Effectiveness of a high-fidelity simulation program based on flipped learning for nurses’ emergency management of seizures: a mixed-methods design

A seizure is a transient occurrence of signs and/or symptoms caused by abnormal excessive or synchronous neuronal activity in the brain. Nurses play a critical role in recognizing and managing seizures, which encompasses airway management, hemodynamic monitoring, and safe administration of antiepileptic medications. High-fidelity simulation (HFS) based on flipped learning integrates self-directed pre-learning with realistic clinical scenarios to enhance clinical performance, problem-solving abilities, and clinical reasoning. Clinical nurses have limited access to HFS based on flipped learning for seizure management despite its benefits. This study aimed to develop and evaluate the efficacy of a high-fidelity simulation program based on flipped learning for nurses’ emergency management of seizures (HFS-EMS). This study employed a mixed-methods design combining a one-group pretest-posttest quasi-experimental design and qualitative focus group interviews (FGIs). In the quantitative phase, a convenience sample of 29 clinical nurses was recruited from a tertiary hospital. Inclusion criteria included a minimum of six months of clinical experience and direct involvement in patient care. Changes in knowledge of seizure nursing, self-confidence in seizure nursing, clinical reasoning competence, and clinical performance ability in seizure nursing were assessed using validated instruments. Quantitative data were analyzed using paired t-tests or Wilcoxon signed-rank tests, depending on normality, with SPSS (version 26.0). In the qualitative phase, 10 participants were purposively selected to participate in FGIs exploring their experiences with the HFS-EMS. Qualitative data were analyzed using conventional content analysis, supported by NVivo software (version 12). After the intervention, significant improvements were observed in knowledge of seizure nursing (pre: 8.79 ± 1.76; post: 9.62 ± 1.27, p = 0.026), self-confidence in seizure nursing (pre: 29.21 ± 7.03; post: 42.21 ± 5.51, p < 0.001), and clinical reasoning competence (pre: 52.04 ± 8.21; post: 63.04 ± 8.23, p < 0.001). The participants exhibited minor improvements in their clinical performance ability in seizure nursing, though this improvement was statistically non-significant. Educational satisfaction (46.76 ± 3.93) and simulation effectiveness (53.62 ± 4.06) were significantly high. Qualitative analysis identified four key themes: (1) enhancement of clinical performance skills, (2) areas requiring improvement, (3) self-reflection, and (4) emergency response competence. The HFS-EMS effectively improved the knowledge, self-confidence, and clinical reasoning competence of clinical nurses in managing patients with seizures. The program offered a realistic, reflective, and organized setting for nurses to develop essential clinical skills. Future studies should investigate long-term impacts and extend the program to diverse clinical settings.