Demographic questions and confirmation of consent.
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TA: Okay, thank you very much. So just sort of as a starter for context, I wonder what term you would use to describe Internet based learning for CPD, continuous professional development?

P5: Oh, how I’d describe, how, yeah, how succinct do you want me?  

TA:  Well just, just so, would you, for instance, use e-learning broadly?

P5:  Yes.

TA:  Or would you call it Internet based learning, or have you actually heard of the term open education resources, which is the language I’m using in my PhD?

P5: Yeah, no I haven't heard that term, but I’m very familiar with e-learning, and that platform.

TA: Okay, so that's the kind of language I’ll use then, throughout the interview, just to make it more relevant.  Open education resources really refers to little pockets of learning, so it might be a YouTube video, it might be a massive open online course. It might be a module in e-Learning for Health, or NHS professionals or something like that. So that's the kind of thing that I’m, sort of focusing on, in terms of e-learning. So, my first question then is, thinking about e-learning that you’ve used, can you tell me about why you were directed to use that learning in the first place?
P5: So, two-fold.  One, I’ve been use it.  Actually no, there are three avenues to it.  One is so I’m aware of what my students are having to produce, so that they can access placement. So, I've accessed that from an overview point of view, to see what my students are doing, and what they’re required to do.

TA:  Yep.

P5: I have also accessed them as part of my [academic] role, to some of the modules I've had to complete to be competent for my [academic] role, and then the other part is where I’m in clinical practice, so I've had to do it as a registered nurse as well, and complete all the, all the training that's required as well, so I’m competent to perform my role as a clinical professional.

TA: Okay, all right. Thank you very much. And so then thinking about, again, that e-learning that you’ve specifically used. Can you tell me about how you approached getting them done, how you approach completing them, or working through them? Have you got a specific approach that you use?

P5: I have. Well, you're given a deadline for some of them, which kind of helps you focus when you need to complete by.  In all honesty I had to spread it out and dedicate time where I could just sit and go through them, so I would spread it out over a few weeks or so, in the evenings, I would have to sit and do them.

TA: Okay. So, do you want to tell me a bit more about, once you were a, once you opened it up, the learning, and you had to work through it. How might, how did you work through it?

P5: Methodically, I guess, and they, it doesn't let you progress into certain bits until you've watched the full length video.  I think it's cottoned on some people skip, skip, skip, skip skip.  I think, in all honesty, when I first started, so, the first module I start quite bright eyed and bushy tailed, it’s just like yes, okay, let me refresh my knowledge. And then by the time you get to number 3 or 4, they're very similar, so I find actually what's actually going in becomes less. It can come, turn into more of a tick box exercise of this is what I need to complete, rather than generally focusing on - so what's the content here, and how do I meet what I need to refresh here, so I’m competent. That kind of dissipates I think, because especially when you're. So, recently, actually a few weeks ago I had to do them, and where I haven't been in clinical practice where I've been [academic role] for a while, I think I had something about 35 to complete. And it did test me, in the end. So, I guess it depends if, when I have time to do them, it's fine. But when I’m trying to fit them around all the other commitments and you're kind of given, this is what you must do, but not necessarily given the time that they require to be completed to the full capacity.  They can become a bit arduous, so, in order to approach them I think the first few I’m fine with, and then as the week goes on I lose that kind of approach to it.

TA: Yeah.  Okay, thank you. So, you've mentioned time a couple of times and working in the evenings, for instance and everything else. So, what, what do you feel about having to do this kind of work in the evenings, or trying to fit it around your other work?

P5: It's challenging. And I think where there's a lot of emphasis is.  There's a lot of emphasis put on completing these modules, especially in clinical practice. It's a big tick for your employer, that you're then competent.  But I think it depends what sector you're in as well, and who the manager is, or the time that they afford their employees to do it. So, for example, I’m enrolling on to the bank to kind of do my clinical practice around my [academic] role. I’m asked to complete the mandatory training, which I’m aware I need to do, but that's not incorporated into my role.  I have to fit that in in my spare time so it can change the way you look at it. And yes it is something that I’m kind of expected to do, above my actual paid role, as it were.

TA: Yeah, and how does that make you feel?

P5: It changes. I guess initially, there's when you compare the expectations compared to other industries, where you would perhaps have, a few weeks as induction, where you're paid and you're given that time to become competent in every kind of aspect they need you, to give you that base knowledge. I think there is, in nursing, it's definitely you're not afforded that time, so it can make you slightly resentful about it and make task, because they're not necessarily easy. They are time consuming. So, it can make a feeling of resentment, or general procrastination, and not wanting to do it and you put it off to the last minute, and then you try and squeeze them in, which then I guess, in time, then makes me personally think ‘oh, what if I’ve missed something’? And then I’m signing off saying, yes, I've done it all, and I've got a nice certificate at the end. But what does that really mean? 

