
TA:  Okay.  Thank you [P15], for agreeing to be interviewed for me again. My first question is how do you think that using open educational resources as continuous professional development, or CPD, is different from using them for mandatory training?

P15:  Well, when it's not mandatory you're accessing them because you want to, because it's something that's more to do with your own personal development most likely. I appreciate it could also be recommended to you by an employer, or for a potential job opportunity, but I think there's an element of you seeking it out yourself, which immediately is more appealing than the mandatory element. Yeah, definitely, because you just feel completely different if you're accessing something because it's something that you know you need to learn about for your job, or for me as a [job title]. If I'm accessing something it's much more motivating. It's more inspiring if it's something that you want to learn about and you feel good about it afterwards because you're doing it for a clinical reason and you want to be better at providing care to the people that you're working with. For example, I work in [clinical specialty] in my clinical role, and if I access something that's about a specific [drug type] or a device that I might use for a patient, then you feel more confident and you feel more motivated, because it's for those reasons that you're doing it. It's more engaging. You feel more engaged. That's a key thing there.

TA:  Okay, so you feel more engaged while you're doing it, and I can see actually that actually, you're engaged in skills afterwards, aren’t you. You're actually applying it in practice.

P15:  I'm a very practical person so it's very much about applying it in a practical way. An example for me would be,I watched a video to understand more about the methodology that I'm using in my research. It was a YouTube video and hearing the person, the author, talk about it, I've also read her book but hearing her talk about it, it was just really interesting. I learned so much from that. I chose, it was probably a 1/2 an hour video. If you had to watch a 1/2 an hour video because you were told you must, whereas when you seek it yourself and you're trying to work out what resources you need to help you learn. You know, it's trying to find things that are going to complement different ways of learning.

TA:  Yeah. So how did you come to find that YouTube video?

P15:  Good question!  I'm trying to remember now. I probably was just doing Google searches. I had the person's book. I had an old edition so I probably would have been trying to find something new. I might have found a journal, a paper that she'd written, and then when you're doing a search, you just happen to see videos. I thought ‘oh, that looks interesting, and started watching it and I've watched the whole thing. I think I've watched it more than once, actually. I just found it really helpful because it's about finding resources that can appeal to different ways of comprehending information and when someone's talking in a conversational style, sometimes that just resonates in a different way to reading it in a book, for example. That's why it's quite useful when you're, if you're a student of any description, but if you're talking about nursing, I think that's why it can be quite good when those sorts of resources are used alongside traditional, teaching methods. Personally, I think that is probably one of the most useful ways of using open education resources, to complement what's happening. For example, if you went to a face to face session, whether that be mandatory or not, and then they use some open education resources, it complements the teacher. You don't want to just hear someone talking at you, when they show you a video or when they direct you to a learning activity, that's online. I think that's probably the most effective way of using them, but I also appreciate that accessibility is a very key thing here so open education resources, you want things to be accessible to people and then they might not be at a study day, or taking part in a course. I'm just aware of all those concepts. How do you make something accessible? How do you make it so that people can find it? How do they know what they're looking for? That's going to be easier for some people than others because it depends on how experienced you are and it depends on what you're looking for.

TA:  Okay. So, with all those things in mind, how do you think we prepare people to find oers, or to even understand the concept of what oers are?

P15:  That's an interesting question because I feel like I'm of a generation where it's a bit like these things came along and I just had to navigate them and figure them out. I wasn't even told what they were, but they just suddenly were there and then you start to understand. When we had the first interview and I'm sure you found this with other people, you didn't even understand it as that concept, of being open education resources. I know that I'm going on a course, online. I know that I'm doing my training on that system, but I didn't necessarily perceive it as this umbrella term. My guess is that students nowadays, if you're thinking about undergraduate nurses, probably are getting more preparation for understanding what these terms are and how to access them and what they mean compared with my generation. They're there and you're trying to get your head around what they are, and I’m sure if I feel like that it must be even worse for nurses of an older generation who perhaps aren't, or nurses that maybe aren't as interested in it. Some nurses do the CPD because they have to do the CPD and it's not something that they will particularly enjoy, or navigate to.

