THE IMPACT OF AN INTERACTIVE MODULE–BASED REFLECTIVE FLIPPED CLASSROOM ON SELF-EFFICACY AND REFLECTIVE THINKING IN SPIRITUAL CARE EDUCATION FOR NURSING STUDENTS IN INDONESIA: A QUASI-EXPERIMENTAL STUDY

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Abstract
Introduction: Spiritual care is essential in holistic nursing; however, nursing students often feel less confident and reflective in providing it. Innovative teaching methods combining active learning and reflection are needed to fill this gap. Objective: This study evaluated the impact of reflective, flipped-classroom spiritual care training on students' self-efficacy and reflective thinking. Methods: A quasi-experimental pretest–posttest design with a control group was conducted among 82 undergraduate nursing students from two universities in Indonesia. Participants were allocated to an intervention group (n = 41) or a control group (n = 41) based on existing class enrollment. The intervention consisted of a 16-week reflective flipped classroom supported by an interactive e-module, while the control group received conventional lecture-based instruction. Self-efficacy and reflective thinking were measured at baseline and post-intervention. Data normality was assessed using the Shapiro–Wilk test. Within-group differences were analyzed using the Wilcoxon signed-rank test or paired sample t-test as appropriate, and between-group differences were examined using the Mann–Whitney U test. Results: Within-group analyses showed statistically significant improvements in self-efficacy and reflective thinking in the intervention group (p < 0.001). In the control group, changes in reflective thinking were not statistically significant (p = 0.062). Between-group post-test comparisons demonstrated significantly higher self-efficacy and reflective thinking scores in the intervention group than in the control group (p < 0.001), with a large effect (r = 0.67 for self-efficacy and r = 0.61 for reflective thinking). Conclusion: The findings indicate that a reflective flipped classroom approach is associated with higher self-efficacy and reflective thinking among nursing students in spiritual care education. While causal conclusions cannot be drawn, the results support the educational value of reflective and interactive learning strategies in undergraduate nursing curricula.