# The Impact of Flipped Classroom Approach on Critical Thinking, Self‐Esteem, and Learning Retention of Nursing Undergraduate Students: A Cluster Randomized Study

## TL;DR

This study shows that flipped classroom teaching improves critical thinking, self-esteem, and learning retention in nursing students compared to traditional methods.

## Contribution

The study provides empirical evidence of flipped classroom effectiveness in nursing education using cluster randomization.

## Key findings

- Flipped classroom significantly improved critical thinking (p < 0.001) in nursing students.
- Self-esteem and learning retention were also significantly higher in the intervention group.
- Results suggest flipped learning is effective for competency-based nursing training.

## Abstract

The flipped classroom model has emerged as a potentially transformative approach in nursing education, reversing conventional learning activities to prioritize active, student‐centered engagement. This study aimed to determine the impact of flipped classroom on critical thinking, self‐esteem, and learning retention of nursing undergraduate students.

This experimental study used a cluster randomization approach, in which nursing students were assigned to either the intervention or control group based on their semester of enrollment. All sixth‐semester nursing students (42 students in the first semester and 45 students in the second semester) were included. The duration of the study was 1 year, with students entering the study in two semesters. Data were collected using the California Critical Thinking Skills Test B, Coopersmith Self‐Esteem Inventory, and two exam scores (final and 1‐month delayed retest). In the intervention group, students were taught using the flipped learning strategies for practical learning. Data were analyzed using SPSS v21.

Before the intervention, no significant difference was found between the groups with regard to critical thinking, self‐esteem, and learning retention. However, after the intervention, a significant difference was found between the groups in critical thinking (p < 0.001, d = 1.8), self‐esteem (p < 0.001, d = 1.2), and retention (p < 0.001, d = 0.9) compared to the control group (p > 0.05).

The findings suggest that the flipped classroom approach positively influences critical thinking skills, self‐esteem, and learning final exam score among nursing undergraduate students. Instructors should prioritize the use of the flipped classroom method in competency‐based training courses (such as crisis management), and this approach should be reinforced by training faculty in digital technologies. Future research should also examine the long‐term effects of this method and its feasibility in different clinical settings.