An Integrative Review of Flipped Classroom Teaching Models in Nursing
Education

Veronica P.S. Njie-Carr PhD, RN, ACNS-BC, FWACN, Emilie Lude-

man MSLIS, Mei Ching Lee PhD, RN, CHPN, Dzifa Dordunoo PhD, RN,
Nina M. Trocky DNP, RN, NE-BC, CCRA, Louise S. Jenkins PhD, RN,
FAHA, ANEF

PII: S8755-7223(16)30084-9
DOI: doi: 10.1016/j.profnurs.2016.07.001
Reference: YJPNU 997

To appear in: Journal of Professional Nursing

Please cite this article as: Njie-Carr, V.P.S., Ludeman, E., Lee, M.C., Dordunoo,
D., Trocky, N.M. & Jenkins, L.S., An Integrative Review of Flipped Classroom
Teaching Models in Nursing Education, Journal of Professional Nursing (2016), doi:
10.1016/j.profnurs.2016.07.001

This is a PDF file of an unedited manuscript that has been accepted for publication.
As a service to our customers we are providing this early version of the manuscript.
The manuscript will undergo copyediting, typesetting, and review of the resulting proof
before it is published in its final form. Please note that during the production process
errors may be discovered which could affect the content, and all legal disclaimers that
apply to the journal pertain.
 ACCEPTED MANUSCRIPT

AN INTEGRATIVE REVIEW OF FLIPPED CLASSROOM MODELS 1

An Integrative Review of Flipped Classroom Teaching Models in Nursing Education

Veronica P.S. Njie-Carr, PhD, RN, ACNS-BC, FWACN

T
Corresponding author

P
RI
Assistant Professor

665 West Lombard Street

SC
Baltimore, MD 21201

NU
USA

Njie-carr@son.umaryland.edu
MA
410-706-4808

Emilie Ludeman, MSLIS

ED

Research, Education and Outreach Librarian

PT

Health Sciences and Human Services Library

Mei Ching Lee, PhD, RN, CHPN

CE

Assistant Professor
AC

Dzifa Dordunoo PhD, RN

Assistant Professor

Nina M. Trocky, DNP, RN, NE-BC, CCRA

Associate Dean for the Bachelor of Science in Nursing Program

Assistant Professor

Louise S. Jenkins, PhD, RN, FAHA, ANEF

Professor

Director, Institute for Educators

University of Maryland School of Nursing

 ACCEPTED MANUSCRIPT

AN INTEGRATIVE REVIEW OF FLIPPED CLASSROOM MODELS 2

Conflict of Interest:

T
The authors declare no conflict of interest.

P
RI
SC
NU
MA
ED
PT
CE
AC
 ACCEPTED MANUSCRIPT

AN INTEGRATIVE REVIEW OF FLIPPED CLASSROOM MODELS 3

Highlights

 Flipped technology-enhanced pedagogy promote active learning and critical thinking

T
 Rigorous studies are needed that are focused on flipped classroom models in nursing

P
RI
 Lessons learned from other disciplines can be integrated to inform implementation

SC
Studies are needed to determine long-term effects in clinical performance

 Teaching assignments and demands for technologic resources should be considered

NU
MA
ED
PT
CE
AC
 ACCEPTED MANUSCRIPT

AN INTEGRATIVE REVIEW OF FLIPPED CLASSROOM MODELS 4

An Integrative Review of Flipped Classroom Teaching Models in Nursing Education

T
Abstract

P
RI
Nursing care is changing dramatically given the need for students to address complex and

multiple patient co-morbidities. Students experience difficulties applying knowledge gained

SC
from didactic instruction to make important clinical decisions for optimal patient care. To

NU
optimize nursing education pedagogy, innovative teaching strategies are required to prepare

future nurses for practice. This integrative review synthesized the state of the science on flipped
MA
classroom models from 13 empirical studies published through May 2016. The purpose of the

review was to evaluate studies conducted on flipped classroom models among nursing students
ED

using a validated framework by Whittemore and Knafl. Multiple academic databases were
PT

searched, ranging in scope including PubMed, Embase (Elsevier), CINAHL (Ebsco), Scopus,

Web of Science and Google Scholar, resulting in 95 unique records. After screening and full-
CE

text reviews, 82 papers were removed. Thirteen empirical studies were included in the final
AC

analysis and results provided: (a) design and process information on flipped classroom models in

nursing education; (b) a summary of the state of the evidence to inform the implementation of

flipped classrooms; and (c) a foundation to build future research in this area of nursing

education. To develop sound evidence-based teaching strategies, rigorous scientific methods are

needed to inform the implementation of flipped classroom approaches.

Index words: Flipped classroom; integrative review; nursing education; nursing students;

teaching models
 ACCEPTED MANUSCRIPT

AN INTEGRATIVE REVIEW OF FLIPPED CLASSROOM MODELS 5

Problem Identification

Introduction

T
To address the problems of complex patients with multiple comorbidities, nursing

P
RI
students must be better prepared for clinical practice with emphasis on developing critical

thinking skills to make sound clinical decisions (Dalton, 2015; Missildine et al., 2013) as

SC
identified in national and international studies (Dalton, 2015; Hanson, 2016; Missildine et al.

NU
2013; Yacout & Shosha, 2016). Students struggle with applying knowledge to meet the unique

needs of the patient populations they encounter. Additionally, nurse educators grapple with
MA
content-laden courses (Giddens & Brady, 2007) and leveraging teaching strategies to help bridge

the education-practice gap by balancing didactic experiences with interactive classroom activities
ED

while maintaining quality instruction for students (Central, 2004; Mackintosh-Frankin, 2016).
PT

To address this gap, new innovative teaching strategies are critical to integrate in nursing

education. The flipped classroom is an evolving pedagogy with opportunities to bridge the
CE

education-practice gap in nursing education and move nursing closer to achieving the
AC

recommendations outlined in the most recent Institute of Medicine report of 2010 (IOM, 2010).

Background

Multiple challenges and opportunities exist to implement innovative teaching and

learning strategies in nursing education that would address the recommendations in the IOM

report. While maintaining quality pedagogy, nursing educators leverage teaching strategies to

address the complex and multiple needs of patients that students encounter in clinical practice.

Important social changes are complicated by competing technologies, and the diversity of the

nursing students who are expected to smoothly transition to the new graduate role after

completing the nursing program. Ensuring that graduates are fully prepared to meet workplace
 ACCEPTED MANUSCRIPT

AN INTEGRATIVE REVIEW OF FLIPPED CLASSROOM MODELS 6

requirements is critical to the nursing profession and most importantly to the safety and optimal

health of patients.

T
These challenges provide educators with opportunities to evaluate current teaching and

P
RI
learning practices and make the necessary modifications to reflect evidence-based practices to

optimize student outcomes and smooth new graduate transitions to practice settings. To address

SC
this growing issue, educators have adapted multiple teaching strategies including simulation

NU
experiences for students (Dalton, 2015). Another evolving pedagogy is the flipped classroom

teaching approach (Bergmann & Sams, 2012). Though nursing educators have interspersed
MA
strategies such as case studies, concept maps, games, and discussion groups in didactic

instruction, these strategies have been limited in methods used to implement them. For example,
ED

as new strategies were implemented, educators failed to remove extra content from curricula
PT

(Giddens & Brady, 2007; Mattis, 2014), which increased the workload for students and limited

the impact the new strategies may have on student outcomes such as increased course
CE

satisfaction and robust increases in course grades.

