Blended Learning to Improve the Physical Examination Ability of Nursing Students

Abstract

Coronavirus disease has an impact on the education sector. Educators use a combined learning method between face-to-face and online learning to break the chain of virus spread. One of the proper methods is blended learning with the help of information and communication technology to achieve learning objectives. This study aimed to determine the effectiveness of the blended learning method on the physical examination abilities of nursing students. This study uses a pre-experiment. The research location is in STIKes (College of Health Sciences), Cirebon, Indonesia, with a sample of 100 Nursing students. The technique uses purposive sampling and the N-Gain value analysis. The result shows a significant difference in the competence of the physical examination before and after getting the blended learning method. The blended learning method is proven effective in increasing the competence of the physical examination of nursing students. In addition, an exciting learning process through online and conventional media provides a high satisfaction value. Blended learning is one of the learning solutions in the new era of the COVID-19 pandemic to suppress the spread of COVID-19 and improve students' abilities.

Full text

International Journal of Educational Qualitative Quantitative Research (IJE-QQR)
ISSN: (Online) 2962-9918
Vol. 1, No. 2, October 2022, pp. 23-30
► 23
Journal homepage: https://journal.qqrcenter.com/
Blended Learning to Improve the Physical Examination Ability of Nursing
Students
Supriatin Supriatin1, Pratuma Rithpho2, Asiah Asiah1, Rokhmatul Hikhmat1
1 Sekolah Tinggi Ilmu Kesehatan Cirebon, West Java, Indonesia
2 Naresuan University, Thailand
Article Info
ABSTRACT
Article history:
Received: Sept 24, 2022
Revised: Oct 24, 2022
Accepted: Oct 31, 2022
Coronavirus disease has an impact on the education sector. Educators
use a combined learning method between face-to-face and online
learning to break the chain of virus spread. One of the proper methods
is blended learning with the help of information and communication
technology to achieve learning objectives. This study aimed to
determine the effectiveness of the blended learning method on the
physical examination abilities of nursing students. This study uses a
pre-experiment. The research location is in STIKes (College of
Health Sciences), Cirebon, Indonesia, with a sample of 100 Nursing
students. The technique uses purposive sampling and the N-Gain
value analysis. The result shows a significant difference in the
competence of the physical examination before and after getting the
blended learning method. The blended learning method is proven
effective in increasing the competence of the physical examination of
nursing students. In addition, an exciting learning process through
online and conventional media provides a high satisfaction value.
Blended learning is one of the learning solutions in the new era of the
COVID-19 pandemic to suppress the spread of COVID-19 and
improve students' abilities.
Keywords: Blended Learning, Teaching, Learning, Physical
Examination, Students' Abilities
This is an open access article under the CC BY-NC-ND 4.0 license.
How to cite this article:
Supriatin, S., Rithpho, P.,
Asiah, A., & Hikhmat, R.
(2022). Blended Learning to
Improve the Physical
Examination Ability of Nursing
Students. International Journal
of Educational Qualitative
Quantitative Research, 1(2),
23–30.
Read online:
Scan this QR code with your smart
phone or mobile device to read
online.
Corresponding Author:
Supriatin Supriatin
Sekolah Tinggi Ilmu Kesehatan Cirebon, West Java, Indonesia
Email: supriatin@stikescirebon.ac.id
1. INTRODUCTION
Education is one of the efforts so that someone can develop their potential through a learning process
(Hidayat & Perdana, 2019). Education aims for students to actively develop their potential to have religious
and spiritual strength, self-knowledge, personality, intelligence, noble character, and skills needed by
themselves, society, nation, and state. Education and health have an essential role in building human
intellectual resources. Developed countries are countries that have citizens who have high intellect. All
countries are affected by the coronavirus (Del Vecchio Blanco et al., 2020; Herlinawati et al., 2022; Kosim,
2022). Therefore, during the pandemic, education is essential for the prevention of COVID-19 (Ng & Or,
2020; Zhong et al., 2020).
Lesson planning needs special attention (Norwich et al., 2021). Even in a pandemic, students still learn
health information by combining face-to-face and distance learning (Singh et al., 2021). In this pandemic
condition, it is necessary to apply the proper learning methods to meet the needs of students (Huriyah &
Hidayat, 2022; Owolabi, 2020). Related to the role of education as a learning agent, an educator must
provide optimal learning. Using various methods and learning models tailored to students' needs and
characteristics (Coussement et al., 2020; Mousavinasab et al., 2021; Rasmitadila et al., 2021).
Utilizing this pandemic, students learn using conventional and online methods to help learn about
nursing. In online learning, blended learning uses the internet as a learning medium (Sefriani et al., 2021).
The internet can be an open source of information for every student (Engelen & Budke, 2022; Kleftodimos

