Training nursing students to make correct decisions when facing various nursing cases is an important and challenging objective. In the Objective Structured Clinical Examination (OSCE) program for nursing students, the educational aim is not only nursing skills, but also critical thinking for making correct decisions and treatments. In this study, a contextual game-based flipped learning approach (GBFL) is implemented to improve nursing students' learning performances and promoting their positive perceptions in an intravenous injection course. Moreover, a quasi-experiment was implemented to assess the effectiveness of the proposed approach. The subjects were 56 students from two classes of a nursing school. One class was assigned to the experimental group learning with the GBFL approach, while the other class was the control group learning with conventional flipped learning. From the experimental results, it was found that the students learning with the proposed approach showed better intravenous injection comprehension as well as higher learning achievement, learning motivation, learning attitudes, flow experience and critical thinking tendency than those learning with conventional flipped learning.