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Completed

NCT Number: NCT07774767

Effects of a Flipped-Learning Empowering Leadership Program on Nurse Leaders, Staff, and Residents in Long-Term Care Facilities

This pilot cluster quasi-experimental study tested a 12-week empowering-leadership training program delivered through flipped learning to nurse leaders in residential long-term care facilities, compared with a conventional brochure-based approach. Six facilities in central Taiwan participated: two (one public, one private) received the flipped-learning program for their leaders, and four (one public, three private) served as controls. The study examined effects at three levels: nurse leaders' own empowering leadership behaviors and facility-level nursing staff retention/turnover and resident hospitalization rates; nursing staff's perceptions of their leader's empowering behaviors, burnout, psychological empowerment, and job satisfaction; and residents' health status, quality of life, and satisfaction with care.

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Key information

Conditions

Empowering Leadership Long-Term Care Nurse Leaders

Age range

20 year and older

Sex eligibility

All sexes

Study type

Interventional

Phase

Not applicable

Primary location

Residential Long-Term Care Facilities

Taichung, Taiwan

Who can participate

Healthy volunteers accepted: No

Only the study team can determine whether someone qualifies for participation.

Inclusion criteria

Nurse Leaders:

  • Age ≥ 20 years
  • Employed as nursing director, supervisor, or head
  • Employed at the facility for more than 6 months
  • Willing to participate and able to give informed consent

Nursing Staff:

  • Registered nurse, licensed practical nurse, or nursing assistant
  • Employed at the facility for ≥ 3 months
  • Age ≥ 20 years
  • Informed consent given

Residents:

  • Resided at the facility for ≥ 3 months
  • Mini-Mental State Examination (MMSE) score ≥ 24
  • No severe hearing impairment
  • Not terminally ill
  • Written informed consent given (or via authorized representative as applicable)

Exclusion criteria

Nurse Leaders:

  • Indicated intent to leave the position within the next 6 months

Treatment and study plan

Flipped-Learning Empowering Leadership Program

Behavioral

A 12-week, 24-hour empowering leadership program (one 2-hour module per week). Each week, a 60-minute instructional video was posted for asynchronous pre-class learning, followed by a 1-hour face-to-face session (small-group discussion, case studies, brief presentations, practical exercises), with instructor summary. Post-class activities included reflection and assignments.

Educational Brochure (Conventional Learning)

Behavioral

Nurse leaders in the control group received a printed brochure covering the same empowerment/empowering-behavior content as the intervention group, without structured flipped-learning sessions. The research team maintained regular contact to answer questions but provided no additional training.

Primary outcomes

  1. Leader Empowerment Behavior

    Time frame: Baseline and immediately post-intervention (approximately 12 weeks)

    Leader Empowerment Behavior Scale (Chinese version), a 27-item self-report measure across 5 subscales (extending meaning of work, engaging staff in decision-making, expressing confidence, encouraging goal achievement, providing autonomy). Each item rated on a 7-point Likert scale (1=strongly disagree, 7=strongly agree); total score range 27-189, with higher scores indicating more empowering leadership behavior (better outcome). Cronbach's α=0.71; test-retest r=0.83.

  2. Staff-Perceived Leader Empowering Behavior

    Time frame: Baseline (at enrollment) and 3 months after intervention completion (approximately August 2019)

    Modified version of the Leader Empowerment Behavior Scale, a 27-item measure completed by nursing staff about their leader, across 5 subscales. Each item rated on a 7-point Likert scale; total score range 27-189, with higher scores indicating more empowering behavior as perceived by staff (better outcome). Cronbach's α=0.85; test-retest r=0.71.

Secondary outcomes

  1. Occupational Burnout

    Time frame: Baseline (at enrollment) and 3 months after intervention completion (approximately August 2019)

    Occupational Burnout Inventory Scale, a 21-item self-report measure across 4 subscales (personal burnout, work-related burnout, client-related burnout, over-commitment to work). Each item rated on a 5-point Likert scale; total score range 21-105, with higher scores indicating greater burnout (worse outcome). Cronbach's α=0.80; test-retest reliability=0.78.

