THE IMPLEMENTATION OF FLIPPED CLASSROOM IN TEACHING ENGLISH FOR NURSING STUDENTS

This research is a case study. The purpose of this study was to determine the process of implementing a flipped classroom for English course and analyse students’ perceptions of the implementation of the Flipped Classroom in teaching English for the nursing students of Nursing Academy of Kesdam Iskandar Muda Banda Aceh. The participant in this study were 50 students of Nursing Academy of Kesdam Iskandar Muda Banda Aceh in the academic year 2020/2021. They consist of 4 male students and 46 female students. Data collection methods in this study are lecturer’s observation checklist, teacher’s fieldnote and questionnaires. Lecturer's observation checklist in the form of a checklist for implementing the flipped classroom strategy at each meeting. Lecturer’s fieldnote is some notes that found while flipped classroom was implemented. Questionnaires are used to obtain results from student opinions and student experiences in Flipped Classroom. More than half of students felt that Flipped classroom aided their English studies. Most of the students enjoyed the flipped classroom learning and believed that this method can support their learning.


INTRODUCTION
As a means of global communication, English has a very strategic role in achieving the success of a profession. The profession as a nurse is very much taken into account in providing health services by the world community (Juliana & Afrianti, 2020). English can be applied to all fields of science, including nursing. The purpose of this course is to equip students with active communication skills in English, namely listening, speaking, reading and writing skills (Syahputra, 2006). In the global era, English is a mandatory material that must be used as teaching material. English in tertiary institutions is taught as a general subject in non-English language majors, as well as in Nursing Academy of Kesdam Iskandar Muda Banda Aceh (AKIMBA).
To face the global era, nursing students are advised to study articles or journals in English. Competent nurses must be able to understand nursing terms in English (Wijayanto, 2008). Learning like this should be structured, to produce nurses who are reliable in terms of theory and practice. Students should create new innovations that can boost individual values and qualities and the campus itself (Benander, 2018). However, the English courses at AKIMBA are not as many as courses related to student expertise. Whereas in fact, along with the development of the global economy, prospective graduates should be provided with sufficient provisions to be able to compete. Foreign language skills are very important for nursing students (Garone & Van de Craen, 2017). Therefore, lecturers are required to find various teaching strategies to support efforts to improve students' English skills, one of which is the use of technology in teaching English (FKIP, 2019).
Based on experience while teaching English courses, English is a burden for students.
With a lot of material and not understanding the meaning, students tend to dislike this course.
The minimum hours of English lessons and the large amount of material that must be delivered by the lecturer, make students sometimes have not mastered the material to be tested. So, it is necessary to have a learning model that helps lecturers in delivering material and adapting to the lifestyle of students who always spend time accessing the virtual world (Casares, Dickson, Hannigan, Hinton, & Phelps, 2013). This learning model should take advantage of technology in education such as e-learning (Arkorful & Abaidoo, 2015).
Teachers and educators really need to adapt to use this technology to get optimal benefits. By utilizing this technology, learning becomes limitless. Learning for students does not always occur in schools, because with technological facilities the reach is wider, beyond walls, dividers, and classrooms as well as learning time at school. In principle, learning can be done from anywhere, anytime and by anyone (Mudarwan, 2018). There are many ways that can be used in teaching by incorporating technology in the nursing department, for example the use of weblogs, wikispace, and LSM (Learning Management System) applications such as Google Classroom. In addition, modules are given to each unit by sending via WhatsApp application to the class leader a day before the class starts to make the students learn it and do some exercise in it. However, based on the observations and experiences of researchers, it was found that many students only downloaded and printed the module without reading or doing the exercises unless there is an instruction for it first. Therefore, many students have not studied the module and the researcher must explain the material and exercises in the module. This method does not effective at all.
