Journal of Nursing Education

Research Briefs 

Flipped Classroom: Do Students Perceive Readiness for Advanced Discussion?

Carrie Ann Hoover, PhD, RN; Georgia Ann Dinndorf-Hogenson, PhD, RN, CNOR; Jennifer Lee Peterson, DNP, FNP-C, CNOR; Bethany Renae Tollefson, DNP, RN; Jodi Lisbeth Berndt, PhD, RN, CCRN, PCCN, CNE, CHSE; Nikki Laudenbach, MSN, RN

Abstract

Background:

Use of the flipped classroom model is recognized as a popular method of instruction. Effective preclass preparation methods can create more time for instructors to reinforce application, evaluation, and analysis of information using active learning strategies.

Method:

This quasi-experimental study used a convenience sample of 42 third-year baccalaureate nursing students. Students were randomized into two groups and received either a narrated video (vodcast) or guided readings for the preclass preparation. A quiz was administered to assess preparation prior to class, and students completed a survey following the classroom activities.

Results:

Students preferred media preparation to guided readings. This preference translated to higher quiz scores. Positive correlations were noted between quiz scores and students' understanding and increased confidence.

Conclusion:

Students' preference for the vodcast translated to the perception of an increase in confidence and understanding of the material. [J Nurs Educ. 2018;57(3):163–165.]

Abstract

Background:

Use of the flipped classroom model is recognized as a popular method of instruction. Effective preclass preparation methods can create more time for instructors to reinforce application, evaluation, and analysis of information using active learning strategies.

Method:

This quasi-experimental study used a convenience sample of 42 third-year baccalaureate nursing students. Students were randomized into two groups and received either a narrated video (vodcast) or guided readings for the preclass preparation. A quiz was administered to assess preparation prior to class, and students completed a survey following the classroom activities.

Results:

Students preferred media preparation to guided readings. This preference translated to higher quiz scores. Positive correlations were noted between quiz scores and students' understanding and increased confidence.

Conclusion:

Students' preference for the vodcast translated to the perception of an increase in confidence and understanding of the material. [J Nurs Educ. 2018;57(3):163–165.]

The flipped classroom method has become a widely popular teaching pedagogy in higher education to promote student engagement (Gilboy, Heinerichs, & Pazzaglia, 2015). Students exposed to a flipped classroom method are expected to learn content independently prior to attending the class, thus allowing for an enriched discussion on the topic (Geist, Larimore, Rawiszer, & Al Sager, 2015). Previous research indicates that the use of the flipped classroom method demonstrates a higher student perception of preparedness for student-centered classroom activities (Della Ratta, 2015; Dickerson, Lubejko, McGowan, Balmer, & Chappell, 2014; Sinouvassane & Nalini, 2016).

Varieties of preparation materials are assigned when using the flipped classroom method, including digital lectures, videos, and reading materials. Research indicates these preparation materials can lead to a variety of outcomes, including empowerment, improved learning, or frustration (McLaughlin et al., 2014; Phillips & Trainor, 2014; Post, Deal, & Hermanns, 2015). Mikkelsen (2015) found that students (n = 34) showed a preference (85%) for videos for preclass preparation. However, this research did not conclude whether this preference translated to improved student outcomes. Recommendations include limiting the preclass preparation materials to one or two different methods to promote preparedness and limit frustration. Geist et al. (2015) reported on 40 nursing students in a pharmacology course and found improved performance on three of the four examinations taken in the course. Geist also suggested flipped classroom success depends on the completion and understanding of preclassroom preparation materials. The preclass preparation materials were not described.

The purpose of this research study was to examine the readiness for active learning and perceived level of student confidence and preparedness with the flipped classroom method using two different types of preclass preparation materials.

Method

A quasi-experimental design with a convenience sample was used within a 3-year baccalaureate tertiary health–nursing course at a private liberal arts university in the Midwest. The institutional review board of the university approved the study. Faculty developed a Camtasia Studio® (vodcast) presentation for the media group and guided readings for the reading group. Camtasia Studio is a screen-capture software program with video-editing capabilities and voice recording. Consent was obtained from 42 students of the 51 student cohort. Students were randomized into either the media materials group or guided readings group for preclassroom preparation. To measure student knowledge following preclassroom preparation, faculty created a 20-point quiz on the assigned preclassroom preparation content. Students completed the quiz at the beginning of class and were aware their performance on the quiz would not impact their course grade.

