title: The evidence for 'flipping out': A systematic review of the flipped classroom in nursing education.
abstract: BACKGROUND
  The flipped classroom has generated interest in higher education providing a student-centred approach to learning. This has the potential to engage nursing students in ways that address the needs of today's students and the complexity of contemporary healthcare. Calls for educational reform, particularly in healthcare programs such as nursing, highlight the need for students to problem-solve, reason and apply theory into practice. The drivers towards student-based learning have manifested in team, problem and case-based learning models. Though there has been a shift towards the flipped classroom, comparatively little is known about how it is used in nursing curricula.
  
  
  OBJECTIVE
  The aims of this systematic review were to examine how the flipped classroom has been applied in nursing education and outcomes associated with this style of teaching.
  
  
  METHODS
  Five databases were searched and resulted in the retrieval of 21 papers: PubMed, CINAHL, EMBASE, Scopus and ERIC.
  
  
  METHODS
  After screening for inclusion/exclusion criteria, each paper was evaluated using a critical appraisal tool. Data extraction and analysis were completed on all included studies.
  
  
  RESULTS
  This systematic review screened 21 titles and abstracts resulting in nine included studies. All authors critically appraised the quality of the included studies. Five studies were identified and themes identified were: academic performance outcomes, and student satisfaction implementing the flipped classroom.
  
  
  CONCLUSIONS
  Use of the flipped classroom in higher education nursing programmes yielded neutral or positive academic outcomes and mixed results for satisfaction. Engagement of students in the flipped classroom model was achieved when academics informed and rationalised the purpose of the flipped classroom model to students. However, no studies in this review identified the evaluation of the process of implementing the flipped classroom. Studies examining the process and ongoing evaluation and refinement of the flipped classroom in higher education nursing programmes are warranted.
authors.affiliation: University of Sydney, Sydney Nursing School, Level A4. Room 7, 88 Mallett St M02, NSW 2006, Australia. Electronic address: vasiliki.betihavas@sydney.edu.au.
authors.forename: Vasiliki
authors.initials: V
authors.lastname: Betihavas
authors.affiliation: University of Tasmania, Faculty of Health, Centre for Rural Health, Locked Bag, 1322, Newnham Drive, Launceston, Tasmania 7250, Australia. Electronic address: Heather.Bridgman@utas.edu.au.
authors.forename: Heather
authors.initials: H
authors.lastname: Bridgman
authors.affiliation: University of Tasmania, Faculty of Health, School of Health Sciences, Corner of Church and Glover Street, Lilyfield, Locked Bag, 5052, Alexandria, NSW, Australia. Electronic address: Rachel.kornhaber@utas.edu.au.
authors.forename: Rachel
authors.initials: R
authors.lastname: Kornhaber
authors.affiliation: University of Tasmania, Faculty of Health, Centre for Rural Health, Locked Bag, 1322, Newnham Drive, Launceston, Tasmania 7250, Australia. Electronic address: Merylin.Cross@utas.edu.au.
authors.forename: Merylin
authors.initials: M
authors.lastname: Cross
mesh_terms: D003479:Curriculum; D004508:Education, Nursing, Baccalaureate / Q000379:methods*; D006801:Humans; D018794:Problem-Based Learning / Q000379:methods*; D013338:Students, Nursing; D013663:Teaching
keywords: Education research; Flipped classroom; Higher education; Nursing; Problem-based learning