Flipped learning for leader empowering leadership among nurse leaders in residential aged care facilities: a pilot cluster quasi-experimental study

Abstract

Empowering leadership by nurse leaders is crucial for creating positive workplace environments. However, no previous studies have investigated the effects of educational interventions utilizing a flipped-learning approach to cultivate empowering leadership behaviors among nurse leaders in aged care settings. Hence, in this exploratory pilot study, we aimed to obtain preliminary descriptive information on delivering a flipped-learning approach to develop empowering leadership behaviors among nurse leaders in aged care settings. A pilot clustered quasi-experimental study was conducted from August 2018 to May 2019 in six non-profit residential aged-care facilities in Taiwan. A 12-week, 24-h empowering leadership program using flipped learning was implemented. Ten nurse leaders participated in the intervention group, while 11 served as booklet-only controls. The program was guided by the theory of leader empowerment behavior. The outcome measured at pre- and post-intervention was leader empowering behaviors. Three ancillary facility-reported contextual indicators (nursing staff retention and turnover rates and resident hospitalization transfer rates) were also collected. The leader-level outcome was analyzed at the facility level, the level at which the intervention was assigned, with a three-level linear mixed model reported as an exploratory sensitivity analysis. Leader empowering behavior improved in both intervention facilities (+ 37.2 and + 39.6 points) and declined in all four control facilities (− 8.5 to − 13.0 points). With only six facilities, statistical significance is not claimed for this difference. An exploratory mixed model gave a consistent estimate (B = 48.13). Three ancillary facility-reported contextual indicators are described: mean staff retention rose from 83.0% to 85.0% and turnover fell from 13.9% to 11.5% in the two intervention facilities, whereas retention fell from 61.0% to 58.8% and turnover rose from 26.2% to 28.8% in the four control facilities. Resident hospitalization transfer rates were 8.0% and 7.9% in the intervention facilities and 4.2% at both time points in the control facilities. The observed facility-level pattern was consistent with improvement in self-reported empowering leadership behaviors and warrants evaluation in a prospectively randomized cluster trial. The three ancillary facility-reported indicators are descriptive and cannot be definitively attributed to the intervention. ClinicalTrials.gov NCT07774767. Registered 13 August 2026 (retrospectively registered).

The authors' abstract, as published at the source. BMC Medical Education, 2026 · DOI ↗