Effect of the Flipped Classroom on the Patient Education Knowledge and Skill of Nursing Students: A Quasi-Experimental Study

Document Type : Original Article

Authors

1 Assistant Professor of Medical Education, Department of Nursing, School of Nursing and Midwifery, Birjand University of Medical Sciences, Birjand, Iran

2 Nursing Instructor, Tabas college of Nursing, Birjand University of Medical Sciences, Birjand, Iran

3 Nursing Instructor, Ferdows Faculty of Medical Sciences, Birjand University of Medical Sciences, Birjand, Iran

4 Hazrat Rasul (PBUH) Hospital of Ferdows, Birjand University of Medical Sciences, Birjand, Iran

10.22062/sdme.2025.200778.1505
Abstract
Background: Strengthening patient education skills in students will improve the quality of future nursing care. With the advancement of technology, the tendency to use blended methods such as flipped classrooms have increased. This study was conducted to determine the effect of flipped classrooms on the patient education knowledge and skills of nursing students.
Objectives: This study aimed to investigate the effect of flipped classrooms on the patient education knowledge and skills of nursing students.
Methods: The present study employed a quasi-experimental design with a control group and a posttest-only format, conducted in 2024 at Birjand University of Medical Sciences. The study population consisted of 52 nursing students selected using a census method. The intervention group was trained using the flipped classroom method. While in the control group, the routine method was used. After the intervention, the patient education skills of both groups were assessed while interacting with a standard patient, utilizing an observation checklist. Data were analyzed in SPSS 16 software using Mann-Whitney, Chi-square, and two-way analysis of variance (p < 0.05).
Results: The mean score of student patient education skill (based on 20) was 15.1 ± 1.71 in the control group and 16.6 ± 1.97 in the intervention group. Results showed a statistically significant difference in the mean scores of patient education skill between the two groups (p=0.009).
Conclusion: It seems that the use of the flipped classroom approach can lead to the improvement of patient education skills of undergraduate nursing students. Therefore, it is recommended to prioritize the use of this approach in the practical unit of the training process for students.

Highlights

Zahra Amouzeshi: (Google Scholar) (PubMed)

Hamidreza Khosravizadeh Tabasi: (Google Scholar) (PubMed)

Mohaddeseh Hosseinzadeh: (Google Scholar) (PubMed)

 