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IJE-QQR, Vol. 1, No. 2, October 2022
& Evangelidis, 2016). However, the openness and ease of internet access do not make the internet always
a good source of learning. Various software can be used in online-based learning, such as Google
Classroom, Moodle, Zoom, Edmodo, WhatsApp, and others (Agusriadi et al., 2021; DS et al., 2022). Each
software has advantages and disadvantages when compared to one another. The learning model is one of
the important components that affect the effectiveness and efficiency of the learning process (Kintu et al.,
2017). The learning model used by an educator must be able to meet the demands of various aspects so that
learning objectives can be met (MacDonald et al., 2001). The learning model must encourage students to
be active in the teaching and learning process to realize student-centre learning (Khalaf, 2018). This means
that the education system, from the conventional to the digital era, learning environment involves
technology and provides innovation through a blended learning system.
1.1. Blended Learning
A learning strategy known as blended learning combines traditional face-to-face instruction with
online remote learning (Mujib & Marhamah, 2020; Widjaja & Aslan, 2022). This learning model combines
two learning methods to make learning flexible and better for material mastery and technological progress.
Five keys to implementing blended learning. According to Ikhwan & Widodo, (2019):
Live event
Live Events are synchronous direct or face-to-face learning at the same time and location or the same
time but in a different location. The primary pattern lecturers still frequently employ in their instruction is
direct learning. This instructional strategy must be created to meet the needs of the students while also
achieving the learning objectives.
Self-paced learning
Online self-paced learning enables students to study whenever and wherever they want. Both text and
multimedia components of lesson plans, such as animation, video, simulation, audio, and images, must be
explicitly made. In addition, self-learning can be packaged as a mobile app, web content, book, and
streaming audio or video content.
Collaboration
Collaboration is a combination of lecturers and students. Communication technologies like chat
rooms, websites, emails, Etc., can be used to create this collaboration. Through social engagement with
other individuals, this partnership is anticipated to enhance the development of knowledge and abilities.
Assessment
An integral part of the implementation of the learning process is assessment. The assessment
determines the degree of competency mastery that students have attained. Additionally, the assessment
serves as a follow-up to the lecturer regarding applying what was learned. As learning designers, the
lecturers must be able to combine several offline and online assessment modalities, including both tests and
non-tests.
Performance Support Materials
One of the critical elements in assisting the learning process is the teaching materials. The usage of
instructional resources will help students learn the content more effectively. To support participants' offline
and online access, blended learning content should be packaged in digital and paper formats. Online
learning applications should be supported by the usage of educational resources that are bundled online.
The five points mentioned above are closely related and significantly impact blended learning
activities. The learning objectives are anticipated to carry out the learning created with the blended learning
model using these five points to ensure that it occurs effectively and efficiently.
Blended learning methods take a student-centered approach to learning and vary by discipline,
academic level, student characteristics, and learning outcomes (Herayanti et al., 2020; Prafitasari et al.,
2021). Blended learning can improve learners' accessibility and flexibility, raise their levels of active
learning, and enhance their learning achievements (Bouilheres et al., 2020). For the teacher, blended
learning can improve teaching practice and classroom management (Anthony et al., 2019). Blended in
question can be in the form of the following: 1. Face-to-face and online learning activities. 2. Conventional
face-to-face classes with different models include weekend, intensive, external, and trimester. 3. technology
such as lecture capture and or social media and technology. 4. Simulations, group activities, web-based
learning, practical.
Student and institutional factors are very influential in the success of blended learning (Previtali &
Scarozza, 2019). From the student's perspective, blended learning can be successful if the teacher has
sufficient knowledge of using the introduced technology. Students must be trained to explore the data and
information provided by blended learning. From an institutional perspective, the allocation of services
offered to support and assist students and facilitators during the development and implementation of the
module is the institutional component necessary for successful blended learning. In order to get instructors
and potential end users involved and fully aware of the value of blended learning, it is necessary to invest
resources in communication.