AC

The flipped classroom model has been extensively used in other disciplines with positive

student outcomes (Mattis, 2014; McLaughlin et al., 2013; Moffett & Mill, 2014; Schultz,

Duffield, Rasmussen, & Wageman, 2014; Simonson, 2014; Simpson & Richards, 2015; Tune,

Sturek, & Basile, 2013). This relatively new pedagogy was first conceptualized by science

teachers in 2006 (Bergmann & Sams, 2012). A “pure” flipped classroom has two major

components: (a) a pre-class individual instruction that is often technology-based and allows

students to learn content, complete readings, view pre-recorded lectures in the form of web cast

videos, and/or narrated power point slides, podcasts, and interactive videos; and to complete

quizzes and module assignments before class; and (b) in-class group interactive activities that are
 ACCEPTED MANUSCRIPT

AN INTEGRATIVE REVIEW OF FLIPPED CLASSROOM MODELS 7

focused on empowering students to apply content by interacting and exchanging ideas through

multiple modalities (Bergmann & Sams, 2012). Different terminology is used to conceptualize

T
flipped classrooms. For example, “active learning,” “inverted classrooms, “team-based

P
learning,” problem-based learning,” etc. (Della Ratta, 2015; Elliott, 2014; Simonson, 2014;

RI
Waltz, Jenkins, & Han, 2014). Bergman and Sams define flipped classroom as, “…that which is

SC
traditionally done in class is now done at home, and that which is traditionally done as

NU
homework is now completed in class” p. 13 (Bergmann & Sams, 2012; Davies, Dean, & Ball,

2013).
MA
A flipped classroom model integrates collaboration, active learning, and team-based

learning, which are important strategies for providing students with the necessary skills and
ED

competence to work in inter-professional practice environments (AACN, 2011; Hamdan,

PT

McKnight, McKnight, & Arfstrom, 2013). In addition, it prepares students to be active, self-

directed learners and to help them develop higher level thinking skills through efficient
CE

processing of knowledge gained (Bergmann & Sams, 2012; Della Ratta, 2015; Mason, Shuman,
AC

& Cook, 2013). The flipped classroom approach has been demonstrated using different models,

across disciplines and across educational levels. However, there have been few studies of

flipped classroom models in its “pure” form investigating its usefulness and effectiveness on

student outcomes. This limitation was found when O’Flaherty and Phillips conducted a scoping

review on the use of flipped classroom approaches in higher education (O'Flaherty & Phillips,

2015) further underscoring the need for more rigorous research methods on flipped classroom

pedagogy. Additionally, other nurse scholars have conducted different reviews to address

flipped classroom models in nursing education and found similar results of limited robust

research methods, limited improvement in student exam scores, and conflicting results on student
 ACCEPTED MANUSCRIPT

AN INTEGRATIVE REVIEW OF FLIPPED CLASSROOM MODELS 8

dissatisfaction with teaching strategy (Betihavas, Bridgman, Kornhaber, & Cross, 2016; Presti,

2016).

T
The purpose of this integrative review was to evaluate the state of nursing science on

P
RI
flipped classroom models among nursing students to inform the role of nurse educators. This

review focuses on national and international nursing studies conducted on flipped classroom

SC
models through May 2016 and contributes to this evolving pedagogy by reporting findings and

NU
providing nurse educators and researchers with an evidence-based foundation to develop and

implement more robust flipped classroom models.

MA
Methods

Given the limited proliferation of research studies on flipped classroom pedagogy in

ED

nursing and the diversity of research methods, an integrative review is considered the best
PT

approach. Whittemore and Knafl (2005) suggest that an integrative review method is appropriate

when diverse methodologies are included to ensure comprehensive representation and unbiased
CE

inclusion of important information to strengthen best practices in teaching pedagogy. These

AC

authors posit that in providing researchers and practitioners with best evidence, it is critical that

all methodologies be included and to conduct a quality, unbiased review of research studies.

Their framework was used to guide this integrated review process and report findings on flipped

classroom models in nursing education by using the four components: (a) problem identification;

(b) literature search; (c) data evaluation; (d) data analysis; and (e) presentation. The first step,

problem identification, was addressed in a previous section. The sections below describe the

other steps in detail.

 ACCEPTED MANUSCRIPT

AN INTEGRATIVE REVIEW OF FLIPPED CLASSROOM MODELS 9

Literature Search

Search Strategy and Results

T
To ensure a thorough and comprehensive review of the literature, search strategies were

P
RI
developed in collaboration with a research librarian and included terms comprised of the

concepts of flipped classrooms and nursing education. The two research questions posed were:

SC
“Do flipped classroom teaching strategies influence student satisfaction and outcomes in nursing

NU
courses? What is the effect of flipped classroom approaches on nursing student satisfaction and

course outcomes? In anticipation of a scarcity of literature on this topic, several databases were
MA
searched including PubMed, Embase (Elsevier), CINAHL (Ebsco), Scopus, Web of Science and

Google Scholar through May 2016. No date restrictions were applied. Authors hand searched
ED

selected journals and checked the reference lists of relevant articles. Please see Appendix A for
PT

search details from each database.

Inclusion and Exclusion Criteria

CE

The literature screening was conducted in two phases to assess the relevance of studies
AC

identified during the literature search. First, titles and abstracts of papers were reviewed that

included nursing students. Second, full-text papers were reviewed in-depth. Papers were

excluded if they were: (a) not empirical studies, (b) written in a language other than English, (c)

dissertation papers, (d) conference abstracts, or (e) conducted with students in disciplines other

than nursing.

Data Evaluation

The titles and abstracts of 95 papers were evaluated for relevance. The review identified

varied types of publications such as books, reports, empirical studies, news reports, conference

abstracts, dissertations, editorials, as well as papers written in another language. Authors

 ACCEPTED MANUSCRIPT

AN INTEGRATIVE REVIEW OF FLIPPED CLASSROOM MODELS 10

reviewed the abstracts of each paper at least once. A full-text review of 20 papers was conducted

to determine if they were empirical studies. Seven were methods papers and were removed.

PT
Another in-depth, full-text review was conducted on the final 13 studies that were included in the

analysis. Figure 1 provides a flow chart illustrating our search strategy and output.

RI
SC
Records identified through Additional records identified
database searching (N =136) through other sources (n = 41)

NU
MA
Records after duplicates removed
(n = 95)
ED
PT

Records screened Records excluded

(n = 95) (n = 75)
CE
AC

Full-text
text articles assessed Full-text articles excluded
for eligibility (n = 7)
(n = 20) - Not research studies

Studies included in synthesis

(n = 13)

Figure 1: Adapted from, Moher et al. (2009). The PRISMA Statement.

