This study compares two teaching methods for helping first-year nursing students learn how to select the correct anatomical site for vital sign measurement in different clinical conditions. Students will be randomly assigned to one of two groups: an escape room simulation group or a case-based learning group. Both groups will receive the same clinical content. Knowledge levels and anxiety will be measured before and after the intervention. Students in the escape room group will also complete scales measuring their gaming experience and satisfaction with learning. Additionally, focus group interviews will be conducted with escape room participants to explore their learning experiences in depth. The study uses a sequential explanatory mixed-methods design.

This sequential explanatory mixed-methods study aims to compare the effects of an escape room simulation and case-based learning on first-year nursing students' knowledge and anxiety regarding the selection of the correct anatomical site for vital sign measurement across different clinical conditions.

The study will be conducted at Acibadem Mehmet Ali Aydinlar University, Department of Nursing and the CASE Advanced Simulation and Education Center during the 2025-2026 academic year fall semester.

Eligible participants are first-year nursing students enrolled in the "Health Assessment" course (N≈101). Participants will be randomly assigned using a computer-generated random number table to either the intervention group (escape room simulation) or the control group (case-based learning). Both groups will work through identical clinical case content involving conditions such as post-mastectomy status, arteriovenous fistula, hemiplegia, oxygen therapy, obesity, and nail polish presence.

In the intervention group, students will solve clinical scenarios through an escape room format in teams of 4-5, followed by a 30-minute structured debriefing session. In the control group, students will discuss the same cases in educator-guided sessions lasting 30-35 minutes.

Data will be collected using a Descriptive Characteristics Form, a Knowledge Test (10-item multiple choice, pre- and post-test), the Gameful Experience Scale (GAMEX), the Student Satisfaction and Self-Confidence in Learning Scale, and the State-Trait Anxiety Inventory (STAI). Qualitative data will be collected via semi-structured focus group interviews with escape room participants and analyzed using content analysis.

Sample size was calculated using G*Power 3.1 (α=0.05, power=0.80, Cohen's d=0.60), indicating a minimum of 45 participants per group (total n=90). The study will be conducted in accordance with the CONSORT guidelines and ethical principles of the Declaration of Helsinki.

Inclusion Criteria:

• Enrolled as a first-year nursing student in the "Health Assessment" course at Acibadem Mehmet Ali Aydinlar University in the 2025-2026 academic year
• Having attended the vital signs lecture and laboratory session
• Not having graduated from a vocational health high school
• Willing to participate voluntarily

Exclusion Criteria:

• Incomplete data collection forms
• Absence from the post-test measurement (T2)
• Voluntary withdrawal from the study

Individual participant data will not be shared in order to protect the privacy and confidentiality of student participants, in accordance with the ethical principles outlined in the study protocol.