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After participating in the flipped classroom activity, the student will be able to:
1. demonstrate 8-10 components of the head to toe physical assessment at the bedside

2. identify one abnormal sound during auscultation of each body system

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Huber, B., & Epp, S. (2021). Teaching & learning focused physical assessments: An innovative clinical support tool. Nurse Education in Practice.
https://doi.org/10.1016/j.nepr.2021.103131

This article describes tools for usefully performing head-to-toe physical assessment and specifically more specifically focused system assessment. Often, students struggle with attempting the full head to toe assessment and also remain unclear when to perform a focused system assessment. Self-assessment and appraisal through video taping of the student performing assessment techniques is highly recommended and has improved student learning.

Moffett, J., (2015). Twelve tips for “flipping” the classroom". Medical Teacher, 37(4), 331–336. https://doi.org/10.3109/0142159X.2014.943710

Twelve tips for "flipping the classroom" article describes the  pedagogical model in which standard lecture and homework elements of a course are reversed. The article describes ways to maximize the learning experience utilizing the flipped classroom approach with the instructor facilitating education that is driven by the student. These strategies facilitate the interaction between the instructor and student while enriching the learning experience.

Nouri, J. (2016). The flipped classroom: for active, effective and increased learning – especially for low achievers. International Journal of Educational Technology in Higher Education, 13(1), 1–10. https://doi.org/10.1186/s41239-016-0032-z

This article reviews a research study performed utilizing qualitative analysis with closed questionnaire to evaluate the use of a flipped classroom with specific regard to three particular aspects of the student’s general experiences and attitudes of learning through flipped classroom, the student’s experiences of using video lectures as a medium for learning, and the student’s experiences of using a Learning Management System in conjunction with the flipped classroom model. This study also considered differences in experiences and attitudes of low and high achieving students.

Oermann, M., De Gagne, J., & Phillips, B. (2018). Teaching in nursing and role of the educator: The Complete Guide to best practice in teaching, evaluation, and Curriculum Development. Springer Publishing Company.

This text is dedicated to novice nurse educators to provide information on teaching, evaluation, and curriculum development. Learning how to appeal to a diverse group of learners and understanding the varied attributes of students and how learning can be affected is addressed in this text. Flipping the classroom is described in chapter five which supports the integration of technology in nursing education.

Schlairet, M., Green, R., Benton, M. (2014). The Flipped Classroom: Strategies for an Undergraduate Nursing Course. Nurse Educator, 39, 321-325.
https://doi.org/10.1097/NNE.000000000000009

This article describes ways to incorporate the flipped classroom into undergraduate nursing curriculum by shifting the ownership of learning to students versus faculty. Flipping the classroom requires curriculum updates and changes, strategies to promote a change to the expected culture of learning, and improving the faculty skillset necessary to perform the necessary changes to the learning environment.

The nursing process. ANA. (n.d.). Retrieved November 21, 2021, from https://www.nursingworld.org/practice-policy/workforce/what-is-nursing/the-nursing-process/.

The ANA supports the nurses ability to autonomously perform physical assessment and is a vital component which is utilized as part of the nursing process. Assessment, diagnosis, planning, intervention, and evaluation are the core components which support the nurses ability to provide competent, holistic, and patient focused care.

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Evidence Based Support & Recommendations

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Evidence Based Support & Recommendations

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Evidence Based Support
Implementation of the flipped classroom has been found to be an effective teaching strategy in undergraduate nursing programs. Students who participate in the flipped classroom learning context have shown to increase exam scores and have an overall increased success and pass rate. The traditional transfer of knowledge from teacher to student may increases dependence of learning on the instructor versus the student. Flipping the classroom creates an environment for students to take responsibility for their own learning and promotes the student's ability to problem solve while developing crucial skills of critical thinking necessary to perform as a registered nurse (Schlairet, Green, & Benton, 2014). A quantitative analysis performed through closed questionnaire of undergraduate students in Sweden proved 75 percent of 240 students surveyed reported feeling positive toward the flipped classroom atmosphere and more specifically pleased with course flexibility and ability to learn and study at their own pace. Students also reported feeling more motivated and in control of their own learning (Nouri, J. 2016).

