Increased Emotional Spiritual Quotient through Reflective Learning in Clinical Nursing Students at Syarif Hidayatullah State Islamic University

Introduction: Reflection is carried out in the realm of practice, the role of professionals, such as teaching and education. Reflection is also used in the health sector, especially nursing practice. Reflection is important in clinical learning for professional and students' intellectual development. The nursing program on nurses learning with the Competency-Based Curriculum at Syarif Hidayatullah State Islamic University, Jakarta has only begun from 12 th generation which is still running in hospitals with scientific and Islamic integration. Objective: The purpose and significance of this research is to determine the effect of Reflection on ESQ clinical nursing students of Syarif Hidayatullah State Islamic University, Jakarta. Methods : the research method used was a pre-experimental design. Respondents were 36 nursing students, with purposive sampling. Intervention used Gibbs’s reflective learning step and ESQ questionnaire The analysis data used t dependent test . Results: the results showed that there were significant differences in the ESQ of Nurse students before and after they were given reflective learning. Discussion: self-reflection learning as part of clinical nurse learning is able to develop student ESQ and is in line with the integration of science and Islam at UIN Syarif Hidayatullah. It is needed the sustainable development and monitoring of learning with reflective learning in nurses study programs for nurses students so that ESQ as a student soft skill can be optimally achieved to improve the quality of nurses' education in Syarif Hidayatullah State Islamic University, Jakarta.


INTRODUCTION
Reflection is carried out in the realm of practice, the role of professionals, such as teaching and education.Reflection is also used in the health sector, especially in nursing practice and the medical and clinical fields.Reflection is important in clinical learning for professional and students' intellectual development (Miguel, N & Tiago, 2016).Reflection is the ability to assess and enhance clinical actions and experience and enhance clinical knowledge.Reflection affects all levels of nursing students (Caldwell & Grobbel, G, 2013).When we reflect on the situation, we will not find something simple.There is a different thing that makes critical thinking.
Various studies on reflection have been carried out, including Bulman, Lathlean, & Gobbi (2012), who find reflection as the process of finding solutions inexperience.Reflection directs students to do their best and to learn from the experience, and evaluate themselves.Ip et al. (2012) added students stated understanding of clinical learning increased, motivating the expression of feelings.Rees (2012) also states that reflection helps find challenges while studying and helps nursing students understand themselves.
One of the reflection models is the Gibbs reflection cycle used to map critical reflection as one of the aspects in developing and demonstrating that reflection can help find sensitivity and empathy from certain aspects of a process (Gibbs, 2013).Gibbs' reflective cycle is a good framework to be used by the students in writing reflections upon literary works they are working on (Adeani, Febriani, & Syafryudin, 2020).Gibbs' reflection model is seen as quite comprehensive and helps humans develop their dimensional integrity.Although doubtful as a basic model, the Gibss model was chosen because it provided a cyclical framework in directing Reflection (Scott, 2013).Anantasari (2012) said that the Gibbs model could develop religiosity.Religiosity is a manifestation of a person's understanding, beliefs, and religious values in daily life.Emotional and spiritual intelligence is part of religiosity.Various studies have shown the meaning of emotional and spiritual intelligence with nurse performance between a positive and significant relationship between emotional maturity and religiosity with nurses' prosocial behavior at the Hospital (Haryati, 2013).
This was also added by Setiawan (2013) that there is a relationship between emotional and spiritual intelligence with the performance of nurses in Nur Hidayah Hospital Bantul Yogyakarta.Agustian (2013) building intelligence is a synergy of emotional quotient (EQ) and spiritual quotient (SQ).EQ means a relationship between humans and humans, while SQ is a human relationship with God.Merging between world rationality (EQ and IQ) and spiritual (SQ) so as to make comprehensive intelligence.To build emotional spiritual quotient (ESQ), there needs to be a method based on ihsan, the pillars of faith, and the pillars of Islam, such as a creed which function as a "mission statement", prayer that functions as "character building", fasting as "selfcontrolling", and zakat and pilgrimage that serves to increase "social intelligence" or social intelligence (Agustian, 2013).
The nursing Program of Syarif Hidayatullah State Islamic University, Jakarta, is an Islamic educational institution in nursing.Our Vision is Making The Nursing Study Program The Leading Study Program in Integrating Scientific, Islamic, and Indonesian Aspects.The Ners program's curriculum at UIN Syarif Hidayatullah Jakarta includes the application of Islamic nursing care in every stage of clinical nursing learning.The competence of clinical nurse students at UIN Syarif Hidayatullah Jakarta is in line with the vision and mission of the study program, one of which is applying spiritual care to patients and having Islamic morals.This competency will later be used in fulfilling the spiritual needs of the patient.Spiritual care, especially spiritual guidance, is able to contribute to patient healing by 20-25% (Wardah, Febrina, & Dewi, 2017).
Preliminary studies obtained from 10 students said that they still had difficulty in clinical learning even though they were accustomed to independent study and discussion during PBL that obtained while pursuing a bachelor's degree in nursing on campus.Reflection on learning has not been done optimally at Nursing Program, Syarif Hidayatullah State Islamic University, Jakarta.Reflection learning is done unstructured by analyzing the facts in the field and theories learned by students.Researchers are interested in conducting this research as an innovative learning in the Nursing Program of Syarif Hidayatullah State Islamic University, Jakarta, especially the Nursing program to improve student competencies on soft skills so as to provide holistic nursing services.This aims to determine the effect of reflection learning on the Emotional Spiritual Quotient (ESQ) of clinical nursing students at UIN Syarif Hidayatullah Jakarta.The absence of research on reflection on clinical nursing science and ESQ as well as the benefits of this research as a basis for developing the curriculum for the clinical nursing program at UIN Syarif Hidayatullah Jakarta, makes this research significant to do.

