Authors: (including presenting author): :
Poon SK, Ho CM, Wong OC, Kan BSP, Choi MPP
Affiliation: :
Department of Neurosurgery, Queen Elizabeth Hospital
Keyword 1: :
Escape Room Simulation
Keyword 2: :
Generation Z Nurses
Keyword 3: :
Situational Awareness
Keyword 5: :
Self-competency
Introduction: :
High-acuity neurosurgical settings demand rapid situational awareness (SA) and critical thinking. Yet, Generation Z nurses frequently report high anxiety and transition shock, traditional simulation is often perceived as an evaluative test, further hindering their psychological safety and learning. This study aimed to evaluate 'NeuroMaze', a gamified Escape Room (ER) simulation, as a proof-of-concept for enhancing Generation Z nurses' SA, knowledge, self-competency and teamwork.
Objectives: :
The study aimed to evaluate the feasibility of the gamified ER simulation; enhance Generation Z nurses’ SA, core knowledge, and self-competency in critical thinking; and foster improvements in teamwork, inter-team communication, and learning incentives.
Methodology: :
This feasibility study used a quasi-experimental pre-test/post-test design. The 45-minute collaborative ER intervention involved novice nurses managing a post-operative trauma patient through tasks on drain management, ventilator care, hypertensive crisis and spinal immobilisation. Outcomes were measured using the validated Situational Awareness Rating Technique scale for SA, an expert-validated MCQ for core knowledge, and an adapted self-competence questionnaire, supplemented by focus group interview.
Result & Outcome: :
Five female novice nurses (2 RNs, 3 trainees; < 2 years experience) were included. The intervention yielded significant positive outcomes: SA: Overall SA increased by 34.15%, including a 140%rise in 'mental space’. This signifies a substantial reduction in cognitive load, allowing for greater alertness and focus. Clinical Knowledge: Mean accuracy rose 20% (70% to 84%), demonstrating high effectiveness in rectifying high-risk events. The knowledge gained was particularly evident in core neurocritical care concepts, including knowledge of medications and the clinical manifestation of Cushing's Triad. Self-Competency: Confidence in critical thinking saw a 280% increase (1.0 to 3.8). This confidence boost was reported across multiple high-stress skills, such as prioritizing nursing actions during emergencies and management of hypertensive crisis Teamwork: Focus groups highlighted improved inter-team communication and significantly higher learning incentives, validating the gamified structure's approach to psychological safety. Implications and Conclusion: The NeuroMaze ER simulation is a feasible and validated educational innovation for Generation Z neurosurgical training. The significant improvements observed in SA, knowledge, self-competency and teamwork validate its strong potential to empower novice nurses in high-acuity settings. This model supports the broader adoption of gamified simulation to enhance Generation Z nurses’ preparedness and engagement.