25 ◄ IJE-QQR
Blended Learning to Improve the Physical Examination Ability of Nursing Students
(Supriatin S., Rithpho, P., Asiah A., & Hikhmat, R.)
1.2. Physical Examination
The physical examination is a head-to-toe review of each body system that provides objective
information about the client and allows us, as nurses, to make clinical judgments (Benbassat & Gilon, 2020;
Huber & Epp, 2022; Hummell & Cummings, 2022). In general, the physical examination aims to (Jarvis,
2018): 1. To collect and obtain primary data about the client's health. 2. To add, confirm or refute the data
obtained in the nursing history. 3. To confirm and identify nursing diagnoses 4. To make clinical judgments
about changes in the client's health system and management. 5. To evaluate the physiological outcomes of
nursing care.
Physical examination benefits nurses and other health professions, including 1. As data to assist nurses
in determining nursing diagnoses (Tan et al., 2021). 2. Knowing the health problems experienced by clients
(Car et al., 2020). 3. As a basis for selecting appropriate nursing interventions (Ackley et al., 2019). 4. As
data to evaluate the results of nursing care (Jarvis, 2018).
There are four primary physical examination techniques that we use, namely: inspection (check
vision), palpation (check touch), percussion (check knock), and auscultation (check to hear) (Narula et al.,
2018). 1) Inspection is examining patients by looking directly at the patient's entire body or only certain
needed parts. This method seeks to see the client's condition using a "sense of sign" through the naked eye
or lighting aids (lamps). Inspection is an active activity, a process by which the nurse must know what she
saw and where it is located. This inspection method assesses the skin colour, shape, position, size, and
others of the patient's body. 2) Palpation is a method of examining patients using a "sense of touch."
Palpation is an examination carried out by palpation and emphasis on body parts using fingers or hands.
The hand and fingers are sensitive instruments used to collect data; for example, this palpation method can
detect body temperature (temperature), vibration, movement, shape, consistency, and size. 3) Percussion is
an inspection action by hitting/tapping to listen to the sound of vibrations/waves transmitted to the body's
surface from the part of the body being examined. The examination involves tapping the finger or hand on
the body surface. The journey of vibration / sound waves depends on the density of the medium through
which it travels. The degree of sound is called resonance. The character of the sound produced can
determine the location, size, shape, and density of structures under the skin. The nature of sound waves is
that the more tissue, the weaker the conductivity and the most resonant air/gas. 4) Auscultation is a physical
examination performed by listening to the sound produced by the body. Usually, using an instrument called
a stethoscope. The things heard are heart sounds, breath sounds, and bowel sounds. Assessment of
auscultation examination includes a) Frequency, namely counting the number of vibrations per minute. b)
Duration is the length of time the sound is heard. c) Sound intensity is a measure of the strength/weakness
of the sound. d) Quality, namely the colour tone/variation of the sound.
2. METHOD
This study uses a pre-experiment. There is no comparison group (control group) through a one-group
pre-test and post-test design approach (Agustin, 2022; R Nur Abdurakhman et al., 2022). In this study, a
blended learning intervention was given to one group to see whether or not there were changes related to
the problem of physical examination abilities before and after treatment. Data collection is only done before
giving the action and after giving the action. The research location is in STIKes (College of Health
SciencesCirebon, Indonesia, with a sample of 100 DIII Nursing students. The sampling technique uses a
purposive sampling technique and the N-Gain value analysis (Kuswanda et al., 2020) of the effectiveness
of blended learning to improve physical examination ability.
3. RESULTS AND DISCUSSION
3.1. Results
Physical examination ability
Table 1. Physical Examination Ability using Blended Learning
Categories
Percentage
Before
After
Competent (Test score ≥ 80)
16
100
Not yet competent (Test score < 80)
84
0
Table 1 shows that 84% of nursing students cannot perform a physical examination. After intervening
using the blended learning method, it decreased to 0%. Table 1 shows that 16% of students can perform a
physical examination. After intervention using the blended learning method increased to 100%.