 ACCEPTED MANUSCRIPT

AN INTEGRATIVE REVIEW OF FLIPPED CLASSROOM MODELS 11

Four studies were quasi- or experimental designs, five were descriptive (quantitative or

qualitative), and four were mixed methods study designs. Studies were evaluated for quality and

T
rigor by using two items (#1 and #6) from the Health Evidence Quality Assessment Tool

P
RI
(HEQAT) for review articles (Health Evidence Assessment Tool, 2013). The HEQAT is short

and easy to use. It is designed for evaluation of systematic review articles, so for this reason it

SC
was modified by removing the items that were not appropriate for individual studies (#2-5 and

NU
#7-10). The total scores from the two items used ranged from 1-8; the higher the score, the

better the quality of study. Reliability and validity of the tool was not assessed in this process
MA
and is recognized as a potential limitation. Table 1 provides results from the evaluation of

studies using the HEQAT.

ED

Table 1: Evaluation of Empirical Studies

PT

Author/Title Design *Quality Rating

CE

www.healthevidence.org

Post et al. (2015). Implementation of a flipped Qualitative 7.5

classroom: Nursing students’ perspectives
AC

Missildine et al. (2013). Flipping the Quasi-experimental 6

Classroom to Improve Student Performance
and Satisfaction

Simpson et al. (2015). Flipping the classroom Quantitative 6

to teach population health: Increasing the
relevance

Quantitative 6

Yacout et al. (2016). Nursing students’

perceptions towards flipped classroom
educational strategy
 ACCEPTED MANUSCRIPT

AN INTEGRATIVE REVIEW OF FLIPPED CLASSROOM MODELS 12

Hanson (2016). Surveying the experiences & Mixed methods 6

perceptions of undergraduate nursing students

T
of a flipped classroom approach to increase

P
understanding of drug science and its

RI
application to clinical practice.

SC
Harrington et al. (2015). Quantitative outcomes Experimental 5.5
for nursing students in a flipped classroom

Geist et al. (2015). Flipped Versus Traditional

NU
Quasi-experimental 5.5
MA
Instruction and Achievement in a
Baccalaureate Nursing Pharmacology Course

Harmon et a. (2015). Transforming psychiatric Quasi-Experimental 5

ED

mental health nursing education with team

based learning
PT

Pence (2016). “Flipping” a first-year medical- Quantitative 5

CE

surgical associate degree registered nursing

course: A 2-year pilot study
AC

Choi et al. (2015). Applying the flipped Mixed methods 4

learning model to an English-medium nursing
course

Mikkelsen (2015). Nursing students’ Mixed methods 3.5

experiences, perceptions and behavior in a
flipped-classroom anatomy and physiology
course

Critz et al. (2013). Using the Flipped Mixed methods 2.5

Classroom in Graduate Nursing Education
 ACCEPTED MANUSCRIPT

AN INTEGRATIVE REVIEW OF FLIPPED CLASSROOM MODELS 13

2013

T
Burden et al. (2015). Flipping the Classroom: Qualitative 2

P
Strategies for Psychiatric-Mental Health
Course 2015

RI
SC
* Possible range of scores of 0-8

NU
Data Analysis
MA
The data analysis phase of the integrated review (Whittemore & Knafl, 2005), included

the following recommended steps: (a) data reduction; (b) data display; (c) data comparison; and
ED

(e) conclusion drawing and verification. This approach is systematic and rigorous to eliminate

risk of bias by inadvertently removing or including studies from the analysis. Having four
PT

authors independently conduct the literature search and review supported validation of the
CE

findings through convergence of results.

AC

Data Reduction

For the identification step, see figure 1. The full-text versions of the remaining 13

empirical studies were reviewed and included in the final analysis and report of findings.

Data Display

To further maintain optimal and quality reporting, the approach suggested by the

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used to

present an illustration of the search strategy and process (Moher et al., 2015) (See Figure 1).

Key study components were compared across the 13 studies that include author and year of
 ACCEPTED MANUSCRIPT

AN INTEGRATIVE REVIEW OF FLIPPED CLASSROOM MODELS 14

publication, study purpose, study design and setting, sample, course, and program flipped

classroom intervention characteristics and main outcomes results in Table 2.

P T
RI
SC
NU
MA
ED
PT
CE
AC
 ACCEPTED MANUSCRIPT

AN INTEGRATIVE REVIEW OF FLIPPED CLASSROOM MODELS 15

Table 2: Comparison of Key Components of Flipped Classroom Models

Author/Year Study Purpose Study Design / Study Flipped Main Outcomes

T
Setting Sample/course Classroom

P
/Program Teaching
Intervention

RI
Model
Burden et al. To describe the Qualitative / USA 359 students in Four hour Analyzed reflective journal
(2015) strategies used in psychiatric sessions entry by students

SC
a flipped mental health Pre-class Themes identified include:
classroom course. folder: Work Students - helpfulness of
model, student Over 2 years sheets and pre-class modules, in-depth
perceptions and (BS) assignment information covered in

NU
implications for guidelines; class; satisfaction.
nursing textbook Faculty - active student
education. assigned engagement, better
readings; communication with
MA
youTube patients, and less anxiety
patient case and increased self-
study; graded confidence in clinical
ticket
ED

worksheet;
view web site
In-class folder:
Concept map
PT

on white
boards; small
assigned group
CE

work; role
plays; short
skits
Wisdom tip
AC

folder: Power
point
presentations;
youTube video
clips; podcasts
with
worksheets;
crossword
puzzles
Choi et al. To revise the Mixed methods / 75 students in Pre-class: Quantitative
(2015) existing English- Seoul, Korea 15 week Pre-recorded 97% viewed pre-recoded
medium English- lectures; group videos.
instruction medium project Students accepted and
nursing course instruction (analysis of favored the flipped
using; explore nursing course movies or classroom model; enhanced
students’ (BS) dramas using 4 understanding of content;
learning nursing meta- motivated students.
experiences and paradigms); Qualitative:
acceptance of health Major themes were –
flipped promotion benefits if flipped course;
 ACCEPTED MANUSCRIPT

AN INTEGRATIVE REVIEW OF FLIPPED CLASSROOM MODELS 16

classroom; and project; self- limitations or challenges;

identify key developed and key success factors
factors in the videos &
success of the uploaded on

T
model. course site
In-class hours:

P
interactive and
creative

RI
learning
activities;

