Effectiveness of flipped classroom in nursing education: A systematic review of systematic and integrative reviews

The flipped classroom is an active methodology that has been implemented for many years in the training of nursing students with multiple studies published on this subject to date. This study sought to answer the question: is flipped classroom effective for improving nursing education? A systematic review of systematic and integrative reviews focused on studies that applied flipped classroom in the teaching of nursing students. Exhaustive literature searches were performed using five electronic databases: Medline, Cochrane, CINAHL Plus, Scopus and Web of Science. Review methods: In total, 670 studies were identified, published from 2010 until 2020. Data were collected by two reviewers following the predesigned extraction form. Quality was assessed with the modified AMSTAR scale. A narrative synthesis of the findings has been used to present the results. 15 reviews (9 integrative reviews and 6 systematic reviews) were selected, comprising 274 studies, and providing a sample of 34,608 students. Most of the studies were conducted in China and the United States. A great heterogeneity and a medium-low methodological quality were detected. In the pre-class stage, individual instruction of students through reviews of articles and textbooks or electronic books is highlighted. In class, group activities were most frequently used, including assignments, presentations, projects, or discussion of topics, and in the post-class stage, course evaluation and self-study. The post-class stage was only recorded in two of the systematic reviews selected. When comparing the flipped classroom with the traditional methodology, better results were obtained in performance (k = 122), competencies (k = 92) and satisfaction (k = 10). The results suggest that the use of the flipped classroom in nursing education increases performance and is satisfactorily evaluated by both students and faculty. However, more studies are needed that meet methodological quality standards to consolidate the evidence.