  2. Psychological Empowerment

    Time frame: Baseline (at enrollment) and 3 months after intervention completion (approximately August 2019)

    Spreitzer's Psychological Empowerment Scale, a 12-item self-report measure across 4 subscales (meaning, competence, self-determination, impact). Each item rated on a 5-point Likert scale; total score range 12-60, with higher scores indicating greater psychological empowerment (better outcome). Cronbach's α=0.87; test-retest reliability=0.82.

  3. Job Satisfaction

    Time frame: Baseline (at enrollment) and 3 months after intervention completion (approximately August 2019)

    Minnesota Satisfaction Questionnaire Short Form, a 20-item self-report measure. Each item rated on a 5-point Likert scale; total score range 20-100, with higher scores indicating greater job satisfaction (better outcome). Cronbach's α=0.88; test-retest reliability=0.84.

  4. Job Stress

    Time frame: Baseline (at enrollment) and 3 months after intervention completion (approximately August 2019)

    Single-item self-report measure ("Do you often feel very stressed at work?"), rated on a 5-point Likert scale; score range 1-5, with higher scores indicating greater job stress (worse outcome).

  5. Health Status (SF-36)

    Time frame: Baseline (at enrollment) and 3 months after intervention completion (approximately August 2019)

    36-Item Short Form Health Survey (SF-36), across 8 domains (physical functioning, role limitations due to physical health, role limitations due to emotional problems, pain, emotional well-being, social functioning, energy, general health). Each domain scored 0-100, with higher scores indicating better health status (better outcome). Cronbach's α=0.78-0.90; test-retest reliability=0.86-0.91.

  6. Quality of Life (WHOQOL-BREF)

    Time frame: Baseline (at enrollment) and 3 months after intervention completion (approximately August 2019)

    World Health Organization Quality of Life Questionnaire, Abbreviated Version (WHOQOL-BREF), across 4 domains (physical health, psychological health, social relationships, environmental health). Domain scores range from 4 to 20, with higher scores indicating better quality of life (better outcome). Cronbach's α=0.80-0.88; test-retest reliability=0.90-0.95.

  7. Care Quality / Customer Satisfaction

    Time frame: Baseline (at enrollment) and 3 months after intervention completion (approximately August 2019)

    Customer Satisfaction Scale, a 25-item self-report measure across 4 subscales (comfort/cleanliness, nursing care, food services, facility care/services). Each item rated on a 5-point Likert scale; total score range 25-125, with higher scores indicating greater satisfaction with care quality (better outcome). Cronbach's α=0.94; test-retest reliability=0.75.

  8. Nursing Staff Retention Rate

    Time frame: 12-month period prior to the intervention (baseline) and 12-month period beginning approximately 1 month after the 12-week intervention was completed (follow-up)

  9. Nursing Staff Turnover Rate

    Time frame: 12-month period prior to the intervention (baseline) and 12-month period beginning approximately 1 month after the 12-week intervention was completed (follow-up)

  10. Resident Hospitalization Rate

    Time frame: 12-month period prior to the intervention (baseline) and 12-month period beginning approximately 1 month after the 12-week intervention was completed (follow-up)

Interested in participating?

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Sponsors and collaborators

Lead sponsor

I-Hui-Chen

Other

Registry information

Official study title

Flipped Learning for Leader Empowering Leadership in Aged Care: A Pilot Cluster Quasi-Experimental Study

Important dates

Study start
2018
Primary completion
2019
Study completion
2020
First posted
Aug 19, 2026
Registry last updated
Aug 19, 2026

OpenTrials presents study information sourced from ClinicalTrials.gov. The official registry record should be consulted for the latest information.

View the official ClinicalTrials.gov record (opens in a new tab)

This listing is for discovery and informational purposes only. It is not medical advice, does not guarantee that a study is recruiting, and does not determine eligibility. Contact the study team and a qualified healthcare professional when considering participation.

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