INTRODUCTION
To deliver high-quality and effective education to university students, innovative teaching methods have been introduced that prioritize active student engagement, foster motivation, and enhance knowledge acquisition, shifting away from traditional instructor-centered approaches. [1]. Although escape rooms began as games, they have recently been introduced as an innovative teaching method [1]. An escape room is a team-based activity where participants work together to uncover clues, solve puzzles, and complete tasks within a designated space to accomplish a specific objective within a limited timeframe [1]. From an educational perspective, escape rooms are based on a socioconstructivist approach [2]. In other words, learners construct their knowledge through real-time experiences obtained from various challenges in the escape room, face new and complex problems, interact with peers, and solve them with the support of the instructor. Studies have introduced the application of escape rooms in classes across various academic fields [3]. As escape rooms are interactive and can enhance interactions among individuals with shared goals, they can be used for team problem-solving, including in nursing education [1]. When applying escape rooms to education, the instructor provides the scenarios, game rules, methods, and time limits according to the learning objectives, while students work with their team members to find hidden clues, solve puzzles, collaborate, recognize tasks, and delegate roles to each other [4].
According to a bibliographic analysis of studies that applied escape rooms to education [3], more than 80% of the analyzed studies were in the field of higher education, mainly focusing on training future healthcare professionals. A systematic literature review of escape rooms [5] also found that most studies were conducted in the health and welfare fields, particularly in nursing and medicine. Escape rooms are increasingly being used as a teaching method in the education of nurses and nursing students. They have been reported to improve nursing students' knowledge, confidence, critical thinking, and teamwork skills [6], as well as enhance teamwork and communication skills [1]. Both novice and experienced nurses evaluated escape room scenarios as an opportunity to improve their practical competencies [1]. Gomez-Urquiza et al.[7] reported that after participating in escape room classes, students' knowledge of the subject increased, the activity itself was interesting, and it enhanced their motivation for learning. Rodriguez-Ferrer et al. [8] conducted a randomized controlled trial in which nursing students participated in a one-hour web-based escape room to improve awareness of severe mental illness, finding that the stigma towards individuals with mental illness was positively changed. Students who participated in the game reported that it was a fun and motivating learning strategy as they could empathize with the main character with mental disorders [9]. Wettergreen et al. [10] reported that using interprofessional escape room games for students from various health and medical fields effectively improved their knowledge of the opioid crisis and attitudes toward interprofessional collaboration. Escape room-based classes utilize scenarios centered on clinical situations, allowing students to collaborate in solving the problems. This approach enhances comprehension of the learning content, promotes teamwork, and increases learning motivation.
Meanwhile, studies that applied escape rooms to nursing students have been conducted in courses such as pharmacology [11], anatomy [12], physiology [13], obstetrics [4], sepsis [14], acute cardiovascular nursing [15], stroke patient care [16], and interprofessional education [10], but their application in psychiatric nursing courses has been rare [8,9]. In South Korea, research on applying escape rooms to nursing students includes studies related to developing emergency medical situation simulation scenarios [17] and scenarios for cancer patients with accompanying depression [18]. However, neither of these studies quantitatively measured the effects of classes that applied escape room teaching methods. While the application of escape rooms as a teaching method has been actively conducted internationally, it remains relatively unfamiliar as a teaching method in South Korea.
Based on previous research findings that escape rooms in nursing education are effective for enhancing knowledge [10,12,15,16,19-21], problem-solving [19], teamwork [1,13,19,21-23], and learning interest and motivation [7,9], this study aims to examine the impact of incorporating escape room activities into a psychiatric nursing course on nursing students' knowledge, proactivity in problem-solving, teamwork, and learning satisfaction.
1. Objectives of the Study
This study aims to assess the impacts of psychiatric nursing classes incorporating escape room games on nursing students' knowledge, proactivity in problem-solving, teamwork, and learning satisfaction. This study's hypotheses are as follows:
Hypothesis 1: The experimental group (EG) participating in psychiatric nursing classes with escape room games will have higher knowledge related to psychiatric nursing compared to the control group (CG) participating in scenario-based group discussions.
Hypothesis 2: The EG participating in psychiatric nursing classes with escape room games will demonstrate greater proactivity in problem-solving compared to the CG participating in scenario-based group discussions.
