An interventional study of Flipped Classroom Training on Pediatric Pain Management and Self-Directed Learning on Pediatric Pain Management in Pain Management, sponsored by Mustafa Belli. Completed at 1 site in Turkey (Türkiye). Per ClinicalTrials.gov, last updated 2025-08-19.
Sponsored by Mustafa Belli · Not applicable, Interventional, and Other
The aim of this randomized controlled trial was to evaluate the effect of the flipped classroom model on pediatric pain management knowledge and learning motivation among nursing students. A total of 84 third-year nursing students from a public university in Turkey were randomly assigned to intervention (n=42) and control (n=42) groups. The intervention group received education using the flipped classroom model, while the control group followed a self-directed learning approach.
Data were collected at three time points: before the intervention (pre-test), one month after the intervention (post-test), and three months after the intervention (follow-up test). The Pediatric Pain Knowledge Test and the Motivation Scale Towards Learning were used to assess outcomes.
At baseline, there were no significant differences between the groups. Post-test and follow-up results showed that the intervention group demonstrated a statistically significant and sustained increase in both pediatric pain knowledge and learning motivation scores (p\<0.001), while the control group showed no meaningful change.
These findings support the flipped classroom model as an effective and sustainable teaching strategy in nursing education, particularly for improving knowledge and motivation in pediatric pain management.
This randomized controlled trial aimed to evaluate the effectiveness of the flipped classroom model in enhancing nursing students' pediatric pain management knowledge and learning motivation. The study was conducted at a public university in Turkey with 84 third-year undergraduate nursing students during the 2022-2023 academic year.
Participants were randomly assigned to either the intervention group (n = 42) or the control group (n = 42) using a computer-generated randomization list. The intervention group received the flipped classroom approach, which included:
Access to a specially designed online learning platform with educational videos and reading materials uploaded one week prior to the face-to-face sessions,
A face-to-face session focusing on discussion, case-based learning, and peer interaction led by the researcher,
Learning materials developed based on the "Pediatric Pain Management" content defined in the national nursing education curriculum and international guidelines.
The control group engaged in self-directed learning by studying the same written materials independently without structured guidance or interaction.
Data were collected at three time points:
Pre-test (baseline) before the intervention,
Post-test immediately after the intervention (1 month later),
Follow-up (retention test) three months after the intervention.
Two validated instruments were used:
Pediatric Nurses' Knowledge and Attitudes Survey Regarding Pain (PNKAS) adapted for nursing students to measure knowledge,
Motivation to Learn Scale to assess students' learning motivation.
A two-way mixed ANOVA was used to analyze the effects of the intervention across time and between groups. At baseline, no significant differences were found between groups in either knowledge or motivation scores. However, after the intervention, the intervention group showed statistically significant and sustained improvements in both variables, whereas the control group did not exhibit notable changes.
The findings support the use of the flipped classroom approach as an effective and sustainable educational strategy in nursing education, particularly in areas requiring complex knowledge and critical thinking such as pediatric pain management. Integration of this model into nursing curricula may enhance both cognitive outcomes and motivation to learn.
1,190 studies on the registry are indexed under Agnosia; 508 are open to participants now.
This study's enrollment of 84 is close to the median of 78 across 1,024 interventional studies indexed under Agnosia.
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Being enrolled in the "Child Health and Diseases Nursing" course for the first time
Having access to the Internet and a computer or smartphone
Agreeing to attend synchronous sessions via Google Classroom
Volunteering to participate in the study
Exclusion Criteria
Having previously received any education on pediatric pain management
Withdrawing consent at any point during the study
Failing to complete the pre-test, post-test, or three-month follow-up assessment (e.g., missing a measurement session due to internet connectivity issues)
Participants in this group received pediatric pain management training through a flipped classroom model for 4 weeks. Training videos and readings were provided in advance and in-class sessions included interactive activities, discussions, and case-based learning.
Behavioral: Flipped Classroom Training on Pediatric Pain Management
Participants in this group received the same pediatric pain management materials as the intervention group (lecture notes, readings, and video lectures) for self-study without any interactive activities or instructor-led sessions.
Behavioral: Self-Directed Learning on Pediatric Pain Management
Participants in this group received pediatric pain management training designed to increase nursing students' knowledge and motivation. The training was delivered using a flipped classroom model over 4 weeks. Students were provided with pre-class educational materials, including video lectures, readings, and lecture notes. In-class sessions included interactive activities, discussions, case-based learning, and problem-solving exercises. Content was based on current pediatric pain management guidelines and adapted to nursing education standards.
Participants in this group received pediatric pain management training designed to increase nursing students' knowledge and motivation. Students were provided with the same pre-class educational materials as the intervention group, including video lectures, readings, and lecture notes, for self-study without any interactive activities or instructor-led sessions. Content was based on current pediatric pain management guidelines and adapted to nursing education standards.
Pediatric Pain Management Knowledge Score
The Pediatric Pain Management Knowledge Scale, developed by Aydın \& Bektaş (2021), measures nursing students' knowledge of pediatric pain. It consists of 29 items rated on a 5-point Likert scale, covering six sub-dimensions: pain awareness (6 items), pain physiopathology (4), barriers to pain management (11), pain diagnosis (2), pain assessment (2), and pain control (4). Items 3, 6, 8, 10-15, 17, and 21 are reverse coded. Scores range from 29 to 145; higher scores indicate greater knowledge. In this study, Cronbach's alpha was 0.845.
Time frame: Baseline (pre-test), 1 month after intervention (post-test), and 3 months after intervention (follow-up)
Motivation Level Toward Instructional Materials
The Motivation Questionnaire for Instructional Materials (MMIM), developed by Keller (2006) and adapted into Turkish by Kutu \& Sözbilir (2011), measures students' motivation toward instructional materials. It has 24 items rated on a 5-point Likert scale, with two dimensions: attention-relevance (items 1-11) and confidence-satisfaction (items 12-24). Items 3, 12, 14, 16, and 18 are reverse coded. Scores range from 24 to 120; higher scores indicate higher motivation. Cronbach's alpha was 0.83 in the original study and 0.789 in this study.
Time frame: Baseline (pre-test), 1 month after intervention (post-test), and 3 months after intervention (follow-up)
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Plan to share: No — Individual participant data will not be shared because participants did not provide consent for external data sharing and the study materials are governed by institutional privacy regulations. Data will remain accessible only to the study team
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