TA:  Yeah. You said that you think that these students probably are being a bit more prepared for using things like oers.

P15:  I do. So, now I've started teaching students, student nurses but also other health and social care students. I don't personally prepare the content of the sessions that I'm teaching them on but I see and I use the resources that are provided to me to teach the students. I can see they're getting directed to YouTube videos, recorded sessions, that are getting them to think about things. What we're teaching them next week is about continuous professional development, so that will be one of the things that will come up there. Things like telling them in more detail about the Royal College of Nursing and how that’s a source of support, but also a resource for education and information, and encouraging them to think broadly about how they access ongoing learning, which I would imagine they might be more used to anyway because they're probably doing that more at school. Its definitely more than I would have done at school because it wouldn’t have existed when I was at school, but it's the way we're going and obviously because of the pandemic everyone's been pushed more that way anyway, because we had to learn to navigate the Internet more to get learning and resources.

TA:  Yeah. So thinking about that teaching you're doing next week. I'm just wondering whether before that week happens, whether the students have ever realised or thought about the extras that we're putting into the teaching, as oers?

P15:  I don't know if you've said those terms to them whether they would really think of it that way. Probably, well now that you've said that I'll make sure that I say it to them to start to understand this concept of open education resources. One positive thing about modern times is that you can access information in a way that suits you. I'm not saying that this would count as open education resources, maybe it would? Artificial intelligence. I've learned in the last year how to use artificial intelligence to help me understand things that I can't always understand. I Google and I don't understand what they're saying. There was an activity that we had to go through with the students and there was some wording in the activity that I didn't really get, and I couldn't get it. It's obviously something to do with how my brain works, I couldn’t grasp it so I put it into artificial intelligence and said can you explain what this means please? I don't understand this bit. And it told me, so you know how but that was obviously with artificial intelligence you can use that for absolutely everything. I'm not saying that's the right way for everything because of course it can give you wrong information, but it can complement things. So, what I'm really beginning to appreciate is if there's something you need to know about, but you don't know how to find out or understand it, there are so many resources out there now. If anything though, that can be a bit overwhelming. I get emails from NHS Professionals [referring to the list on my meeting background] all the time with various things that they're running, and I just think, ‘oh my God’, and delete. I've got too much on. I can't access that as well but maybe there'll be some individuals for whom that's really useful. I think it's challenging working out what you need to access and what's most useful for you, and a lot of that is sort of searching Google. Truth is Google's really useful, and YouTube. I know the RCN, there's loads out there. It's trying to navigate it all isn't it?

TA:  Yeah. So you mentioned in there about accessing information in a way that suits you, and also about wrong information, and maybe using oers to complement teaching. You may not have come across this scenario but if you were to get an oer and you were to use it, say in the classroom or even for yourself, and then you spotted something you weren't happy with, that you thought was wrong, then just talk me through what you might do if that happened, or what you're aware you can do if that happens.

