Underground nursing students' experiences in a face-to-face, hybrid, and online escape room model: a comparative analysis in Serbian context.

Educational escape rooms (EERs) are gamified teaching and learning tools increasingly used in nursing education. This study aims to compare undergraduate nursing students' gameful experiences (GEs) across three EER models: face-to-face, hybrid, and online. A cross-sectional study was conducted with 136 first-year students in a Serbian undergraduate nursing programme. All models EERs had the same narrative, which included several topics from the Fundamentals of Nursing course. Face-to-face and hybrid EERs were implemented in faculty skills laboratories, while the online model used the Zoom® platform. Face-to-face EERs were conducted in 2021/2022. and hybrid and online in the 2022/2023 school year. Immediately after the EER activity, the Gameful Experience Scale (GAMEX) assessed students' GE across six dimensions (Enjoyment, Absorption, Creative Thinking, Activation, Absence of Negative Effects and Dominance). All students solved the puzzles in the allotted time and 'escaped from the room.' Median escape time from face-to-face EER was 39.2 (IQR = 2.1), from online 37.4 (IQR = 4.1), and hybrid 37.2 (IQR = 3.5) minutes. By comparing GE students in three EER models, significant differences were found in five dimensions of the GAMEX scale. Students in face-to-face EER enjoyed significantly more (p < 0.001) and thought more creatively (p < 0.001), while the GE of online model students indicated significantly higher levels of activation (p < 0.001), dominance (p < 0.001), and negative effect (p < 0.001). In the face-to-face and hybrid models, students' GE were more moderate in these dimensions. All EER models can generate positive emotions with moderate negative effects, aligning with the goals of EERs as educational games. Further research is needed to identify the most effective EER model for different areas of nursing education.