NURS 764 Week 5 Project: Innovative Strategies Example

Two Innovative Strategies for Teaching the Golden Minute: A Newborn Resuscitation Escape Room and Rapid Cycle Deliberate Practice

The Problem the Strategies Must Solve

The classroom plan from Module/Week 4 teaches the golden minute in one lecture and one simulation day. That plan gives each student perhaps three attempts at the skill before the knowledge test and the timed checklist. For a sequence that must be performed in under a minute, under stress and from memory, three attempts are not enough, and the retention studies reviewed in Module/Week 2 show that skills fade quickly after a single training. The classroom portion also asks students to sit and listen for most of an hour, which does little for the teamwork and role clarity that objective four requires. Bradshaw and Lowenstein (2014) describe innovative strategies as ways to make students active participants in their own learning, and the two strategies below were chosen to add attempts, speed and teamwork.

Strategy One: A Newborn Resuscitation Escape Room

Evidence

Campos et al. (2026) designed a simulated neonatal resuscitation escape room for undergraduate nursing students from six schools in South India, who first completed an asynchronous maternal-fetal course. Facilitators recorded whether each group completed the resuscitation skills, and students rated the experience. Most groups completed the sequence with minimal assistance, posttest items about recognizing a newborn in distress showed better retention and students reported stronger teamwork and collaboration. Students and facilitators described the room as engaging and psychologically safe. The project was descriptive quality improvement without a comparison group, so it shows feasibility and acceptability more than effect.

A systematic review by Esmaeilzadeh and Aygün (2025) located seven studies of escape rooms in nursing education, one randomized and six quasi-experimental, and concluded that escape room activities improved students' theoretical knowledge, clinical skills and motivation, while calling for larger and more rigorous studies. Taken together, the evidence supports the escape room as an engaging way to rehearse a sequence and practice teamwork, with modest certainty about its effect on skill.

Design

The room is set in the skills lab during the week nine lab session for teams of four, with six teams rotating through two identical rooms in forty-minute slots. Each team receives a scenario card: a mother in active labor with thick meconium-stained fluid and a prolonged second stage. Four locked boxes sit around a newborn manikin, and each opens with a code found by completing a stage correctly.

• 1. Prepare. The team must find the risk factors in the scenario card and choose the correct equipment from a cart holding distractors, such as an adult mask. The correct items reveal a three-digit code.
• 2. Initial steps. A recorded birth plays, and the team must dry, warm, position and stimulate the manikin. A facilitator with a stopwatch gives the next code only if these are done within thirty seconds.
• 3. Ventilate. The manikin remains apneic. The team must begin ventilation with visible chest rise, and the code is the heart rate the monitor shows when ventilation becomes effective.
• 4. Correct. In the final box, the chest stops rising, and the team must work through the corrective steps in order to unlock a card announcing that the baby is breathing.

A fifteen-minute debriefing follows every room, using the role cards to ask each student what they did and what they would change. The design serves objectives two, three and four directly, and the puzzles in the first box reinforce the knowledge tested by objective one.

Strategy Two: Rapid Cycle Deliberate Practice

Evidence

Hunt et al. (2014) developed rapid cycle deliberate practice for pediatric residents learning the first five minutes of resuscitation. In place of a full scenario followed by a long debriefing, the facilitator interrupted whenever an error occurred, gave brief direct feedback and had residents try again, so that the time was spent mostly on correct repetitions. In a pre-post comparison of seventy residents before and fifty-one after the change, the median pause before defibrillation fell from 84 seconds to 8 seconds, and the hazard ratio for beginning compressions inside sixty seconds of pulselessness was 3.8 after adjustment. The method draws on the account of deliberate practice by Ericsson (2004), who argued that expert performance develops through focused, repeated practice on well-defined tasks with immediate feedback, not through accumulated experience alone.

The fit to the golden minute is close. Both the residents' first five minutes and the newborn's first sixty seconds are brief, clocked sequences with predictable errors, such as delaying ventilation to suction a clear airway, and a benchmark against which each attempt can be judged.

Design

Each team of four runs the golden minute in three rounds of increasing difficulty during one hour of the lab session.

When an error occurs, I say "pause," name the error in a sentence, show the correct action once and say "rewind," and the team repeats from the start of that stage. Each round continues until the team completes it without a pause, and students rotate roles between rounds so that everyone ventilates at least twice. Feedback is short by design; the longer reflective conversation is saved for the end of the hour.

