Effects of a Flipped Classroom Combined with Problem-Based Learning on Nursing Students’ Nursing Process Learning Outcomes

Effects of a Flipped Classroom Combined with Problem-Based Learning on Nursing Students’ Nursing Process Learning Outcomes | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effects of a Flipped Classroom Combined with Problem-Based Learning on Nursing Students’ Nursing Process Learning Outcomes Chia-Chen Tseng This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8288603/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background The nursing process is a core competency in professional nursing practice. However, in both clinical and educational settings, nursing students often struggle with insufficient conceptual understanding, difficulties in writing nursing care plans, and limited ability to use the nursing process to support clinical reasoning. Aim: This study aimed to examine the effects of a flipped classroom combined with problem-based learning (PBL + FI) in a fundamental nursing course on nursing students’ learning outcomes regarding nursing process knowledge, competence in writing nursing care plans, and learning attitudes. Methods: An action research design was adopted. Participants were 54 second-year nursing students enrolled in a fundamental nursing course at a university of technology in Taiwan. Over one semester, four PBL + FI teaching units related to the nursing process were implemented. Quantitatively, a self-developed 17-item Nursing Process Learning Outcomes Scale with acceptable internal consistency was administered before and after the intervention, and paired-sample t-tests were used to analyze pre-post differences. Qualitatively, students’ reflective writings, course assignments, and semi-structured interviews were collected and analyzed using analytic induction and thematic analysis. Results: After the intervention, scores for overall nursing process learning outcomes and for the three subscales-nursing process cognition, competence in writing nursing care plans, and learning attitudes-increased significantly from approximately 3.11–3.24 at pretest to 4.35–4.39 at posttest on a 5-point scale (all p < 0.001). Qualitative findings indicated that students progressed from “not knowing where to start” to being able to apply the nursing process to think systematically in case scenarios. They demonstrated a clearer understanding of the functions and writing requirements of each column in the nursing care plan. Through peer discussions and teacher feedback, students also reported greater willingness to engage actively in learning and felt better prepared for future clinical practicums. Conclusions: Implementing a flipped classroom combined with problem-based learning in a fundamental nursing course can simultaneously improve nursing students’ cognition, skills, and learning attitudes related to the nursing process. This PBL + FI model appears to be a feasible and educationally valuable approach to strengthening nursing process teaching in basic nursing education. Future studies should replicate this model in different institutions and course contexts and examine its long-term effects on students’ performance in specialized nursing courses and clinical practice. Nursing Educational Philosophy and Theory nursing process flipped classroom problem-based learning nursing education Full Text Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8288603","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":555860533,"identity":"a74a46b8-d572-49f2-bf37-f32f17ff0af8","order_by":0,"name":"Chia-Chen 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However, in both clinical and educational settings, nursing students often struggle with insufficient conceptual understanding, difficulties in writing nursing care plans, and limited ability to use the nursing process to support clinical reasoning. Aim: This study aimed to examine the effects of a flipped classroom combined with problem-based learning (PBL + FI) in a fundamental nursing course on nursing students’ learning outcomes regarding nursing process knowledge, competence in writing nursing care plans, and learning attitudes.\u003c/p\u003e\n\u003cp\u003eMethods: An action research design was adopted. Participants were 54 second-year nursing students enrolled in a fundamental nursing course at a university of technology in Taiwan. Over one semester, four PBL + FI teaching units related to the nursing process were implemented. Quantitatively, a self-developed 17-item Nursing Process Learning Outcomes Scale with acceptable internal consistency was administered before and after the intervention, and paired-sample t-tests were used to analyze pre-post differences. Qualitatively, students’ reflective writings, course assignments, and semi-structured interviews were collected and analyzed using analytic induction and thematic analysis.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eResults: After the intervention, scores for overall nursing process learning outcomes and for the three subscales-nursing process cognition, competence in writing nursing care plans, and learning attitudes-increased significantly from approximately 3.11–3.24 at pretest to 4.35–4.39 at posttest on a 5-point scale (all p \u0026lt; 0.001). Qualitative findings indicated that students progressed from “not knowing where to start” to being able to apply the nursing process to think systematically in case scenarios. They demonstrated a clearer understanding of the functions and writing requirements of each column in the nursing care plan. Through peer discussions and teacher feedback, students also reported greater willingness to engage actively in learning and felt better prepared for future clinical practicums.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConclusions: Implementing a flipped classroom combined with problem-based learning in a fundamental nursing course can simultaneously improve nursing students’ cognition, skills, and learning attitudes related to the nursing process. This PBL + FI model appears to be a feasible and educationally valuable approach to strengthening nursing process teaching in basic nursing education. 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