Application of Flipped Classroom Combined with Scenario Simulation in Non-Technical Skills Training for Operating Room Nurses in Emergency Response

Huiling Qian; Xi Chen; Siyu Liu; Kunling Zhang; Meixue Zhang

doi:10.62177/apjcmr.v2i5.1758

Authors

Huiling Qian Guangzhou Women and Children's Medical Center, Guangzhou Medical University
Xi Chen Guangzhou Women and Children's Medical Center, Guangzhou Medical University
Siyu Liu Guangzhou Women and Children's Medical Center, Guangzhou Medical University
Kunling Zhang Guangzhou Women and Children's Medical Center, Guangzhou Medical University
Meixue Zhang Guangzhou Women and Children's Medical Center, Guangzhou Medical University

DOI:

https://doi.org/10.62177/apjcmr.v2i5.1758

Keywords:

Flipped Classroom, Scenario Simulation, Operating Room Nurses, Non-Technical Skills (NTS)

Abstract

To investigate the effect of flipped classroom combined with scenario simulation on non-technical skills (NTS) training for operating room nurses in crisis management. Fifty-three operating room nurses received NTS training in crisis management through flipped classroom combined with scenario simulation. SimBaby was used to run simulation scenarios, and the TeamTAG scale was used to facilitate guided reflection. All participants (100%) were satisfied with the 17 items of the scenario simulation teaching design. After training, participants' familiarity with NTS concepts increased from (2.53±1.07) to (3.98±0.46) points, with a statistically significant difference (P<0.001). The score of grouped emergency drills increased from (82.30±9.82) to (89.81±6.30) points, and the mean TEAM score increased from 33 to 39.9 points. This teaching program can effectively enhance training engagement and improve the NTS of operating room nurses in crisis management, thereby strengthening their comprehensive emergency response capabilities.

Downloads

Download data is not yet available.

References

Flin, R., & Maran, N. (2004). Identifying and training non-technical skills for teams in acute medicine. Quality & safety in health care, 13 Suppl 1(Suppl 1), i80–i84. https://doi.org/10.1136/qhc.13.suppl_1.i80

Flin, R., O'Connor, P., & Crichton, M. (2008). Safety at the sharp end: A guide to non-technical skills. Ashgate.

Azuara-Blanco, A., Reddy, A., Wilkinson, G., & Flin, R. (2011). Safe eye surgery: non-technical aspects. Eye (London, England), 25(9), 1109–1111. https://doi.org/10.1038/eye.2011.127

Siu, J., Maran, N., & Paterson-Brown, S. (2016). Observation of behavioural markers of non-technical skills in the operating room and their relationship to intra-operative incidents. The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland, 14(3), 119–128. https://doi.org/10.1016/j.surge.2014.06.005

Vioque, S. M., Kim, P. K., McMaster, J., Gallagher, J., Allen, S. R., Holena, D. N., Reilly, P. M., & Pascual, J. L. (2014). Classifying errors in preventable and potentially preventable trauma deaths: a 9-year review using the Joint Commission's standardized methodology. American journal of surgery, 208(2), 187–194. https://doi.org/10.1016/j.amjsurg.2014.02.006

Mitchell L. (2008). The non-technical skills of theatre nurses. Journal of perioperative practice, 18(9), 378–379. https://doi.org/10.1177/175045890801800901

Mitchell, L., Flin, R., Yule, S., Mitchell, J., Coutts, K., & Youngson, G. (2011). Thinking ahead of the surgeon. An interview study to identify scrub nurses' non-technical skills. International journal of nursing studies, 48(7), 818–828. https://doi.org/10.1016/j.ijnurstu.2010.11.005

Wu, L., Guo, A., Yang, H., Gu, R., & Ma, Q. (2018). Application of simulation teaching based on multi-disciplinary cooperation in clinical thinking training course for master of nursing specialist. Chinese Nursing Management, 18(7), 927–930. https://doi.org/10.3969/j.issn.1672-1756.2018.07.014

He, J., Shao, Q., Liao, B., Zhang, M., Wang, K., Yan, X., & Rui, D. (2023). Application and dissemination of a blended teaching model centered on the flipped classroom in medical statistics teaching. Chinese Journal of Health Statistics, 40(2), 295–297.

https://doi.org/10.11783/j.issn.1002-3674.2023.02.035

Li, N. (2023). Observation on the application effect of PBL combined with flipped classroom in PICU clinical nursing teaching. Chinese Higher Medical Education, (5), 107–109. https://doi.org/10.3969/j.issn.1002-1701.2023.05.048

Redjem, I. D., Huaulmé, A., Jannin, P., & Michinov, E. (2025). Crisis management in the operating room: A systematic review of simulation training to develop non-technical skills. Nurse education today, 147, 106583. https://doi.org/10.1016/j.nedt.2025.106583

