TA:  Thank you, [P14], for coming along and agreeing to be interviewed for the second stage of the research. I've got some questions which have come out of the stage one interviews, and I outlined those briefly in the participant information. So, my first question is how do you think that using oers as continuing professional development is different to using them for mandatory and statutory training? 

P14:  I think you view mandatory training in a different view. Before you've even started, you know it's, ‘oh God, I've had that e-mail reminding me I've got to do fire, health and safety’, or whatever. That is seen to be more a process to get through, whereas, I think with the CPD online learning you are actually more interested in what you're actually going to learn. I'm not saying you don't learn things from the mandatory, and you don't, perhaps. No, I'm not saying that some things aren't quite useful in that, but I just think it is really very different how you view it. I think the CPD is usually things that perhaps you're interested in, or you know are going to be useful for you, or you know you want to learn more on. Mandatory is thinking right from the word go, I think it's how you think about it. How you perceive your time and you're reminded quite a lot, even though you know. I always think it's a bit, because they say oh, it's due at, just for example, the end of October, but then you think I've got three weeks, but then you'll be kept reminding and you’ll think ‘I know’. So, again, with the CPD, you know, it feels a bit more voluntary, and perhaps, there's a bit more enthusiasm for it.

TA:  Thank you. You'll see on the screen, there's some brief examples of what oers might be. So, thinking about stuff that you have accessed, how did you know what's available, do you think, in terms of oers?

P14:  A lot of the things that I attend are through networking and a couple of groups I've joined. I get loads of emails from them, literally about probably four or five a week. You fill in at the beginning what areas you're interested in, where you work and things like that, and then it tailors the e-mails that you get, of your own personal interests. Personally, a lot of what I look at and see is because it's come to me via something I've previously completed, rather than actually going searching for it. I know that I could do, but I seem to think that a lot of the things actually come because I've either completed something else, so they say ‘oh, because you've done this, you might like this, or just because they know it's a general interest or a field that I'm part of.

TA:  OK, so that might not necessarily be like a subscription, but obviously once you've engaged, then you are entered on some kind of system, and you sign up for alerts, or you sign to say that you're happy to receive some kind of communication.

P14:  Yeah. 

TA: Can you remember how you first found them?

P14:  That was years ago when I was actually a clinical nurse, so we're probably talking maybe 15 years ago, when I changed roles from being a [clinical specialist] nurse, to being more of a [clinical specialist] nurse, and working with the [care setting], I wanted to find out as much information as I could. It was quite topical and it was recommended to me from CHAIN. That's what it's. I joined that, and like I say, you fill in what your interests are and it's not just about courses. You'll often just get an updated article on something. It will talk to you about what government papers have been developed. NHIR often put on free courses. A lot of the stuff I've attended just gets sent to me. I think it's fantastic. I talk about it to as many people as I can actually. I think it's a really fantastic resource. And, about once a year they e-mail you and say, ‘is all this still relevant’, your information, so you can update it. I think those sorts of resources are what's really good, and it takes a lot of the effort out of it for yourself. You don't feel that you're out there searching. As I said earlier, I know that you can, if I suddenly thought, 'oh, I really want to know something about safeguarding' for example, I know that I could. I might not necessarily find it in some of the networks that I’m already in, so I could. I know that I could search for it online or something. But that's when, I know we talked about this last time, but that's when it feels potentially unsafe, as in how do you know what you're reading about is, or what you found in that manner, how do you know that it's? Yeah, and often they're quite costly and you think well why does that cost X amount? I know there's other resources that can be free, you know, often the more validated ones from the, some of the resources I could see up there [referring to list of open education resources on the meeting background], you don't actually have to pay for. It can be a bit of a minefield.

TA:  All these on the screen you shouldn't have to pay for. They're all open access resources in the sense that they're all free to you, available to anybody. You said about the cost. Have you ever been in a situation where you felt like you should pay the cost, or whether you might negotiate to get the cost back 
from your employer or anything, to do some learning?

