Available online 22 May 2023

The flipped classroom pedagogy transforms teaching methods into student-centered learning that enhances higher-order thinking, communication, and decision-making skills. There is a gap in nursing student and higher education research using robust study methodology to demonstrate effective learning outcomes from flipped classrooms. This quality improvement (QI) project aims to identify factors associated with student success utilizing a flipped classroom approach. Participants were a convenience sample of 107 first semester prelicensure nursing students enrolled in a physical assessment course. Students completed practice questions, viewed a PowerPoint lecture with voice-over, read the assigned material, and attended a 2-and-a half-hour flipped classroom didactic session once per week. Student learning was measured by three unit exams and a standardized final exam. Results indicate that students who attended class in person had higher course grades than students who attended virtually.

FC is a pedagogical approach that exchanges previous class content and assigned homework activities. In so doing, learning becomes student-centered and supportive of higher-order thinking (O'Flaherty & Phillips, 2015). FC is used to increase student engagement, metacognition, understanding, and achievement (Al-Samarraie et al., 2020). FC is a teaching and learning strategy that has been successfully employed in various disciplines for many years but has recently found its place in nursing

Participants included first-semester baccalaureate nursing students attending a physical assessment course at a public university in southeast Texas. Students completed practice questions, viewed a PowerPoint lecture with voice-over, and read the assigned material prior to attending a FC didactic session. Student learning was measured by three unit exams and a standardized final exam. Data were collected at the end of the semester on multiple variables including attendance, the total number of

The data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 28.0. The unit of analysis was at the individual level. The exploratory data analysis was conducted to examine the central tendency of the data and detect outliers. A total of 111 students completed all the assigned course activities. Out of these, four students were outliers as the range of practice questions they completed was extremely low (0-169). After excluding these four students, 107 students'

Out of 107 students, 78 (72.9%) students fully attended eight didactic sessions; 29 (17.8%) attended seven didactic sessions; eight (7.5%) students attended six sessions; and two students (1.9%) attended five sessions. Students completed practice questions before each exam throughout the semester; students completed, on average, 649.80 practice questions before Exam 1; 522.13 before Exam 2; and 627.08 before Exam 3 (see Table 1). On average, the total number of practice questions completed by

Commonly, completing practice questions designed to mimic exams leads to better exam scores (Roche et al., 2017). The more practice questions a student completes, the more likely they will do well on associated exams (Roche et al., 2017). As part of the course assignments, students were expected to complete hundreds of practice questions using the e-resources provided by the publisher. We expected that the greater number of practice questions completed would coincide with higher exam scores.

The physical and emotional toll from Coronavirus disease 2019 (COVID-19) may have limited student achievement and class attendance. Many students and their family members contracted COVID-19, resulting in long recovery periods. Self-documenting attendance at the start of class may have been incomplete, and students may have signed in for each other even though they were reminded to sign in only for themselves. An FC model is not appreciated by all students, and some may achieve higher scores in

An FC is a space for increased critical thinking and creative problem-solving. Of all the variables in this study, attending a FC resulted in higher exam scores and a higher final course grade for first-semester nursing students. As indicated by previous researchers, nursing curricula that support critical thinking and clinical reasoning in the classroom, as is found in a FC, are more likely to develop safe and competent nurses (Al-Samarraie et al., 2020; Dehghanzadeh & Jafaraghaee, 2018; Ozbay

The authors declare that they have no conflict of interest to disclose.

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