Rasero, L., Magi, C. E., Iovino, P., Cappelletti, M. F., Durante, A., de Angeli, P., Natali, B., Cichero, F., Gori, P., Lumachi, L., Pallari, C., Pizza, G., Ibba, M., Spessot, G., & Bambi, S. (2026). Interventions to improve technical and non-technical skills of nurses working in operating theatres: A scoping review with evidence gap mapping. Applied nursing research : ANR, 89, 152085. https://doi.org/10.1016/j.apnr.2026.152085

Qin, H., Zhang, G., Zhu, S., & Zhang, Z. (2024). Current status and development trends of emergency response competency training for junior nurses in China: A CiteSpace-based knowledge mapping analysis. Modern Nurse, 31(8), 21–26. https://doi.org/10.19792/j.cnki.1006.6411.2024.08.006

Shen, Y., Peng, Y., Huang, Y., Qiu, R., & Wang, Y. (2021). Translation and reliability and validity testing of the Scrub Nurse Non-Technical Skills Behaviour Scale. Chinese Nursing Management, 21(1), 31–36. https://doi.org/10.3969/j.issn.1672-1756.2021.01.008

Zhu, F., Wu, L., & Zhang, D. (2017). Reliability and validity of the Chinese version of Simulation Design Scale. Chinese Nursing Management, 17(12), 1620–1623. https://doi.org/10.3969/j.issn.1672-1756.2017.12.010

Cooper, S., Cant, R., Connell, C., Sims, L., Porter, J. E., Symmons, M., Nestel, D., & Liaw, S. Y. (2016). Measuring teamwork performance: Validity testing of the Team Emergency Assessment Measure (TEAM) with clinical resuscitation teams. Resuscitation, 101, 97–101. https://doi.org/10.1016/j.resuscitation.2016.01.026

Chen, S., & Wen, C. (2015). Application of SimBaby simulation teaching in neonatal resuscitation training. Chongqing Medicine, 44(6), 856–857. https://doi.org/10.3969/j.issn.1671-8348.2015.06.051

Ey, J., Treloar, E., Kollias, V., Lee, O., Young, S., Edwards, S., Wells, A., Bruening, M., & Maddern, G. (2025). Interventions to Improve Nontechnical Skills in Surgery: A Systematic Review And Meta-Analysis. Journal of surgical education, 82(9), 103586. https://doi.org/10.1016/j.jsurg.2025.103586

Hassan, E. A., & Elsaman, S. E. A. (2023). The effect of simulation-based flipped classroom on acquisition of cardiopulmonary resuscitation skills: A simulation-based randomized trial. Nursing in critical care, 28(3), 344–352. https://doi.org/10.1111/nicc.12816

Jin S, Lu Q, Pang D, et al. Development and evaluation of a standardized patient-based scenario simulation teaching case for “tibial fracture”[J]. Chinese Nursing Management, 2021, 21(07): 1064-1068. https://doi.org/10.3969/j.issn.1672-1756.2021.07.020

Park, I., & Suh, Y. (2021). Meta-Analysis of Flipped Learning Effects in Nursing Education. International journal of environmental research and public health, 18(23), 12814. https://doi.org/10.3390/ijerph182312814

Kim, H., & Jang, Y. (2017). Flipped Learning With Simulation in Undergraduate Nursing Education. The Journal of nursing education, 56(6), 329–336. https://doi.org/10.3928/01484834-20170518-03

Freytag, J., Stroben, F., Hautz, W. E., Penders, D., & Kämmer, J. E. (2021). Effects of using a cognitive aid on content and feasibility of debriefings of simulated emergencies. GMS journal for medical education, 38(5), Doc95. https://doi.org/10.3205/zma001491

Wang, J., Zhang, H., Zhu, H., Sheng, J., Lu, L., Zhang, J., & Chen, L. (2019). Practical application of comprehensive emergency response competency rounds for nurses based on crisis resource management. Chinese Journal of Critical Care Medicine (Electronic Edition), 12(2), 139–141.

https://doi.org/10. 3877/ cma. j. issn. 1674-6880. 2019. 02. 015

Sánchez-Marco, M., Escribano, S., Rubio-Aparicio, M., Juliá-Sanchis, R., & Cabañero-Martínez, M. J. (2023). Effectiveness of nontechnical skills educational interventions in the context of emergencies: A systematic review and meta-analysis. Australian critical care : official journal of the Confederation of Australian Critical Care Nurses, 36(6), 1159–1171. https://doi.org/10.1016/j.aucc.2023.01.007

Yang, M., Zhang, X., Han, R., Ding, X., Gao, R., Jing, Q., Cai, W., Ma, A., Gao, Q., & Li, H. (2025). Evaluation of the effectiveness of rehabilitation nursing training for clinical nurses based on the Kirkpatrick model. BMC nursing, 24(1), 374. https://doi.org/10.1186/s12912-025-02889-1