Demographic questions and confirmation of consent
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TA: Okay, first of all, I wonder if you could just tell me about how or why you were directed to use the e-Learning for Health portal in the first place.

P1: Well, I decided when the COVID pandemic started that I would volunteer to be a vaccinator. But because I've been a nurse academic for quite some time and not in clinical practice, I obviously had to update myself and anyway, you had to do all the vaccination training and stuff. Apart from basic vaccination training, there was all the background e-Learning for Health around safeguarding and infection control, for example. So, I did all that as well. I'd not had any experience of it, apart from as an [academic role], where you're asking your students to do it, and you're just looking to see if they've done it. So, it is quite an insight to see the extent of it actually. It's simple in many ways, but it's actually quite lengthy, too.

TA: Thank you. So, I want to go on to a very broad question, which is just to ask you to tell me a bit about your experiences of using the e-Learning for Health portal, so building on that fact that you said it was simple but lengthy perhaps. 

P1: There's, there's several aspects of it (hand gestures indicate width/breadth) I would say. One is the technical aspect, by which I mean getting into it, and actually using it and using it so that it logs your learning etc., etc. I found that really frustrating, but I don't think it was necessarily a problem with e-Learning for Health, rather a problem with the people that were hosting it. Their IT systems, in this case [Trust name] and I think to be fair to them, they had huge number of people interested in becoming vaccinators. They had a lot of people to process over a very short period of time, and we also had a health crisis going on. So I'm not sort of blaming anybody, I'm just saying it was really annoying. I started the process in the January and I don't think it really all got through till end of March really. So that was a bit irritating, and then the actual use of it. Sometimes, if you didn't press the right button in the right order, it didn't save it, and then you'd have a whole mess to sort of manage, because you you have to show that you've done certain things in order to move on to the next thing. So, that is temporary because you then learn it and get over it. I mean the actual way of trying to get education to an awful lot of people quickly, and for that education to be consistent is a really good thing. I think that is a really good thing. Obviously that’s the upside of it. The downside of it is it is limited in terms of interaction, question asking, that kind of thing. It's just not there, really. It's very much a knowledge delivery platform. The knowledge, obviously they're assuming, a certain level that you’re at, at the beginning, and then they take you through your objectives. Your objectives are very clear. You go through those. So, if you're a bit ahead of that, or you a bit behind that, then, that's. I don't think the platforms’ really flexible enough to cope with that. But I imagine, if it hadn't been a pandemic, that there would have also been an opportunity for some face-to-face stuff as well as the e-learning platform. I don't know, but I think the combination in my mind, particularly speaking as an educator, would be good, the opportunity to just clarify a few things, perhaps.

TA: Okay, thank you. So, you talked about the consistency. I wonder if you could just say a little bit more about your experience of that.

P1: Yeah. By consistency, I'm meaning that obviously some central objectives were agreed and I'm imagining it's a national programme, that's agreed at a national level and therefore the objectives are agreedand then it's rolled out. That to me would mean that it's therefore consistent in its of what they're aiming to do, and what exactly they deliver. How it's received at the other end is obviously maybe not so consistent, because I know from talking to other people that they sometimes guess the answer, or quickly just shove their way through page after page after page because, and a lot of these things you had, it was like annual update. Even I had to do annual update, even though I was only there for a short time, doing it for a couple of years. And you know it's the same stuff, so you can see why people that are busy don't maybe go through it all. I’m a bit kind of if it's there I've got to read it, and I've got to make sure that I've done it all properly. That's just how I am, but I can see that it's open to maybe abuse in that respect. So that's what I mean, consistent in terms of what they're trying to deliver, but I don't think you can guarantee consistency in how it's received. But let's face it, what education can you guarantee is consistent in the way it's received? You just can't do that. I suppose the added advantage you have maybe with face to face is that you’ve got a bit of non verbals and you can do on the spot questioning and all that sort of stuff. But the reality is there was a lot, there's an awful lot of people to get through an awful lot of information. And there’s opportunities I think. I don't know much about the total platform but I imagine that it has its lowest level, and then it can build up and is used in lots of different ways, I would imagine. I suppose the downside I’d say of e-Learning for Health is it might, because of its ease of delivery from the provider's point of view, the education provider's point of view, I think there's maybe a temptation to put too much out there, on the grounds that it's really important they know this, and they know that and the next thing. We've got to show that they know this, that and the next thing, so we're putting it on the e-Learning for Health platform and they've all got to do it mandatorily. I'm not sure that actually does deliver in reality.