Recommendation

Working as a faculty member in an associate degree nursing program, I have witnessed the benefits of the flipped classroom teaching strategy. Flipping the classroom provides experience in problem solving techniques and allows students to engage in critical thinking in the classroom. Students are required to work together which supports teamwork and collaboration which will be a skill necessary after graduation when working in a collaborative healthcare environment. I promote the flipped classroom strategy as the responsibility for learning is placed equally between the student and the instructor increasing the students motivation to learn and retain information.

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Initially, flipping the classroom will require additional training for faculty. Students may also be resistant to the new learning model which will require a sophisticated approach and introduction to the flipped classroom.
*Flipping the classroom will require training of faculty
*Student assignments will be created to promote self-driven learning
*Faculty must facilitate classroom activities and student learning
*Implementing the flipped classroom will create a learning curve for seasoned faculty members

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Cost will include:
*Technology fees for the use of D2L learning management system which is included in the cost of tuition.
*Presentation software such as Power Point by Microsoft will be necessary to display short video or slides especially for students joining via web conferencing.
*The cost of text books and fee for ATI which is utilized to supplement learning. Students will be required to complete ATI health assess prior to coming to the interactive classroom sessions as part of the preparation to participate in flipped classroom activities.
*Simulation mannequins will be utilized as a realistic model to perform head to to physical assessment. Simulation mannequins have been purchased by the college and utilized with other nursing simulation courses and will require no additional cost.
*Faculty training on the flipped classroom technique which can be accomplished through continuing education webinars such as Nurse Tim (Moffett, 2015)

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*The student learning objectives align with the associate degree end of program student learning outcome: making judgements in practice substantiated with evidence practices to provide safe, quality care to patients and their families .
*Physical assessment is a key component of the nursing process and an autonomous skill performed by registered nurses vital to providing competent patient care (Huber & Epp, 2021).

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Accessibility Considerations
*physical disabilities of the student may make patient physical assessment difficult
*Self-motivated learning may cause difficulty for those with learning disabilities
*Foreign born students who do not speak English as a first language may struggle to understand complex theories and content
*Students must have access to a computer and be able to navigate the D2L online learning platform to access materials, assignments, and discussion boards.
*Internet access will also be required to access course platform

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Audience
The flipped classroom approach is appropriate for:
*face-to-face or online synchronous web-conferencing classrooms
*Motivated, independent learners
*Pre-licensure nursing education
*Learners who benefit from group activities
*Hands on learners

Flipping the classroom may be inappropriate for:
*Asynchronous distance learners
*Faculty who are not trained in the flipped classroom approach
*Learners who have difficulty taking responsibility for their own learning (Schlairet, Green, & Benton, 2014).
*Learners who excel with passive learning such as lecture which is provided by faculty

Setting
*Initial learning will take place off campus and be student driven
*In person learning will occur following students self preparation. Students will participate in return demonstration and role playing (Oermann, De Gagne, & Phillips, 2018).  Learning will take place in a large classroom setting. Preassigned student groups will be required to present to the class the components of physical assessment specific of an assigned body system. Following instruction, students will work in groups, demonstrating physical assessment of the body systems. Students will be formally evaluated by faculty through observation of the complete head-to-toe physical assessment.

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Flipping the classroom is a popular strategy utilized in prelicensure nursing programs to promote the student's ability to excel in complex and unpredictable environments. The flipped classroom presents students with an opportunity to become active agents in learning versus passive recipients of teaching (Schlairet, Green, & Benton, 2014). Students are required to engage in learning prior to coming to the classroom which prepares them to participate in preplanned classroom activities. This teaching strategy is different from traditional lecture followed by homework learning approach. Flipping the classroom utilizes class time for small group and active learning exercises versus traditional delivery of contextual information during class time (Moffett, 2015).

The flipped classroom will be utilized to provide pre-licensure nursing education specific to physical assessment. The student will engage in pre-class room learning activities in preparation to perform the hands on skill of physical assessment.