TA:   Oh we like nice certificates don’t we, in nursing!  Okay. So, again, you've talked a bit about how that learning is allocated to you by somebody, and there's a lot of it. 35 modules is a lot. So, can you tell me your feelings about the relevance of all the learning that you're allocated?

P5: Oh, yeah, it's important, absolutely without a shadow of the doubt. And it was some that I found really good for my role at minute were the ones that are specific to my field. So, [clinical skill] and refreshing my knowledge of the procedure of the [clinical procedure]. So, it was really nice, those ones to be able to refresh and it kind of slips into categories. There are those ones like manual handling, which you know is very important, because you don't want to hurt yourself, but it's one that's repeated all the time. That doesn't really change, and then you are tested on the legislation but I couldn’t tell you now all the dates, even though you have to pass that to be able to get your certificate. So, the ones that are specific to my field I find interesting and helpful as a refresher. And then there's some that you need to do continually which I understand the relevance of. They're all important. Don't get me wrong. They're necessary, definitely, especially your safeguarding ones, and your Prevent ones.  They’re all necessary to do.

TA: Okay. Thank you. So, you've said a little bit about doing them in the evenings, but can you tell me where you do your learning, whereabouts you might do your learning?

P5: And so, again, it again depends.  Sometimes, well initially, I will start by sitting at my desk and do it, going through them very methodically, perhaps taking notes, and then as the week’s gone on, that did dwindle and I ended up doing them on the sofa with a nice cup of tea to kind of make myself do them more, to fit them around, so I could kind of do it while I was relaxing as well, rather than sitting at my desk until 9'clock at night. So yeah, my environment changed depending on the capacity and the time I had, basically.

TA: Yeah. So that was always at home?

P5: Yes, always at home. I haven’t done them in the office. 

TA:  Not ever? 

P5: No.

TA:  Can you tell me a bit more about that. Why, that might be?

P5: Yeah. Well, I haven't.  So, I find personally if I’m going to concentrate on them and listen to all the videos, and be able to stop things and answer the questions, I need a kind of quiet environment, where I’m not going to be disturbed. Either as a nurse, your access to the computer is in the middle of an office where you have lots of different people coming in, including your service users, so, you're very frequently interrupted, and it ends up taking you ages. For example, you've got an hour to complete a package which is the recommended time. It can easily double that.  If you're on shifts trying to do one, and you're kind of frowned upon I think, if you're sat there doing a mandatory training, and there's other jobs that need doing that are seen as more important. And you're not then being active on the floor or active in in a role that's thought sometimes superficial perhaps, is serving the role of the needs of the service user. You can get that kind of disgruntled look from other staff that you're just sat on the computer clicking away. And then, in my role as a [academic role] again in the office. Not so much. I think there is definitely as a [academic role] more capacity if you've got some online training to do.  That's definitely more accepted in that culture. But again, you will have someone come up to you and ask you a question about x, y and z, or could you come over and look at this, or could you pop down to this? So again, the package then does double in time, I find. So, the reason I do it at home is, I need that kind of undisturbed area to be able to do them, basically.

TA:  Okay, all right, thank you. Yeah, that’s, yeah, I can understand that.  Thinking about the learning that you've done. Have you used any of it, would you say, in practice? Or have you taken any of it back to practice or talked about it with other people?

P5:  Yeah. So yeah, one of the, the [clinical procedure] I actually used.  My students actually were looking at med errors, and one of the training packages just had you go through the percentages of [medication group], and being mindful that you can overdose people on a percentage if they're prescribed prn, and they've also got a regular medication. They were year one students, so, they hadn’t had much experience in practice, and I asked them if they’d come across this, or how they felt about drug errors, and then showed them the percent, and some of them were quite surprised actually. So, it was interesting to go through them with percentage monitoring of [medication group]. So, I used that and I use the template as well, which is one you can access anyway, but that I went through for the training to then discuss with, with my students.

TA:  Okay. that's a lovely example. Have you ever used any of the other e-learning that you've done in practice at all, sort of discussed it with other peers or colleagues?

P5: Yeah, a huge one, especially as nursing, coming back to the manual handling one. If I’m working with, people that perhaps are in bed for a long period of time, you need to use your slide sheets, or any hoists.  The manual handling one is huge there to make sure you're all standing correctly, and because it's very common practice that you can see people not bending their legs, or in awkward positions when they’re trying to move people.  So, I've definitely been one of those annoying people that have said ‘right, hang on, make sure we're all comfy.

