Implementing a Flipped Classroom Approach in Undergraduate Nursing Education

QUESTION

I currently work in the cardiothoracic ICU in my hospital.  We don’t train new hires on extracorporeal membrane oxygenators (ECMO) during general orientation.  It is too complex to understand when grappling just to figure out hemodynamics.  The nurses have to be in the unit for at least a year, have to have a working knowledge and understanding of hemodynamics, and have performed well in their bedside duties and actions to be placed on the trajectory for ECMO training.  The ECMO committee and the PCDs decide much of this for readiness.

The ECMO committee is comprised of 10 ECMO preceptors divided between days and nights (I am one of the 10), the PCDs, the CNS, and the ECMO Program Director.  We have about 140 nurses but given the nature of the unit, we lose about 20 per year to school enrollment, new positions as NPs, or life changes.  This means we onboard about 20 -30 per year.  This is a staggering number of orientees for ECMO preceptors to get through.  We are also responsible for teaching all skills days quarterly, managing simulation attendance, and monitoring compliance with annual training.

Given the number requiring training, they are required to pre-read about ECMO.  We notify those that will have been placed on the trajectory, ensure they have completed the mandatory ECMO e-learning module, supply them with articles to read, PowerPoint lectures on ECMO,  enroll them in the next available skills day if they have not already attended, and HIGHLY suggest they attend a simulation.  Simulation has not been mandatory since COVID, but we want to reinstate that for all nurses caring for ECMO.

Essentially, we are using the “flipped classroom” with the orientees.  We expect them to come to skills days with a base knowledge of ECMO and its functions.  We conduct the skills days by using a “Jeopardy” PowerPoint to ask questions and have discussions about those questions.  The “Jeopardy” game covers all of the information in the PowerPoints.   We then “play” ECMO “Jeopardy” in skills days.  The feedback has been exceedingly positive, with many stating they learned more in this setting than in a traditional lecture.

The Flipped Learning Network defines flipped learning as “a pedagogical approach in which direct instruction is shifted from the group learning dimension to the individual learning dimension, transforming the remaining group space into a dynamic and interactive learning environment, in which the educator guides students in the application of concepts and in their creative engagement with the course content” (Flipped Learning Network (FLN), n.d.). Simplistically defined “school work at home and homework at school,” (Flippedlearning.org, 2015).

The FLN (2015) identifies four pillars of a flipped classroom.

• Flexible environment for learning:  The students decide when, where, and how they study, and the teachers can design their classroom that is conducive to the discussion.
• Learning culture: This is a shift from the traditional teacher lecture/student listen to having the students study the content before class to provide a more in-depth discussion.
• Intentional content (targeted content): educators choose and prioritize content that is accessible to students on their own and determine what they will need to teach and what the students should learn on their own.
• Professional educator: The role of the educator in a flipped classroom is less prominent than in the traditional classroom.  The educator’s role in flipped classrooms is to observe, provide feedback, and assess the students’ work.

Along with the four pillars of FLN, Barbour & Schuessler (2019) identified three main components for a flipped classroom.  These are:

• Pre-class work:  This involves audio/visual information, powerpoints with voice-overs, videos with embedded quizzes, or online discussions regarding the videos.
• In-class work:  This is a group discussion, critical thinking exercises, and other interactive activities for the students to utilize their pre-class knowledge.
• Post-class work:  This involves feedback and evaluation for the students.

A systematic literature review performed by Barranquero-Herbosa, M., et al., (2019) affirms that “The flipped classroom applied to nursing studies proves to be effective in nursing education, especially with regard to academic performance, measured through exam scores and final grades of the courses and students positive opinions about the method of teaching.  The students reported its usefulness, flexibility, autonomy, and student involvement.  Their sample included almost 35,000 people and 670 studies in flipped classrooms.

A study by Öz & Abaan (2021) utilized a randomized control study to assess the flipped classroom method for teaching nursing leadership to undergraduate nursing students.  Their results demonstrated “Students in the flipped classroom group had obtained significantly higher scores than the students in the traditional teaching group regarding the assignments, the final exam, and overall grade” (Öz, G & Abaan, S.,  2021).