P15: Well, the first, the most obvious thing that popped to my mind was that there might be something on it that I don't agree with actually. Not necessarily that's wrong but that I would question. The first thing is I might say to the students, what did you think about that statement, and sort of encourage them to be thinking about it because obviously there's more than one way of interpreting certain things. Just trying to get them to engage in a bit of critical thought because, just because I think it's not the right interpretation of a specific thing, doesn't mean that it's wrong, it's just I don't view it that way. I'll just tell you what the thing was that made me think of this. There was a video on the NMC that I was looking at this week and it was something about professionalism. It was talking about how you, as a nurse, you're representing your profession and that that obviously needs to extend into how you present yourself to the world. Now I take professionalism very seriously, and I feel that nursing is absolutely embedded into me as an individual. I've been a nurse since I was 18. That's when I started my training. So, don't get me wrong, I take it very seriously but I also felt that the way that the NMC had said it felt like it put a lot of pressure on an individual. We're all going to have our moments that we're not the perfect professional nurse in our personal life. The video was saying about, relating that to your your physical and mental health, that you've got a responsibility and how you look after your physical and mental health is reflecting on your profession. I thought about the nurses that I know and the people I know and I've had health issues myself, okay, what? So, if you're an overweight nurse you're not a good model for your profession because you didn't manage to control your weight. That's just an example. So, that's something where I think I could engage the students in a bit of critical discussion and we could talk around it and help them to not maybe take it too literally. If I saw something that I actually thought was actually wrong, because that could happen, couldn't it. It could be something that was out of date or something? I suppose there'll be some method. Well, it depends, because if it was like YouTube or something, I don't know how I would necessarily contact the person to tell them. But if it's a company video or something there's normally a way that you could contact them. But if it was in say e-learning for health, I don't know actually. I'd probably be really lazy and I just wouldn’t do it because I feel I've got enough on my plate, which is really bad and totally unprofessional.

TA:  Why is that really bad and unprofessional, then?

P15:  Well, because if you saw something that's wrong and you know it's wrong and then that's being taught to other people! That's not good, is it? I don't know. You pick your battles, don't you?

TA:  Yeah.  So, you talked already about quality assessing oers, in a way, by just thinking about whether something might be simply out of date, and looking, I suppose, actually looking at what the production date and things was it, what of, it was, but are you aware of the ways that we can change open education resources to suit our context?  So, where I said before, inaccuracy or whatever, it could just be that it's not right for our context, so I just wondered if you were aware of any ways that we can work with oers to overcome that, and you might not be, so there's not a test.  It's not a test.

P15:  Not really, no.  I'm just trying to think.  No, I mean, I guess I would just.  I don't know.  I was looking at, because I was looking at a few things, seeing if there was something that I thought was relevant for the students, that was different to what we'd already got, and.  I just sort of pick and choose things, but if.  I guess.  I guess if there was something more sort of specific, no, I wouldn't.  I'm not really clear about how I'd go about changing it, really.

TA:  Okay. That’s fine. So, what do you think makes open education resources, good quality, or relevant to your context?

P15:  Well, I think kind of, as with anything, you're always looking at, where did you get that source from, like where?  So, for example, if it's e-learning for health, then I guess I do have some trust in it, that it's been produced by, you know, health professionals, and based on research.  Whereas something 
like a TED talk.  That's a bit more like, subjective, which is still valid.  I'm still interested in what people have to say, but it's who's saying it, where are they from?  So, it's making an assessment, as you would if you were looking at a journal paper, or reading something in an article.  It's who's saying it, and what experience or skills, what evidence is there?  Is this just someone's opinion, which I might agree with? But that's not necessarily strong, evidence at such.  It's just interesting and I'm, you know, I want to hear what they've got to say, which I have that, I think that's particularly relevant with TED talks, actually.  You know, I've, watched quite a few TED talks, and some of them are really interesting and they're very thought provoking, but they're not necessarily evidence.  Whereas yeah, something like e-learning for health, it's like you're, you are learning about this vaccination, because you're going to deliver this vaccination, and this is the information you need to know, and this is the best information we have at this time.  You see what I mean?  So, I think it's looking at who?  Where's it?  What's your source?  Who's created it?  Is it up to date?  Yeah.  And it's same like, if you're looking at, just the same as if you're looking at an NHS website.  I'm not, I'm not naive enough to think that everything on the NHS website is definitely correct.  But it's, the best knowledge we have at that point.  It's agreed with healthcare professionals, or National Institute for Clinical Excellence, whatever.  You know what I mean?

TA:  Yeah.  And you're obviously role modelling some of that, with what you talked about, how you get the students to think about some of those things in class, which is really useful.  You did make a comment earlier about ‘often we're told to do things’, and that doesn't apply just to mandatory training, does it?  I think when the student nurses are starting, they're often told to do specific.

P15:  Yeah.  To look at specific activities, yeah.

