Paradoxical effect of flipped classroom on nursing students' learning ability and satisfaction in a fundamental of nursing clinical course: A quasi-experimental study

Abstract

Background

The “Fundamentals of Nursing” course is crucial for equipping novice undergraduate nursing students with essential skills for their professional practice. However, a gap exists between nursing education and clinical readiness—a challenge exacerbated by the COVID-19 pandemic and issues like absenteeism in clinical sessions. The flipped classroom has been proposed as an innovative strategy to bridge this gap, offering students opportunities for self-paced learning before class and enabling more active, hands-on practice during lab sessions.

Objectives

This study aimed to evaluate the effects of the flipped classroom approach on undergraduate nursing students' knowledge retention, skill performance, self-directed learning, collaborative learning, work engagement, learning ability, and satisfaction in a Fundamentals of Nursing clinical course.

Design

A non-equivalent quasi-experimental design was used to compare the flipped classroom method against traditional demonstration-based instruction within a clinical skills lab setting.

Participants

The study included 100 nursing students enrolled in the “Fundamentals of Nursing” theory and lab courses at Sultan Qaboos University, Muscat, Sultanate of Oman, during the fall and spring semesters of 2022.

Methods

The experimental group engaged with pre-recorded video lectures, infographics, and other educational materials before class, while the control group received conventional demonstration-based instruction. Data were collected through pre-quiz and post-quiz scores, skill evaluation checklists, and surveys assessing various learning outcomes.

Results

Although students in the flipped classroom group showed significantly higher pre-quiz scores, indicating better initial understanding, there was no significant difference in post-quiz scores, skill evaluation, or other measured learning outcomes compared to the control group. Unexpectedly, the flipped classroom approach had a detrimental effect on self-reported learning ability and satisfaction. Specifically, the mean scores for learning ability were 35.57 (SD = 5.30) in the flipped classroom group versus 37.89 (SD = 5.26) in the control group, with t = 2.186, p = 0.031 (95 % CI 0.21 to 4.42). Satisfaction scores in the flipped classroom were 44.35 (SD = 11.07) compared to 48.43 (SD = 7.53) in the control group, t = 2.119, p = 0.037 (95 % CI 0.26 to 7.91).

Conclusions

The flipped classroom approach did not significantly enhance most of the educational outcomes compared to traditional demonstration-based teaching. While it offers benefits in terms of adaptability to remote scenarios, its impact on self-directed learning and student satisfaction requires careful consideration and further investigation. Future research should explore its application across multiple skills and longer durations to fully ascertain its effectiveness.