Long-term effects of flipped learning on nurses’ self-efficacy and satisfaction in pressure injury management: A multi-center quasi-experimental study

Abstract

Aims

Investigate the long-term effects of a flipped education —based on adult learning theory and incorporating multimedia teaching and physical workshops—on nurses’ self-efficacy in preventing and managing pressure injuries.

Background

Pressure injuries remain a global challenge, requiring caregivers to blend theory with practice. Flipped learning has shown promise in boosting nurses' confidence and competence in managing these injuries through higher-level processes such as interaction, reflection, application, analysis and integration.

Design

A single-blind, multicenter, quasi-experimental, two-group parallel repeated-measures design was conducted in seven medical institutions.

Method

A total of 404 participants adopted an adult self-directed learning model. The control group received PDF-based materials, while the intervention group additionally underwent a flipped education program that combined multimedia teaching with physical workshops. Self-efficacy in the four domains—assessment, planning, monitoring and decision-making—was measured at baseline, immediately post-intervention and at one- and three-months post-intervention. Data were analyzed using descriptive statistics, chi-square tests, t-tests and generalized estimating equations.

Results

Following the intervention, both groups showed a significant increase in self-efficacy (p < .05). The intervention group scored higher in all domains, with improvements lasting three months and reported greater learning satisfaction.

Conclusion

Multimedia teaching enhances learners’ motivation and improves the effectiveness of adult self-directed learning. Physical workshops focused on higher-level analysis, integration and hands-on teaching further strengthened care confidence and self-efficacy. These findings confirm the effectiveness of flipped education in pressure injury education, especially regarding its long-term impact and offer valuable insights for designing future nursing training programs.