SC
critical
thinking
activities;
group

NU
discussions;
real-time polls
Critz et al. To explore Mixed methods / 20 students in Pre-class: 11 Content - 60% felt the
(2013) student course USA graduate pre-class material covered was
MA
satisfaction pediatric modules; pre- extremely worthwhile; 40%
course. recorded felt it was very worthwhile.
Over 2 power point Students reported that
semesters lecture videos current, evidence-based
(MS) (20 – 40 articles were useful.
ED

minutes); Out of class readings – 65%

assigned of the students reported that
textbook they were extremely
PT

materials; 4 to worthwhile; 30% reported

5 current, they were very worthwhile.
peer-reviewed, Students commented that
evidence- pre-class readings were very
CE

based journal relevant and great for future

articles; reference. Questions related
posttest to current practice
(online quiz –
AC

guidelines were helpful and

60% of grade). thought provoking.
In-class: Classroom activities – 70%
unfolding case of the students felt that
studies, role working through case
playing, group scenarios was extremely
problem- worthwhile, and 15%
solving reported very worthwhile.
exercises, Two students reported the
student case studies to be just
presentations moderately worthwhile
(10%).
Comments were positive for
all the students except for
one of them.
Geist et al. To gather Quasi- 40 in control Control Three unit tests and a
(2015) scientific data on experimental / and 46 in group - comprehensive final exam
the effects of the USA flipped traditional Flipped classroom treatment
flipped classroom methods of group performed better on
classroom on group. instruction the three unit tests during
 ACCEPTED MANUSCRIPT

AN INTEGRATIVE REVIEW OF FLIPPED CLASSROOM MODELS 17

knowledge 86 students in Flipped the course.

acquisition. pharmacology classroom
course. treatment
Over 2 group –

T
semesters Pre-test
(BS) HESI mid-

P
curricular test
to measure

RI
aptitude/ability
before taking

SC
course.
HESI scores
provide a
standardized

NU
national
performance
scale, which
was used as a
MA
covariate.

Hanson (2016) To assess Mixed methods / 51 second year 6 components Quantitative:

response to a Australia undergraduate Pre-class: 88% viewed videos in 2013
flipped students (13% ELectures compared to 64% in 2014.
ED

classroom response rate) In-Class: Grades improved, but

model; evaluate in 2013 & Lectures; students had negative
the impact of 2014 over 2 quizzes; peer attitudes about the flipped
PT

understanding of years discussion; classroom model

course content; (BS) teacher
and its discussion; & Qualitative:
application to case studies. Themes were: increased
CE

practice understanding, pause and

replay, wider and deeper
thinking
AC

Harmon et al. To evaluate the Quasi- 347 students in Control Significant differences in
(2015) effect of team- experimental – the 4th year group test scores between the
based learning uncontrolled undergraduate Traditional groups (p <.001).
on course before and after psychiatric lecture-based Students enjoyed the change
outcomes. design / USA mental health. format with in course pace; like the
over 4 med-term & quizzes each week; quizzes
semesters final exams shifted emphasis from
(2010-2012). Intervention cramming to applying”
group
174 students in Intervention
the control program with
group & 173 educational
students in the package to
intervention access online
group case studies &
(BS) specialty
testing.
Team
assignments
and team
 ACCEPTED MANUSCRIPT

AN INTEGRATIVE REVIEW OF FLIPPED CLASSROOM MODELS 18

quizzes
through the
Readiness
Assurance

T
Process; role
plays, online

P
case studies
using QSEN,

RI
Evolve, and
web info;

SC
shared
accountability
for team
assignments

NU
Harrington et al. To objectively Experimental / 82 students in Control Test scores and course
(2015) compare USA medical group outcomes
learning surgical Weekly online No significant differences
MA
outcomes of two nursing theory just-in-time found between the
pedagogies as course. quizzes, class traditional and flipped
measured Over 1 with minimum classroom groups:
quantitatively semester (BS) activities Wilks lambda = 0.851, p =
through exam Treatment .057 (p.180).
ED

questions, quiz group

scores, and Weekly online
course grades. just-in-time
PT

quizzes
Pre-class
preparation
CE

Mikkelsen To explore Mixed methods / 34 students Pre-class: Student experiences and

(2015) nursing students’ Denmark (out of 48; Animated perceptions
experiences, 71% response power point Students expressed a very
AC

perceptions and rate) in slides high degree of satisfaction

behavior during anatomy and Short lecture with assigned videos.
a course on physiology videos with 26% of the students
kidney and course. slide show and preferred videos, 56% felt
urinary system Over 4 days or narration they were of equal benefit,
anatomy and 10 hours of uploaded on and only 18% felt they
physiology class (over 2 youTube (3-9 benefited most from face-to-
designed weeks) minutes in face lectures.
according to the (BS) duration) 8 18% preferred traditional
flipped- days before teaching over flipped
classroom class; read classroom teaching, 41%
approach. assigned preferred flipped classroom
textbook pages and 41% did not prefer one
In-class: group approach over the other.
discussion to
review
exercises, case
study,
problem-
solving
 ACCEPTED MANUSCRIPT

AN INTEGRATIVE REVIEW OF FLIPPED CLASSROOM MODELS 19

activities.
Reminders to
complete
online

T
questionnaire
Missildine et al. To determine the Quasi- 445 students Comparison of Academic success and

P
(2013) effects of a experimental / (75.55% 3 learning course satisfaction
flipped USA response rate) approaches. Students in the flipped

RI
classroom and in 3 adult Traditional classroom scored higher on
innovative health courses. lecture exams; students were less

SC
learning Over 3 Lecture and satisfied with the flipped
activities on semesters lecture capture than other methods.
academic (BS) back-up
success and the Innovative

NU
satisfaction of classroom
nursing students. activities

Pence (2016) To pilot test a Descriptive – 70 students in Pre-class: Course evaluation:

MA
flipped learning quantitative / the first year of Audio 9 out of 50 reported
model USA program over 2 podcasts listening to the podcast
classes (2013 recorded in before class.
& 2014) 10- to 35- Students reported that the
(AD) minute flipped class was helpful to
ED

segments their learning; podcasts

using a “really helped me to learn
handheld and remember the
PT

recorder & information;” wrote that

saved as MP3 doing the podcasts and other
file, & preparation before class
downloaded helped them to “learn a lot
CE

into the on- more” and “put it all

line together” during class; & “it
Blackboard makes it possible for any
type of learner to do well.”
AC

course site;
printed outline
of lecture
content used in
the traditional
class was
provided to
guide note
taking.
In-class: active
learning
experiences;
calling on
students to
determine
understanding

Post et al. To explore Qualitative 18 students in Pre-class: pre- Focus Group Interview data:
(2015) student phenomenological medical- recorded Four major themes were
experiences of / USA surgical lecture videos identified from student data:
 ACCEPTED MANUSCRIPT

AN INTEGRATIVE REVIEW OF FLIPPED CLASSROOM MODELS 20

flipping the nursing I and II In-class: case 1. Frustration- not

classroom in two courses. study analysis, able to ask
Medical/Surgical Over 2 critical instructors a
courses. semesters thinking question, new

T
(BS) activities, learning approach
question and 2. Disconnect-

P
answer decrease time with
sessions instructors, hard to

RI
set priorities
3. Depersonalization-

SC
video lectures not
helpful to some
students,
technology naive

NU
4. Time- time
management was
difficult, increase
workload
MA
Simpson et al. To increase the Descriptive & 29 third year Pre-class: Quantitative:
(2015) relevance of exploratory /USA students in a Voice-over No statistical differences
population population power point, between the two groups.
ED

health course to health nursing teaching Students first struggled with

students’ future course videos, changes in pedagogy; but
practice compared to 64 interactive later in course were
PT

students in the online enthusiastic; model allowed

previous public modules, more flexibility to control
health science reading of learning pace; enjoyed case
course. texts. studies & felt they were
CE