TA: Yeah. Because you refer to people maybe flicking through the pages and things like that as well, I don't know. Can you tell me any more about that? What you felt about that for, instance?

P1: Well, obviously ethically you say well they shouldn’t do that, but I could kind of see sometimes why they did do that. And then it isn't just e-Learning for Health. People have told me that on the IT stuff that we have to do for [university name], you know, I’m not going through all of that. I only have to get 70% right, okay, I'll just do this, kind of thing. I mean it's people who are bright, they're on the ball. They make good guesses and there you go really. But I think that's just a fact of life. Would somebody sat in the classroom listen to a 100% to every single word that’s said? I don't know that they would really. It's just an interesting thing because for me e-learning is a much later thing in terms of my educational knowledge and experience. I guess people will find their way around things they really want to, but that's not to say that I mean for me. When I first started, I should say, doing the vaccination programme, I was quite, anxious is over-describing it, but I was a little bit worried. I thought well crikey, I've not done this for ages you know, am I going to be able to do it? And you know it's all changed such a lot and everything like that. So, for me I absolutely love the fact that I had the vaccination type stuff there for me to go through at the pace that I wanted to go through it. And then I felt much more confident because I realised that I actually knew far more than I thought I knew, that all that learning from years ago was still there, but obviously was needing to be updated. So, as time went on, rather than being absolutely fixated on every single detail, I’d think I know that so I'm going to go on to this bit, which I don't know. For example, we had to do all the flu vaccination stuff as well, which I hadn't done anything on, didn't know anything about flu vaccines, and so all of that I did go through in a lot of detail. But, other stuff I would think well, ethical things and equality and stuff like that I know that, at a very high level, so I didn't need to go into it in quite the same depth. 

TA: Yeah. Thank you. Did you find they were relevant then for what you were doing?

P1: Now, is there any that I thought were irrelevant? The only really irrelevant ones, well I found them irrelevant anyway, were in doing the flu vaccine stuff. You had to do all the vaccine programme. You had to do all of the e-learning for vaccines, so therefore, it was MMR and I can’t remember the name of them, but there were quite a number of other ones, diphtheria, or something like that. Yeah, I had to do about 4 or 5 different other vaccines that I'm never going to give, I never was intending to give and it just seemed absolutely ridiculous and that annoyed me. But I tried to circumvent it in the way I'm trying to describe to you that other people do. I couldn't. I just couldn't do it. I had to plod my way through. I had to get my 10 out of 10 or whatever it was and in the end I just thought, oh well, it is quite interesting. I suppose I have got grandchildren so it is interesting to know what diphtheria is, but then I'm in the position where I can find things interesting, whereas somebody who’s you know really busy and in a full time job. I’m busy, but I’m not in a full time job. You know that that's probably going to be really annoying but it just seemed in the end you just think oh, well get on with it, and then it's done.

TA: Yeah. Thank you. You just referred there to sort of the time commitment. I wonder if you could just say any more about that at all.

