The Effect of Escape Room Simulation on Nursing Students' Clinical Decision-Making and Teamwork Attitudes Regarding Cardiopulmonary Resuscitation: A Randomized Controlled Study

Cardiopulmonary arrest is a critical emergency requiring cardiopulmonary resuscitation (CPR), defined as the sudden and unexpected cessation of breathing or circulation for any reason. In the United States, 350,000 to 450,000 people experience cardiopulmonary arrest annually, while this figure is reported to be 700,000 in Europe. CPR is a life-saving emergency intervention applied to maintain blood flow and oxygenation to vital organs during cardiac arrest. CPR consists of two main components: chest compressions and artificial respiration. Chest compressions are performed to restore blood circulation, while artificial respiration aims to provide oxygenation. Survival rates following CPR are reported to be only around 10-20% in most centers. When examining patient outcomes after CPR; Survival rates for out-of-hospital cardiac arrest range from 3-16%, while in-hospital survival rates are 12-22% in adults and 33-49% in children; however, this rate drops to approximately 5% for nocturnal cardiac arrests compared to daytime arrests. Effective CPR is considered one of the strongest predictors of neurological recovery and overall survival after cardiac arrest. These results indicate a need to improve CPR outcomes. The International Liaison Committee on Resuscitation (ILCOR), in its 2024 international consensus document, emphasizes that early defibrillation, effective chest compressions, and teamwork significantly improve patient outcomes in CPR applications. The literature supports the idea that CPR outcomes are directly related not only to technical skills but also to factors such as team communication, leadership, and coordination. The literature reports that effective teamwork in the CPR process is significantly associated with the rapid and timely application of defibrillation to the patient (Butler et al., 2019). Furthermore, a study by Rosenman et al. (2019) revealed that half of the errors in CPR applications were related to teamwork. In line with the literature, ILCOR emphasizes that teamwork, effective communication, and rapid clinical decision-making are the most critical components of the systematic intervention chain and play a decisive role in patient outcomes. The document specifically states that team coordination and communication are key elements of CPR success, and that simulation-based training yields more effective results in developing these skills compared to traditional methods. Accordingly, strengthening clinical decision-making skills and teamwork attitudes towards CPR in nursing students emerges as an important requirement in light of current scientific guidelines and international recommendations. Escape room simulation, an innovative learning method in nursing education, is seen to improve students' clinical decision-making, communication, teamwork, and problem-solving skills, and studies on this topic are rapidly increasing in the literatüre. However, no studies have been found in the literature examining the application of escape room simulation for CPR on nursing students. Accordingly, it is predicted that an escape room simulation prepared for CPR administration will increase nursing students' clinical decision-making and teamwork skills.

Materials and Methods The research was planned as a randomized controlled trial.

Hypotheses:

H1: Escape room simulation increases nursing students' clinical decision-making levels regarding cardiopulmonary resuscitation practice. H2: Escape room simulation increases nursing students' teamwork attitudes regarding cardiopulmonary resuscitation practice.

Study Location and Characteristics This research will be conducted with students of the Nursing Department of Başkent University Faculty of Health Sciences between December 29, 2025 and February 28, 2026. The research will be conducted in the Professional Skills Laboratory of Başkent University Faculty of Health Sciences.