Class sessions review learning relevant

every 2 weeks. material and information; increased
(USA) take online critical thinking.
AC

quiz Themes:
In-Class: Student engagement;
random flexibility in learning;
assignment to student ownership of
groups for learning.
assignments; Faculty thought students
interactions had better grasp of content
using white & focused more on acute
boards; care and not community
computer setting.
access; case
studies; web
quests; videos;
and group
developed
presentations

Yacout et al. To investigate Exploratory 146 students in Pre-Class: Students demonstrated a

(2016) perceptions, descriptive / the 4th year of Pre-recorded moderate level of
 ACCEPTED MANUSCRIPT

AN INTEGRATIVE REVIEW OF FLIPPED CLASSROOM MODELS 21

satisfaction, and Egypt their videos satisfaction (58; 39.7%) and

experiences community distributed by positive perceptions
towards a health course email, social (85.6%) of flipped
flipped in the year media or CDs classrooms; 57.5%

T
classroom 2015-2016. In-Class: preferred the traditional
educational (BS) group method; 35.6% preferred the

P
strategy assignment flipped classroom;
with practice Significant differences

RI
problems observed between students‟
gender, age, residence and

SC
last academic achievement
(p < .05);
Stated, "facilitate
understanding topic; give

NU
ideas about class activities;
& increased retention of
information; "need extra
time to watch; no possibility
MA
of immediate feedback
during watching videos;
flipped classrooms cannot
be applied in all nursing
courses".
ED

AD = Associate degree; BS = baccalaureate degree; MS = Master’s degree; QSEN = Quality and

PT

Safety Education for Nurses

CE

Data Comparison and Presentation

AC

Of the 13 empirical studies using a flipped classroom model with nursing students, 11

were conducted with undergraduate BSN students (Burden et al., 2015; Choi et al., 2015; Della

Ratta, 2015; Geist et al., 2015; Harmon & Hills, 2015; Harrington et al. 2015; Mikkelsen, 2015;

Missildine et al., 2013; Post et al., 2015; Simpson & Richards, 2015; Yacout & Shosha, 2016 ).

There was one study with associate degree nursing students (Pence, 2016) and another with

graduate nursing students (Critz & Knight, 2013). Content areas ranged from graduate pediatrics

(Critz & Knight, 2013), adult health (Harrington et al., 2015; Missildine et al., 2013; Post et al.,

2015), pharmacology (Geist et al., 2015; Hanson, 2016), anatomy and physiology (Mikkelsen,
 ACCEPTED MANUSCRIPT

AN INTEGRATIVE REVIEW OF FLIPPED CLASSROOM MODELS 22

2015), psychiatric mental health (Burden et al., 2015; Harmon & Hills, 2015), maternal and child

health (Yacout & Shosha, 2016), and population health (Simpson et al. 2015).

P T
One study (Harrington et al., 2015) used an experimental study design; three (Geist et al.,

RI
2015; Harmon & Hills, 2015; Missildine et al., 2013) used a quasi-experimental design. In

SC
addition, five studies used descriptive (quantitative and/or qualitative) designs (Burden et al.,

2015; Pence, 2016; Post et al., 2015; Simpson & Richards, 2015; Yacout & Shosha, 2016), and

NU
four were mixed methods (Choi, 2015; Critz & Knight, 2013; Hanson, 2016; Mikkelsen, 2015).
MA
Most of the studies lacked statistical power and used descriptive statistics to analyze study data.

The descriptive study designs focused on student satisfaction, students’ perception of the
ED

duration of the pre-class lecture recordings, and other process-related instructional activity

outcomes (Burden et al., 2015; Critz & Knight, 2013; Post et al., 2015). Across studies that
PT

evaluated outcome measures, the flipped classroom group had higher mean exam scores than the
CE

comparison group (Geist et al., 2015; Missildine et al., 2013; Yacout & Shosha, 2016); while

others failed to find a statistical difference (Harmon & Hills, 2015; Simpson & Richards, 2015).
AC

However, there were mixed results related to student satisfaction. In addition, one study failed to

find differences between the flipped and traditional methods (Simpson & Richards, 2015), which

could be attributed to the small sample size (N = 29). One unusual finding found in this

integrative review was a flipped classroom model that was implemented because administrators

at the institution had a partnership with an industry and they were conducting studies to

determine the effect of space, technology, and pedagogy on student teaching (Burden et al.,

2015). The school of nursing at this institution was selected to participate in the flipped

classroom approach by university administrators.

 ACCEPTED MANUSCRIPT

AN INTEGRATIVE REVIEW OF FLIPPED CLASSROOM MODELS 23

Improvement in students’ course grades and student satisfaction were outcome measures

across the studies (Critz & Knight, 2013; Harmon & Hills, 2015; Harrington et al., 2015). Most

T
of the studies reported the need for more time for faculty to dedicate on course content, videos,

P
RI
and other course-related activities. The studies also reported the need for more technological

support. Additionally, student preparation before class was identified as an important component

SC
and key to the success of the flipped classroom pedagogical approach. Authors reported that

NU
often times some students were not adequately prepared before class, which led to student

dissatisfaction and frustration (Critz & Knight, 2013; Post et al., 2015). Overall, there were vast
MA
differences in how the flipped classroom was implemented across the studies (see Table 2).
ED

Conclusion Drawing and Verification

The quest for innovative teaching strategies to better prepare nursing graduates continues
PT

with some educators implementing flipped classroom models. Nurse educators are increasingly
CE

conducting research studies to investigate the use and effectiveness of flipped classroom models

on student performance and course satisfaction. Yet, evidence explicating how this pedagogy
AC

prepares students to transition into their new roles after graduation is limited. Few studies were

found assessing the integration of the flipped classroom in nursing courses. Effective flipped

classroom models could propagate collaborative learning, team-work, active participation in the

learning process, and improve critical thinking and decision-making skills for optimal patient

outcomes. To determine the impact of flipped classroom models on student outcomes, it is

critical to ensure that research studies are conducted using rigorous scientific methods.
 ACCEPTED MANUSCRIPT

AN INTEGRATIVE REVIEW OF FLIPPED CLASSROOM MODELS 24

Using robust research methods

The limited number of rigorous experimental studies employing control groups for

T
comparison is significant and has gained the attention of educators within and outside of nursing

P
RI
(Betihavas et al., 2016; Mikkelsen, 2015; O'Flaherty & Phillips, 2015; Presti, 2016). Perhaps the

focus of these research studies was on flipped classroom methodology and process and not

SC
scientific design. Nonetheless, the context of the papers could have been more clearly explicated

NU
in the reports. Robust scientific rigor could provide guidance on frameworks for content areas,

pre, and in-class activities. Additionally, rigorous methodologies could inform the appropriate
MA
course level(s) to implement flipped classroom models and the types of courses that are most

amenable to this pedagogy. Importantly, the use of robust research methods in implementing
ED

flipped classrooms could also increase validity for specific methods and frameworks to guide
PT

consistent and strong comparisons across interventions. This will allow educators to apply and

replicate studies with confidence in the context of educational systems. Other papers on flipped
CE

classroom pedagogy were found that focused solely on methodology and the report of findings
AC

(Best et al., 2014; Dalton, 2015; Della Ratta, 2015; Elliott, 2014; Schlairet, Green, & Benton,

2014; Schwartz, 2014).