Yahoo and Taylor Nelson Sofres (TNS) has done a research and found that the largest accesses in Indonesia are those age 15-19 years old (Agustifar & Suprihatini, 2013). These results indicate that students use more free time to access the internet and can be used to view online videos, read material, and do quizzes at home to help the learning process.
One of the methods introduced to students is the flipped classroom. Flipped classroom is a setting where teaching which is traditionally done in class is now done at home, and that which is traditionally done as home work is now completed in class (Hantla, 2014). In other words, flipped classroom is a reversal of conventional learning procedures, where what is usually done in class is done at home as homework or homework done in class (Prabaharan, 2014). That's why this strategy in called reverse classroom learning or flipped classroom. In the flipped classroom, the material is first given by uploading the material on a website (on a blog or social media such as YouTube) or Learning Management System Applications such as Google Classroom in the form of learning videos that must be downloaded or accessed online. Learning with flipped classroom refers more to student-centred because more activities are carried out by students. Referring to the International Society for Technology in Education (ISTE) Standard 2017, student-centred learning is successful if the creativity and effectiveness of using technology to support the learning process meet their learning needs (Fuller, 2020). Some previous studies have been discovered related to flipped classroom. A research finding found that the implementation of flipped classroom in teaching English in the Information Technology Department is not running according to the principle of the method itself (Asri, Widowati, & Roisatin, 2019). Students were accustomed to work independently on the assigned task because they think that assignments given were to be done at home, not in class. In flipped classroom method, assignment was supposed to be done in class, while at home they just learn about the materials.
In contrast to finding before, another result found that Flipped classroom makes the students' performance in the learning process of speaking English gets better in each cycles  (Kurnia & Lidyawaty, 2018). This research is about the flipped classroom strategy to improve speaking ability through students' minimovie project. The research consisted of two cycles.
Another previous study is about the application of the flipped classroom strategy with a scientific approach in Mathematics learning (Usmadi & Ergusni, 2019). The results of the research are the mathematics learning outcomes of students who apply learning with the flipped classroom strategy are better than those who do not. The motivation and interest of students towards learning by applying the flipped classroom strategy is high.
Based on book "Flip Your Classroom: Reach Every Student in Every Class Every Day (Bergmann & Sams, 2014) there are some advantages of Flipped Classroom as follows: 1. Flipped classroom can help students improve their abilities 2. Flipped classroom allows students to pause and rewind the teacher 3. Flipped classroom improves teacher-student interaction 4. Flipped classroom allows teachers to find out students' strengths 5. Flipped classroom improves interaction between fellow students 6. Flipped classroom allows all variations in the classroom 7. Flipped classroom changes the class management used 8. Flipped classroom changes the way we talk to parents 9. Flipped classroom educates parents 10. Flipped classroom makes the class more transparent and open 11. Flipped classroom is the best technique for teachers who can't attend class.
In addition, another result was flipped classroom also made students satisfied with student achievement, experiencing a significant increase in students' exam scores compared to previous semester when did not flip the classes (Graham, McLean, Read, Suchet-Pearson, & Viner, 2017;Johnson, 2015). Flipped Classroom offered a great deal to English language instruction and has received a positive reaction (Choe & Seong, 2016).
Another result finding also stated the disadvantages of flipped classroom. Students admitted that the application of this model was quite complicated and required more time for students to learn. They assumed that by applying the flipped classroom model, school time increases and reduces their free time. Students also were afraid that their learning results would be bad because of learning outcomes that they do not understand well (Wicaksono, AB, Krismiyati, Nikijuluw, 2015).
Based on the background above, this article aimed to implement the flipped classroom as an alternative strategy for teaching English for nursing students to overcome the lack of faceto face hours of this course and help students improve their English proficiency by utilizing technology, namely video and Google Classroom Application. This study aimed: 1. to determine the process of implementing a flipped classroom for English courses.