So having read several studies on the flipped classroom, I realized that the ECMO committee had already converted the training we provide into a “flipped classroom”.  We unintentionally met all four of the pillars described by the FLN, we also met the three components of Barbour & Schuessler of a flipped classroom.  It is a great way to teach and understand the topic.  Having discussions instead of lectures in class reinforces the knowledge obtained prior to class.  It can help clarify questions, force critical thinking, and requires those coming to class to be prepared for conversation.  This wouldn’t work for all classes, such as statistics, but this form of learning would be very helpful for a nursing curriculum.

Question: What part of the undergraduate nursing curriculum should be taught in a “flipped classroom” format?

Barbour, C., & Schuessler, J. B. (2019). A preliminary framework to guide implementation of The Flipped Classroom Method in nursing education. Nurse Education in Practice, 34, 36-42. https://doi.org/10.1016/j.nepr.2018.11.001

Barranquero-Herbosa, M., Abajas-Bustillo, R., & Ortego-Maté, C. (2022). Effectiveness of flipped classroom in nursing education: A systematic review of systematic and integrative reviews. International Journal of Nursing Studies, 135, 104327-104327. https://doi.org/10.1016/j.ijnurstu.2022.104327

Öz, G. Ö., & Abaan, S. (2021). Use of a flipped classroom “Leadership in Nursing” course on nursing students’ achievement and experiences: A quasi-experimental study. Journal of Professional Nursing, 37(3), 562-571. https://doi.org/10.1016/j.profnurs.2021.02.001

ANSWER

Implementing a Flipped Classroom Approach in Undergraduate Nursing Education

Introduction

The traditional lecture-based approach to teaching in nursing education is evolving as educators seek innovative methods to enhance student engagement and learning outcomes. One such approach is the flipped classroom, which shifts the focus from passive listening during lectures to active learning and student-centered discussions. This essay explores the potential application of the flipped classroom method in a specific component of the undergraduate nursing curriculum.

The Flipped Classroom Model

The Flipped Learning Network (FLN) outlines four pillars of a flipped classroom: flexible learning environment, learning culture, intentional content, and professional educator. Additionally, Barbour and Schuessler (2019) identify three key components of a flipped classroom: pre-class work, in-class work, and post-class work. These elements emphasize the importance of pre-class preparation, interactive activities during class, and feedback and evaluation afterward.

Adapting the Flipped Classroom to Nursing Education

The concept of the flipped classroom aligns well with nursing education, where active learning and critical thinking are crucial for developing clinical reasoning skills. The flipped classroom can be effectively utilized in various nursing courses, such as pharmacology, patient assessment, or leadership.

For instance, in a nursing leadership course, pre-class work could involve students reviewing audiovisual materials or engaging in online discussions about leadership theories and case studies. In-class activities may include group discussions, problem-solving exercises, and simulation scenarios to apply leadership principles and analyze real-world scenarios. Post-class work could consist of reflection exercises, peer feedback, and assessments to reinforce learning.

Benefits of the Flipped Classroom in Nursing Education

Evidence from studies supports the effectiveness of the flipped classroom in nursing education. Barranquero-Herbosa et al. (2022) conducted a systematic review that highlighted positive outcomes, such as improved academic performance and students’ positive opinions about the method. Similarly, Öz and Abaan (2021) found that undergraduate nursing students in a flipped classroom group achieved significantly higher scores in assignments, exams, and overall grades compared to those in traditional teaching groups.

The flipped classroom approach fosters active engagement, critical thinking, and collaboration among students. It enhances their ability to apply theoretical concepts to practical situations and promotes a deeper understanding of nursing principles. By actively participating in discussions, students develop essential communication and teamwork skills necessary for their future nursing practice.

Conclusion

The implementation of a flipped classroom approach in nursing education offers an innovative and effective way to engage students and enhance learning outcomes. By shifting the focus from passive lectures to active learning and discussions, the flipped classroom model aligns with the goals of nursing education. Its application in specific components of the undergraduate nursing curriculum, such as leadership or patient assessment, can foster critical thinking, promote student engagement, and improve overall academic performance.