Exploring the pedagogical design features of the flipped classroom in undergraduate nursing education: a systematic review

Punithalingam Youhasan, Yan Chen, Mataroria Lyndon, Marcus A Henning, Punithalingam Youhasan, Yan Chen, Mataroria Lyndon, Marcus A Henning

Abstract

Background: In recent years, technological advancement has enabled the use of blended learning approaches, including flipped classrooms. Flipped classrooms promote higher-order knowledge application - a key component of nursing education. This systematic review aims to evaluate the empirical evidence and refereed literature pertaining to the development, application and effectiveness of flipped classrooms in reference to undergraduate nursing education.

Methods: A PRISMA systematic review protocol was implemented to investigate the literature pertaining to the development, implementation and effectiveness of flipped classroom pedagogy in undergraduate nursing education. Seven databases (Scopus, PsycINFO, CINAHL, ERIC, MEDLINE, Cochrane, Web of Science) were utilised to survey the salient literature. Articles were appraised with respect to their level of evidence, the origin of study, study design, the aims/s of the study, and the key outcomes of the study. A qualitative synthesis was then conducted to summarise the study findings.

Results: The initial search identified 1263 potentially relevant articles. After comprehensively reviewing the initial catchment using several analytical phases, 27 articles were considered for the final review, most of which were conducted in the USA and South Korea. A range of research designs were applied to measure or discuss the outcomes and design features of the flipped classroom pedagogy when applied to undergraduate nursing education. The review indicated that a common operational flipped classroom model involves three key components, namely pre-classroom activities, in-classroom activities and post-classroom activities, guided by two instructional system design principles. The review predominantly identified positive learning outcomes among undergraduate nursing students, after experiencing the flipped classroom, in terms of skills, knowledge and attitudes. However, a few studies reported contrasting findings, possibly due to the incompatibility of the flipped classroom pedagogy with the traditional learning culture.

Conclusions: Current evidence in this systematic review suggests that incorporating the flipped classroom pedagogy could yield positive educational outcomes in undergraduate nursing education. There are promising pedagogical models available for adapting or developing the flipped classroom pedagogy in undergraduate nursing education.

Keywords: Blended Learning; Design principles; Flipped classroom; Inverted classroom; Nursing education; Systematic review.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Search methodology PRISMA flow diagram
Fig. 2
Fig. 2
Thematic synthesis
Fig. 3
Fig. 3
Nine design principles for developing flipped classroom [15]
Fig. 4
Fig. 4
“ADDIE” model and Flipped Classroom Operational Model