TA:  These are not necessarily, not necessarily mandatory, but they're told to look at those things. So how do you think then we move them on, from, the position of being told, to feeling free, to look for things, themselves?

P15:  I'm still navigating that myself, to be honest with you, because one of the challenges I think is how much are they actually looking at the stuff we're telling them to look at, because I know I'm coming in the class sometimes.  Now, obviously there can be access issues, you know, we might have had technical reasons they couldn't get on to something, but, you know, you always get this vibe of ‘how many of you have actually tried to even look at this particular thing?’.  And then it's like thinking, well, I don't want to baby them, and they need to be independent.  But yeah, it's sort of trying.  How much do I sort of incorporate it into the lesson, and say let's do this in the lesson, because you know, I want to make sure everyone's done it, sort of thing.  I think it probably happens.  It's going to depend on the individual, because some people are going to enjoy that kind of learning more than others, and want to watch videos and things.  I think it's going to be a lot of encouragement.  It depends on how you're assessing them.  I suppose as well, when it comes to referencing, encouraging them to, well, sort of saying maybe that it's okay that you've accessed some information, not just from like peer reviewed journals, that you might have actually learned something from another source, as well, and that, you know, just put that in your reference list.  I guess it's just trying to find ways of incorporating it as much as you can, into the taught side of things, so that they get used to it, and that they're actively encouraged to do it, and to understand, to appreciate, that we know that that's a way of accessing information.

TA:  Thinking about that and just, all the things we're teaching them really, what sort of skills do you think nurses need to work in the current, NHS environment?

P15:  Wow, that's a loaded question because it's just infinite, really.  I mean, it's just so phenomenal.  I feel like, gosh, no pressure, nurses, you know, because you need so many skills, you know.  It's a, very multi skilled role, and obviously everyone's got different strengths and weaknesses, so some people are going to excel in some areas compared with others, because you know, it is, it's so, the crux of nursing, to be a caring, kind person, who's trying to support somebody, through whatever situation they are, you know.  To be able to look after themselves, or do what they can't do for them, or to help them to get better, whatever, obviously that is the most important aspect of being a nurse.  But it's, not enough because you, you know, you've got to have skills in negotiating, in being part of a team, record keeping, accessing resources.  You know, being able to use all these, I think tech is a huge thing.  You know, the technology is phenomenal.  It's incredibly difficult to keep up with it, and it does make me nervous, because when you don't do clinical work for a little while, there's this constant fear.  I mean, there's always been this thing about you worry about getting deskilled, but you're not just getting deskilled in a physical, practical way of like ‘oh, well, I remember how to take blood or take someone's blood pressure’ or whatever.  It’s, ‘well will I be able to use the system’?  Will I be able to use the record keeping system?  Will I be able to, you know, I work in [clinical speciality] and we use [drug] pumps, [speciality] systems.  They're quite complicated and there's so many different ones, and they're evolving all the time, and it's really challenging to keep up with it.  It's not, you know, it's hard.  It is hard.

TA:  So perhaps, this gives a hint of where I’m going, so perhaps the focus isn't so much on preparing people to use oers, but preparing people to adapt, to the changes, including the use of oers. 

P15:  I think you do have to.

TA:  I mean that was just one thing.  By the time people are used to using those, there’ll be something else, no doubt.