The quiz was followed by classroom activities that included case studies, small-group discussion, and micro lecture. The micro lecture was a 5- to 10-minute presentation on a specific complex content area. Students completed a survey following the quiz and classroom activities. The survey included the following demographic information: gender, age, familiarity with the flipped classroom approach, and seven questions to address level of preparation, confidence, perception of understanding, and satisfaction. A 5-point Likert-type scale quantified five of the seven questions and included (a) I feel the preclassroom assignments prepared me for the classroom quiz, (b) I feel the preclassroom assignments gave me confidence to contribute to the classroom discussion and activities, (c) I feel the preclass assignments contributed to my understanding of the classroom content, (d) In addition to the preclassroom assignments, I used additional resources to help me understand the content, and (e) I would recommend this type of preclassroom preparation as a good way to prepare for a nursing class. The final two questions asked the students to provide a range of minutes spent on preclass preparation and the percentage of preclass quiz material assignments completed.

Data were coded and entered into SPSS® software version 24. Analysis of the variables included descriptive statistics, independent sample t tests, chi-square, and bivariate correlations.

Results

Forty-two students consented to participate in this study. The sample was White, 86% female, and between the ages of 21 to 23 years. There were no significant differences between the two groups in demographic variables of age, gender, admission ACT, current grade point average, class standing, or experience with flipped classroom pedagogy.

The preclassroom preparation survey results revealed students who received the media preparation for class rated multiple criteria higher than the guided readings group (Table) and they scored significantly higher in the classroom quiz. However, neither group performed well on the 20-point quiz (66% versus 56%). Students in the media group were more likely to complete the assignment (100% versus 81%), and spent less time in preparation. In the media group, the majority of the students (52%) spent 21 to 60 minutes preparing for class, whereas the reading group (67%) spent 41 to 90 minutes on preclassroom preparation. Although not statistically significant, the reading group was also more likely to seek additional resources when preparing for class. Relational variables to the higher quiz scores included increased confidence in class (r [42] = .31, p = .049), contributed to my understanding (r [42] = .39, p = .012), and would recommend (r [42] = .50, p = .001).

Perceptions of Preclassroom Preparation Survey

Table:

Perceptions of Preclassroom Preparation Survey

Discussion

Students preferred media preparation to guided readings. The students assigned to the media group were less likely to consult additional resources, spent less time in preparation, and were more likely to complete the preclassroom assignment. Previous research indicated that students report decreased satisfaction with the flipped classroom approach when they perceive out-of-class preparation time to be greater than expected (Simpson & Richards, 2015). This study reported less time spent with classroom preparation for the students assigned to the media presentation, which is likely to have contributed to their preference for this type of preparation.

The students in the media group reported more confidence and better understanding of the content, which translated to a higher performance on the classroom quiz. Students' perception of confidence in class could be interpreted as feeling prepared and ready for the discussion and is consistent with previous literature indicating the flipped classroom method is associated with student perceptions of preparedness for classroom activities (Della Ratta, 2015; Dickerson et al., 2014; Sinouvassane & Nalini, 2016). In this study, neither group performed well on the quiz, indicating some students have gaps in knowledge that may require faculty attention prior to implementing higher learning activities in the classroom.

Limitations

Limitations of this study were related to sample size and lack of diversity in the demographic pool. All the participants were White and between 20 to 23 years old, which may limit the generalizability of the findings. Students had varied levels of experience with the flipped classroom model from previous nursing courses and this may have affected how they performed in the study and how they used the preclass preparation methods. Individual learning preferences were not considered during the randomization of the assigned preclass preparation method. This may have influenced their individual performance on the assessment.

Students were also aware that their quiz performance would not affect their course grade, and this may have influenced their motivation to engage in the preclassroom learning.

Implications

This study adds to the literature on the effectiveness of preclass preparation methods that are used with a flipped classroom model. Further research is needed with more participants and more diversity within the sample to determine which types of preclass preparation methods are most effective. Educators who implement the flipped classroom model rely on students completing the preclassroom learning independently and applying the knowledge gained in an advanced level of discussion through active learning strategies in classroom (Geist et al., 2015). Additional research could provide insight into the alignment of preclass preparation methods to the variety of learning styles in a nursing cohort, which could translate to improved understanding of the content prior to the classroom activities. Future research should examine students' understanding of the preclass content, using different approaches such as targeted classroom exercises and guided discussion and postclassroom student understanding of the material through additional quizzes or unit examinations.

