Applying the Flipped Classroom Model to Psychomotor Skill Acquisition in Nursing Education

This descriptive study aimed to examine baccalaureate student psychomotor skill performance when given different methods of pre-skill lab preparation materials in a flipped classroom environment. Bandura’s Social Cognitive Theory was used for development of the study. Social cognitive theory supports the observational learning, imitation, and modeling for sequence of events for the medication administration skill. Lab skill demonstration allows students to actively engage in the learning process. Flipped classroom pedagogy allows students a collaborative and cooperative environment for learning (Mikkelsen, 2015). A convenience sample was used. Students were randomized into two groups (media or reading pre-skill lab preparation) by the department administrator using random.org. Students utilized either a narrated video demonstration of the skill or a skill instruction sheet with photographic images as lab preparation materials. Psychomotor skill performance of insulin pen administration was evaluated using a thirty-point rubric and verified for content validity by six (6) faculty. The rubric included a systematic point range (from 0 to 3) for each skill element. Dosage calculation was deliberately avoided to strictly evaluate the skill performance. Elements measured on the skill performance rubric included a) handwashing, b) choosing correct equipment, c) swabbed pen with alcohol before attaching needle, d) attached needle without contamination, e) primed needle with 2 units of insulin, f ) selected correct dose on pen by dialing (2 units), g) swabbed the subcutaneous injection practice pad, h) administration angle, i) inserted needle without pressing the pen button during the needle insertion, j) pressed the administration button on insulin pen to deliver insulin, k) held finger down on administration button for 10 seconds after dose initiated, l) and proper sharps disposal. A demographic questionnaire was demographic questionnaire prior to skill performance that included gender, age, current cumulative grade point average, years in college, ACT score, previous exposure to flipped classroom teaching approach, and class standing at university. Students were provided instructions prior to entering the simulation room (faculty were not present). The appropriate supplies were set up in the rooms for student use. A single evaluator, blinded to the pre-skill lab method of preparation, used the rubric to score all subjects’ skill performance from the video recordings. An acceptable Cohen’s kappa of 0.51 was calculated to support interrater reliability. Following the skill performance, participants were asked to fill out a 5-point Likert-type scale questionnaire with eight stem questions addressing a) perception of feeling prepared for the skill, b) confidence to complete the skill, c) if additional resources were used to help the student understand the content, d) contributed to the student’s understanding, and e) whether the type of assignment is a good way to prepare for the skill. Results suggest the type of preparation methods used with the flipped classroom pedagogy does not significantly affect student performance on psychomotor skill acquisition. Students in the media group preferred video preparation for skills (M = 4.67, SD = .66) when compared to the reading group (M = 3.62, SD = .74), t(40) = −4.85, p = .001. The reading group was more likely to report use of additional resources, t(40) = −2.32, p = .026. Students in the media group were more likely to agree with the statement, “I would recommend this type of preparation” (M = 4.67, SD = .66) when compared to the reading group (M = 3.62, SD = .74), t(40) = −4.85, p = .001. A small subset of 5 students had prior experience with insulin pens as medication administrators in long term care homes. The five students with prior experience performed significantly worse than the students with no previous experience skill performance score (r = −.414, p =.006). Mwale and Kalawa (2016) described student motivation and knowledge disparity as features affecting psychomotor skill acquisition. Faculty should be aware of students with prior experience in performing a skill may be less motivated to prepare than students who are learning the information for the first time. Findings of this study have implications for psychomotor skill acquisition and education for nursing students with previous experience.