METHOD Research Design
The study design used quantitative by applying pre-experimental study.

Population and Sample
The sample used in this study was 36 respondents with purposive sampling with inclusion criteria: willing to be a respondent and be on the morning shift and was not currently sick when data collected.

Instrument
The research instrument on the treatment of reflective learning used the Gibbs model, which consists of 6 steps (description of the experience, feelings, and thoughts about the experience, evaluation of the experience, analysis to make sense of the situation, and conclusion.ESQ instruments are 23 statements adapted from Agustian (2013).The validity and reliability tests were carried out in the clinical nurse student UIN Syarif Hidayatullah, a total of 30 students other than the respondent with 23 statements in the ESQ questionnaire valid and a Cronbach alpha value of 0.823.

Research Procedure
The data collection stage, before the respondents were distributed ESQ questionnaire, then conducted reflective learning treatment for two days for 1 hour, and given the ESQ questionnaire again as a post-treatment.Data analysis used a t-dependent test to find out the differences in respondents' ESQ before and after reflection.Previously, the data was carried out normality test by the Kolmogorov test with normal data results.

Ethical Clearance
The research ethics test is submitted to the health research ethics committee with the results that the ethics test passes, and the research can be carried out (number: 137/KEPK-FIKesUINJKT/VII/2019).

RESULTS
1. Univariate Analysis Table 1 shows the majority of female nursing clinical students, Senior high school from Pesantren / MAN, although there is a slight difference from SMA and the majority do not participate in student organizations on campus.

Bivariate Analysis
Table 2 states that the average ESQ score of nurse students before being given a reflective learning intervention is 96.92 with 95% of CI 93,92 -99,91, the standard deviation is 8.85 with a minimum range of 78 and a maximum of 113.Meanwhile, the average ESQ score of Nurse Students after being given a reflective learning intervention is 99,56 with 95% of CI 96,87 -102,24, the standard deviation is 7.95 with a minimum range of 81 and a maximum of 115.Bivariate analysis in ESQ scores before and after the intervention by the paired t-test showed a significant difference in the mean (p-value 0,000 <α 0.05).