In this study, students preferred the media preclass preparation and reported less out-of-class time spent reviewing the vodcast. Vodcasting is designed to increase retention of knowledge and may improve readiness for integration and application of knowledge in the classroom. Educators may find it worth their time to produce voice-narrated content using video recording software for preclass preparation for the flipped classroom as this method is likely to engage more students in the preclass preparation and result in improved readiness. Further research is needed to quantify the level of readiness for advanced discussion in the classroom. The perception of preparedness and readiness for engaging in the classroom activities may not necessarily translate to comprehension of content gained from preclass assignments.

References

  • Della Ratta, C.B.D. (2015). Flipping the classroom with team-based learning in undergraduate nursing education. Nurse Educator, 40, 71–74. doi:10.1097/NNE.0000000000000112 [CrossRef]
  • Dickerson, P.S., Lubejko, B.G., McGowan, B.S., Balmer, J.T. & Chappell, K. (2014). Flipping the classroom: A data-driven model for nursing education. The Journal of Continuing Education in Nursing, 45, 477–478. doi:10.3928/00220124-20141027-11 [CrossRef]
  • 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 Education Perspectives, 36, 114–115. doi:10.5480/13-1292 [CrossRef]
  • Gilboy, M., Heinerichs, S. & Pazzaglia, G. (2015). Enhancing student engagement using the flipped classroom. Nutritional Education Behavior, 47, 109–114. http://dx.doi.org/10.1016/j.jneb.2014.08.008 doi:10.1016/j.jneb.2014.08.008 [CrossRef]
  • Ginsberg, S.M. (2010) “Mind the gap” in the classroom. The Journal of Effective Teaching, 10, 74–80. http://www.uncw.edu/jet/articles/Vol10_2/Ginsberg.pdf
  • McLaughlin, J., Roth, M., Glatt, D., Gharkholonarehe, N., Davidson, C., Griffin, L. & Mumper, R. (2014). The flipped classroom: A course redesign to foster learning and engagement in a health professions school. Academic Medicine, 89, 236–243. doi:10.1097/ACM.0000000000000086 [CrossRef]
  • Mikkelsen, T. (2015). Nursing students' experiences, perceptions and behavior in a flipped-classroom anatomy and physiology course. Journal of Nursing Education and Practice, 10, 28–35. https://doi.org/10.5430/jnep.v5n10p28
  • Phillips, C. & Trainor, J. (2014). Millennial students and the flipped classroom. Journal of Business and Educational Leadership, 5, 102–113.
  • Post, J., Deal, B. & Hermanns, M. (2015). Implementation of a flipped classroom: Nursing students' perspectives. Journal of Nursing Education and Practice, 5, 25–32. http://dx.doi.org/10.5430/jnep.v5n6p25 doi:10.5430/jnep.v5n6p25 [CrossRef]
  • Simpson, V. & Richards, E. (2015). Flipping the classroom to teach population health: Increasing the relevance. Nursing Education in Practice, 15, 162–167. http://dx.doi.org/10.1016/j.nepr.2014.12.001 doi:10.1016/j.nepr.2014.12.001 [CrossRef]
  • Sinouvassane, D. & Nalini, A. (2016). Perception of flipped classroom model among year one and year three health science students. International Journal of Information and Education Technology, 6, 215–220. doi:10.7763/IJIET.2016.V6.687 [CrossRef]

Perceptions of Preclassroom Preparation Survey

VariablenMSDtp
Prepared me for the classroom quiz2.04⩽ .05
  Media213.710.56
  Reading213.290.78
Gave me confidence to contribute to classroom discussion4.13⩽ .001
  Media214.380.74
  Reading213.570.51
I used additional resources− .653⩾ .05
  Media212.761.04
  Reading213.001.30
Contributed to my understanding of the content4.05⩽ .001
  Media214.480.51
  Reading213.860.48
I would recommend8.92⩽ .001
  Media214.810.40
  Reading213.240.70
Quiz test scores4.76⩽ .001
  Media2113.191.25
  Reading2111.141.53
Authors

Dr. Hoover is Associate Professor, Dr. Dinndorf-Hogenson is Assistant Professor, Dr. Peterson is Visiting Assistant Professor, Dr. Berndt is Assistant Professor, and Ms. Laudenbach is Clinical Instructor, College of Saint Benedict and Saint John's University, St. Joseph, Dr. Tollefson is Assistant Professor, College of Saint Scholastica, St. Cloud, Minnesota.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Carrie Ann Hoover, PhD, RN, Associate Professor, College of Saint Benedict and Saint John's University, 29633 Kraemer Lake Road, St. Joseph, MN 56374; e-mail: choover@csbsju.edu.

Received: May 25, 2017
Accepted: November 13, 2017

10.3928/01484834-20180221-07

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