to identify and analyse students' perceptions of the implementation of the Flipped
Classroom in teaching English for the nursing students of Nursing Academy of Kesdam Iskandar Muda Banda Aceh.

Design
This research was a case study. Based on its objectives, this research was an exploratory case study because this research aimed to increase the researcher's insight in the field of English language teaching by combining technology in classroom teaching and learning activities and developing a theory about the application of Flipped Classroom (J. W. Creswell, Shope, Plano Clark, & Green, 2006;Setiyadi, 2006;Tellis, 1997). In addition, based on the data source, this research included a single case study in which the researcher obtained and analysed data from one class and examined only one aspect, namely the application of flipped classrooms in teaching English in that class. The technique used was a time series which aimed to see the development of a variable or phenomenon from time to time.

Participants
In this study, the subjects of the study were 50 students of the Academy of Nursing Kesdam Iskandar Muda Banda Aceh in the academic year 2020/2021. They consist of 4 male

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students and 46 female students. This was the purposive sampling based on the class which was consistently researcher taught the most. Their English level was intermediate in the context of EFL situation. They were enrolled at semester 3.

Instruments
The research instrument is a tool used to measure the natural and social phenomena observed (Sugiyono, 2016). In this study, researchers used 3 kinds of instruments that were used in the data collection materials, they are lecturer's observation checklist, teacher's fieldnote and questionnaires. Lecturer's observation checklist in the form of a checklist for implementing the flipped classroom strategy at each meeting. Lecturer's fieldnote is some notes that found while flipped classroom was implemented. The questionnaires were adapted from Johnson (Ogden, 2015) consisting of a total of 13 questions, mixed quantitative and qualitative.
Quantitative results were collected by asking students to respond to sixteen statements using 5-  (Widoyoko, 2016).

Data Collecting Technique
To collect the data, some research procedures of case study were done in implementing the flipped classroom in teaching English or nursing students of Nursing Academy of Kesdam Iskandar Muda Banda Aceh. It was begun from determining the research questions, determined the case, data collection technique, data analysis, prepared the research instruments, collected the data, evaluated, analysed data, and made conclusion and create reports and articles.

The research implementation stage entitled implementation of Flipped Classroom in
Teaching English for nursing students was carried out for 7 meetings, starting from week 1 The first week of this research (25 September 2020) began with an introduction to the course accompanied by a discussion of parts of the body. In addition, students were explained the Flipped Classroom method which will be applied for the next 7 meetings which aimed to facilitate learning English for nursing students. This was done by uploading a video as well as material to be discussed at each meeting to be seen, read, and understood by students before the class starts. Students were asked to do all the exercises in the class either individually, in pairs, or in groups.

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After creating a video, it uploaded to the Google Classroom application in www.classroom.google.com so that an account in required in Google Classroom. The researcher has created an account and created a class, namely the name of each class. In this case, it was class 2A. from the introduction of Google Classroom, many students were still confused about how to use their account and its features. The making of the first video was an introduction to the first topic Parts of Body which includes the names of parts of body as well as their functions. In addition, at the end of the video section, the assignments that students must do to work were described and discussed at the next meeting, Tuesday, 29 September 2020. Furthermore, the material in the form of PowerPoint slides about the topic also sent as supporting material to the Google Classroom account for all students in class to learn and read. This was also done to get students used to get online modules because this research was limited by time.
The next meeting (29 September 2020) began with a video discussion and ask about problems faced by students. Furthermore, students work on practice questions. However, almost all students have done the exercises at home individually. Meanwhile, several others were asked to do the task by discussing with the group if they had difficulty doing the task.
The making of the second video was carried out this week with the second topic "Medical Specialties", which was completed on 30 September 2020 and immediately uploaded to Google Classroom account. In addition, at the end of the video section, the tasks that students had to do and discussed at the next meeting are described. In this meeting, students were given pre-recorded video lectures about medical specialties about five to ten in length to watch before class in addition to a one-page reading from the topic. After the lecture, students were required to complete the task about medical specialties. The task about some cases of medical specialties were discussed in the next meeting on Friday, 02 October 2020. The task should be done in pair.
The third meeting (02 October 2020) began with some question related to last topic "medical equipment" and discussed about the task. After that, researcher and students discussed about the last video about "medical equipment". In this meeting found that some students did not watch the video so that they did not understand the topic discussed in the class. Then the researcher asked the students to read the material again and ask them to make some clipping related to medical equipment and submit it to the Google Classroom account.
Researcher also emphasized the importance of asking and discussing with group members and reminding students to reapply the Flipped Classroom method by reading posts about the procedures.
The fourth meeting (16 October 2020) began with watching video about "Patient od Admission". The researcher sent the video late so that the video should be watched in the class before class. After watching it, the researcher asked the students about what they had known and understood about the topic. They discussed it together. In the last meeting the researcher gave the assignment and asked them to send it in the Google Classroom account.
The researcher gave some options to students if they had difficulties in sending the task via Google Classroom. They can send it via email.

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The eighth meeting (20 January 2021) the researcher spread the questionnaires to all respondents who come at the day.

Data Analysis Technique
This study implemented a mixed-methods approach for data analysis. Mixed methods research is a research design with philosophical assumptions as well as methods of inquiry (J. .

a. Quantitative Analysis
To get data, the researchers did several ways; gave a questionnaire consisting of 13 questions related to implementation of Flipped Classroom in teaching English. Questionnaires are used to obtain results from student opinions and student experiences in Flipped Classroom.
The questionnaire uses the Likert Scale. Likert Scale is an agree-disagree or satisfieddissatisfied approach to measure opinions, attitudes, behaviours or opinions, or interviews in the form of a questionnaire in various forms; education, politics, economics and so on in the form of an opinion order (Boone & Boone, 2012). In addition to questionnaires, researchers also used observation list and fieldnote.