IJE-QQR ► 26
IJE-QQR, Vol. 1, No. 2, October 2022
Student satisfaction
Tabel 2. Student Satisfaction
Categories
Percentage
Very satisfied
75
Satisfied
16
Quite satisfied
9
Less satisfied
0
Very dissatisfied
0
Table 2 shows nursing students' satisfaction with using blended learning methods in physical
examinations. 75% of nursing students stated that they were very satisfied. 16% of nursing students stated
that they were satisfied. 9% of students stated that they were quite satisfied.
N-Gain analysis
Tabel 3. The Effectiveness of Blended Learning on Physical Examination Ability
No.
Student
Test scores
N-Gain
Score
N-Gain
%
No.
Student
Test scores
N-Gain
Score
N-Gain
%
Pre-test
Post-test
Pre-test
Post-test
1
65
100
1.00
100.00
51
87
100
1.00
100.00
2
70
100
1.00
100.00
52
65
100
1.00
100.00
3
65
100
1.00
100.00
53
61
87
0.67
66.67
4
70
100
1.00
100.00
54
83
100
1.00
100.00
5
70
100
1.00
100.00
55
70
100
1.00
100.00
6
70
100
1.00
100.00
56
65
100
1.00
100.00
7
83
100
1.00
100.00
57
88
100
1.00
100.00
8
87
100
1.00
100.00
58
65
100
1.00
100.00
9
65
91
0.74
74.29
59
52
91
0.81
81.25
10
78
100
1.00
100.00
60
70
100
1.00
100.00
11
70
100
1.00
100.00
61
87
100
1.00
100.00
12
70
100
1.00
100.00
62
70
87
0.57
56.67
13
70
100
1.00
100.00
63
70
91
0.70
70.00
14
74
96
0.85
84.62
64
83
100
1.00
100.00
15
70
100
1.00
100.00
65
89
100
1.00
100.00
16
70
96
0.87
86.67
66
70
100
1.00
100.00
17
83
96
0.76
76.47
67
61
100
1.00
100.00
18
70
100
1.00
100.00
68
65
100
1.00
100.00
19
65
100
1.00
100.00
69
70
100
1.00
100.00
20
65
100
1.00
100.00
70
65
100
1.00
100.00
21
70
100
1.00
100.00
71
70
100
1.00
100.00
22
70
83
0.43
43.33
72
65
100
1.00
100.00
23
65
100
1.00
100.00
73
65
100
1.00
100.00
24
74
100
1.00
100.00
74
61
87
0,67
66.67
25
96
100
1.00
100.00
75
60
100
1.00
100.00
26
65
100
1.00
100.00
76
70
100
1.00
100.00
27
70
100
1.00
100.00
77
65
100
1.00
100.00
28
83
91
0.47
47.06
78
60
100
1.00
100.00
29
70
96
0.87
86.67
79
65
100
1.00
100.00
30
91
100
1.00
100.00
80
52
91
0.81
81.25
31
70
100
1.00
100.00
81
70
100
1.00
100.00
32
70
100
1.00
100.00
82
65
100
1.00
100.00
33
91
100
1.00
100.00
83
70
87
0.57
56.67