References

    1. Oh J, Kim SJ, Kim S, Vasuki R. Evaluation of the effects of flipped Learning of a nursing informatics course. J Nurs Educ. 2017;56(8):477–483. doi: 10.3928/01484834-20170712-06.
    1. Benner P. Educating nurses: a call for radical transformation-how far have we come? J Nurs Educ. 2012;51(4):183–184. doi: 10.3928/01484834-20120402-01.
    1. 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.
    1. Lee Y, Martin KI. The flipped classroom in ESL teacher education: an example from CALL. Educ Inf Technol. 2020;25(4):2605–2633. doi: 10.1007/s10639-019-10082-6.
    1. Missildine K, Fountain R, Summers L, Gosselin K. Flipping the classroom to improve student performance and satisfaction. J Nurs Educ. 2013;52(10):597–599. doi: 10.3928/01484834-20130919-03.
    1. Hew KF, Lo CK. Flipped classroom improves student learning in health professions education: a meta-analysis. BMC Med Educ. 2018;18(1):38. doi: 10.1186/s12909-018-1144-z.
    1. Persky AM, McLaughlin JE. The flipped classroom – from theory to practice in health professional education. Am J Pharm Educ. 2017;81(6). .
    1. FLN. Definition of Flipped Learning Flipped Learning Network 2014 [09.03.2020]. Available from:
    1. Love B, Hodge A, Corritore C, Ernst DC. Inquiry-based Learning and the flipped classroom model. PRIMUS. 2015;25(8):745–762. doi: 10.1080/10511970.2015.1046005.
    1. Njie-Carr VPS, Ludeman E, Lee MC, Dordunoo D, Trocky NM, Jenkins LS. An integrative review of flipped classroom teaching models in nursing education. J Prof Nurs. 2017;33(2):133–144. doi: 10.1016/j.profnurs.2016.07.001.
    1. Hashemiparast M, Negarandeh R, Theofanidis D. Exploring the barriers of utilizing theoretical knowledge in clinical settings: a qualitative study. Int J Nurs Sci. 2019;6(4):399–405.
    1. Hoover CA, Dinndorf-Hogenson GA, Peterson JL, Tollefson BR, Berndt JL, Laudenbach N. Flipped classroom: do students perceive readiness for advanced discussion? J Nurs Educ. 2018;57(3):163–165. doi: 10.3928/01484834-20180221-07.
    1. Bernard JS. The Flipped Classroom: Fertile Ground for Nursing Education Research. Int J Nurs Educ Scholar. 2015;12(1):99. doi: 10.1515/ijnes-2015-0005.
    1. Betihavas V, Bridgman H, Kornhaber R, Cross M. The evidence for ‘flipping out’: a systematic review of the flipped classroom in nursing education. Nurse Educ Today. 2016;38:15–21. doi: 10.1016/j.nedt.2015.12.010.
    1. Lee MK, Park BK. Effects of flipped Learning using online materials in a surgical nursing practicum: a pilot stratified group-randomized trial. Healthc Inform Res. 2018;24(1):69–78. doi: 10.4258/hir.2018.24.1.69.
    1. Morrison GR, Ross SM, Kalman HK. Designing effective instruction, 7th edition. Wiley Global Education; 2012.
    1. Moher D, Liberati A, Tetzlaff J, Altman DG, The PG. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med. 2009;6(7):e1000097. doi: 10.1371/journal.pmed.1000097.
    1. Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4(1):1. doi: 10.1186/2046-4053-4-1.
    1. Amir-Behghadami M, Janati A. Population, intervention, comparison, outcomes and study (PICOS) design as a framework to formulate eligibility criteria in systematic reviews. Emerg Med J. 2020;37(6):387. doi: 10.1136/emermed-2020-209567.
    1. Thomas J, Harden A. Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Med Res Methodol. 2008;8(1):45. doi: 10.1186/1471-2288-8-45.
    1. Eccles M, Freemantle N, Mason J. Using systematic reviews in clinical guideline development. In: Systematic Reviews in Health Care.2001. p. 400-9.
    1. Jensen LS, Merry AF, Webster CS, Weller J, Larsson L. Evidence-based strategies for preventing drug administration errors during anaesthesia. Anaesthesia. 2004;59(5):493–504. doi: 10.1111/j.1365-2044.2004.03670.x.
    1. Webster CS, Luo AY, Krägeloh C, Moir F, Henning M. A systematic review of the health benefits of tai chi for students in higher education. Prev Med Rep. 2016;3:103–112. doi: 10.1016/j.pmedr.2015.12.006.