TA:  Yeah. Keeping safe is really important.

P5:  Absolutely.

TA: So, some of the modules that you might do, things maybe around safeguarding and things.

P5:  Yes.

TA:  When you're completing those on your own. Have you got any thoughts about, that kind of topic being covered on e-learning, when you're generally doing it on your own?

P5: Yeah, I’m a person that learns better from discussion anyway.  I mean, it's difficult isn't it. I can see why a lot of these are online due to what I've been referring to, the time. So, if you’re classroom based and discussion based, all of these will take all year, probably. But, I think, which [university name] do really well, actually is there’s, quite a few aspects of safeguarding training. So, we've got your online training, but then there are opportunities and expectancy.  Is that the right word? Yeah, you join the online Teams in discussion. I think, specifically in safeguarding, it's really important to have discussion with team members of how that then relates to your practice. What are your protocols? And that differs, depending on your environment you're in. But, specifically for my clinical practice, there hasn't been the opportunity for that. So yeah, just been online, looking at safeguarding and Prevent training. And then I'll be in practice, practicing it all.  Yeah, and then it's up to me, which it is quite right. It's up to them me to find out. So, who's the Safeguarding Lead, to where do I need to go?  But, often, I think things with issues with safeguarding, there's often quite a lot to unpack there, and a lot of staff have lots of experiences, and there's some debates to be had, because it's not always clean cut so that’s perhaps something that I think can be engaged with in a, in a more multi-faceted way, perhaps.

TA: Yeah. When you're doing your e-learning do you feel as if you're supported? Do you feel as if you're part of a learning community or anything, or?

P5: No, not really. I wouldn't say so. No. The only, I guess the only community you'd get, again, this is at [xxxx] University, is when there's a few people starting at a similar time.  And then you're, you're doing the packages, not necessarily together, but you’re, you're going through that motion, but particularly for clinical practice. No, that feels very individual.

TA: So, if you had problems with an e-learning module, or anything, would you know where to go to get help or support?

P5: They usually give you the number, at the top of the package, if you've got any concerns or report any issues. But that's, that's about it.

TA: Okay. Thank you. Have you ever suffered any kind of technical issues or difficulties in accessing any of your e-learning, or progressing through it because of glitches in the system or anything like that?

P5: Yeah, sometimes either it, which could be a user error definitely, that it hasn't recognised the password.  Or if you get timed out of sessions, that's the frustrating one. So, if you've worked through a load and then it, you've been timed out, and then it forgets your progress.  And then you go through it again.  So, that, that's happened a few times, or some of the ones where you're expect, you, they ask you to write little sentences in the boxes, and then it doesn't save it. 

TA:  And how does that make you feel?

P5: Yeah, well, it's frustrating, and then especially where time is quite precious, and like I said, it's in my own time I’m doing it, sometimes it's, maybe I'll come back to that tomorrow. Then I'll leave that for now, because especially usually I am a bit tired when I’m doing them, so. My tolerance isn't as, where it usually is. So, a few little things go wrong can feel a lot bigger when you're tired at the end of the day.

TA: Yeah.  Okay, fair enough. Thank you. So, have you ever sourced any of your own e-learning that's outside of what you've done for mandatory training or required training, or anything like that, have you ever done anything, that you've sourced for yourself?

P5: No.

TA: Okay. And would you know where to look if you wanted to do something for yourself?

P5:  No.

TA: Okay. So, what do you feel you've learned really from using the e- learning? You've talked about practical things you can take into practice, but is there anything else you feel that you've learned. Any other skill, sets or anything?

P5: I think they serve, where I've done a few now, they definitely serve for me as good refreshers of knowledge. I wouldn't say I've learned anything ground-breaking or new, or necessarily something I didn't know through my practice.  So, I haven't come across a topic that necessarily introduces a new idea or concept.  For me, they're definitely useful in refreshing my knowledge, and policies change don’t they. So, making sure I’m up to date with new legislation or things that perhaps have been edited, or changed.

TA: Yeah. Okay, Thank you. So, you haven't recorded anything for the NMC, yet, through using your e-learning. What kind of things do you use for?  Have you re-validated at all?  

P5:  That’s coming up? 

TA:  Yeah. And have you already developed any evidence towards that, or not quite yet?

P5:  Yeah. Well, I guess, I need to kind of compile it already. I've got a little folder of CPD evidence that I've been doing through research and practice and teaching. I haven't kind of compiled it yet into one kind of succinct document. 

