Effectiveness of Blended Learning with Flipped Classroom Method on the Knowledge Level and Self Efficacy among Nurses During the Basic Life Support Course

Abstract


INTRODUCTION
Two years ago, since WHO's global pandemic declaration in December 2019 [1], Indonesia has been struggling to coexist with the COVID- This sudden shift pushes immediate adjustment that extensively involves various technology tools and digital learning platforms [2]. The adoption of online learning continues to persist today, portraying the unceasing investment in online-based education, even during the post-pandemic era [3]. The utilization of digital information technology 4.0 is an actual example of a rapid and mobile technology revolution that cuts time, space, and place limitations [4].
The Indonesian government responded to the educational transformation during the pandemic by issuing remote and online learning policies/regulations. Students who lived in the green-zoned area were allowed to conduct face-to-face-based learning under strict health measures [5]. Previous studies yielded the effective influence of blended learning on educational processes [6], [7].
Further, blended learning is perceived as a novel method of learning in the 2 st century, in line with technology as primary source of information in this era [10].
The poor level of BLS knowledge and skill among nursing students, it may occur due to ineffective transfer of knowledge process during the course [21]. The combination of blended learning in the online and in-class study with a flipped classroom that focuses on the participant's need and involves attractive learning media (video simulation and electronic module) [22], [23] proposes an as effective method to improve knowledge and self-efficacy in performing BLS.

RESULTS
We enrolled 60 eligible participants in this study. The majority of them were women  Blended learning has met the ECC gold standard course: the presence of mentors in improving knowledge, skill, and self-efficacy [29]. However, BL may offer several weaknesses: 1) lack of knowledge of the teaching resources "man" in using the digitalbased technology, 2) the absence of means "material" such as computers and internet access; 3) inadequate "method" of learning [30]. However, these shortages have been managed by establishing an initial requirement to participate in the study.
Participants were mandated to follow a course about using smart devices in online learning sessions. In addition, the COVID-19 pandemic has forced everyone to own a smart device to adapt with the learning demands.
This finding was in line with a study conducted by Wulandari. A (2020). They found significant changes in CPR knowledge in the class with a Flipped Classroom method ( p = 0.000) [31]. Another study conducted among medical students also found similar findings. Flipped Classroom Approach was found to be associated with significant changes in knowledge scores, in comparison with the standard approach (77% compared to 65% in the knowlege test, p= 0.0001) [32].
The BLS Course with BLFC has fulfilled the ECC standard requirement. Student-Centered Learning (SCL) was delivered in conventional and non-conventional forms [20], [27]. Flipped Classroom with SCL offers advantages in the education process and transfer of knowledge. By using this method, participants and mentors would have more time for discussion and evaluation sessions.
Participants were asked to explore information independently through the content provided by the mentors, thus they could start the discussion and evaluation afterward. This method is also complemented with a simulation to apply the information shared before the face-to-face class. This concept was perceived as a sufficient idea to meet knowledge fulfillment, self-efficacy, and skills [31]. However, digital media use remains a barrier for the mentors. Organizing attractive media seemed more challenging due to the unfamiliar digital media [33].
However, as the skill improved, the ability to master the technology would be developed.