. Suggestions:

  • Graded assignment for course content.
  • Topic for online discussion board assignment.
  • Pre-work assignment for class.
  • Small group discussion and debriefing during class.
  • Make-up assignment for missed clinical.
  • Clinical pre/post-conference activity.

What’s included:

  • Virtual escape room activity to share with students.
  • NextGen NCLEX question formats including:
    • Drop-down CLOZE items
    • Matrix multiple-choice items
    • Matrix multiple response items
    • Multiple response, select all that apply items
    • Highlight text/table items
    • Trend items
  • Student results are immediately available for review.
  • Purchase provides educators with an access license for one year.

KeithRN Clinical Reasoning Escape Rooms are a collaboration between KeithRN and Martha Johnson, RN, MSN of BreakoutRN, known for her unique strategies to develop active learning resources for nurse educators.


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.

Vestal, M.E., Matthias, A.D. & Thompson, C.E. (2021). Engaging students with patient safety in an online escape room. Journal of Nursing Education, 60(8), 466-71.

Reviews from Students & Nurse Educators

I tried the online escape room during my theory course, which prompted the students to ask further questions regarding the content previously taught and apply it in a different way. I’d recommend these tools to other nurse educators due to their flexible nature in and out of the classroom!

— Faculty

I have used the DKA Clinical Reasoning Escape Room long enough to confidently state that the statistical gap between the online and in-person gap for this competency is closing. Students are understanding the priorities and making safe choices. During their exam reflections, this activity is commonly stated to be one of their favorites and they are always asking for more opportunities to learn like this.

— Faculty

Some days you don’t know what to do in post-conference, other days your students do not have the emotional or mental capacity to continue learning, and some days you just don’t have the space. This product fits the needs of all those roadblocks. While I used the DKA Clinical Reasoning Escape Room as an individual learning opportunity, it was a great experience to watch students work in groups of 2-3 on these rooms as well. The collaborative thinking, sharing of ideas, and troubleshooting was a great opportunity for teamwork.

— Faculty

With the implementation of NGN and CJM, educators need tools like this to bring clinical to the theory classroom. These activities allow students to make clinical decisions in a safe environment with real-time feedback. I found that my evaluations switched from fixing gaps in foundational information to helping students advance their clinical judgment!

— Faculty

Working through a case study in this format helped me to remember key steps to management of patient care. It is easier to learn the material when it is applied to an actual patient.

— Student

During my most recent clinical I had a lot of practice with diabetes and insulin administration. It was awesome to be able to continue to apply that knowledge to this scenario.

— Student

I can use what I learned in this case study to prioritize patient care, determine relevant and irrelevant information, interpret labs, and use critical thinking during medication administration.

— Student