TA:  Yeah. And is that more based on practice things that have happened rather than learning specifically, because you have to have some academic learning in there, don’t you?

P5:  Yeah, it's a mixture. And where I’m doing the [course] qualification at the minute, a lot of that's based on your reflective practice, so I’m hoping to use some of those situations. Yeah, a lot of it's reflection.  Some of it is feedback I've had from other people as well about my practice. So, I’ve got a little folder with all of that in. 

TA:  Yeah. But there's potential for you to use e-learning as a part of your CPD in the future, perhaps?

P5:  Yes.

TA:  Okay. Okay. So maybe just one final question then. Is there anything else that you'd like to tell me about your experiences or your feelings of using e-learning as CPD?

P5: I just remembered some extra e-learning I was involved with. 
Some uncoded information removed to preserve confidentiality.

TA:  Okay. Why was that so good then, that different aspect of it, the immersive bit? 

P5:  I think it, it helps you apply the knowledge to the situation, so you can be given the the facts or the legislation, or what's appropriate, and perhaps what's not appropriate, especially in clinical practice. And it gives you, yeah, it gives you that opportunity to, to be able to see and reflect on what it, what it might look like.

TA: Yeah.  Did you get any feedback from that as you were interacting?  Do you have to say, make decisions and have an answer about impact. 

P5:  Yes.

TA:  So, so how do you feel about that?

P5:  Yeah, it was, it was good. You got to see, in a situation, you got to see a scenario that perhaps needed improvement, and then you had to respond and comment about what you might do, or what was appropriate, and then you got to see how it could have been done in an approved, improved nature. So, you could compare the scenarios which is effective, but on a example service user.

TA:  Okay. And then was there anything else about any other experiences or feelings about a e-learning specifically, or, or anything like that that you'd like to share?

P5:  I think some of them depend on, on who's written them as well. So, some I’ve done recently, so like I was discussing the [clinical procedure] one was really effective, but there was one that was about [clinical speciality] in general, in practice. Some of the correct answers I disagreed with. So that was interesting. And I think it was all my thing.  I thought I might write to whoever wrote it and say ‘actually, have you thought about this and this’? but I didn't get round to it. Maybe it's something I should do. But yeah, that's the first time actually I've felt a bit frustrated and thought that's not quite right.

TA:  Yeah.

P5:  In some of the correct answers. So, then you can get a wrong answer, a cross, or a fail. I was like, no!

TA:  So, why was, why were you particularly frustrated in that situation.  I know that like not getting it right and being seen to be wrong is obviously a really annoying thing, but was there anything else that made you frustrated?

P5:  I think from my perspective, I think all of my students will be doing that, so will other people that have some [clinical speciality] nursing specific, so some of the correct answers perhaps portrayed the wrong image, or didn't give the opportunity to allow people to think a little bit more deeply about the answers. It was kind of telling people boxing, I think some of the situations, in my opinion, are easily boxed or categorised like that and you could quite rightly have multiple answers. So, if perhaps someone isn't trained, or specific to that area of [clinical speciality] they could then go out into practice thinking that that's the only way that someone might present with [clinical condition], or the only way someone might present with [clinical condition], and actually there's multiple contributors and multiple presentations. This learning package didn't offer the opportunity for that, so that's what I found quite frustrating. But yeah, not just the wrong or right, but how it's setting up other people to then go on practice.

TA:  Yeah. Did you feedback that to work, or anything at all? 

P5:  No, I haven't.  But it's on my to do. I need to get around to doing that.

TA: Can you think of any other way of using that resource then, that might enable you to have those discussions instead, of just everybody doing them?

P5:  Yeah. I say its simple but I wouldn't be the IT person having to change it all.  But, I think perhaps a training package such as that perhaps needs to not be a wrong and a right. There needs to be options for multiple answers or more scope to enter what perhaps what the user might be thinking. More of a broader approach to the way the answers are collated, I think, rather than a yes and a no.  That definitely works for basic life support, moving, handling, that it’s a format that works, because there is a yes or no. But I think, yeah, when you're looking at [clinical speciality] conditions, or how people might be in different scenarios, I don't think it's, it isn't a yes or no answer, or a black and white clear cut.  There, it can be different, and people will have different experiences. And then what I've worried about is, especially someone that's perhaps newer to the field, thinking that perhaps that what they've seen, or what they practice is wrong, because what they’ve then been told on their training.

TA:  Yeah. Okay, Any other thoughts or comments?

P5: No.  That’s it.

TA:  Thank you.


