Effects of a Flipped-Learning Empowering Leadership Program on Nurse Leaders, Staff, and Residents in Long-Term Care Facilities

Flipped Learning for Leader Empowering Leadership in Aged Care: A Pilot Cluster Quasi-Experimental Study

This pilot cluster quasi-experimental study tested a 12-week empowering-leadership training program delivered through flipped learning to nurse leaders in residential long-term care facilities, compared with a conventional brochure-based approach. Six facilities in central Taiwan participated: two (one public, one private) received the flipped-learning program for their leaders, and four (one public, three private) served as controls. The study examined effects at three levels: nurse leaders' own empowering leadership behaviors and facility-level nursing staff retention/turnover and resident hospitalization rates; nursing staff's perceptions of their leader's empowering behaviors, burnout, psychological empowerment, and job satisfaction; and residents' health status, quality of life, and satisfaction with care.

Study Overview

• Status: Completed
• Conditions: Long-Term Care; Empowering Leadership; Nurse Leaders
• Intervention / Treatment: Behavioral: Flipped-Learning Empowering Leadership Program; Behavioral: Educational Brochure (Conventional Learning)

• Study Type: Interventional
• Enrollment (Actual): 287
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Taiwan
  • Taichung, Taiwan
    • Residential Long-Term Care Facilities

Participation Criteria

Eligibility Criteria

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

Description

Inclusion Criteria:

Nurse Leaders:

• Age ≥ 20 years
• Employed as nursing director, supervisor, or head
• Employed at the facility for more than 6 months
• Willing to participate and able to give informed consent

Nursing Staff:

• Registered nurse, licensed practical nurse, or nursing assistant
• Employed at the facility for ≥ 3 months
• Age ≥ 20 years
• Informed consent given

Residents:

• Resided at the facility for ≥ 3 months
• Mini-Mental State Examination (MMSE) score ≥ 24
• No severe hearing impairment
• Not terminally ill
• Written informed consent given (or via authorized representative as applicable)

Exclusion Criteria:

Nurse Leaders:

- Indicated intent to leave the position within the next 6 months

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Health Services Research
• Allocation: Non-Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Flipped Learning Intervention; 2 residential long-term care facilities (1 public, 1 private): 10 nurse leaders, 40 nursing staff, 100 residents. Nurse leaders received a 12-week flipped-learning empowering leadership program.	Behavioral: Flipped-Learning Empowering Leadership Program; A 12-week, 24-hour empowering leadership program (one 2-hour module per week). Each week, a 60-minute instructional video was posted for asynchronous pre-class learning, followed by a 1-hour face-to-face session (small-group discussion, case studies, brief presentations, practical exercises), with instructor summary. Post-class activities included reflection and assignments.
Active Comparator: Conventional Learning / Control; 4 residential long-term care facilities (1 public, 3 private): 11 nurse leaders, 40 nursing staff, 86 residents. Nurse leaders received a printed brochure with identical content, without structured flipped-learning sessions.	Behavioral: Educational Brochure (Conventional Learning); Nurse leaders in the control group received a printed brochure covering the same empowerment/empowering-behavior content as the intervention group, without structured flipped-learning sessions. The research team maintained regular contact to answer questions but provided no additional training.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Leader Empowerment Behavior	Leader Empowerment Behavior Scale (Chinese version), a 27-item self-report measure across 5 subscales (extending meaning of work, engaging staff in decision-making, expressing confidence, encouraging goal achievement, providing autonomy). Each item rated on a 7-point Likert scale (1=strongly disagree, 7=strongly agree); total score range 27-189, with higher scores indicating more empowering leadership behavior (better outcome). Cronbach's α=0.71; test-retest r=0.83.	Baseline and immediately post-intervention (approximately 12 weeks)
Staff-Perceived Leader Empowering Behavior	Modified version of the Leader Empowerment Behavior Scale, a 27-item measure completed by nursing staff about their leader, across 5 subscales. Each item rated on a 7-point Likert scale; total score range 27-189, with higher scores indicating more empowering behavior as perceived by staff (better outcome). Cronbach's α=0.85; test-retest r=0.71.	Baseline (at enrollment) and 3 months after intervention completion (approximately August 2019)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Occupational Burnout	Occupational Burnout Inventory Scale, a 21-item self-report measure across 4 subscales (personal burnout, work-related burnout, client-related burnout, over-commitment to work). Each item rated on a 5-point Likert scale; total score range 21-105, with higher scores indicating greater burnout (worse outcome). Cronbach's α=0.80; test-retest reliability=0.78.	Baseline (at enrollment) and 3 months after intervention completion (approximately August 2019)
Psychological Empowerment	Spreitzer's Psychological Empowerment Scale, a 12-item self-report measure across 4 subscales (meaning, competence, self-determination, impact). Each item rated on a 5-point Likert scale; total score range 12-60, with higher scores indicating greater psychological empowerment (better outcome). Cronbach's α=0.87; test-retest reliability=0.82.	Baseline (at enrollment) and 3 months after intervention completion (approximately August 2019)
Job Satisfaction	Minnesota Satisfaction Questionnaire Short Form, a 20-item self-report measure. Each item rated on a 5-point Likert scale; total score range 20-100, with higher scores indicating greater job satisfaction (better outcome). Cronbach's α=0.88; test-retest reliability=0.84.	Baseline (at enrollment) and 3 months after intervention completion (approximately August 2019)
Job Stress	Single-item self-report measure ("Do you often feel very stressed at work?"), rated on a 5-point Likert scale; score range 1-5, with higher scores indicating greater job stress (worse outcome).	Baseline (at enrollment) and 3 months after intervention completion (approximately August 2019)
Health Status (SF-36)	36-Item Short Form Health Survey (SF-36), across 8 domains (physical functioning, role limitations due to physical health, role limitations due to emotional problems, pain, emotional well-being, social functioning, energy, general health). Each domain scored 0-100, with higher scores indicating better health status (better outcome). Cronbach's α=0.78-0.90; test-retest reliability=0.86-0.91.	Baseline (at enrollment) and 3 months after intervention completion (approximately August 2019)
Quality of Life (WHOQOL-BREF)	World Health Organization Quality of Life Questionnaire, Abbreviated Version (WHOQOL-BREF), across 4 domains (physical health, psychological health, social relationships, environmental health). Domain scores range from 4 to 20, with higher scores indicating better quality of life (better outcome). Cronbach's α=0.80-0.88; test-retest reliability=0.90-0.95.	Baseline (at enrollment) and 3 months after intervention completion (approximately August 2019)
Care Quality / Customer Satisfaction	Customer Satisfaction Scale, a 25-item self-report measure across 4 subscales (comfort/cleanliness, nursing care, food services, facility care/services). Each item rated on a 5-point Likert scale; total score range 25-125, with higher scores indicating greater satisfaction with care quality (better outcome). Cronbach's α=0.94; test-retest reliability=0.75.	Baseline (at enrollment) and 3 months after intervention completion (approximately August 2019)
Nursing Staff Retention Rate		12-month period prior to the intervention (baseline) and 12-month period beginning approximately 1 month after the 12-week intervention was completed (follow-up)
Nursing Staff Turnover Rate		12-month period prior to the intervention (baseline) and 12-month period beginning approximately 1 month after the 12-week intervention was completed (follow-up)
Resident Hospitalization Rate		12-month period prior to the intervention (baseline) and 12-month period beginning approximately 1 month after the 12-week intervention was completed (follow-up)

Collaborators and Investigators

• Sponsor: I-Hui-Chen

Study record dates

Study Major Dates

• Study Start (Actual): August 1, 2018
• Primary Completion (Actual): May 30, 2019
• Study Completion (Actual): May 30, 2020

Study Registration Dates

• First Submitted: August 13, 2026
• First Submitted That Met QC Criteria: August 17, 2026
• First Posted (Actual): August 19, 2026

Study Record Updates

• Last Update Posted (Actual): August 19, 2026
• Last Update Submitted That Met QC Criteria: August 17, 2026
• Last Verified: August 1, 2026

More Information

Terms related to this study

• Other Study ID Numbers: CRREC-105-002

Drug and device information, study documents

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