Operationalizing flipped classroom models

One of the biggest challenges encountered during the review was the variation in which

educators conceptualized and operationalized the flipped classroom model. Some study

findings were more clearly explicated than others. No two models were similar making it

difficult to compare, replicate findings, or validate certain components of the model. The

operationalization of the flipped classroom interventions ranged from well-designed, prescriptive

pre-class and in-class activities to poorly developed activities that were not well developed or
 ACCEPTED MANUSCRIPT

AN INTEGRATIVE REVIEW OF FLIPPED CLASSROOM MODELS 25

explicated. In some cases, very limited information was provided on the pre and in-class

activities used for the intervention. Some authors accorded students course credit for up to 60%

T
of the course grade for pre-class activities, motivating them to complete and prepare for class

P
RI
discussions (Critz & Knight, 2013; Harmon & Hills, 2015; Harrington et al., 2015). Students

were sometimes asked to spend a “minimum of 10 hours” (p. 210) on pre-class activities (Critz

SC
& Knight, 2013), but it was unclear if this was over the course of the semester or a week.

NU
Important variations in operationalizing outcomes were related to course satisfaction

outcomes, the components of the flipped classroom such as the length of the videos if used, and
MA
what constituted a reasonable timeframe for pre-class activities. Some of the authors developed

their own online or paper surveys to ask questions related to quality and quantity of content and
ED

process information related to how the flipped classroom model was implemented (Critz &
PT

Knight, 2013; Hanson, 2016; Mikkelsen, 2015; Pence, 2016; Schwartz, 2014). Other authors

used qualitative data or exam scores for outcome measures for satisfaction and course
CE

performance (Burden et al., 2015; Harrington et al., 2015; Post et al., 2015). Authors did not
AC

share course implementation challenges that might have occurred. For example, it was unclear if

authors encountered problems enrolling students as study participants or whether faculty

teaching the courses was also the researcher. Only two studies addressed attrition rate (Hanson,

2016; Mikkelsen, 2015). It is interesting to note that the study with the highest quality score in

this review (Post et al., 2015) reported that students responded negatively to the flipped

classroom model change.

In nursing education, the pure flipped classroom appears to be variable at best in the

United States and international contexts. Perhaps this makes sense in the context of nursing

education pedagogy because instructors must select appropriate teaching and learning strategies
 ACCEPTED MANUSCRIPT

AN INTEGRATIVE REVIEW OF FLIPPED CLASSROOM MODELS 26

that meet the needs of the students to achieve the intended course outcomes. So a viable

question worth pursuing is, how best can the evidence in the area of flipped classroom pedagogy

T
in nursing education be built? If indeed flipped classroom approaches are strategically tailored

P
RI
to the learners, they will be highly variable. Thus, future reviews reporting impact on variables

such as student satisfaction with the course and improved grades, will remain challenging to

SC
review and interpret, but enhanced study rigor can be a step in the right direction.

NU
Building the foundation for best practice evidence and developing sound pedagogy

Despite the variations in implementation processes and outcome measures, these

MA
preliminary studies provide important information for nursing educators and provide a beginning

foundation to inform future studies. In five studies, the flipped classroom encouraged active
ED

engagement in class activities, improved performance outcomes, and increased course

PT

satisfaction (Burden et al., 2015; Critz & Knight, 2013; Geist et al., 2015; Harmon & Hills, 2015;

Pence, 2016). Two studies noted improvement in clinical outcomes through increased self-
CE

confidence and patient interactions (Burden et al., 2015; Yacout & Shosha, 2016). However,
AC

students were not always satisfied and did express concerns such as the increase in amount of

work, a perception of distancing from the instructors, and being unable to manage their time.

Additionally, few of the studies addressed how students were prepared by faculty for the flipped

classroom experience.

Implications for Nursing Education and Research

Nursing educators continue to prepare the future workforce by increasing opportunities

for students to engage in active, team-based, and collaborative, problem-based activities. The

strategies used in flipped classroom pedagogy could help support nursing students in making

sound and accurate clinical decisions related to scenarios similar to those encountered in
 ACCEPTED MANUSCRIPT

AN INTEGRATIVE REVIEW OF FLIPPED CLASSROOM MODELS 27

practice. However, studies that are more robust are needed in this area of nursing education

research. In addition, it is important to consider critical student and faculty related factors that

T
might facilitate or impede implementation of flipped classroom models. Unless these factors are

P
RI
addressed in robust research designs, flipped classroom models will continue to be implemented

on a trial and error basis at best. From this integrative review, authors have observed a trend

SC
towards more rigorous research of flipped classroom and presentation of study findings with

NU
recent publications demonstrating the growth of evidence in this area. On the student side, major

student-related factors were identified including the time involved in pre-class assignments;
MA
length of videos and other media; and internet access. Faculty-related factors include workload

needed to dedicate time for the development of a flipped classroom course; incorporating
ED

different student learning styles in activities, and increased technology support for faculty.
PT

To develop sound evidence-based teaching strategies, the science needs to be strong, so

educators can use the framework as a model to implement flipped classroom approaches. There
CE

is a need for rigorous research studies to address operationalizing pre- and in-class activities, and
AC

type of content and level of students that might be best amenable to this pedagogy. Other health

disciplines, such as pharmacy, have contributed extensively to implementing flipped classroom

models. Nursing educators could integrate lessons learned in their work making sure

components are appropriate in the context of nursing education. There is need to investigate

faculty workload issues and how those would impact implementation of flipped classroom

models. Most importantly, research studies are needed to determine how flipped classroom

models will influence student performance in clinical judgment and decision-making skills

months after they complete the flipped classroom course. This point is critical and remains a gap

given the rationale provided for implementing flipped classroom models in the studies reviewed.
 ACCEPTED MANUSCRIPT

AN INTEGRATIVE REVIEW OF FLIPPED CLASSROOM MODELS 28

Nursing educators could then translate these models in more strategic ways to transform the

teaching-learning process. In order to be effective, it is also important to consider streamlining

T
duplicate and unnecessary course content to accommodate this innovative pedagogy to best

P
RI
prepare graduate nurses with the skill set they need to be effective and transformative

professionals.