27 ◄ IJE-QQR
Blended Learning to Improve the Physical Examination Ability of Nursing Students
(Supriatin S., Rithpho, P., Asiah A., & Hikhmat, R.)
34
91
100
1.00
100.00
84
70
91
0.70
70.00
35
65
100
1.00
100.00
85
65
100
1.00
100.00
36
87
100
1.00
100.00
86
65
100
1.00
100.00
37
70
100
1.00
100.00
87
70
100
1.00
100.00
38
70
91
0.70
70.00
88
65
100
1.00
100.00
39
70
100
1.00
100.00
89
65
100
1.00
100.00
40
65
100
1.00
100.00
90
61
87
0.67
66.67
41
70
100
1.00
100.00
91
60
100
1.00
100.00
42
70
83
0.43
43.33
92
65
100
1.00
100.00
43
70
100
1.00
100.00
93
70
100
1.00
100.00
44
61
100
1.00
100.00
94
65
100
1.00
100.00
45
83
100
1.00
100.00
95
70
100
1.00
100.00
46
61
100
1.00
100.00
96
70
100
1.00
100.00
47
65
100
1.00
100.00
97
70
100
1.00
100.00
48
70
100
1.00
100.00
98
70
91
0.70
70.00
49
65
100
1.00
100.00
99
70
87
0.57
56.67
50
70
100
1.00
100.00
100
70
100
1.00
100.00
Total
7033
9800
93.56
9354.9
6
Average
70.33
98.00
0.9356
93.549
6
Information
Medium
Very
high
Effecti
ve
Effecti
ve
Table 3. Shows the bivariate analysis results, namely before using the blended learning method, the
average student's physical examination ability was 70.33, and after that, it was 98.00. With details, the
highest score is 100, and the lowest score is 52.
The effectiveness of the blended learning method in physical examination learning can be known
through the N-Gain value. According to Hidayat & Perdana (2021), it is not effective if the N-Gain
percentage is < 40, less effective if the N-Gain percentage = 40-55, quite effective if the N-Gain percentage
= 56-75, and effective if the N-Gain percentage is > 76 (Wahab et al., 2021).
Table 3. shows the average percentage of N-Gain = 93.5496. That is, the blended learning method
effectively improves the physical examination ability of nursing students.
3.2. Discussion
Student satisfaction
In blended learning, it is possible for learning interactions to occur from anywhere and anytime (time
and place flexibility) (Jalinus, 2021). Students can interact with learning resources that have been packaged
electronically. Students can access the internet at any time and from any location (Karma et al., 2021; Le
et al., 2022). Likewise, the tasks of learning activities can be handed over to the teacher as soon as they are
completed, and students are not tightly bound by the time and place of learning activities, as is the case in
conventional education.
This study showed that 75 students were very satisfied with the blended learning method in physical
examination learning. 16 students were satisfied with the blended learning method in physical examination
learning. 9 students were quite satisfied with the blended learning method in physical examination learning.
That shows that most students are very satisfied with the blended learning method. This satisfaction is
supported by implementing an exciting learning process because it passes through online and conventional
media (Mathivanan et al., 2021). Lecturers need to prepare a learning process with an attractive online and
face-to-face learning system to make it easier for students to understand the material being taught
(Rasmitadila et al., 2020). In addition, lecturers need to master information technology so that the learning
process runs smoothly (Monk et al., 2020).
The effectiveness of the blended learning
The use of information technology in the blended learning model has positively influenced and
improved student understanding and learning outcomes (Sefriani et al., 2021; Zheng et al., 2022) but also
increased learning motivation, encouraged cooperative and independent learning, and supported the
development of student problem-solving and critical thinking skills (Yustina et al., 2020).

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IJE-QQR, Vol. 1, No. 2, October 2022
The results of the study are supported by research by Laili and Tanoto (2020), entitled "Blend Learning
Strategies for Concepts and Physical Examination Procedures for Nursing Students". This study states that
blended learning effectively improves student outcomes in understanding concepts (cognitive) and
procedures (skills/psychomotor).
The study results were supported by Pancaningsih's (2021) research on "The Blended Learning
Training Model Improving Nurses' Learning Outcomes About Basic Operating Rooms". The results
showed a relatively practical effect of the blended learning training method in improving nurses' learning
outcomes about the basic operating room. The advantages of blended learning are cost and time efficiency
and more optimal learning outcomes.
4. CONCLUSION
There is a significant difference in the competence of the physical examination before and after getting
the blended learning method. That shows the blended learning method is proven effective in increasing the
competence of the physical examination of nursing students. In addition, an exciting learning process
through online and conventional media provides a high satisfaction value. Blended Learning is one of the
solutions for learning in the new era of the covid-19 pandemic. This method has a role in suppressing the
spread of COVID-19 and improving students' abilities during the COVID-19 transition to a COVID-19-
free period.
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