    1. Oh J, Kim SJ, Kim S, Kang KA, Kan J, Bartlett R. Development and evaluation of flipped learning using film clips within a nursing informatics course. Jpn J Nurs Sci. 2019;16(4):385–395. doi: 10.1111/jjns.12245.
    1. Kim HS, Kim MY, Cho MK, Jang SJ. Effectiveness of applying flipped learning to clinical nursing practicums for nursing students in Korea: A randomized controlled trial. Int J Nurs Pract. 2017;23:5.
    1. Ya-Qian L, Yu-Feng L, Meng-Jie L, Peng-Xi L, Julie T, Li-Na M, et al. Effectiveness of the flipped classroom on the development of self-directed learning in nursing education: a meta-analysis. Front Nurs. 2018;5(4):317–329. doi: 10.1515/fon-2018-0032.
    1. Im S, Jang SJ. Effects of a clinical practicum using flipped Learning among undergraduate nursing students. J Nurs Educ. 2019;58(6):354–356. doi: 10.3928/01484834-20190521-06.
    1. Kim YM, Yoon YS, Hong HC, Min A. Effects of a patient safety course using a flipped classroom approach among undergraduate nursing students: a quasi-experimental study. Nurse Educ Today. 2019;79:180–187. doi: 10.1016/j.nedt.2019.05.033.
    1. Maxwell KL, Wright VH. Evaluating the effectiveness of two teaching strategies to improve nursing Students' knowledge, skills, and attitudes about quality improvement and patient safety. Nurs Educ Perspect. 2016;37(5):291–292. doi: 10.1097/01.NEP.0000000000000043.
    1. Holman R, Hanson AD. Flipped Classroom Versus Traditional Lecture: Comparing Teaching Models in Undergraduate Nursing Courses. Nurs Educ Perspect. 2016;37:6. doi: 10.1097/01.NEP.0000000000000075.
    1. Kim H, Jang Y. Flipped Learning with simulation in undergraduate nursing education. J Nurs Educ. 2017;56(6):329–336. doi: 10.3928/01484834-20170518-03.
    1. Geist MJ, Larimore D, Rawiszer H, Sager AWA. Flipped versus traditional instruction and achievement in a baccalaureate nursing pharmacology course. Nurs Educ Perspect. 2015;36(2):114–115. doi: 10.5480/13-1292.
    1. Dabney BW, Mitchell R. Flipping an undergraduate Gerontological nursing course: student perceptions. Nurs Educ Perspect. 2017;38(6):340–341. doi: 10.1097/01.NEP.0000000000000209.
    1. El-Banna MM, Whitlow M, McNelis AM. Flipping around the classroom: accelerated bachelor of science in nursing students' satisfaction and achievement. Nurse Educ Today. 2017;56:41–46. doi: 10.1016/j.nedt.2017.06.003.
    1. Simpson V, Richards E. Flipping the classroom to teach population health: increasing the relevance. Nurse Educ Pract. 2015;15(3):162–167. doi: 10.1016/j.nepr.2014.12.001.
    1. Greenwood VA, Mosca C. Flipping the nursing classroom without flipping out the students. Nurs Educ Perspect. 2017;38(6):342–343. doi: 10.1097/01.NEP.0000000000000167.
    1. Saunders A, Green R, Cross M. Making the most of person-centred education by integrating flipped and simulated teaching: an exploratory study. Nurse Educ Pract. 2017;27:71–77. doi: 10.1016/j.nepr.2017.08.014.
    1. Green RD, Schlairet MC. Moving toward heutagogical learning: illuminating undergraduate nursing students' experiences in a flipped classroom. Nurse Educ Today. 2017;49:122–128. doi: 10.1016/j.nedt.2016.11.016.
    1. 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.
    1. Cho M-K, Kim MY. Outcomes and influential factors applying flipped learning methods in a clinical adult nursing practicum. Int J Nurs Pract. 2019;25(2):e12724. doi: 10.1111/ijn.12724.
    1. Harrington SA, Bosch MV, Schoofs N, Beel-Bates C, Anderson K. Quantitative Outcomes for Nursing Students in a Flipped Classroom. Nurs Educ Perspect. 2015;36:3. doi: 10.5480/13-1255.
    1. 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.
    1. Hanson J. Surveying the experiences and perceptions of undergraduate nursing students of a flipped classroom approach to increase understanding of drug science and its application to clinical practice. Nurse Educ Pract. 2016;16(1):79–85. doi: 10.1016/j.nepr.2015.09.001.