Keywords


1. Taylor CR, Lillis C, LeMone P. Fundamentals of Nursing: The Art and Science of Nursing Care. Philadelphia: Lippincott Williams and Wilkins; 2005.
2.  Mardani Hamuleh M,Shahraki Vahed A, Roozitalab M. A comparison of the importance of patient educational programs in the viewpoint of nurses and patients. Pars Journal of Medical Sciences. 2022; 8(4): 49-55. doi: 10.29252/jmj.8.4.49. [In Persian]
3.  Ashghali Farahani M, Maserat Aghdam Arjestan E, Haghani H. Effect of Role-play Training on the Knowledge of Nursing Students on Patient Education. Iran Journal of Nursing. 2018; 31(115): 29-40. doi: 10.29252/ijn.31.115.29. [In Persian]
4.  Vernon R, Chiarella M, Papps E. Confidence in competence: legislation and nursing in New Zealand. Int Nurs Rev. 2011; 58(1):103-8. doi: 10.1111/j.1466-7657.2010.00853.x. PMID: 21281301
5.  Challa KT, Sayed A, Acharya Y. Modern techniques of teaching and learning in medical education: a descriptive literature review. MedEdPublish (2016). 2021; 10: 18. doi: 10.15694/mep.2021.000018.1. PMID: 38486533 PMCID: PMC10939590
6.  Tummons J. Higher education, theory, and modes of existence: thinking about universities with Latour. Higher Education Research & Development. 2021; 40(6): 1313-25. doi:10.1080/07294360.2020.1804337.
7.  Persky AM, McLaughlin JE. The flipped classroom–from theory to practice in health professional education. Am J Pharm Educ. 2017;81(6):118. doi: 10.5688/ajpe816118. PMID: 28970619 PMCID: PMC5607728
8.   Fan J-Y, Tseng Y-J, Chao L-F, Chen S-L, Jane S-W. Learning outcomes of a flipped classroom teaching approach in an adult-health nursing course: a quasi-experimental study. BMC Med Educ. 2020; 20(1):317. doi: 10.1186/s12909-020-02240-z.
PMID:
32948178 PMCID: PMC7501708
9.  Sajid MR, Laheji AF, Abothenain F, Salam Y, AlJayar D, Obeidat A. Can blended learning and the flipped classroom improve student learning and satisfaction in Saudi Arabia? Int J Med Educ. 2016; 7: 281-5. doi: 10.5116/ijme.57a7.83d4. PMID: 27591930 PMCID: PMC5018351
10.  Schmidt SMP, Ralph DL. The flipped classroom: A twist on teaching. Contemporary Issues in Education Research. 2016;9(1):1-6. doi: 10.19030/cier.v9i1.9544.
11.  McLaughlin JE, Roth MT, Glatt DM, Gharkholonarehe N, Davidson CA, Griffin LM, et al. The flipped classroom: a course redesign to foster learning and engagement in a health professions school. Acad Med. 2014; 89(2): 236-43. doi: 10.1097/ACM.0000000000000086. PMID: 24270916
12. Dehghanzadeh S, Jafaraghaee F. Comparing the effects of traditional lecture and flipped classroom on nursing students' critical thinking disposition: A quasi-experimental study. Nurse Educ Today. 2018; 71:151-156. doi: 10.1016/j.nedt.2018.09.027. PMID: 30286373
13.  Shiau S, Kahn LG, Platt J, Li C, Guzman JT, Kornhauser ZG,
et al. Evaluation of a flipped classroom approach to learning introductory epidemiology. BMC Med Educ. 2018;18(1):63. doi:
10.1186/s12909-018-1150-1. PMID: 29609654 PMCID: PMC5879803
14.  Kim H, Kim Y-H. An action research on flipped learning for fundamental nursing practice courses. Journal of Korean Academy of Fundamentals of Nursing. 2017;24(4):265-76. doi: 10.7739/jkafn.2017.24.4.265.
15. Aydin B, Demirer V. Are flipped classrooms less stressful and more successful? An experimental study on college students. International Journal of Educational Technology in Higher Education. 2022;19(1):55. doi:10.1186/s41239-022-00360-8.
16. Dehghanzadeh S, Alizadeh S. Explaining Nursing Students’ Experiences of a Flipped Classroom: A qualitative Study. J Med Educ Dev. 2018; 11 (31) :1-15. doi: 10.29252/edcj.11.31.1.
17. Ng EKL. Student engagement in flipped classroom in nursing education: An integrative review. Nurse Educ Pract. 2023 Mar:68:103585. doi: 10.1016/j.nepr.2023.103585. PMID: 36868159
18. Bingen HM, Steindal SA, Krumsvik R, Tveit B. Nursing students studying physiology within a flipped classroom, self-regulation and off-campus activities. Nurse Educ Pract. 2019; 35:55-62. doi: 10.1016/j.nepr.2019.01.004. PMID: 30690317
19. Kugler AJ, Gogineni HP, Garavalia LS. Learning outcomes and student preferences with flipped vs lecture/case teaching model in a block curriculum. Am J Pharm Educ. 2019; 83(8):7044. doi: 10.5688/ajpe7044. PMID: 31831896 PMCID: PMC6900813