Hypothesis 3: The EG participating in psychiatric nursing classes with escape room games will exhibit higher levels of teamwork compared to the CG participating in scenario-based group discussions.
Hypothesis 4: The EG participating in psychiatric nursing classes with escape room games will report higher learning satisfaction compared to the CG participating in scenario-based group discussions.
METHODS
1. Study Design
This study employed a quasi-experimental design with a non-equivalent control group pretest-posttest approach to evaluate the effects of applying escape room in psychiatric nursing class (Table 1). One class (EG) participated in class incorporating escape room, while the other class (CG) engaged in team-based discussion using scenarios. The escape room activity was composed of three parts. First, participants solved crossword puzzles made up of psychiatric terms to find a code, unlock the safe, and retrieve a scenario involving the admission of a patient with schizophrenia for 10 minutes. Second, they spent 25 minutes identifying non-therapeutic communication between a nurse and the patient in the scenario and converting it into therapeutic communication. Lastly, they moved to a simulation room to complete a 15-minute room of error activity related to patient safety. The CG was given a longer scenario that incorporated additional situations to the same patient admission scenario used by EG. They were instructed to work in groups for 50 minutes to identify non-therapeutic communication and change it to therapeutic communication. The CG will also participate in the escape room sessions identical to the EG later. Both groups had identical intervention times of 50 minutes, with each team consisting of 5 to 6 members. Based on prior research, which indicated that 60 minutes was the most common duration for escape room activities, followed by 30~50 minutes, and that teams most consisted of 5 members, followed by 6 members [5], the escape room activities in this study were set for 50 minutes with teams of 5~6 participants.
2. Sample Size and Calculation
The study participants were nursing students enrolled in the psychiatric nursing course at the university where the primary researcher is affiliated, who willingly agreed to take part in the study. The sample size was calculated using the G*Power 3.1.9.7 software, setting the t-test with an effect size of 0.8 [8], a significance level of .05, and a power of .95 for an independent t-test, which indicated that 35 participants per group, totaling 70 participants, were required. Considering the 10% dropout rate, the final calculated sample size was 77. Out of the total 94 students enrolled in the psychiatric nursing course, 90 agreed to participate in the study, with 46 assigned to the EG and 44 to the CG. The final analysis included data from 82 students, excluding 8 students with incomplete survey responses, comprising 39 from the EG and 43 from the CG.
3. Instruments
Knowledge Knowledge was assessed using a tool developed by the principal investigator to measure knowledge acquired from two scenarios provided during the escape room activities. The tool consisted of 10 items divided into two areas: nursing care for a patient with schizophrenia and nursing care for a patient with alcohol use disorder, with 5 items in each area. Each item required a yes/no response, scored as 1 for correct and 0 for incorrect, with a total score range of 0 to 10. Higher scores indicated a higher level of knowledge. The knowledge measurement tool was refined and validated by two nursing faculty members with over 10 years of experience in teaching psychiatric nursing and its practicum, resulting in a content validity index (CVI) of .95.
Proactivity in Problem-Solving Proactivity in problemsolving was defined as the anticipation of potential issues related to team activities, active data collection, and appropriate actions for resolving problems [24]. It was measured using an instrument originally developed by Marshall [24] and modified by Kwon [25], with permission from the author. The tool comprised 8 items, each evaluated on a 5-point Likert scale. Scores ranged from 0 to 40, with higher scores reflecting greater proactivity in problem-solving. The Cronbach’s ⍺ for the tool was .86 at the time of its development [25], and in this study, it was .93 before and .96 after the intervention.
Teamwork Teamwork was assessed using the same instrument developed by Marshall [24] and modified by Kwon [25], also with permission from the author. The instrument included 11 items, each measured on a 5-point Likert scale. Higher scores indicated better teamwork. Cronbach’s ⍺ for the tool was .86 during its development [25], and in this study, it was .94 before and .97 after the intervention.
Learning Satisfaction Learning satisfaction was measured using the learning satisfaction tool developed by Ji and Chung [26], used with permission from the author. This tool consisted of 7 multiple-choice and 3 open-ended questions, with scores ranging from 0 to 35. The open-ended questions asked participants to describe the strengths, weaknesses, and desired improvements of the class. The Cronbach’s ⍺ coefficient for the multiple-choice questions was .88 in Ji and Chung’s study [26], and in this study, it was .94.