    1. Xu P, Chen Y, Nie W, Wang Y, Song T, Li H, et al. The effectiveness of a flipped classroom on the development of Chinese nursing students' skill competence: a systematic review and meta-analysis. Nurse Educ Today. 2019;80:67–77. doi: 10.1016/j.nedt.2019.06.005.
    1. Lee J, Lim C, Kim H. Development of an instructional design model for flipped learning in higher education. Educ Technol Res Dev. 2017;65(2):427–453. doi: 10.1007/s11423-016-9502-1.
    1. Smith CM, McDonald K. The flipped classroom for professional development: part II. Making podcasts and videos. J Contin Educ Nurs. 2013;44(11):486–487. doi: 10.3928/00220124-20131025-92.
    1. Strayer JF. How learning in an inverted classroom influences cooperation, innovation and task orientation. Learn Environ Res. 2012;15(2):171–193. doi: 10.1007/s10984-012-9108-4.
    1. Garrison DR, Kanuka H. Blended learning: uncovering its transformative potential in higher education. Internet High Educ. 2004;7(2):95–105. doi: 10.1016/j.iheduc.2004.02.001.
    1. Nuray G, Ercan K, Ozden MY. Design of a blended learning environment: Considerations and implementation issues. Aust J Educ Technol. 2013;29:1. doi: 10.17232/KSET.29.1.1.
    1. Herreid CF, Schiller NA. Case studies and the flipped classroom. J Coll Sci Teach. 2013;42(5):62–66.
    1. Arnold I. John Hattie: visible learning: a synthesis of over 800 meta-analyses relating to achievement. Int Rev Educ. 2011;57(1):219. doi: 10.1007/s11159-011-9198-8.
    1. Roehl A, Reddy SL, Shannon GJ. The flipped classroom: an opportunity to engage millennial students through active Learning. J Fam Consum Sci. 2013;105(2):44–49. doi: 10.14307/JFCS105.2.12.
    1. Talbert R. Learning MATLAB in the Inverted Classroom. 2012 ASEE Annual Conference & Exposition; San Antonio, Texas. San Antonio ASEE Conferences; 2012. p. 25.883.1–25..19.
    1. Hsu TC, Lee-Hsieh J, Turton MA, Cheng SF. Using the ADDIE model to develop online continuing education courses on caring for nurses in Taiwan. J Contin Educ Nurs. 2014;45(3):124–131. doi: 10.3928/00220124-20140219-04.
    1. Lu SC, Cheng YC, Chan PT. Using ADDIE model to develop a nursing information system training program for new graduate nurse. Stud Health Technol Inform. 2016;225:969–970.
    1. Cheung L. Using the ADDIE model of instructional design to teach chest radiograph interpretation. J Biomed Educ. 2016:9502572.
    1. Reinbold S. Using the ADDIE model in designing library instruction. Med Ref Serv Quart. 2013;32(3):244–256. doi: 10.1080/02763869.2013.806859.
    1. Kim MK, Kim SM, Khera O, Getman J. The experience of three flipped classrooms in an urban university: an exploration of design principles. Internet High Educ. 2014;22:37–50. doi: 10.1016/j.iheduc.2014.04.003.
    1. Bakr MM, Massey WL, Massa HM. Flipping a dental anatomy course: a retrospective study over four years. Educ Res Int. 2016:7097398.
    1. Galway LP, Corbett KK, Takaro TK, Tairyan K, Frank E. A novel integration of online and flipped classroom instructional models in public health higher education. BMC Med Educ. 2014;14(1):181. doi: 10.1186/1472-6920-14-181.
    1. Liebert CA, Lin DT, Mazer LM, Bereknyei S, Lau JN. Effectiveness of the Surgery Core Clerkship Flipped Classroom: a prospective cohort trial. Am J Surg. 2016;211(2):451–457. doi: 10.1016/j.amjsurg.2015.10.004.
    1. McLaughlin JE, Griffin LM, Esserman DA, Davidson CA, Glatt DM, Roth MT, et al. Pharmacy student engagement, performance, and perception in a flipped satellite classroom. Am J Pharm Educ. 2013;77(9):196. doi: 10.5688/ajpe779196.
    1. Morton DA, Colbert-Getz JM. Measuring the impact of the flipped anatomy classroom: The importance of categorizing an assessment by Bloom's taxonomy. Anat Sci Educ. 2017;10(2):170–175. doi: 10.1002/ase.1635.

Source: PubMed

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