The Effect of Flipped Learning on Handwashing Skills (FL-SHW)

The Effect of Flipped Learning on Nursing Students' Knowledge and Skills in Surgical Hand Hygiene: A Randomised Controlled Trial

Brief Summary The aim of this randomised controlled intervention study is to investigate the effect of the flipped learning model on nursing students' knowledge and skills regarding surgical hand hygiene. The study will be conducted with two groups, each comprising 64 participants: a control group and an intervention group. Participants in the control group will receive surgical hand hygiene training using traditional teaching methods, whilst those in the intervention group will receive training using the flipped learning approach.

Study Overview

• Status: Not yet recruiting
• Conditions: Surgical Hand Washing; Surgical Hand Washing Knowledge; Surgical Hand Washing Skills
• Intervention / Treatment: Other: surgical handwashing training with flipped learning method

Detailed Description

Detailed Description Despite the necessary precautions being taken, Healthcare-Associated Infections (HAIs) remain a significant public health problem worldwide. HCAIs contribute to increased healthcare costs, prolonged hospital stays, and higher rates of morbidity and mortality. Among infection control practices, hand hygiene stands out as one of the most effective interventions for preventing HCAIs. In particular, surgical hand antisepsis is a critical component of general aseptic technique in surgery, aimed at removing transient microorganisms and reducing the resident skin flora. Surgical hand washing with antimicrobial solutions is a low-cost, easy-to implement and effective method for removing microorganisms from the hands and forearms prior to surgery.

Nurses form a key professional group in the delivery of healthcare services; they play a critical role in the protection and maintenance of health, as well as in the prevention and treatment of diseases. Nurses' theoretical knowledge and clinical competence are directly linked to the quality of the education they receive during their training. Nursing education consists of theoretical instruction and practical training; practical training is conducted in clinical and laboratory settings to support the acquisition of skills. In this context, the surgical nursing module is one of the specialist areas where nursing students acquire critical competencies such as surgical hand hygiene and principles of asepsis. However, there are studies indicating that, despite receiving training on surgical hand hygiene as part of the curriculum, students' knowledge levels do not reach the desired standard. This finding suggests that simply increasing knowledge levels may not always be sufficient; there is a need for learning designs that support skill acquisition, accuracy of application, and retention.

In recent years, there has been an increasing use of innovative pedagogical approaches in nursing education, such as artificial intelligence-supported learning applications, simulation laboratories, gamified educational videos and case-based learning. It has been reported that simulation-based training can enhance knowledge of hand hygiene; however, knowledge alone has been found to be limited in bringing about behavioural change. In contrast, it has been reported that training delivered using a video-based self-assessment approach is effective in developing surgical handwashing skills, and the importance of innovative teaching methods in nursing education has been emphasised.

One of these innovative approaches is the Flipped Learning Model (FLM). Unlike traditional teaching, in the FLM, students prepare for the topic individually by accessing teaching materials (videos and presentations) prepared online prior to class; in class, they consolidate their learning through interactive activities that support discussion, case presentations and practical application. By promoting active and student-centred learning environments, the model enables nursing students to develop their self-directed learning skills. Indeed, a meta-analysis reported that, compared to traditional lecture-based learning, TYÖM significantly improved the theoretical exam marks of Chinese nursing students. Similarly, some studies have shown that TYÖM may be more effective than traditional education in developing fundamental skills during clinical practice periods, as well as in theoretical learning.

Whilst there are various studies utilising the TYÖM approach specifically within nursing education, it is evident that there are limited studies directly examining the impact of TYÖM on a critical practice such as surgical handwashing, which requires both knowledge and technical skill proficiency. This situation necessitates research into the extent to which the flipped classroom approach supports nursing students' knowledge levels, skill performance and the retention of learning in surgical handwashing training. Therefore, this study aims to examine the effect of the flipped classroom model on nursing students' knowledge and skills regarding surgical handwashing.