P14:  I haven’t. When I was in my last role my employer approached me and said ‘we would like to pay for you to go on this, as a recognised [role specific] training, online course, we want you to do. It included e-learning modules, as well as actual face to face, although online, face to face online. But I myself, I'm just trying to think, I'm sure I have paid things like 10 or 15 pounds here. Maybe not recently, but perhaps a few years ago. I have, but I probably normally haven't claimed it back.  I think I would, if you're asking me, in the future.  I’m probably a lot more wise to the system that I’m now in, that I probably think, can I get it for free, or is there a better place to get it for free first? But if it's something, I can't think of an example, if it was something that was more specific, I might perhaps think ‘oh OK, maybe this is the only place and I'll do it, but again, because I've chosen it I often think well, I've made that decision. The employer hasn't required me to do it, so I think actually, maybe that it is fair. After all, it's for my learning and my future, regardless of whether I'll be still this employee, or whatever. It's part of my learning so I think it's not something that I would actively do.

TA:  A specific example that I'm aware of, is that sometimes you might do a course and it may be on FutureLearn or OpenLearn, or similar, through a nurses’ network. You do the course and they say it's an accredited course, or it will give you so many hours of CPD, but then they offer you a certificate at the end if you want to purchase it. Have you ever experienced anything like that?

P14:  No, I haven't. That's interesting, isn't it, because obviously we want the certificate, because we want the evidence, don't we. No, I haven't. That is crafty. I think that would really annoy me, if I'd gone through it, thought it was perhaps free, but then end up having to pay for the certificate. I mean, that's quite, a clever marketing, thing, isn't it actually? And it's a shame if I did come across something like that, I would. I don't think I would, but I think I would still use it as the fact that I'd done it as evidence. I think it's more about evidencing what you've gained from the module, and your learning from it, rather than actually, evidence that you've completed it. With revalidation, I think luckily we can do that. We can write up any reflection on it, or some notes about what we gained from it, and that is actually quite good. We're lucky that it's seen to be enough. but no, I haven't come across that and I think it would really annoy me, and I don't think I would on principle. We don't have to have certificates, but nurses do like certificates, don't they. It's probably a bit of a myth, and I think it's only when you've been a nurse for many years and revalidated lots, you come to know that? Even with the mandatory training it says well, if you want, you can print off your certificate. I often think, but I don't know why I would do that. It's logged on the system that I've done it, but definitely when I first qualified, I kept a file, even before revalidation, I kept a really immaculate, because when I trained as a nurse, that's how we had to. We had to have a folder of evidence as part of our training, and I kept that going. I would be quite obsessed with collecting certificates and things that went in my folder, but I've definitely moved on from that.

TA:  Yeah. So, thinking about that in the broader context then, how do you think we prepare our students for the world of independent CPD once they're qualified? How do we get them to know about oers, that they're available and that we can use them. How do you think we need to start preparing people?

P14:  I think we've probably all got our own little skills that we could share around how we go about it.  Obviously, everyone's different, how they go about it. I think it could definitely be some form of session, perhaps attached to. But you know, it wouldn't take even half an hours session on how would you do, the wrongs and the rights about doing online training, and just advising that they're actually a thing. They’re used to doing the e-learning for health, aren't they, and some of the lectures we do are online. They're probably going to obviously appreciate that there is an online aspect to their learning, but that might fizzle out once they're qualified. I think it could be something that could quite easily be, or maybe even with the library learning. It could perhaps be in the third year, there could be just a small session on making the most of your revalidation, and almost like a message that we can all perhaps have ingrained an oer, because if I'm teaching third years, I say things like, ‘when you qualify and you revalidate, often that's related to reflection. I talk about first revalidation but perhaps in the future I could elaborate on that and say that there will be the opportunity to gain a lot of CPD through online learning too. They're so savvy with regards to online and all the different online things that they have available to them, in a non-professional way, that it’s almost if they have that culture anyway, it would be almost just carrying on,  directing their interests away from all the social media, but use the skills that you've perhaps developed for that, to be thinking about your learning for the future as well.

TA:  Yeah. How, would you make a decision about whether to use an open education resource or not?  For instance, if you started using one and then had some concerns about its context, the cultural context or whatever. How would you decide whether you would still continue to use it?