b. Qualitative Analysis
The qualitative question portion of the questionnaire consisted of 2 open-ended questions regarding students' perceptions of the application of flipped classrooms in teaching

English. Responses to the open-ended questions were accepted in both English and Bahasa
Indonesia to allow students express their thoughts comfortably. The questions were: (1) What are the advantages of the Flipped Classroom? (2) What are the disadvantages of the Flipped Classroom? Data was collected by administering a questionnaire via Google Form. Each student's response was coded into common themes. It was drawn from significant similar

Flipped Classroom Implementation
There are several obstacles encountered during the implementation of the Flipped classroom in the classroom. In the first stage, students have difficulty accessing and studying videos because of the internet network and quotas. they also have not been able to divide the time due to the many assignments from other courses. Furthermore, it was not running as the instruction or principle of Flipped classroom for the nursing students of Nursing Academy of Kesdam Iskandar Muda Banda Aceh. In this method, the teaching materials that had been uploaded to Google Classroom should be learned and read at home or outside the classroom.
While in class, students work on assignments by discussing with classmates and the teacher as a facilitator to observed and helped when needed. However, what happened during the implementation of flipped classroom was still like the situation in the classroom in general.
There were no differences between these two methods. Students were accustomed to work individually on the assigned tasks because they think that the assignments given were to be done at home, not in class.

b. Video Lessons
There were three items related to video lesson. They are item 4, 8, and 9 (Table 2).
Item 4 stated: I like watching lessons on video. The total of 28 students or 56% responded positively about the statement. While 22% neither agreed nor disagreed with the statement.
The last 22% responded negatively. Item 8 assessed whether they watched the video regularly. Surprisingly, a large majority of the class (52%) said that they did, 40% were neutral and a minority of the students (8%) did not do it. No one of them strongly disagreed with the statement. Item 9 stated: I would rather watch a traditional teacher led lesson than a video lesson. Besides all the result of statements above, students still prefer watching lessons lead by the lecturer in traditional class than video lessons. Almost all of them agree with the item (90%) while only 10% were neutral. No one of them disagree with the statement.  Based on the result, students love watching the video multiple times. It can help them to replay the video when they found something understandable till they got the point of the material. But they still love to study in traditional way by leading by the lecturer when learning process.

c. Time
Next, some items that assessed were about time. There are two items related to the time when studying by Flipped Classroom. They are item 6 and 7. Item 6 stated: I spend less time working on traditional English homework. More than half of students in the class (64%) either agreed or strongly agreed to this statement. 12% were neutral and 12% were

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disagreeing to the statement. Item 7 assessed whether Flipped Classroom gave them less time to practice English or not. A half of them (50%) responded positively, either agreeing or strongly agreeing. 32% were neutral and only 18% of students disagreed. No students strongly disagreed. Overall, most students agreed that time is one of aspects that important in learning.
By using flipped classroom, they can finish the homework faster than usual. But there were also students who felt that by implementing flipped classroom also took much time on finishing the task and practicing English.

d. English Mastery
The last part that assessed by lecturer was about students' perception on their mastery. There was item 5 which assessed about the flipped classroom has improved students learning of English. 62% responded positively either agree or strongly disagree, while 24% were neutral. The rest 18% were disagree or they had not.

Advantages of Flipped Classroom
The qualitative questions consisted of 2 open-ended questions. Students allowed to respond it in both English and Bahasa Indonesia. But all the students responded in Bahasa.

