A randomized controlled trial of an escape laboratory challenge through gamified learning to improve cardiopulmonary resuscitation performance among nursing students

Effective cardiopulmonary resuscitation (CPR) training is a cornerstone of nursing education. However, conventional instruction often leads to inconsistent skill acquisition and fails to prepare students in emergencies situation. Although gamified learning can improve motivation, structure practice, and teamwork, there is still a lack of randomized evidence regarding its effectiveness in undergraduate CPR training. Therefore, the study aimed to assess the effectiveness of the Nusantara 1: CPR Adventure gamified module in improving CPR performance relative to conventional training methods. The research utilizes an intervention design to fulfill the study's objectives. A two-arm, parallel-group randomized controlled trial was conducted with undergraduate nursing students who had no prior formal CPR training. Participants were allocated 1:1 to either gamified or conventional training, ensuring equal contact time and comparable group sizes. This study was conducted in December 2024 at the Faculty of Nursing, Universitas Muhammadiyah Banjarmasin, Indonesia. The research team established specific inclusion and exclusion criteria to determine student eligibility for participation in this project. The sample size was calculated using G*Power software. A total of 140 nursing students participated and were randomly assigned to two groups of 70 students each. CPR performance was evaluated by blinded assessors using an 18-item Objective Structured Clinical Examination (OSCE) based on the Basic Trauma Cardiac Life Support (BTCLS) checklist. Assessments were conducted at baseline (T0) and 14 days post-training (T1). To analyze the results, between-group differences were compared using the Mann-Whitney U test, while within-group changes over time were assessed with the Wilcoxon signed-rank test. At follow-up, the gamified group significantly outperformed the control group (Cliff’s δ=0.259), with a 63% probability of superiority. Improvements were consistent across all critical CPR components, including chest compressions, ventilation, resuscitation, and Automated External Defibrillator (AED) utilization. These findings indicate that integrating escape room-style gamification into nursing curricula can enhance clinical performance. Keywords: Cardiopulmonary resuscitation, escape lab, gamification, nursing skills, nursing students, randomized controlled trial