Effectiveness of escape room in Chinese nursing education: a systematic review and meta-analysis

Educational escape rooms (EERs), which use immersive, game-based challenges to foster teamwork and critical thinking, are emerging globally in nursing education. As an emerging educational intervention model, EERs have gradually been introduced in China in recent years. While individual studies report positive outcomes, the existing evidence on their effectiveness within the specific context of Chinese nursing education remains fragmented and lacks quantitative synthesis. This gap necessitates a systematic evaluation to consolidate the findings. To synthesize the available evidence to definitively assess the application effects of escape rooms in Chinese nursing education, thereby providing an evidence base for educators. We searched for relevant studies published between January 2016 and May 2025 in six databases (PubMed, EBSCO, Web of Science, CNKI, VIP, and Wanfang), restricting our search to articles in English or Chinese. RevMan5.4 software was used to conduct a meta-analysis of the binary data in the included studies. The Risk of Bias 2 (RoB 2) tool and Newcastle-Ottawa Scale (NOS) were used to assess the quality of studies. Subgroup and sensitivity analyses were used to assess statistical heterogeneity, and I2 was used to measure it. The review was conducted and reported in compliance with the Preferred Reporting Items for Systematic Reviews and Meta‑Analyses (PRISMA) 2020 guidelines. On August 27, 2025, the review protocol has been registered in PROSPERO (CRD420251135200). A total of 19 studies were included, comprising 2,091 participants. Overall, escape rooms had a more significant positive effect than traditional learning methods on knowledge standardized mean difference (SMD) = 4.59, 95% confidence interval (CI); 3.3–5.82, P < 0.001, clinical skills (SMD = 5.33, 95% CI: 2.61–8.05, P < 0.001), critical thinking (SMD = 11.06, 95% CI: 5.55–16.56, P < 0.001), learning satisfaction (OR = 10.24, 95% CI: 3.03–34.60, P < 0.001), teamwork (SMD = 11.38, 95% CI: 5.77–16.99, P < 0.001), learning engagement level (SMD = 5.40, 95% CI: 4.65–6.16, P < 0.001). Regarding self-directed learning ability, there are statistically significant differences in learning awareness (P < 0.001), learning strategies (P < 0.001), learning behaviors (P < 0.001), and learning evaluation (P < 0.001), but no significant difference in interpersonal relationship skills (P = 0.09). Escape rooms affect nursing students’ and nurses’ critical thinking, knowledge, nursing skills, teamwork, learning satisfaction, and learning engagement level. The findings of this study can be used as evidence that escape rooms is a more effective method than traditional teaching for improving active learning. Not applicable.