Discussion
The study is to determine the process of implementing a flipped classroom to English course and to identify students' perceptions of the implementation of the flipped classroom in teaching English for the nursing students of Kesdam Iskandar Muda Nursing Academy Banda Aceh. For that reason, it is need to compare between current findings and previous evidents. The style of teaching was new to students and made it difficult for them. From the data obtained from the research instruments, the implementation of the flipped classroom in teaching English for nursing students is not running according to the principle of method itself. It was in line with a previous study that the reality of flipped classroom application in class was different to the flipped classroom generally. In previous study, students finished all assignments at home. In fact, the did not have to did it at home because they just have to read and learn material (Asri et al., 2019). While assignments were should be done in the class. In this method, it is started that teaching materials are provided in the form of videos that are uploaded to Google Classroom application to be studied at home or outside the classroom. While in class, students did assignments with classmates and teacher as facilitator. But students did not do like instructions even though they have been instructed many times.
Students also believed that this Flipped classroom can be recommended to friends.
It gave them more opportunities to communicate with their friends in making some discussion related to the material given by the lecturer. The flipped classroom gave them greater motivation in learning English and can improved their English ability. Students also love watching the video multiple times. It can help them to replay the video when they found something understandable till they got the point of the material. But they still love to study in traditional way by leading by the lecturer when learning process. Furthermore, time is one of aspects that important in learning. By using flipped classroom, they can finish the homework faster than usual. It is in line with Usmadi (2019) and Kurnia (2018) who stated that the motivation and interest of students towards learning by applying the flipped classroom strategy is high.
The first theme that students responded more is about communication. Students argued that Flipped Classroom make the explanation of the lecturer can be listened well. The theory can be learned from the video and the discussion with friends can be happened mostly to discuss about the materials. So Flipped classroom encourages student to be more active by their own ways. The second theme is participation. This Flipped classroom encourage students to be more active in participating the class. They learned the material individually and try to search some supporting theory to the material. they can study everywhere. The third one is preparedness. Students felt more prepared when discussing the materials. They had learned the materials before class so that they can explore their opinion based on what they got and understood. Fourth, feedback. Students received more feedback because of flipped classroom. The feedback that they received such as improve their understanding in English. Their motivation in learning is also increasing. Feedback usually given by lecturer at the end of class. Students gave their opinion about learning and gave some review about their understanding. It was in line with the result that flipped classroom could be really helpful for many students (Choe & Seong, 2016). All of it were suitable with an effective EFL classroom.
Based on the responses of the students, it found that there were still many disadvantages of Flipped Classroom. Many of them said that the disadvantages come from the connection. For those who live in the remote area of village found some obstacles in connect the internet. The students also need more quota of the internet to be able to download and open the video also to browse some materials related to the topic. Some students noted that they were not used to this style of class and made them difficult to interact and understand the topic. Other responses were regarding focus. Some said that there was lack of direct communication with the lecturer. They also cannot interact with the lecturer directly so that it was hard to understand. They also had lack understanding in doing homework. It was in line with the result that something happened in class was a short discussion about things that are not understood in the material given (Wicaksono, AB, Krismiyati, Nikijuluw, 2015). Students assume by applying the flipped classroom model, school time increases and reduces their free time

CONCLUSION AND SUGGESTION
This study aims to determine the process of implementing a flipped classroom for English course and analyse students' perceptions of the implementation of the Flipped Classroom in teaching English for the nursing students of Nursing Academy of Kesdam Iskandar Muda Banda Aceh. Based on the results, the researchers have reached the subsequent conclusions.
The implementation of Flipped classroom has been done correctly in the classroom although the result was not as good as the expectation. Some students were denial of the researcher's instruction, but it was still running well.
Students' responses of the advantages of flipped classroom were analysed based on four key themes emerged. They are communication, participation, preparedness, and feedback.
Flipped classroom can encourage students to be autonomous learners, students have more flexible time to learn in campus or outside the campus. Students also can browse some material directly using internet. Most of the students enjoyed the flipped classroom learning and believed that this method can support their learning. Furthermore, the responses of disadvantages were analysed based on some key themes. They are connection, design, focus, time, and miscellaneous.
From those results, this study recommends the effective use of flipped classroom for the nursing students. However, it is suggested for the students to follow the lecturer's instruction well and do it as instruct. Meanwhile, for the lecturers who want to apply flipped classroom in their class, it is suggested to give more attention and interesting video to attract students so that they will not find some difficulties in understanding the lesson materials through flipped classroom. Finally, since the current study was conducted in a short time, it is hoped for other researchers to conduct related research better by allocating more time.

IMPLICATION
From the results of research on the implementation of flipped classroom in teaching English for nursing students, the suggestions that can be given are as follows. For educators. The flipped classroom presented in this study is just an example of how a flipped classroom can be implemented. Educator can continue to experiment with flipped classroom strategies to find their curricular needs. While for the management of the AKIMBA to be able to provide the good network in order to make educators and students able to use it in learning process as well as the use of higher technology in teaching learning process.
It is hoped that all elements in AKIMBA can apply these suggestions to improve the learning process in AKIMBA to be better in the future.

BIO-PROFILE
Juliana is a former head of English Laboratory and an English lecturer of Nursing Academy of Kesdam Iskandar Muda Banda Aceh. She received her master's degree from Syiah Kuala University (USK) in 2015. She specialized in teaching English for Specific Purposes (ESP).
She is a postgraduate student at Syiah Kuala University (USK) specializes in ELT program.