P1: Yeah. I must admit I found that quite something to get my head around initially, because I’m from the era where in the NHS you were provided with free training. You were usually given time to do that training, usually because it was like a study day or something. And that seems to have completely, almost gone, and we're now in the situation where we've got these e-learning programmes. You're expected to do them in order to do your job, and in fact things are put in your in your way to not do the job if you don't do it, so you have to have done them, but you have to do them in your own time. I did find that really quite something to get my head around because it was quite a lot of time. But, especially when I'm just thinking latterly we moved from just giving the COVID vaccine to adults to giving it to children. That involved a whole huge bunch of more e-learning because you had to do a lot of stuff around safeguarding. In the basic programme I think you had to do safeguarding level one and two, but when you started to give vaccines to children you had to do level three, and that was quite a big programme. It was really interesting, but it was a lot to do. So, I thought, well crikey, this is a lot. It's a lot. I remember saying to someone at work, you know have you done all this, and if there was any time there was no nobody there having vaccines you were allowed to do the e-learning then. But then somebody said to me, oh no, you just do it and then you can claim your time back. You can say I've spent 5 hours on this or whatever and you get the time back, but I never knew that. A lot of people didn't know that, and it was something that was not publicised at all, deliberately or not deliberately I don't know, but generally speaking, you had to do it in your own time.

TA: So, did, did you actually manage to claim back then?

P1: I can't remember. I think I did. I mean working as a bank nurse, which is what I was, the system was a little bit complicated until you knew what to do, and then it was all right, and I think I did.

TA: Okay. Thank you. You talked earlier about the human contact element and the face to face and the questioning. I just wonder if you could say any more about that.

P1: Well, what I feel, and it's probably, I mean I can't park the fact that I'm a [academic role]. Sometimes, when we're looking at some elements of e-learning, like there was a quite a big one you had to do on equality and diversity or something like that. I think that was part of the safeguarding, and there were these great big concepts that we were talking about. And I was thinking, well there’s a bit more to it than that, having delivered some of this before. But was that because I just thought, well I know more about this and I can see that there is maybe a wider argument to talk about here, or was it because I really needed to know any more. That's the issue, isn't it, because it never claimed to be at degree level, master’s level or anything. They just claim to be giving you, I don't know what level it does claim to be at. I would have thought it was only level four I suppose, I guess. Anyway, so it was only a basic knowledge level shall we say. So, getting back to your question, there would have been a situation where you thought well that would have been interesting to talk about, you know. There was another one on learning disability and things like that. There were quite a few, quite meaty stuff really, that you just went through, this is it basically. I suppose it fulfilled the need at one level, but there was a lot more potential to do other things. I suppose if you're thinking well, what would be the point of talking about it, or discussing it or asking questions, well, I think it would be around applying the knowledge. It's about applying the knowledge in context, and that's more tricky to do on an online platform, maybe. Although they did provide some quite useful case studies as you went along in various different places, and I think they were very good, particularly when they were talking about legal stuff and accountability. It was more about legal, and it talked about different case studies and I thought that was pretty good. So, generally speaking, I would say that the e-learning package had many pluses to it, but it's just I also feel personally that it's limited too. I suppose I'm getting back down to what I said earlier really is that a lot depends on how the individual engages with it, and if you have somebody who's very motivated. I'm a very motivated person. I'm not going to not do something well because that's my way I am. But if you're not that motivated, or you haven't got a time, or you can't prioritise it or whatever, and you're able to get through without doing that, then you have to wonder how good is it. So, it's what happens after the e-learning packages. Is there any follow up? And I don't know about that because I wasn't a sort of proper employee, apart from on the bank.

TA: Yeah. Thank you. I just wonder did you talk about any of the learning with other people that you knew had also done the learning or anything like that?