Facilitator Preparation

Rapid cycle deliberate practice depends on facilitators who interrupt consistently, and four faculty members will facilitate the rounds. Before the semester, we will meet for two hours to agree on the list of errors that trigger a pause, the one-sentence wording for each correction and the target times. We will practice on one another, with one person playing a hesitant student, so that each facilitator hears how an interruption sounds from the learner's side. A shared scoring sheet will record, for each team and round, the number of pauses and the time to ventilation, which gives the course data on where students most often stumble. Consistency matters because students compare notes, and a team that is paused for an error another facilitator ignored will rightly feel the process is unfair.

Fit with Theory and with These Learners

Both strategies follow from the theories used in the classroom plan. The escape room completes Kolb's cycle within a single activity: students experience the scenario, reflect in the debriefing, connect it to the algorithm and try again in the next round. Rapid cycle deliberate practice applies Ericsson's account of expertise directly, turning a single long scenario into many short, corrected repetitions. For the diverse learners described in the Module/Week 3 forum, both strategies use the same ten spoken phrases and the same pictorial action plan as the lecture, and both use role cards so that no student must invent a role under pressure. Students who learned English later benefit from hearing the same phrases repeated dozens of times in an afternoon, and students with performance anxiety meet interruptions first in a round designed to be easy, where correction feels like coaching rather than failure.

How Success Will Be Measured

The strategies will be judged against the project's objectives rather than students' enjoyment alone. Time to initial steps and time to ventilation on the timed checklist will be compared with the previous cohort, which was taught by lecture and a single simulation. Facilitators will record the role checklist for objective four during the escape room debriefing. The six-week recheck in week fourteen will show whether the extra repetitions slow the loss of skill that the retention studies predict. Students will also complete a brief anonymous survey on each strategy, asking what helped and what felt stressful. If deliberate practice improves times but students report high stress, I will shorten the first round and add a demonstration before it rather than abandon the method.

Comparing the Two Strategies

The strategies do different work and fit different moments. The escape room is better at engagement, teamwork and helping students see the whole sequence as a story with stakes; it is less precise, because a team that succeeds slowly still opens the box. Rapid cycle deliberate practice is better at speed and accuracy, since every error is corrected at once and each student repeats the skill several times; it is more intense, and anxious students may find the interruptions difficult at first. I will therefore run the deliberate practice rounds first, to build correct technique, and the escape room afterward, as a team challenge that tests whether technique holds under the pressure of a game.

Risks and Limits

Both strategies need more faculty time than a lecture, about four facilitators for one lab afternoon, and the escape room needs two identical rooms and a rehearsal. Students who are anxious about performing in front of peers may find the interruptions of deliberate practice hard, which the prebriefing described in the Module/Week 3 forum is meant to address. The evidence for both comes largely from other learners, residents for deliberate practice and students in another country for the escape room, so my results may differ. I will treat the first semester as a test of the strategies, not a proof of them, and compare checklist times with the previous cohort's.

References

Bradshaw, M. J., & Lowenstein, A. J. (2014). Innovative teaching strategies in nursing and related health professions (6th ed.). Jones & Bartlett Learning.

Campos, E. M., Dambrino, K. L., Sternberg, J., McCoy, T., Garner, S. L., Natt, K., Prater, L. S., Ke, W., Lourduswamy, L., Victor, S., Kirubha, V., Hallmark, B., & Honey, J. (2026). Launching a neonatal resuscitation escape room to combat high infant mortality rates: A quality improvement project. Advances in Neonatal Care, 26(3), 247-254. https://doi.org/10.1097/ANC.0000000000001356

Ericsson, K. A. (2004). Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. Academic Medicine, 79(10 Suppl.), S70-S81. https://doi.org/10.1097/00001888-200410001-00022

Esmaeilzadeh, S., & Aygün, M. (2025). The effectiveness of game-based learning in nursing education: A systematic review of the escape room approach. Nurse Education in Practice, 87, Article 104494. https://doi.org/10.1016/j.nepr.2025.104494

Hunt, E. A., Duval-Arnould, J. M., Nelson-McMillan, K. L., Bradshaw, J. H., Diener-West, M., Perretta, J. S., & Shilkofski, N. A. (2014). Pediatric resident resuscitation skills improve after "rapid cycle deliberate practice" training. Resuscitation, 85(7), 945-951. https://doi.org/10.1016/j.resuscitation.2014.02.025