DISCUSSION
This research states that there was a significant increase in the ESQ Spiritual intelligence after reflective learning.Anantasari (2012) said that the reflective learning Gibbs model could develop religiosity.Steps in gibs include a description of the experience, feelings, and thoughts about the experience, evaluation of the experience, analysis to make sense of the situation, a conclusion in reflective learning helps students reflect on the learning process in interpreting themselves in life by interpreting through thoughts and feelings for learn to be a better self.This has to do with ESQ.Religiosity is a manifestation of a person's understanding, believes, and practices of religious values in daily life.Emotional and spiritual intelligence is part of religiosity.Spiritual intelligence (SQ) is the basis needed to effectively function our intellectual and emotional intelligence because spiritual intelligence is the highest intelligence (Hanafi, 2010).
Agustian ( 2013) building intelligence is a synergy of emotional quotient (EQ) and spiritual quotient (SQ).It is merging between world rationality (EQ and IQ) and spiritual (SQ) so as to make comprehensive intelligence.To build emotional spiritual quotient (ESQ), there needs to be a method based on Ihsan, the pillars of faith, and the pillars of Islam, such as a creed which functions as a "mission statement," prayer that functions as "character building", fasting as "selfcontrolling", and zakat and pilgrimage that serves to increase "social intelligence" or social intelligence.SQ is obtained from understanding and practice contained in Al-Qur'an (Asmaul Husna or 99 attributes of Allah SWT) is the source of all human conscience (self-conscience), a trait that often suddenly appears which is felt.It can be a prohibition, warning, or a desire or guidance and regret if someone misses it.Therefore, some of the values in Asmaul Husna are simplified into seven spiritual core values (ESQ basic values), which are held in high esteem as a form of human service to the nature of God, which lies at the center of the orbit (God Spot), namely honest, responsibility, fair, caring, visionary, discipline, and cooperation (Agustian, 2013).
There was a score increasing before and after ESQ students' reflective learning treatment, although it was not too significant.Nursing learning is field learning where students directly learn through actual practice to patients.This certainly makes students need to manage good self-control when communicating in providing nursing care to patients.Students of Syarif Hidayatullah State Islamic University, Jakarta have also used the nurses curriculum at UIN Syarif Hidayatullah Jakarta includes Islamic nursing care in every stage of clinical nursing and Competency-Based Curriculum in previous academic learning using the PBL method in which students learn with cases that require active and critical thinking to find learning resources.Most of the students in table 1 show that respondents were educated from the pesantren.This allows students to have a spiritual experience that builds ESQ.Agustian (2013) stated that one of the factors that influence ESQ is education; other factors include emotional training and psychological factors.
Reflection is an active, careful consideration of a belief or any form of belief to solve a problem.Reflective individual character is having an open mind, a willingness to accept responsibility for personal views, courage to face fear, and uncertainty and enthusiasm.Various studies on reflection have been carried out, including Bulman, Lathlean, & Gobbi (2012), who found reflection learning as a process of finding solutions in experience, reflection directs students to move on and do their best to learn from experience and evaluate themselves.Ip et al. (2012) added that students' understanding of clinical learning increased, motivating the expression of feelings.Rees (2012) also states that reflection helps find challenges while studying and helps nursing students understand themselves.
Emotional Spiritual Quotient (ESQ), or Indonesian terms, is often referred to as emotional and spiritual intelligence.ESQ consists of two aspects, namely emotional intelligence and spiritual intelligence.Psychologists agree that IQ has a role in contributing about 20% of factors to influence one's success, while the remaining 80% comes from other factors, including emotional intelligence factors (Goleman, 2015).Someone with emotional intelligence or emotional quotient (EQ) will have the ability to control themselves, to motivate themselves, and survive from the frustration and will have the ability to regulate his mood.Goleman (2015) states that individuals who can manage their emotions will help them success in the future.Emotional intelligence in nursing such as self-awareness, self-management, social awareness, and social/relationship management.These attributes facilitate the emotional well-being of advanced practice nurses and enhance the ability to practice in a way that will benefit patients, families, colleagues, and advanced practice nurses as working professionals and as individuals (Raghubir, 2018).