SC
Conclusions

NU
Nurse educators are interested in integrating evidence-based pedagogy through the

curricula as a means to better prepare the next generation of nursing students. The flipped
MA
classroom model has gained in popularity and as a result, research on the impact of the flipped

classroom model on student exam scores, course performance, and satisfaction is evident.
ED

However, results are mixed, derived from primarily non-experimental studies, employing various
PT

methods to implement within the classroom, and examining a variety of outcomes (e.g., a single

exam score or a course grade). This integrative review summarizes, critiques, and analyzes
CE

previously conducted research studies examining the impact of the flipped classroom model
AC

integrated into nursing education. Even though there is progress in the scientific rigor of the

studies evaluated, there is a need for more robust research methods with adequate sample sizes to

advance the evidence that the flipped classroom model is effective in preparing future nurses to

competing practice within the current healthcare system.

 ACCEPTED MANUSCRIPT

AN INTEGRATIVE REVIEW OF FLIPPED CLASSROOM MODELS 29

Acknowledgements

Funding:

T
“This research did not receive any specific grant from funding agencies in the public,

P
commercial, or not-for-profit sectors.”

RI
SC
NU
MA
ED
PT
CE
AC
 ACCEPTED MANUSCRIPT

AN INTEGRATIVE REVIEW OF FLIPPED CLASSROOM MODELS 30

References

American Association of the Colleges of Nursing (AACN). (2011). Core competencies for inter-

T
professional collaborative practice: Report of an expert panel. Washington, DC: Inter-

P
RI
professional Education Collaborative.

Bergmann, J., & Sams, A. (2012). Flip your classroom: Reach every student in every class every

SC
day. Eugene, Oregon: International Society for Technology in Education.

NU
Best, D., Naber, J. (2016). Is a flipped classroom an effective educational method to meet

nursing students' learning needs? Madridge Journal of Nursing, 1(1),7-10. doi:

MA
10.18689/mjn.2016-102

Betihavas, V., Bridgman, H., Kornhaber, R., & Cross, M. (2016). The evidence for 'flipping
ED

out': A systematic review of the flipped classroom in nursing education. Nurse

PT

Education Today, 38, 15-21. http://dx.doi.org/10.1016/j.nedt.2015.12.010

Brooks, B. A (2015). An emerging role: the nurse content curator. Nursing forum, 50(1). 51-54.
CE

Burden, M. L., Carlton, K. H., Siktberg, L., & Pavlechko, G. (2015). Flipping the classroom:
AC

Strategies for psychiatric-mental health course. Nurse Educator, 40(5), 233-236.

doi:10.1097/NNE.0000000000000162

Central, P. (2004). Does active learning work? A Review of the Research, 93, 223-231.

Choi, H., Kim, J., Bang, K., Park, Y., Lee, N., & Kim, C. (2015). Applying the flipped learning

model to an English-medium nursing course. Journal of Korean Academy of Nursing,

45(6), 939-948. http://dx.doi.org/10.4040/jkan.2015.45.6.939

Critz, C., M., & Knight, D. (2013). Using the flipped classroom in graduate nursing education.

Nurse Educator, 38(5), 210-213. doi:10.1097/NNE.0b013e3182a0e56a

Dalton, L., Levett, T., & Gee, T. (2016). Using clinical reasoning and simulation-based
 ACCEPTED MANUSCRIPT

AN INTEGRATIVE REVIEW OF FLIPPED CLASSROOM MODELS 31

education to ‘flip’ the Enrolled Nurse curriculum. Australian Journal of Advanced Nursing,

33(2), 28 - 34.

T
Davies, R. S., Dean, D. L., & Ball, N. (2013). Flipping the classroom and instructional

P
RI
technology integration in a college-level information systems spreadsheet course.

Educational Technology Research and Development, 61(4), 563-580. doi:10.1007/s11423-

SC
013-9305-6

NU
Della Ratta, C. B. (2015). Flipping the classroom with team-based learning in undergraduate

nursing education. Nurse Educator, 40(2), 71-74. doi:10.1097/NNE.0000000000000112

MA
Elliott, S. (2014). Using a modified team-based learning approach to teach nursing students

about communicable disease control and community health nursing. Journal of Nursing
ED

Education, 53(11), 651-653. doi:10.3928/01484834-20141027-01

PT

Geist, M., J., Larimore, D., Rawiszer, H., & Al Sager, A. W. (2015). Flipped versus traditional

instruction and achievement in a baccalaureate nursing pharmacology course. Nursing

CE

Education Perspectives, 36(2), 114-115. doi:10.5480/13-1292

AC

Gilboy, M. B., Heinerichs, S., & Pazzaglia, G. (2015). Enhancing student engagement using the

flipped classroom. Journal of Nutrition Education & Behavior, 47(1), 109-114. Retrieved

from

http://search.ebscohost.com/login.aspx?direct=true&db=sph&AN=100703544&site=ehost-

live

Hanson, J. (2016). 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 Education in Practice, 16(1), 79-85.

http://dx.doi.org/10.1016/j.nepr.2015.09.001
 ACCEPTED MANUSCRIPT

AN INTEGRATIVE REVIEW OF FLIPPED CLASSROOM MODELS 32

Hamdan, N., McKnight, P., McKnight, K., & Arfstrom, K. (2013). A review of flipped learning.

Flipped Learning Network, FLN Research Committee.

T
Harmon, R., & Hills, R. (2015). Transforming psychiatric, mental health nursing with team

P
RI
based learning. Archives of Psychiatric Nursing, 29, 413-418.

http://dx.doi.org/10.1016/j.apnu.2015.06.014

SC
Harrington, S., Ann, Vanden Bosch, M., Schoofs, N., Beel-Bates, C., & Anderson, K. (2015).

NU
Quantitative outcomes for nursing students in a flipped classroom. Nursing Education

Perspectives, 36(3), 179-181. doi:10.5480/13-1255

MA
Health Evidence Assessment Tool (2013). Retrieved from

http://www.healthevidence.org/documents/our-appraisal-
ED

tools/QA_tool&dictionary_18.Mar.2013.pdf
PT

Hessler, K. L. (2016). Nursing education: Flipping the classroom. The Nurse practitioner, 41(2),

17.
CE

Institute of Medicine of the National Academies. (2010). The future of nursing: focus on nursing
AC

education. Retrieved from

https://www.nationalacademies.org/hmd/~/media/Files/Report%20Files/2010/The-Future-

of-Nursing/Nursing%20Education%202010%20Brief.pdf

Koo, C., Demps, E., Farris, C., Bowman, J., Panahi, L., & Boyle, P. (2016). Impact of a flipped

classroom design on student performance and perceptions in a pharmacology course.

American Journal of Pharmaceutical Education, 80(2), 1- 9.

Liebert, C., Lin, D., Mazer, L., Bereknyei, S., & Lau, J. (2016). Effectiveness of the surgery

core clerkship flipped classroom: a prospective cohort trial. American Journal of Surgery,

211(2), 451-457. http://dx.doi.org/10.1016/j.amjsurg.2015.10.004

 ACCEPTED MANUSCRIPT

AN INTEGRATIVE REVIEW OF FLIPPED CLASSROOM MODELS 33

Mackintosh-Franklin, C. (2016). Pedagogical principles underpinning undergraduate nurse

education in the UK: A review. Nurse Education Today, 40, 118-122.

