Background: There is an ever-growing need to change the pedagogy of nursing education to meet the demands of highly-technological and dynamic healthcare systems with more complex, diverse and higher acuity populations (Kaddoura, 2011). Nurse educators are challenged to bridge the theory-practice gap to ensure that new nurse graduates are well-quipped with the skills to critically reason through patient situations that require sound clinical judgment (Benner, Kyriakidis, & Stannard, 2013; Kaddoura, 2011). In meeting these challenges, nurse educators must transform the classroom, shifting teaching and learning paradigms (Benner, Kyriakidis, & Stannard, 2013; Nilson, 2016, October 24). The classroom environment must promote and support student engagement through deeper, more meaningful learning that foster critical reasoning (Kaddoura, 2011). A flipped classroom creates an environment in which students actively engage with content, thereby stimulating and encouraging higher level thinking (Honeycutt, 2016). The use of case scenarios promotes the development of critical reasoning through open-ended and unfolding situations that require students to interpret, analyze and synthesize the most salient patient data to support clinical decisions (Kaddoura, 2011; Nilson, 2016, October 24). Case scenarios also provide a format for students to explore alternatives, describe rationales that support their decisions, receive feedback from their peers and faculty, and promote a greater awareness of their own cognitive reasoning (Kaddoura, 2011; Nilson, 2016, October 24).
Methods: Case-based learning within a flipped classroom model was used to teach critical care content to senior level nursing students. Quantitative data was compiled using a pretest-posttest design with student results from Assessment Technologies Institute (ATI) Medical-Surgical Proctored examination before and after a senior-level critical care course. Qualitative data was also analyzed through student evaluations at the end of the course.
Participants: Convenience samples from four different cohorts (total n=48) in pre-licensure Baccalaureate Nursing programs were used to evaluate student learning outcomes.
Results: A pretest-posttest was performed from ATI Medical-Surgical Proctored examination percentages before and after the critical care course. The t-test results indicated statistical difference in students’ performance for all four cohorts with t values ranging from 2.24 to 5.38. The resultant p values were less than 0.05. Themes from student comments in course evaluations ranged from wanting “more lecture” to “challenging” and “Hard work but very rewarding.”
Conclusion: Quantitative and qualitative data suggests that integrating case-based learning within a flipped classroom model may be effective in promoting deeper and more meaningful learning to enhance critical reasoning.