Designing a Flipped Classroom Model for Clinical Nursing Education
Transforming clinical nursing education through pre-, during-, and post-clinical learning strategies to enhance clinical reasoning and student preparedness.
The Imperative for Active Learning in Clinical Nursing Education
Introduction
Contemporary nursing practice demands clinical judgment, prioritization, collaboration, and adaptability (Benner et al., 2008). Yet traditional instructional models in clinical education often emphasize task completion and observational learning rather than structured reasoning development (Zhang et al., 2021). Limited clinical hours further constrain opportunities for guided analysis and feedback (Zhang et al., 2021).
The flipped classroom model offers a practical solution. By relocating foundational knowledge acquisition to the pre-clinical phase, clinical time can be dedicated to application, coaching, and deliberate practice. This shift enables faculty to focus on developing clinical reasoning rather than re-teaching didactic content (Arca-Contreras, 2021, pp. 1–7).
Theoretical Foundations
Adult Learning Theory
Adult learners are self-directed, bring prior experience to new learning, and are motivated by relevance and immediate applicability (Knowles et al., 2015). Flipped learning supports these principles by allowing students to review foundational material independently and engage in applied learning during faculty-supervised clinical experiences.
For example, consider a student nurse performing medication reconciliation. Having reviewed the necessary pharmacological information beforehand, the student uses clinical time to apply this knowledge directly, engaging in discussion with faculty to address patient-specific considerations and refine understanding. This practical application reinforces learning and demonstrates adult learning principles in real-world clinical settings.
Similarly, envision a student conducting a patient discharge planning session. After studying discharge protocols and follow-up care procedures in advance, the learner can focus on tailoring the discharge plan to the patient’s specific needs during the clinical encounter. Collaborating with mentors ensures the plan meets safety and continuity-of-care standards. These examples illustrate how flipped learning can be integrated effectively into diverse clinical practice areas.
Constructivist Learning Theory
Constructivist theory emphasizes that knowledge is constructed through experience and social interaction (Vygotsky, 1978). Clinical learning inherently aligns with constructivist principles; however, without structured facilitation, experiential learning may not translate into deeper understanding (Fowler, 2008, pp. 427–433).
The flipped model strengthens constructivist learning by embedding guided questioning, case analysis, and structured reflection into clinical encounters (Zhang et al., 2021).
A Framework for Flipped Clinical Education
Pre-Clinical Preparation: Establishing Readiness
Pre-clinical learning should focus on foundational concepts required for safe patient care.
Strategies may include:
- Brief recorded lectures (10–15 minutes)
- Focused readings or guideline reviews
- Medication and pathophysiology refreshers
- Low-stakes readiness quizzes
- Pre-clinical case previews
These activities foster accountability and ensure students enter clinical settings prepared to apply knowledge, minimizing the need for remedial instruction (Shatto et al., 2017, pp. 206–208).
During Clinical: Facilitating Clinical Reasoning
The greatest value of the flipped model lies in faculty-guided development of reasoning (Fan et al., 2020).
Clinical instruction should emphasize:
- Higher-order questioning (e.g., “What is your priority and why?”)
- Real-time prioritization exercises
- Bedside concept mapping
- Micro-debriefs following patient interactions
- Structured simulation when direct exposure is limited
Rather than focusing exclusively on psychomotor task performance, faculty intentionally coach students in assessment synthesis, pattern recognition, and anticipatory thinking. This approach redefines the educator’s role as a facilitator of clinical reasoning (The Flipped Classroom in Nursing: The Nurse Educators’ Experience, 2020, pp. 168–174).
Post-Clinical Reinforcement: Reflection and Integration
Structured reflection consolidates learning and strengthens metacognitive awareness.
Post-clinical strategies may include:
- Guided reflective journaling focused on decision-making
- Short written or video-based clinical reasoning analyses
- Discussion board examinations of complex cases
- Identification of evidence-based interventions for follow-up study
- Faculty-led debrief sessions
Students should be encouraged to connect reflective insights to patient outcomes or simulation performance to deepen learning impact. Reflection promotes integration of theory and practice and supports ongoing development of clinical judgment (Condren, 2025, pp. 290–292). Linking reflection to measurable outcomes enhances students’ ability to assess growth and identify areas for improvement.
Faculty Workload and Sustainability Considerations
Although flipped learning requires initial planning, it is sustainable with strategic implementation (Zhang et al., 2021, p. 104922).
Faculty may begin with a pilot program using a single clinical module. Initial steps include:
- Selecting a module covering essential skills
- Developing concise recorded lectures on foundational topics
- Creating a short pre-clinical quiz to assess understanding
Student feedback gathered during the pilot phase should inform refinement. Shatto, L’Ecuyer, and Quinn (2017) note that the flipped approach can reduce time spent on repetitive content delivery, allowing educators to prioritize higher-level learning activities. Students who arrive prepared require less foundational review, enabling faculty to focus on advanced reasoning and individualized coaching (pp. 206–208).
Addressing Barriers
Common barriers include faculty resistance, perceived increases in workload, and student discomfort with increased accountability (Zhang et al., 2021). Clear communication of expectations and rationale is essential. Faculty development initiatives and peer collaboration further support adoption (Sullivan, 2022, pp. 40–44).
Complex technology is not required. Simple recorded lectures, structured questioning guides, and reflective prompts are sufficient to begin implementation (Wilson & Hobbs, 2023, pp. 144–147). The primary focus should remain on pedagogical objectives rather than technological sophistication.
Implications for Nurse Educators and Faculty Leaders
The flipped classroom model aligns with competency-based nursing education and the growing emphasis on measurable clinical outcomes (Chang & Hsu, 2024, pp. 265–272). By reallocating instructional time toward application and feedback, educators can enhance students’ preparedness for independent practice (Using a Flipped Teaching Strategy in Undergraduate Nursing Education, 2023).
For faculty leaders, sustainability depends on:
- Institutional support for instructional redesign aligned with national accreditation standards (e.g., AACN and QSEN competencies)
- Faculty mentorship and learning communities
- Alignment with program outcomes and accreditation requirements (Mueller-Burke et al., 2024, pp. 62–69)
- Ongoing evaluation of student performance metrics in relation to established competencies (QSEN Learning Modules, n.d.)
Evaluation tools may include:
- Clinical performance rubrics
- Objective Structured Clinical Examinations (OSCEs)
- Reflective journals assessing critical thinking and decision-making
When implemented strategically, flipped clinical education transforms clinical hours from primarily observational experiences into structured environments for developing clinical reasoning (Post et al., 2015, pp. 25–30).
Conclusion
Flipped learning provides a theory-informed and practical framework for enhancing clinical nursing education (Elzeky et al., 2022). Shifting foundational learning outside scheduled clinical time enables faculty to prioritize clinical reasoning, formative feedback, and reflective practice (Hughes et al., 2022).
This model fosters learner accountability, increases engagement, and prepares novice nurses for safe, competent practice in complex healthcare environments. Thoughtful planning, incremental implementation, and ongoing evaluation are essential to ensure sustainability and effectiveness (Özbay & Çınar, 2021). As nursing education evolves, flipped clinical instruction represents a viable strategy for advancing educational quality and patient safety (Hassler et al., 2021, pp. 534–537).