4. Procedure
The psychiatric nursing class with the escape room was conducted during the final session of the 15th week, lasting 50 minutes. Students attended the psychiatric nursing course throughout the semester, covering topics such as therapeutic communication, mental status examinations, schizophrenia spectrum disorders, and substance use disorders. The study was carried out following approval from the Institutional Review Board (IRB) of the institution affiliated with the principal investigator. A professor and a research assistant with a master's degree from another university explained the study's purpose and procedures to the EG and CG, respectively, and distributed consent forms. Students who agreed to participate signed and returned the consent forms. All students participated in the activities as part of the regular class, and those who consented completed pre- and post-intervention surveys.
Participants were assigned to either the EG or CG based on the researcher’s convenience, with one class assigned to each group. The EG consisted of 9 teams, each participating in 3 activities, grouped into sets of 3 teams. The first activity was a crossword puzzle involving psychiatric terms that had to be completed within 10 minutes to find the code to unlock a safe. The safe contained a scenario of a hospitalized schizophrenia patient [27], which the team had to review and identify non-therapeutic communication, modifying it to therapeutic communication within 25 minutes. The primary researcher was present in the room to provide orientation and time notifications for each activity. Following this, the third activity, the “room of error,” took place in the simulation lab, where 3 identically set up rooms contained mannequins representing patients undergoing alcohol withdrawal treatment. The scenario required teams to identify 12 safety hazards within 15 minutes to escape the room, focusing on medication safety and environmental hazards. Another research assistant with a master's degree in nursing welcomed students, provided a brief orientation, and administered post-intervention surveys to participants who gave consent after all activities had done.
The CG was also divided into 9 teams. After receiving an explanation of the study from the research assistant and signing the consent forms, participants who agreed to take part completed the pre-intervention survey. They then participated in a 50-minute team-based discussion in two classrooms, reviewing a scenario of a hospitalized schizophrenia patient and modifying non-therapeutic communication to therapeutic communication. The scenario provided to the CG included additional situations compared to the EG. After 50 minutes of activity, the research assistant administered the post-intervention survey to the consenting participants and collected the responses. To prevent contamination of the intervention, the use of mobile phones and electronic devices was prohibited during the 50-minute intervention, and movement paths were separated to avoid overlapping between groups. Participants were allowed to leave after completing the surveys.
5. Data Analysis
Data were analyzed using SPSS 29.0 statistical software (Version 29.0; IBM Corp., Armonk, NY, USA). Descriptive statistics, such as frequencies, percentages, means, and standard deviations, were used to describe the general demographics of the study participants and to analyze knowledge, proactivity in problem-solving, and learning satisfaction. Differences in general characteristics between groups were assessed using t-tests for continuous variables and x2 or Fisher’s exact tests for categorical variables. The normality of dependent variables was assessed using the Shapiro-Wilk test, which indicated that the data did not meet the assumption of normal distribution (p<.05). Therefore, non-parametric tests, including the Mann-Whitney U test, were employed to evaluate group homogeneity and the effect of the intervention. Changes in dependent variables within groups were analyzed using the Wilcoxon signed-rank test, with statistical significance determined at p<.05
To gain a deeper understanding of the students' responses, additional analysis of the answers to the open-ended items of learning satisfaction was conducted using summative content analysis. Summative content analysis is a method that quantitatively identifies specific keywords or content within a text to understand the contextual usage of words or themes in the data. This approach focuses on analyzing and interpreting the frequency of specific words or themes within textual data, enabling the discovery of the meanings inherent in those words or themes [28]. The researchers read thoroughly the participants' responses, identifying, counting, and synthesizing significant statements related to the advantages and drawbacks of each class to construct meaning. After conceptualizing the keywords, those with thematic similarities were grouped and categorized.
6. Ethical Considerations
This study assessed the effects of new teaching methods, which required official approval from the head of the researcher's institution, as it did not fall under standard educational practices according to the IRB guidelines. The study proceeded only after receiving approval from the IRB of the researcher’s affiliated institution (Approval NoBUIRB-202310-HR-019). Students participated in the regular class, and their involvement in the survey was completely voluntary, as clearly stated in the consent form provided to them.