T
http://doi.org/10.1016/j.nedt.2016.02.015

P
RI
Mason, G. S., Shuman, T. R., & Cook, K. E. (2013). Comparing the effectiveness of an inverted

classroom to a traditional classroom in an upper-division engineering course. IEEE

SC
Transactions on Education, 56(4), 430-435. doi:10.1109/TE.2013.2249066

NU
Mattis, K. V. (2015). Flipped classroom versus traditional textbook instruction: Assessing

accuracy and mental effort at different levels of mathematical complexity. Technology,

MA
Knowledge and Learning, 20(2), 231-248.

McLaughlin, J. E., Griffin, L. M., Esserman, D. A., Davidson, C. A., Glatt, D. M., Roth, M. T.,
ED

… Mumper, R. J. (2013). Pharmacy student engagement, performance, and perception in a

PT

flipped satellite classroom. American Journal of Pharmaceutical Education, 77(9), 1-8.

Retrieved from
CE

http://search.ebscohost.com/login.aspx?direct=true&db=aph&AN=98951750&site=ehost-
AC

live

Mikkelsen, T. R. (2015). Nursing students’ experiences, perceptions and behavior in a flipped-

classroom anatomy and physiology course. Journal of Nursing Education and Practice,

5(10), 28 -35. http://dx.doi.org/10.5430/jnep.v5n10p28

Missildine, K., Fountain, R., Summers, L., & Gosselin, K. (2013). Flipping the classroom to

improve student performance and satisfaction. Journal of Nursing Education, 52(10), 597-

599. doi:10.3928/01484834-20130919-03
 ACCEPTED MANUSCRIPT

AN INTEGRATIVE REVIEW OF FLIPPED CLASSROOM MODELS 34

Moffett, J., & Mill, A. C. (2014). Evaluation of the flipped classroom approach in a veterinary

professional skills course. Advances in Medical Education & Practice, 5, 415-425.

T
doi:10.2147/AMEP.S70160

P
RI
Moher, D., Shamseer, L., Clarke, M., Ghersi, D., Liberati, A., Petticrew, M., . . . PRISMA-P

Group. (2015). Preferred reporting items for systematic review and meta-analysis protocols

SC
(PRISMA-P) 2015 statement. Systematic Reviews, 4, 1-4053-4-1. doi:10.1186/2046-4053-

NU
4-1

O'Flaherty, J., & Phillips, C. (2015). The use of flipped classrooms in higher education: A
MA
scoping review. The Internet and Higher Education, 25, 85-95.

http://dx.doi.org/10.1016/j.iheduc.2015.02.002
ED

Pence, P. L. (2016). Flipping a first-year medical-surgical associate degree registered nursing

PT

course: A 2-year pilot study. Teaching and Learning in Nursing, 11(2), 52-57.

http://dx.doi.org/10.1016/j.teln.2015.12.006
CE

Post, J. L., Deal, B., & Hermanns, M. (2015). Implementation of a flipped classroom: Nursing
AC

students’ perspectives. Journal of Nursing Education and Practice, 5(6), 25-30.

doi:10.5430/jnep.v5n6p25

Presti,C. R. (2016). The Flipped Learning Approach in Nursing Education. Journal of Nursing

Education, 55 (5), 252 – 257. doi:10.3928/01484834-20160414-03

Schlairet, M., C., Green, R., & Benton, M., J. (2014). The flipped classroom. Nurse Educator,

39(6), 321-325. doi:10.1097/NNE.0000000000000096

Schultz, D., Duffield, S., Rasmussen, S. C., & Wageman, J. (2014). Effects of the flipped

classroom model on student performance for advanced placement high school chemistry

students. Journal of Chemical Education, 91(8), 1334-1339. doi:10.1021/ed400868x

 ACCEPTED MANUSCRIPT

AN INTEGRATIVE REVIEW OF FLIPPED CLASSROOM MODELS 35

Schwartz, T., A. (2014). Flipping the statistics classroom in nursing education. Journal of

Nursing Education, 53(4), 199-206. doi:10.3928/0148434-20140325-02

T
Simonson, S. R. (2014). Making students do the thinking: Team-based learning in a laboratory

P
RI
course. Advances in Physiology Education, 38(1), 49-55. Retrieved from

http://search.ebscohost.com/login.aspx?direct=true&db=eric&AN=EJ1021047&site=ehost-

SC
live; http://dx.doi.org/10.1152/advan.00108.2013

NU
Simpson, V., & Richards, E. (2015). Flipping the classroom to teach population health:

Increasing the relevance. Nurse Education in Practice, (15), 162-167.

MA
doi:http://dx.doi.org/10.1016/j.nepr.2014.12.001

Tune, J. D., Sturek, M., & Basile, D. P. (2013). Flipped classroom model improves graduate
ED

student performance in cardiovascular, respiratory, and renal physiology. Advances in

PT

Physiology Education, 37(4) Retrieved from

http://search.ebscohost.com/login.aspx?direct=true&db=eric&AN=EJ1016939&site=ehost-
CE

live; http://dx.doi.org/doi:10.1152/advan.00091.2013
AC

Waltz, C., Jenkins, L., & Han, N. (2014). The use and effectiveness of active learning methods in

nursing and health professions education: A literature review. Nursing Education

Perspectives, 35(6), 392-400. doi:10.5480/13-1168

Warugaba, C., Naughton, B., Hedt-Gauthier, B., Muhirwa, E., & Amoroso, C. (2016).

Experience with a massive open online course in rural Rwanda. International Review of

Research in Open and Distance Learning, 17(2), 222 - 231.

Whittemore, R., & Knafl, K. (2005). The integrative review: Updated methodology. Journal of

Advanced Nursing, 52(5), 546-553. doi:JAN3621

Yacout, D., & Shosha, A. (2016). Nursing students’ perceptions towards

 ACCEPTED MANUSCRIPT

AN INTEGRATIVE REVIEW OF FLIPPED CLASSROOM MODELS 36

flipped classroom educational strategy. Journal of American Science, 12(2), 62-75.

doi:10.7537/marsjas12021607

P T
RI
SC
NU
MA
ED
PT
CE
AC
 ACCEPTED MANUSCRIPT

AN INTEGRATIVE REVIEW OF FLIPPED CLASSROOM MODELS 37

Appendix A

Data Bases and Search Results

T
Databases Search Strategies Number of papers

P
RI
CINAHL (flipp* W2 class* OR invert* W2 classroom*) 19
AND nurs*

SC
NU
Embase (flipp* NEAR/2 class*) AND nurs* 16
MA
ERIC (flipp* W2 (class* OR course* OR instruction OR 0
teaching OR learning) OR invert* W2 class*) AND
nurs*
ED

Google Scholar allintitle: nurse OR nurses OR nursing "flipped 15

PT

classroom"
CE

PubMed ((flipp* AND (class* OR teaching[tiab])) OR 17

inverted classroom*) AND nurs*
AC

Scopus ((flipp* W/2 (class* OR learning)) OR “inverted 19

class*") AND nurs*

Web of Science (flipp* NEAR/2 (class* OR learning) OR “inverted 20

class*”) AND nurs*