The Impact of Flipped Classroom Approach on Nursing Education in Iran: A Systematic Review

Background: Instructional approaches such as the flipped classroom have been shown to improve nursing education by promoting student engagement and learning outcomes. This review aimed to examine the flipped classroom application in Iranian nursing programs, focusing on strategies, outcomes (such as knowledge acquisition, critical thinking skills, self-directed learning, satisfaction levels, motivation, and academic performance), challenges, facilitators, and virtual adaptations during COVID-19.Methods: Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, a systematic review assessed the flipped classroom's impact on Iranian nursing education. Databases searched included PubMed, Scopus, SID, Magiran, MEDLINE, and Google Scholar for studies from 2012 to 2022. Studies were included if they involved Iranian undergraduate or postgraduate nursing students, utilized the flipped classroom as the primary intervention or exposure, reported quantifiable outcomes, and were published in English or Persian. Exclusions encompassed research from non-nursing fields, studies without a flipped classroom component, systematic reviews, meta-analyses, letters to the editor, editorials, case reports, pilot studies, preliminary reports, or short communications. Two independent reviewers screened titles and abstracts, followed by full-text assessments; they then extracted data on study design, participant characteristics, intervention details, and results. Study quality was assessed using Kmet criteria, with scores ≥0.55 for inclusion.Results: The systematic search identified 845 articles, of which 12 met the inclusion criteria for analysis. The included studies comprised 588 undergraduate nursing students, with sample sizes ranging from 34 to 102. Ten studies were quasi-experimental, one was descriptive, and one was qualitative. Flipped classroom sessions lasted 45–120 minutes and were sometimes adapted to participants’ preferences. The studies reported diverse outcomes, including improvements in self-directed learning readiness, satisfaction, motivation, knowledge, critical thinking, learning approaches, and average course scores. Only two studies examined virtual flipped classrooms during the COVID-19 pandemic. Quality assessment indicated that all included studies met acceptable methodological standards.Conclusion: Flipped classrooms boost nursing education aspects like self-directed learning and critical thinking, though inconsistencies and limited postgraduate research exist. Broader implementation could improve student preparation and patient care.