Since the participants were students from the primary researcher's class, they were considered vulnerable populations and specific measures were taken to protect them. A professor and a graduate student from another institution explained the study’s purpose and procedures to both the EG and CG, emphasizing that survey participation should be voluntary and that non-participation would not affect their academic grading. No personal identifiers were collected, and data analysis occurred only after grading process was completed. They were also informed that the data would be securely stored on the primary researcher’s computer, which is protected by a password, for three years prior to its permanent deletion.
RESULTS
1. General Characteristics of Study Participants and Homogeneity Test
The study included a total of 82 participants, with 39 in the EG and 43 in the CG. The mean age of the participants was 23.00 years in the EG and 22.42 years in the CG. The majority of participants were female, with 32 (82.1%) in the EG and 38 (88.4%) in the CG. Regarding religion, the majority of participants in both groups were non-religious: 22 (56.4%) in the EG and 22 (51.2%) in the CG, followed by Christianity: 15 (38.5%) in the EG and 15 (34.9%) in the CG. For satisfaction with their major, the most common response in both groups was "somewhat satisfied," with 19 (48.7%) in the EG and 16 (37.2%) in the CG, followed by "neutral." No statistically significant differences were found between the EG and CG in terms of general characteristics, indicating homogeneity between the groups. (Table 2).
2. Homogeneity Test for Outcome Variables
Prior to participating in the study, knowledge scores were 6.49±1.02 in the EG and 6.63±1.31 in the CG (Z=-0.41, p=.680). Problem-solving proactivity scores were 4.06±0.71 in the EG and 4.20±0.53 in the CG (Z=-0.29, p=.775), and teamwork scores were 4.33±0.55 in the EG and 4.48±0.50 in the CG (Z=-1.37, p=.169). No statistically significant differences were observed between the EG and CG, confirming their homogeneity (Table 3).
3. Effects of Psychiatric Nursing Classes Incorporating Escape Room
1) Hypothesis 1
The hypothesis that the EG participating in the psychiatric nursing class with escape room would have higher knowledge related to psychiatric nursing than the CG participating in scenario-based group discussions was rejected. The difference in knowledge scores before and after the intervention was 0.23±1.16 in the EG and 0.47±1.16 in the CG, showing no significant difference between the two groups (Z=-0.87, p=.382), thus rejecting hypothesis 1 (Table 4). Within-group analysis of pre- and post-intervention knowledge scores showed that the post-intervention scores increased in the EG, but the increase was not statistically significant (Z=-1.37, p=.172). However, the CG demonstrated a significant increase (Z=-2.40, p=.017).
2) Hypothesis 2
The hypothesis that the EG participating in the psychiatric nursing class incorporating escape room games will have higher problem-solving proactivity than the CG participating in scenario-based group discussions was rejected. The change in problem-solving proactivity scores before and after the intervention was 0.33±0.64 in the EG and 0.29±0.50 in the CG, with no significant difference observed between the two groups (Z=-0.05, p=.963), leading to the rejection of hypothesis 2 (Table 4). Analysis of within-group changes in problem-solving proactivity scores before and after the intervention showed significant increases in both the EG (Z=-3.47, p<.001) and CG (Z=-3.96, p<.001).
3) Hypothesis 3
The hypothesis that the EG participating in the psychiatric nursing class incorporating escape room games will have higher teamwork than the CG participating in scenario-based group discussions was rejected. The difference in teamwork scores before and after the intervention was 0.22±0.40 in the EG and 0.11±0.39 in the CG, with the EG showing a greater increase. However, no significant difference was found between the two groups (Z=-1.11, p=.266), thus rejecting hypothesis 3 (Table 4). Within-group analysis of pre- and post-intervention teamwork scores showed significant increases in both the EG (Z=-3.55, p<.001) and CG (Z=-2.08, p=.037).
4) Hypothesis 4
The hypothesis that the EG participating in the psychiatric nursing class incorporating escape room games will have higher learning satisfaction than the CG participating in scenario-based group discussions was rejected. The post-intervention learning satisfaction scores were 4.57± 0.55 in the EG and 4.37±0.65 in the CG, with the EG scoring higher. However, no significant difference was observed between the two groups (Z=-1.32, p=.187), resulting in the rejection of hypothesis 4 (Table 4).