P1: When the child vaccination thing came in that caused quite a bit of debate I think, because many of the people who were vaccinating were people who had either had a career break, or had retired, come back, or they weren't kind of. There were some people that had other jobs, but quite a few people didn't, and of that number the vast majority were adult nurses, definitely not children's nurses. Sometimes you had the army. I remember I worked with a podiatrist as well, or something like that, and a dietitian, so I suppose they do general work around children too. But that was what the debate was, should we, as adult nurses, be giving vaccinations to children, having not done much on child health. I didn't have a children's nursing qualification. I had a SRN qualification, State Registered Nurse, so I had some experience of children apart from also having children. So, there was a bit of a debate about that, and whether the e-learning could really provide everything that you needed, because obviously the e-learning talked about what were the sites that you used? What were the indicators? A little bit about maybe how you could manage a child who was anxious and that kind of thing. So what happened is they used to have a little kind of, when time allowed, a kind of briefing at the beginning, and if they did have time, a briefing at the end of the shift. In that time the lead nurse, who was a band seven, or eight, sometimes talked about some issues, and that was some of the issues around vaccinating children, and in particular the major thing was, around safeguarding. Because what they found, I worked at the vaccination centre. I worked in three places, [xx hospital], [xxx], and then, [xxx xxx]. And it, at [xxx xxx] was when we started doing children and they picked up quite a few safeguarding issues when they started to do that. Children who were maybe coming on their own, or distressed, and not being allowed to speak, and that kind of thing, and then picking up what was the actual background, and who was it that had brought them and that kind of thing. And that was really quite tricky stuff, because if they were with, and we had occasionally with adults as well, particularly adults who didn't have English as their first language and had been brought there by somebody who was speaking for them, that was also quite tricky. And maybe it wasn't talked about quite as much as it needed to do in the e-learning, but it certainly was talked about on the ground, and we picked up issues from the e-learning. Yeah, they picked up quite a few people who were vulnerable. But it could be tricky because you might be in a situation where it became a confrontation, because you were asking things that this person who brought the person didn't want you to ask. Just say, no. Come on, give it, you know she's fine. She's fine, give it, kind of thing and you're sort of trying to buy a bit of time while you're getting somebody else to come along and help you. So, you could say that the e-learning was utilised in that respect, because particularly with the children's safeguarding, I can remember the band eight saying don't forget the bit about X. You can always go back and look at that. So that's the only example I can actually think of where the e-learning was literally was mentioned in terms of the actual practice and in practice.

TA: Okay. Thank you. I just wonder if you wanted to say any more about the technology and the, the irritation stuff?

P1: Yeah. I do wonder, you know how it is Tanya, how much is it that you think well, it's just me being stupid or how much is it that the actual technology isn't any good. Because you were doing the online learning generally not in the workplace but on your own computer at home, then you are reliant on that. We had moved house, out of a town into a very small village with Internet which was pretty rubbish, so that was frustrating because you'd be waiting sometimes, something crashed. Sometimes the things wouldn't open, and all the rest of it. That was annoying. I suppose there probably would have been a backup thing where I could have gone somewhere and done it, but in the end you just sort of battle through, don't you, really. I guess the overall infrastructure is getting better. We've got fibre now and it's absolutely fantastic, so, you know, that's just how the situation’s changing. The way the actual e-learning programmes worked you know, press the button for the next bit, that all seemed to sort of be okay. It was sometimes very text heavy, so not that interesting. But every so often you'd have a bit of a video or a case study, and that made a bit more interesting. The assessment thing sometimes didn't work. Sometimes you'd get to the point where you'd have filled in the assessment and then it hadn't picked up the fact you'd filled it in, so you had to remember what you've done and go back and do it again. I didn't have to reread it. I just remembered what I'd said before, but that was sometimes a problem. A major thing with the technology was really much more to do with how it was processed by the IT people. For example, I had several things where I'd done something and then it didn't record that I'd done it, and then I would have to get a hold of the team in IT. They were always really busy so it was sometimes quite a while before things got sorted, and it had to be sorted because I couldn't do the next thing unless I got it recorded that I'd done this thing. 

TA: Okay. I suppose just the other final thing that I was quite interested in was like that I, I would call it stick and carrot. Can you say any more about that kind of feeling controlled?

