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

Background and Aims: 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. Methods: 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. Results: 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). Conclusion: 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.