• Study Type: Interventional
• Enrollment (Estimated): 128
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Yeliz Ciğerci; Phone Number: +902724440304; Email: yelizceylin@hotmail.com
• Study Contact Backup: Name: Pakize Ozyürek, Doçent; Phone Number: 0532 693 81 08; Email: pakize.ozyurek@afsu.edu.tr

Study Locations

• Turkey (Türkiye)
  • Afyonkarahisar, Turkey (Türkiye)
    • Afyonkarahisar Health Sciences University
    • Contact: Yeliz Ciğerci; Email: Yelizceylin@hotmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Be a second-year nursing student taking the Surgical Nursing course
• Be aged 18 or over
• Be willing to participate in the study
• Provide informed consent
• Agree to participate in all stages of the data collection process (pre-test, training, post-test and follow-up assessment)

Exclusion Criteria:

• Have previously received comprehensive/advanced training in surgical hand hygiene
• Be working in the healthcare sector (e.g. have active clinical experience) (optional but recommended)
• Not participate in any stage of the data collection process (pre-test, training, post-test or 3-month follow-up)
• Withdrawing from the study during the study period
• Filling in missing data

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Triple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Control group; Students in the control group will receive training in surgical handwashing using traditional teaching methods.
Experimental: Intervention group; Students in the experimental group will receive training in surgical handwashing using the flipped learning method.	Other: surgical handwashing training with flipped learning method; One of these innovative approaches is the Flipped Learning Model (FLM). Unlike traditional teaching, in the FLM, students prepare for the topic individually by accessing teaching materials (videos and presentations) prepared online prior to class; in class, they consolidate their learning through interactive activities that support discussion, case presentations and practical application. By promoting active and student-centred learning environments, the model enables nursing students to develop their self-directed learning skills. No studies have been found in the literature where surgical handwashing training has been delivered using the flipped learning technique.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Surgical Handwashing Skills Assessment Scale	The Surgical Handwashing Skills Assessment Scale, developed by Şengör et al. (2025), is an analytical, performance-based assessment scale designed to evaluate observable and sequential behaviours based on standardised surgical handwashing protocols. This scale consists of 13 sequential and standardised steps based on surgical handwashing protocols and is designed to assess performance observable through direct observation. The maximum total score obtainable from the scale is 26 points. Each step is scored using the scale according to both the accuracy of execution and the correctness of the sequence: 0 = Inadequate; = Partially Adequate; = Adequate This scoring approach aims not to reflect increasing levels of overall competence, but to determine whether each critical step has been performed in accordance with standardised expectations.	Data will be collected in the first and third months.

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Self-Directed Learning Skills Scale	The scale was developed by Askın Tekkol and Demirel (2018) to assess self-directed learning skills among 2,600 students. The scale is a five-point Likert-type scale. Analysis of the scale revealed that its fit indices fell within the range of acceptable to good fit, and the structure of the scale-comprising 4 factors and 21 items-was validated as a model. The reliability of the scale, calculated using Cronbach's Alpha internal consistency coefficient, was determined to be 0.895.	Data will be collected in the first and third months.
Surgical Handwashing Information Form	Prepared using the WHO guidelines on 'Hand Hygiene in Health Care' published by the World Health Organisation (WHO) and a review of the literature, and drawing on expert opinion, this form is designed so that participants will answer 'True', 'False', "Don't Know", and consists of a total of 18 items assessing nursing students' knowledge in areas such as the importance of healthcare-associated infections and surgical hand hygiene, surgical handwashing methods, correct handwashing technique, and the use of hand antiseptics.	Data will be collected in the first and third months.

Collaborators and Investigators

• Sponsor: Yeliz Ciğerci

Study record dates

Study Major Dates

• Study Start (Estimated): June 1, 2026
• Primary Completion (Estimated): September 1, 2026
• Study Completion (Estimated): June 1, 2027

Study Registration Dates

• First Submitted: April 14, 2026
• First Submitted That Met QC Criteria: April 29, 2026
• First Posted (Actual): May 4, 2026

Study Record Updates

• Last Update Posted (Actual): May 4, 2026
• Last Update Submitted That Met QC Criteria: April 29, 2026
• Last Verified: April 1, 2026

More Information

Terms related to this study

• Keywords: training; knowledge; nursing students; clinical skills; Flipped learning; surgical hand washing
• Other Study ID Numbers: 2026/177

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No