P1: Yeah. It's a tricky one isn't it, in education, because obviously you know people need to do something. There's obviously the overall principle that you've got to know what you're doing in order to practice safely, which, you know in an ideal world, that should be fine. We all do it, but I suppose the problem is that for the organisation that is employing you, they need to know that you've done that. They're not going to maybe take your word for it. They need to have it like on a bit of paper they can tick off, oh (P1), she’s done that. So, I can see that. But that adds an element, which is absolutely understandable from an accountability in a processing point of view, but there is an element that therefore turns e-Learning for Health, or maybe any e-learning into a more mechanistic thing. So, rather than education being enjoyable and opening your eyes to new things and all that, it got to the point with so much of it that you just really were right, on to the next box, next box, next box, and that's very mechanistic. What do you do about that? I don't know, really, because you can see people need to read something but reading doesn't mean they've taken in. It is tricky. I can't see it going away because I can see that from a litigation point of view they will always want to know that somebody has done something, that they've done their bit to expose you to that information. You’ve said you've done it, so if you then go on, and I don't know, kill somebody or something, then they can, do you know what I mean? I'm being dramatic, but I guess there is an element of that isn't there?

TA: Yeah. because it links to our professional accountability doesn't it as well?

P1: Yeah, and how much you’re then allowing for that, you know how much are we able to say as an accountable practitioner, I'm telling you I have done that. That, I just don't believe these days that would be taken. 

TA: Yeah. Okay. So the final question then, is there anything else you wish to tell me about your experiences of using the e-learning?

P1: On the plus side, I would say it was a great way that somebody like me, who had been out of things, could get in quickly, access knowledge and get into what I needed to do, and do it at my pace. I think that was a big, positive. On the downside, I would say it had an element of monotony about it, because it was so much of the same sort of thing really, going forward. But, in that there were some gems like, for example, in the safeguarding for the children. In the level three one there was some really interesting stuff that I'd never come across before, and really made me think. It really did make me think, so it’s got its pluses, but there was also some really, really monotonous stuff around infection control and things like that. But how important is infection? Infection control is so important, that's the thing. It's absolutely vital. Nobody can say it's not vital and I suppose over time, maybe we'll get better at, at delivering things like e-learning. I’m doing an e-learning programme at the moment. It's about autism, because, potentially one of my grandchildren's autistic, so I'm trying to find out about it. This is quite a modern programme. It's done by a college and it's really a little bit different. It's a little bit more interactive, and so maybe as time goes on things will get better. The e-Learning for Health was my first real big bite at having to do e-learning, engaging with it. It is a little bit different. It’s got more visuals in it. I mean it's still basically I suppose a PowerPoint in the end, but there are more pictures in there and more kind of little sub-menus then come up with links to take you through to stuff, sometimes videos that kind of thing. The case study is quite rich in terms of case studies, and for something like autism that's really good because it's such a spectrum, and I don't know really very much about it at all. It's giving you a bit of insight into that spectrum, but the links through are good. It's weighty. I have to say there's an awful lot to it, but I guess it's not just click through, it's click and see this basic information. Here's some additional information for you to look at, if you want to look at it. So it gives you options. If you're thinking of your stick and carrot scenario, I suppose you could say the stick is that I've signed up for it, so therefore I've got to get through it, but the carrot is that I've got extra things that I can look at that are particularly pertinent to my situation should I wish to do that. That gives it a little bit of an edge. Yeah.

TA: Are you prepared or able to say a little bit more about that autism e-learning that you're doing? You said it's more interactive? Is there any other interaction than watching the different things? 

P1: The main way it's interactive is it has these stop and think pages, and sometimes there, the scenario is there, you’re stopped and asked a question. You put in an answer and then it will tell you if it's right or not, then give a little bit more information. Sometimes it's just what do you think about this? For example, should society tolerate diversity more, or something like that? It'll ask you to think about some various points and then give you some links to go through to, to boost your argument, should you wish to do that, if you're not able to do it out of your head, and that seemed different to me. I don't know if it is different, but it just did seem it.

TA: Yeah. Is there any engagement with any other people, within it?

P1: Yeah, there is. I haven't done it because I’m behind on the assignment. But yeah, there's a group, you can get together. It's only a small group and they're doing the unit at the same time, and there's an asynchronous forum for you to chat to each other. I understand that later in the programme there is a synchronous one as well. Now, that's when I suppose you are marrying up a kind of face to face with a bit of e-learning, and people are accessing this from all over the country, so, you know that's a way to go, isn’t it.

TA: Yeah. Thank you.