4. Additional Analysis of Responses to Open-Ended Items on Learning Satisfaction
The common responses of EG regarding the advantages of the escape room class were categorized into three main areas: learning effect, team interaction, and interest. In terms of learning effect, many participants noted that “applying concepts from the theory class to real-life situations improved retention”. Key themes included enhanced memory, clinical application, and better focus. Regarding team interaction, numerous comments highlighted that “engaging with team members revealed perspectives I hadn’t previously considered,” with keywords like sharing, conversation, discussion, cooperation, and collaboration. Additionally, in the EG, there were numerous mentions of “it was interesting to apply to real-life situations” and “it was very enjoyable to learn.” In contrast, for the CG, the advantage most frequently noted was the ability to learn therapeutic communication through cases. Team interaction was primarily associated with keywords like sharing and communication. However, there were no mentions related to interest or fun in the CG.
The most frequently cited drawbacks or limitations of the teaching method were lack of time and lack of answers. Other feedback included difficulty in conducting the class, inability to unlock a safe lock despite solving the puzzle, and issues related to desk configuration and freeriding by team members. Table 5 summarizes the categorized themes of both groups on the strengths and drawbacks of the class (Table 5).
Suggested improvements for the class included adjusting the time allocation to be more flexible, providing feedback on scenarios and activities through debriefing, and reinforcing pre-class learning of therapeutic communication. In the EG, there was also a suggestion to enhance continuity by using a single, cohesive scenario for both the therapeutic communication and room of error activities.
DISCUSSION
This study aimed to examine the effects of escape room-based psychiatric nursing classes on knowledge, proactive problem-solving, teamwork, and learning satisfaction among nursing students. It holds significance as the first quantitative study in South Korea's nursing education field to apply escape rooms and verify their effects.
The results showed no statistically significant difference in knowledge scores between the EG, which participated in escape room activities, and the CG, which participated in scenario-based group discussions. However, the post-intervention knowledge scores in the CG significantly increased compared to their pre-intervention scores. This finding contrasts with previous studies that reported the effectiveness of escape room activities in enhancing knowledge acquisition [10,12,15,16,19,20]. For example, Yang et al. [19] found that an online escape room activity (50 minutes) related to delivery situations significantly improved academic achievement in the EG compared to a standard online lecture (50 minutes) in the CG. Fusco et al.[20] also observed that interprofessional escape room activities related to sepsis cases resulted in significantly higher knowledge scores in the EG compared to the CG, which participated in lectures on the same topic. Similarly, Molina-Torres et al. [12] reported significant differences in knowledge scores between the EG, which participated in a 15-minute escape room activity in their final week of anatomy class, and the CG, which received a traditional lecture. While prior studies provided standard lectures to CG, this study employed scenario-based group discussions, which may have led to the significant increase in knowledge scores in the CG due to active participation rather than passive listening.
In studies without CGs, such as Millsaps et al. [16], who conducted three 30-minute escape room sessions on stroke patient cases totaling 90 minutes, and Morrell and Eukel [15], who applied escape rooms (60 minutes) in cardiovascular nursing classes, post-intervention knowledge scores significantly increased compared to pre-intervention scores. Millsaps et al. [16] conducted escape room activities for a much longer duration (90 minutes) compared to this study, and Morrell and Eukel [15] allowed students to use four types of hints, including medical reference materials and assistance from supervising professors while solving puzzles. In contrast, this study did not include debriefing to prevent information sharing among students after the escape room activity, which may explain the lack of significant knowledge score increases. Additionally, debriefing was conducted online only after all students had completed the post-intervention survey, which included scenario reviews, Q&A, and answers. This differs from the inclusion of debriefing in the class structure in previous studies. Wettergreen et al.[10] reported no significant changes in knowledge scores between pre- and post-intervention surveys in an escape room on acute care management of drug overdose patients, similar to the results of this study. To enhance knowledge acquisition through escape room activities, it is necessary to provide sufficient time, offer reference materials and professor assistance, and include debriefing sessions following the escape room activities.
Regarding proactive problem-solving, there was no significant difference between the EG and the CG. This result contrasts with the study by Yang et al. [19], where the EG that participated in an online escape room (50 minutes) related to delivery situations scored significantly higher in problem-solving compared to the CG, which participated in standard online lectures (50 minutes). In this study, the CG participated in scenario-based group discussions rather than passive lectures, which likely contributed to the lack of significant differences between the groups. Both groups in this study showed significant increases in post-intervention proactive problem-solving scores compared to pre-intervention scores, supporting Morrell and Ball's [13] findings that escape rooms, where participants solve clues to escape, aid in improving problem-solving, critical thinking, and teamwork. Since escape room activities inherently involve a series of problem-solving tasks, they are likely beneficial for enhancing problem-solving skills. However, few studies, aside from Yang et al. [19], have specifically set problem-solving as a dependent variable. Future research should explore the effects of escape room activities on problem-solving ability.