Gibbs's reflection model can develop religiosity.The first step in the Gibss model is a selfdescription which is able to develop student religion, namely awareness of the meaning of life development through relationships with Allah, others, and nature.in stage 2, namely thoughts and feelings will be able to help students foster self-awareness (thoughts and feelings) that lead to a better person.The next step is analysis, which helps students examine the meaning and experience and analyzes alternative actions based on values, held beliefs that foster renewal and dynamic life development.The fourth step is evaluation, in which students learn whether the actions taken are able to benefit themselves and others and be accountable to Allah.The fifth step, namely synthesis, helps students find the text or lessons learned from their experience.Steps in Gibss reflection help students learn about meta-cognition and relating to Allah as the creator of the experience of providing nursing care to patients (Anantasari, 2012).
Religiosity is a manifestation of a person's understanding, belief, and practice of religious values in daily life.Emotional and spiritual intelligence is part of religiosity.Various studies have shown the influence of emotional and spiritual intelligence on religiosity.Agustian (2013) building intelligence is a synergy of emotional quotient (EQ) and spiritual quotient (SQ).It merges between world rationality (EQ and IQ) and spiritual (SQ) to make comprehensive intelligence.To build emotional, spiritual quotient (ESQ), there needs to be a method based on ihsan, the pillars of faith, and the pillars of Islam, such as a creed which functions as a "mission statement", prayer that functions as "character building", fasting as "self-controlling", and zakat and pilgrimage that serves to increase "social intelligence" or social intelligence.
Several studies have shown that reflection learning has an effect on ESQ.Reflection has an effect on the spiritual well-being of students, which is part of ESQ.A significant difference was found between the two groups' means in spiritual well-being scores after the intervention compared to before that.Likewise, a significant difference was observed in the intervention group students' total scores of attitudes before and after the intervention.Reflective learning at the time of the intervention was carried out in groups.A significant difference was found between the two groups' means in spiritual well-being scores after the intervention compared to before that.Likewise, a significant difference was observed in the intervention group students' total scores of attitude before and after the intervention at Nursing student in Iran (Momennasab, Shadfard, Jaberi, Najaf, & Hosseini, 2019).(Por, L., Fitzpatrick, & Roberts (2011) add that emotional intelligence strongly influences learning achievement in academic aspects, personality, and self-esteem.The findings also showed that there was a strong positive relationship between EQ and SQ with SO students.Both of these variables are able to predict 56.70% of the student's outcomes.The implication of this study will hopefully reinforce the teaching and learning theory and practice to help improve students' outcomes by applying the EQ and SQ elements (Rayung & Ambotang, 2018).
Factors that influence caring for nursing students include spiritual intelligence and emotional intelligence (Sukartini, Asmoro, & Pradana, 2019).Nursing students involve interpersonal relationships with patients and students, and a greater understanding needs to be given to emotions that arise in such relationships with the patients at clinical learning (Leonard., 2017).Gorji, Darabina, & M (2017) find that a significant correlation was found between emotional and spiritual intelligence students' emotional intelligence can be fostered by reinforcing their spiritual intelligence, and correct behaviors can be promoted in accordance with social values.Agustian (2013) states that the steps in building ESQ include the first steps to clear up emotions so that the birth of a clear and holy subconscious is expected, or the conscience that lies in the God spot so that individual is free from liver diseases that harm mental and physical thoughts such as envy, prejudice, envy, and sedition.The next step is mental development which is applied by the six pillars of faith.Personal toughness as the next step is applied in a clear vision, character building, and self-control.The final step in building ESQ is social resilience which in Islam is carried out by alms.
Reflective learning is not easy to implement because it requires all aspects, starting from the curriculum, tutors, and students themselves.However, remembering that reflection learning is appropriate during clinical nursing learning where students learn skills, self-awareness, analysis, meaning that can increase ESQ so that the vision and mission for Islamic nurses and the integration of Islam and integration of Islam and nursing are in line with science can be achieved.Added by previous research, the need for student reflective learning habituation in every professional clinical learning requires the participation of teachers (Leonard., 2017;Pamungkasari, Kumara, & Armis, Emilia, 2017).

CONCLUSIONS
The results showed that there were significant differences in the ESQ of Nurse students before and after they were given reflective learning (p-value <0.005).The results showed that there were significant differences in the ESQ of Nurse students before and after they were given reflective learning treatment (p-value <0.005).There was a significant increase in ESQ scores with an average increase of 2.64.It is needed sustainable development and monitoring of learning by reflective learning in nurse's study programs for nurses students so that ESQ as a student's soft skill can be optimally achieved to improve the quality of nurses' education in Syarif Hidayatullah State Islamic University, Jakarta.Further research can be done by quasi-experiment with control or the relationship of reflective learning by caring nurses as a component of ESQ or with qualitative methods.