P14:  I have started doing some free courses, or free information sessions before. Maybe not so much recently, but I though this doesn't. This feels like a bit of a waste of my time.  It's perhaps not exactly what it said it was. For example, if it says it's directed at a certain level of nurse, or these are the things that you're going to learn, then actually, after half an hour you think, well hang on a minute, it feels like maybe it's going in a completely different way, especially if it's sponsored by somebody. I have definitely come into contact with that where adverts pop up and you think oh, hang on a minute, this feels like it's going in a different direction what it's billing. It's wasting my time. I think I'll stop it there. But it's very difficult isn't it, to know, because I guess there's no standard regulation, is there. If I was looking at your list there [referring to the list on the background wallpaper], the majority of those I probably would think would be good to use because they're the names, organisations that I've heard about. I would make an assumption that e-learning for health, obviously I know about e-learning for health. LinkedIn. I'm not on LinkedIn but I know what it's for, and I would make an assumption that perhaps that would be all checked. I don't think there's a fail safe, easy way of knowing, no definitely.

TA: Do you think those resources can still be used as a trigger for learning?

P14:  In terms of reflecting on the information, yes. You might know it isn't correct for your situation but that can cause discussion. Sometimes it's quite good to do an up-to-date training because you think actually I do know. It's quite empowering. Sometimes when you attend training or update sessions and actually you find that you know it. That's probably something to encourage students to do, so even if you feel you know, it's still a learning opportunity because you learn that your knowledge is good. That's still a learning thing, isn't it. You’ve still learned that you are up to date.

TA:  What about if you thought the information was incorrect?  Could you still learn from it, and is there any action that you're aware of, that you could take in terms of using the materials?

P14:  I guess if something really feels wrong you could cross reference it against a more reliable source, even if it means there's additional work to do.  So, if something comes up maybe about a medication, you could then find a BNF [British National Formulary] and check. Confirm yeah, that's completely wrong. You would believe the BNF over what you were reading. I guess it teaches students, or student nurses. It teaches them to check things. Nothing is necessarily always going to be 100% correct, even if it the most senior doctor, who’s had 25 years experience of something. If you're unsure what they've done is correct there's no harm in actually double checking it, because of your autonomy. There's no reason why you couldn't apply that principle to online learning, just to double check material, to make sure. I guess there's a difference between a genuine, small error and information which is just wrong. Does that make sense? 

TA:  Yeah.

P14:  Is it an error, or just uninformed, unresearched, nonsense? When it comes to what you do about it, I honestly wouldn't know. If a student came to me and said, hey, I've looked up on this and I’ve found that this is really inaccurate. That would prompt me to want to know what you have to do. If it was me, I probably would just be, oh bah, that's rubbish and just stop it, and perhaps not pursue it, but, I would be more inclined to do something if a student had approached me. I would have to look at the company where the source is from. There must be some sort of contact details. 

TA:  You said about how the nurses are quite savvy now. I just wondered what sort of skills you think nurses need, technology skills particularly. What skills they need to work in today's healthcare system?

P14:  Certainly more than when I qualified. I think it's partly a confidence thing. I know when a lot of electronic systems first started. I know when I started doing my training, I barely even touched a computer. I didn't really do computers at school, and one of our first lessons at the university was literature searching. I still remember now feeling like ‘oh my God’, completely out of my depth because I just did not know, and I just didn't even want to try because I thought everything I was going to do was going to be wrong. I think now, because of all the online systems that children, teenagers, students are a part of, I think they would have the confidence to start it and go for it, so I think confidence is definitely a thing. I think often they know that, I think some of the kinds of abbreviations or if an online system tells you to do something, or download another programme or something, I think they would know what that would mean. I think experience has given them, just experiencing lots of different online forums and things, and sessions, that experience has probably given them that knowledge to be able to pursue in different directions. Obviously some of the generation of our students now, who were at school or college during COVID would have probably learned a lot of computer skills, because of that being a lot more mandatory now than when I was at school. I didn't take it as an option, so I didn't ever know it, but now they do it as part of parcel of everything. I think definitely experience, confidence. There's the actual knowledge of things like literature searching. The library skills sessions that they do early on, I think obviously are crucial, because a lot of what our (undergraduate nursing) students will be doing whatever, it is online. It is all is around searching, isn't it? Searching via keywords and the learning about key words and things is another skill, which perhaps they wouldn't know until they've come to the university. Troubleshooting. They might be better at troubleshooting, again I only refer to myself years ago, I probably would just give up. Ask somebody ‘oh, can you help me'? No. They perhaps know a bit more about when things go wrong, I do this, or I look on this url, watch a YouTube clip on something. My youngest is 15 and she will often say ‘oh, I just YouTubed it, how to do it. I’ve never thought about it. Yeah, so I think troubleshooting is probably a bit of a skill, the more that they, that's useful.

