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Strategy Submission

Escape Game for Postpartum Hemorrhage for Nursing Education


Linda Beaverstock



Perinatal Clinical Educator


Vanessa Enloe, MSN, ED., RNC-MNN, IBCLC - Texas Health Resources


Texas Health Resources


Competency Categories:

Quality Improvement, Safety, Teamwork and Collaboration

Learner Level(s):

Continuing Education, New Graduates/Transition to Practice, Pre-Licensure ADN/Diploma, Pre-Licensure BSN, RN to BSN, Staff Development

Learner Setting(s):

Classroom, Skills or Simulation Laboratories

Strategy Type:

Case Studies

Learning Objectives:

K: Recognize that nursing and other health professions students are parts of systems of care and care processes that affect outcomes for patients and families (QI - K) S: Use appropriate strategies to reduce reliance on memory (such as forcing functions, checklists) (Safety - S) A: Value teamwork and the relationships upon which it is based (Teamwork and Collaboration - A) Objectives addressed for specific OB Escape game activities are as follows: Students will work in teams to: analyze patient data (history, vital signs, lab values, blood loss) Identify areas of a focused postpartum assessment (BUBBLE HE) evaluate blood loss using Quantitative Blood Loss (QBL) identify risk factors identify appropriate medications prioritize interventions practice use of professional terminology

Strategy Overview:

As part of a national effort to improve early acknowledgment and intervention to postpartum hemorrhage (PPH), complicated by the fact that nursing students and graduate nurses are held accountable for a tremendous amount of content and skills, meaningful and interactive teaching techniques are needed. A game-based learning tool was developed to enhance nursing students’ knowledge retention, use of teamwork, and critical thinking in response to postpartum hemorrhage. This game, called "Escape Postpartum Hemorrhage," which is currently being utilized with BSN students and nursing residents, has shown to improve their test scores and perceived understanding of content. This case study scenario includes activities (puzzles, a decoder, a hidden message crossword, and sorting games) to unlock information to move forward. The activity guides students through recognizing PPH risks, presentation, and best practices in providing the recommended interventions. This in turn fosters a timely response, therefore improving patient safety and outcomes. The learning activity was initially created as a hands-on tool and was subsequently adapted to a digital format during COVID restrictions. Currently, a hybrid version is being used with the graduate residents and both have proved to enhance learning.

Additional Materials:

Please see attached:
Directions for OB escape game (for instructor use)
Pre-brief - instructional information/background for students
Post activity survey

Evaluation Description:

A study involving 20 hospital nursing residents was conducted to evaluate flow and perception. A 4-point Likert scale survey with a comment section evaluated the participants' perception of learning effectiveness. The digital escape game was successfully implemented in April 2020 for 120 university J2 students via Zoom in breakout groups of 3 or 4. All 120 students completed the game and participated in a post-conference debrief. Results revealed 95-100% of participants “strongly agreed” or “agreed” the activity promoted teamwork, reinforced knowledge, prepared for clinical experience, prioritization, and clinical reasoning. Students broadly commented they enjoyed it. The university students improved their test score averages over the related content by 4-6% compared to prior semesters with lecture alone. Responses strongly reinforced the use of escape tools to enhance learning. The creation of the attached digital escape version, which utilizes Google forms, revealed to be more affordable, less labor-intensive, adaptable and had the advantage of creating multiple locks or levels to breakthrough. Creating both helped to compliment the overall game. Also, see attached survey for individual evaluation following the application of this game.
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