20. Abeysekera L, Dawson P. Motivation and cognitive load in the flipped classroom: definition, rationale and a call for research. Higher Education Research & Development. 2015;34(1):1-14. doi: 10.1080/07294360.2014.934336.
21. Kang HY, Kim HR. Impact of blended learning on learning outcomes in the public healthcare education course: a review of flipped classroom with team-based learning. BMC Med Educ. 2021; 21(1):78. doi: 10.1186/s12909-021-02508-y. PMID: 33509176 PMCID: PMC7845047
22. Park EO, Park JH. Quasi‐experimental study on the effectiveness of a flipped classroom for teaching adult health nursing. Jpn
J Nurs Sci. 2018;15(2):125-134. doi:
10.1111/jjns.12176. PMID: 28834418
23. Soltaninejad Z, Amouzeshi Z, Mohsenizadeh S M, Biabani F. The effect of flipped classroom on nursing students’ physical examination skills: A Quasi-Experimental Study. J Res Dev Nurs Midw. 2024; 21 (2): 37-9. doi: 10.61186/jgbfnm.21.2.37.
24. Chikeme PC, Ogbonnaya NP, Ihudiebube-Splendor C, Abonyi EO, Madu O, Okoronkwo I. Self-directed learning readiness and learning achievements of a flipped classroom model approach in research methods class: a quasi-experimental study. Nurse Educ Pract. 2024; 77:103968. doi: 10.1016/j.nepr.2024.103968. PMID: 38640708
25. Dong Y, Yin H, Du S, Wang A. The effects of flipped classroom characterized by situational and collaborative learning in a community nursing course: A quasi-experimental design. Nurse Educ Today. 2021; 105:105037. doi: 10.1016/j.nedt.2021.105037. PMID: 34247009
26. Cotta KI, Shah S, Almgren MM, Macías-Moriarity LZ, Mody V. Effectiveness of flipped classroom instructional model in teaching pharmaceutical calculations. Currents in Pharmacy Teaching and Learning. 2016;8(5):646-53. doi: 10.1016/j.cptl.2016.06.011.
27. Mohamad Khah F, Amin Shokravi F, Faghihzadeh S, Babaie Heydarabadi A, Kazembeigi F, Maghsoodi R. Comparison of two methods of dental health education lectures and film screenings on knowledge, attitude and practice of students. J Ilam Univ Med Sci. 2013;20(5):43-50. [In Persian]
28. O'Rourke DJ, Lobchuk MM, Thompson GN, Lengyel C. Video feedback: A novel application to enhance person‐centred dementia communication. Int J Nurs Pract. 2020; 26(4):e12820. doi: 10.1111/ijn.12820. PMID: 32074398
29. Román‐Sánchez D, De‐La‐Fuente‐Rodríguez JM, Paramio A, Paramio‐Cuevas JC, Lepiani‐Díaz I, López‐Millan MR. Evaluating satisfaction with teaching innovation, its relationship to academic performance and the application of a video‐based microlearning. Nurs Open. 2023;10(9):6067-6077. doi: 10.1002/nop2.1828. PMID: 37221960 PMCID: PMC10416003
30. Heidarzadeh H, Heidarzadeh Z, Azadi A. Comparison of pre‐hospital triage training by role playing and lecture on nursing students' knowledge, attitude and performance. Nurs Open. 2020; 7(4):935-942. doi: 10.1002/nop2.464. PMID: 32587711 PMCID: PMC7308685
31. Dorri S, Ashghali Farahani M, Maserat E, Haghani H. Comparison of role play and conventional training methods on long-term learning of nursing students. Development Strategies in Medical Education. 2020;7(1):61-77. doi: 10.29252/dsme.7.1.61.
32. Liebrecht C, Montenery S. Use of simulated psychosocial role-playing to enhance nursing students’ development of soft skills. Creat Nurs. 2016;22(3):171-175. doi: 10.1891/1078-4535.22.3.171. PMID: 29195526
33. Delnavaz S, Hassankhani H, Roshangar F, Dadashzadeh A, Sarbakhsh P, Ghafourifard M, Fathiazar E. Comparison of scenario based triage education by lecture and role playing on knowledge and practice of nursing students. Nurse Educ Today. 2018;70:54-59. doi: 10.1016/j.nedt.2018.08.006. PMID: 30145535
34. Huang SM, Fang SC, Lee SY, Yu PJ, Chen CJ, Lin YS. Effects of video-recorded role-play and guided reflection on nursing student empathy, caring behavior and competence: A two-group pretest-posttest study. Nurse Educ Pract. 2023; 67:103560. doi: 10.1016/j.nepr.2023.103560. PMID: 36731259
35. Jasemi M, Goli R, Zabihi RE, Khalkhali H. Educating ethics codes by lecture or role-play; which one improves nursing students' ethical sensitivity and ethical performance more? J Prof Nurs. 2022; 122-129. doi: 10.1016/j.profnurs.2021.11.002. PMID: 35568451