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Effect of flipped classroom and screen-based simulation on nursing students' clinical judgment: A quasi-experimental
Rachid Gouifrane1, Halima Lajane1, Mounir Arai2
1Laboratory of Care, Health and Sustainable Development, Higher Institute of Nursing Professions and Health Techniques of Casablanca, Morocco; Laboratory of Mathematics, Artificial Intelligence, and Digital Learning, Hassan II University of Casablanca, Morocco.
Background:
Clinical judgment is essential in nursing education, especially in emergency care. However, several studies report that nursing students face persistent challenges in developing this competency. Traditional teaching methods and limited instructional time in nursing curricula often fail to provide the necessary conditions for fostering these skills. This quasi-experimental study investigated the effect of a flipped classroom combined with screen-based simulation on clinical judgment development.
Method:
Seventy-nine second-year nursing students enrolled in an emergency care course were stratified by gender, academic performance, and baseline knowledge, then randomly assigned to one of three groups: (1) traditional lecture (control), (2) flipped classroom, or (3) flipped classroom combined with screen-based simulation (FC + SBS). Clinical judgment was assessed using a Key Features exam (five scenarios, 30 items), developed in accordance with the NCSBN Clinical Judgment Measurement Model and the Lasater Clinical Judgment Rubric, and administered at both immediate and six-week delayed post-tests.
Results:
Experimental groups demonstrated significantly higher clinical judgment scores than the control group (p < .001). At six weeks, the FC + SBS group showed the highest retention (M = 75.2%, SD = 5.7) compared to the flipped classroom group (M = 69.1%, SD = 6.5) and the control group (M = 61.4%, SD = 8.2; p < .001). While the trend favored the FC + SBS group over the flipped classroom group, post-hoc analysis did not reach statistical significance (p = .08). More students in the experimental groups reached the "Accomplished" level on the Lasater Clinical Judgment Rubric, consistent with the quantitative findings.
Conclusion:
Integrating screen-based simulation into flipped classrooms appears to be effective in supporting clinical judgment development and promoting retention of decision-making skills in nursing education. Further studies are needed to confirm long-term effects and clarify the impact of flipped classroom and screen-based simulation in real patient care settings.
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