A Flipped Classroom Versus a Traditional Classroom Approach to Improving Nursing Student Outcomes

Purpose: Cerebrovascular Accident (CVA), commonly known as a stroke, is the second most common cause of death and the leading cause of adult disability in China (Norrving, 2017). However, newly graduated nurses not only in China, but throughout the world, have been shown to have limited stroke care skills and experiences as they start their nursing careers (Das & Das, 2013; Islam, Geum. Lee, & Kim, 2017). Clinical education plays an important role in providing the opportunities for students to develop critical thinking and problem solving skills necessary to care for these complex patients (Islam et al., 2017). The flipped classroom approach is an interactive and autonomous learning method that has been used in many areas of education with positive results. However, few studies have investigated FC’S effectiveness within complex clinical settings (Best & Naber, 2016).

The purpose of this study was to compare the effectiveness of presenting a cerebrovascular accident training program in three one-hour classes using a flipped classroom (FC) approach to traditional classroom (TC) teaching to third year Chinese nursing students during their neurological clinical rotation. Specifically, this study examined the following student outcomes: learning performance, critical thinking skills, motivation and satisfaction, relating to FC teaching.

Methods: This research study used a quasi-experimental pre-test and post-test design with two equivalent groups. The control group was taught using a traditional classroom (TC) approach. The experimental group learned from study materials that were made available one week before the class using an internet platform. It was expected that all students would come to each class having reviewed the contents (Brame, 2013; McDonald & Smith, 2013). During the last week of the clinical rotation all students took a 26-item posttest survey and a final 30 item multiple choice exam over the class content.

Results: In all, 62 students completed the study: 29 in the FC and 33 in the TC groups. While all students’ scores improved, the flipped classroom students did statistically significantly better, even though both groups were exposed to the same content, participated in the same patient scenarios, and spent a similar amount of clinical time in the same clinical setting with the same instructors. The flipped classroom group had moderate to higher effects in knowledge achievement, critical thinking, autonomy, relatedness, and overall learning satisfaction.

Conclusion: The majority of studies that have looked at the flipped classroom approach have looked at its use in a traditional class room setting, often focusing on improved knowledge performance as the outcome. This study provides important evidence that supports the value of a flipped classroom as a creative, effective, and easy methodology to adapt to an already developed course in a clinical setting that includes critically ill patients.