P15:  Yeah, because, well now I know that there's more kind of like, simulation of situations and things.  I mean, like open education resources are useful, like, for me, if I'm learning how to use a piece of [speciality] technology, or to show a person how to use it themselves.  But that's going to, you know, how we show people will change as well, and I can see the student nurses were sort of looking on the computer and showing me a simulation that they, and, you know, you do feel like ‘wow, this is going over my head’, you know, like please don't ask me any questions about actually using it.  I haven't got a clue!  But I think, yeah, being, supporting people to adapt is important, because you’re constantly having to adapt, and I think it, that I think that is very stressful.  You know nursing is a stressful profession, as are many jobs working in the health service,  and you know, if you're someone that.  I like to know what I'm doing and when I'm doing it, and that aspect of nursing doesn't suit me [brief laughter], because it's like, it just changes all the time, and you have to be prepared for it, you know.  But, accept that it's okay to struggle with that, and, learn, you know, have support and learn how to use resources.  And I think employers have got a big responsibility, in making sure that, nurses and other professionals, have that space, to learn to adapt, and know where to access support, and they could do so much to take some of the stress out.  When I, I joined NHS professionals,  and I was doing some agency nursing in the local hospital, and they were using a different, record keeping system, to the one I'd used in my previous role.  It took so long to get me onto their system, and then they were faffing around with what training I needed to do.  And as ever, that was the stress.  It was much more stressful than me going to see the people on the wards, and supporting them, or working as part of the nursing team.  It was the stress of how do I use this system?  And you ring IT, and you speak someone different every time.  It's not good.  It's, there's so much room for improvement with IT support in the National Health Service.  They really do need to put more support into that, and that links in very much with these resources.  If they want, you know, because we need to be able to use them.  We need to be able to feel confident with them, and that’s a big part of it.

TA:  Yeah. What knowledge and skills do you feel, are necessary for using oers for CPD?  Do you think there's any specific skills that you need, in order to use oers specifically?

P15:  Well, yes. Yes, there are.  I mean I suppose.  I'm just thinking about people that I know that maybe less techie.  I mean, I'm not.  I don't consider myself particularly techie, but what I think I am quite good at is, I'm not afraid to sort of like click around, and search for things, and I think some people who are not very techie are frightened of doing that.  They think they're going to make, they're going to do something wrong, or they, you know, some people just don't even know how to do quite basic things on computers, especially.  Truthfully, especially older, older people.  So, knowing how to do a lot of basic stuff on the computer is really important. 't.  They don't necessarily know, you know.  Well, they don't know things like, say, you've got a specialist interest in something, and you want to keep looking at videos, they don't know that actually, if you create an account on YouTube, the algorithms will mean that, you will start to be signposted to some of those things, for example.  So, I think it's having that basic sort of IT knowledge, knowing how to search for things, knowing where to go, knowing what search terms to look for, knowing what organisations provide these resources.

TA:  And you already talked about the critical analysis bit as well, so I won’t re-cover that.  So, I'll just finish with one last question then, which is, is there anything else you'd like to tell me, about how, how you think we should be prepared, or we should be preparing others, or what's important about being prepared to use oers?

P15:  I guess it's just that this is an important part of where we are right now and it's going to evolve, so we need to make sure that people are informed and we mustn't forget the basics.  And that is so crucial, because I started nursing at a time when we still hand wrote our assignments. Halfway through my course they started to move over towards more use of computers, and so for my final year dissertation as an undergraduate it was expected that I would hand in my dissertation and it would be word processed. So I'm undergraduate student nurse. I remember one of the lectures we had was about statistics, because we went to a research lecture. That’s probably put me off statistics for life and that's why I'm a qualitative researcher! So knowing how to access them in the first place, knowing what sorts of things to put into a search or knowing who to ask, you know. That can be quite easy if you're part of a team where they're using these sorts of resources all the time or you're part of an organisation like the RCN, or something like that. I guess some people probably haven't really used YouTube for stuff like this, or looked at TED talks and they wouldn't, as much as I can ever be. We were having this talk about statistics and I was standing in that room and I felt like crying because I didn't know how to turn the computer on. Don't tell me how to use a statistics programme on the computer, I don't even know how to switch it on. I haven't got a clue. A tutor was really kind, she sorted out an old computer from the nursing department, showed me how to use it and I'm perfectly fine at word processing and doing it. So we mustn't forget the basics and make assumptions about what people can and can't do. You don't want to be patronising. You don't want to teaching your grandmother to suck eggs but that's why, when I'm in the classroom with the students, I do try to show them what I mean, and I keep saying it's okay to ask silly questions. 

TA:  Yeah, that's really, really powerful. Thank you.