TA:  Yeah, and that refers to the immediacy of information, doesn't it? Sometimes the students and the nurses will be looking stuff up in practice, for that quick information. So do you think there are any specific skills or knowledge we need around them accessing that information, and how they deal with it?

P14:  I think it's got to be about going back to reliable sourcing and not just typing it into Google and taking the first thing that comes up. It was many years ago, but I was always taught to avoid things that does have a lot of adverts on, because that's obviously a paid site. It's not likely to come from a reliable source like the NHS and the RCNi, which you know. Okay, the RCNi might have some adverts, but it's all about RCN things. It's not selling anything else, so I think that's. That's quite an easy thing to just recommend isn't it, don't click on the sponsored, on the first few sponsored links on Google. Look for recognised ones. Avoid those things that have got adverts on, and even just stick to a very few. I think in healthcare there could probably only a very few search engines, databases, things that they probably should use, like the online BNF ones, the medication ones. I would encourage that they use tried and tested areas that they have used previously, or that have been recommended to them, rather than random, wild searches. You know, stuff we'd advise our patients in a way. We would advise them to be very localised and very particular with what they look at. Ask what resources are already used on the ward. What do your colleagues use? What do staff use?

TA:  So, a lot of that's by word of mouth and by prior testing, where people have used it and felt it's been good.

P14:  Yeah. I'm absolutely sure there's always going to be new stuff out there that's going to be relevant, that a student or a new nurse, or anyone would find, and it would be absolutely great, and then they can share it.  But I think it's better the devil you know in in a way, isn't it? Better to use something that has been. A lot of the stuff that you could potentially want to search, or would need to search online, would be very easy to do, within a very few resources, rather than lots.

TA:  Yeah. What would help to give you trust in a resource? Is there any specific thing? You said you've looked for reputable people. Is there anything else you'd look for specifically?

P14:  I probably would look at a lot of what we're taught to do and what we teach about things that are referenced. I would always want to know where that information had come from that I was reading. I think just reading a word, a paragraph of something, that doesn't really tell you where it's come from. It probably would always be a bit of a red flag, so I would want to see that it had been referenced as to who said it and where it comes from, and what the source was. I think information should be open and honest about what the source of it is. I would always check that and get that to be checked. It's difficult to explain, but if it's in the right place, as in if what you're searching for is where it should be, and it says what you're expecting it to, and nothing is completely surprising. I don't know if I've explained that very well, but I know I have sometimes looked for things and come across stuff, and thinking well that's obviously utter nonsense because that's nothing relating to whatever. How is that? How have they all put all this together, if it's not even? So I think there’d have to be some logic to it, in what you're looking at and it isn’t in a very relevant place. I think it's always just being a bit, cautious, isn't it. I suppose it depends what you’re using the information for. If you were God forbid a newly qualified nurse and there was no one else around to double check what a potential side effect might be on a medication, and you were literally relying on an online source to be able to know whether to give a medication or not, I would say that is just not a good use of. But, if you're using the information to give you a rounded view, or a rounded bit of information, or another input or another source of something, well then that gives you a little bit more safety, because you think, well, okay, as long as I can reference it and I'm comparing it to other things as well, that's quite safe to do. It's not directing me to do something. Actually that's probably quite a good point, what is it you're going to do with this information? Is it actually directing what you're going to do now, in the moment, as in patient facing, or is it about a bigger picture? Is it just some learning for you more generally?

TA:  Thank you. So, my final question is if there is anything else you think you'd like to tell me about using open education resources as CPD, in the context of what you might need to know, or what would help you to use them better if you would come to them new, or just how we might help students to, become aware of them and use them?

P14:  It really would be good to have almost like an A-Z of what are good and reputable. I think it would encourage the use of them. It would maybe make people feel more confident in using online materials, rather than, just doing a blanket search yourself. If you knew that you could go somewhere, a regularly updated source of good, useful information, or even somewhere we could all add something if we found something good we'd done. I think that would be probably helpful for staff as well as students. Just a bit more guidance on what is good to be used, or even some ones to avoid as well, something like that.

TA:  OK.  Thank you.  