Teamwork scores in the EG that participated in escape room-based psychiatric nursing classes did not differ significantly from those in the CG who engaged in regular group discussions. However, both groups demonstrated significant increases in post-intervention teamwork scores compared to pre-intervention scores. This aligns with the findings of Fusco et al.[20], where interprofessional collaboration scores increased in both the EG that participated in escape room activities related to sepsis cases and the CG that participated in lecture-based acute care management classes on sepsis cases, with no significant differences between the groups. In the single-group pre-and-post design study by Foltz-Ramos et al. [22], a short-duration interprofessional escape room was reported to enhance teamwork and, consequently, simulation performance. Similarly, Hursman et al.[23] conducted escape rooms on drug overdose cases in virtual environments, finding that online escape rooms effectively improved interprofessional teamwork perception. Since escape rooms require group communication and collaborative problem-solving, they hold potential for improving teamwork among nursing students.
Regarding learning satisfaction, the EG scored 4.57 points, while the CG scored 4.37 points, with no significant differences between the groups. An analysis of subjective responses to the learning satisfaction survey revealed that both groups frequently mentioned learning effectiveness and team interactions. Additionally, the EG reported responses such as “interesting” and “fun,” which were not observed in the CG. This finding is consistent with Molina-Torres et al.[12], where the score for the item “the escape room activity was fun” was very high (4.88 out of 5). Feedback from students on the limitations of the escape room activity included a lack of time and uncertainty about the answers, highlighting the need for debriefing. Recommendations for improvement included providing adequate prior information and pre-learning, similar to the approach taken by Fusco et al.[20], who suggested offering more details about the scenario and allowing more time to complete the escape room. Morrell and Eukel [15] found that perceptions of escape rooms, such as “I gained considerable knowledge from my peers during the cardiovascular escape room activity” (4.28 points) and “escape rooms proved to be an effective method for reviewing the topic of cardiovascular diseases” (4.24 points), were similarly high. While escape rooms effectively engage nursing students, enhancing proactive problem-solving and teamwork, they require significant time and resource investment from educators [21]. Since the effects of escape rooms did not significantly differ from group discussions, scenario-based group discussions could be regularly applied to achieve similar learning objectives with less burden on educators, while occasionally incorporating escape room activities to maintain student interest. Future studies should compare the effects of lectures, group discussions, and escape rooms.
The limitations of this study include the absence of debriefing, the possibility of testing effects due to the pre-and post-tests being conducted on the same day, and the difficulty in generalizing the findings as the study was conducted at a single university. Despite these limitations, this study differs from previous studies, which either lacked a CG or provided standard lectures to CG, by comparing escape rooms with scenario-based group discussions, making it the first quantitative study in South Korea's nursing education field to apply escape rooms.
CONCLUSION
This study aimed to evaluate the effects of escape room-based psychiatric nursing classes. The findings indicated no significant differences in knowledge, proactivity in problem-solving, teamwork, and learning satisfaction between the EG and the CG. However, both groups showed significant increases in proactivity in problem-solving and teamwork scores after the intervention compared to pre-intervention, while only the CG demonstrated a significant increase in knowledge. Analysis of subjective responses to the learning satisfaction revealed that both teaching methods enhanced learning effectiveness and team interactions, with additional reports of interest and enjoyment in the EG. Thus, it is recommended to frequently use scenario-based group discussions that require less effort from educators, and occasionally apply escape rooms to stimulate students’ interest.
Based on the results and discussion, future research should involve randomized controlled trials to accurately measure the effects of escape room, lecture, and group discussion. Moreover, considering that students regarded the 50-minute duration of the escape room as insufficient, it is recommended that future research explore the possibility of extending this time frame. Students noted that while distinct scenarios were utilized for both the therapeutic communication activity and the room of error activity, the implementation of a continuous scenario could significantly enhance the overall experience. Therefore, future studies should focus on designing a three-step escape room that incorporates a unified and cohesive scenario.
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