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

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.