TA:  The first question I'm going to ask you is to summarise how you think using open education resources is different when you're doing it for CPD than when you're doing it for just mandatory training?

P16:  How do I think it's different? 

TA:  Yes. 

P16:  Well, I think if it's mandatory, no. If it’s something I want to do rather than mandatory then I take more of an interest in what I am actually reading. I take more time in actually reading the content and answering some of the questions that they are proposing, or doing some of the quizzes. I seem to be more engaged if it's something that I've decided to look at rather than it's something that I have to do.

TA:  Thank you. My next question, thinking about that being more engaging is what kind of skills do you think that nurses need to work in the modern NHS?

P16:  They need to have extremely good communication skills. They need to have extremely good change management skills and they need to have patience. I don't mean patients as in patients, I mean patience, as in the broader. They need to be able to listen, internalise what they've heard and try to make sense of what is happening in the workplace.

TA:  OK, so do you think you need any specific skills? Not you personally, but do nurses need any specific skills to be able to use OERs effectively, whether that's finding them or engaging with them?

P16:  I think now with the trainee nurses I feel it's second nature. They are so used to doing things online, they spend the vast majority of their life online, either through Facebook or Snapchat or whatever they do, things I don't do. For them, I think they find their educational learning is easier than somebody who has been in nursing for quite a while. Whereas when you switch on the computer, you think well, what? What do I need to do? How am I going to find out what I need to know?

TA:  So, you think that some of these things might come a bit more naturally to them?

P16:  Absolutely. It will be second nature. I don't think there'll be so much going into a classroom and sitting and being educated. I think more will be online and so you educate yourself. The education of yourself will be from where the person who has guided you, to show you what you need to look at. They will then give you some hints and tips of where you are to find this information, but I think the youngsters would definitely find it easier than people who have been nursing for 30 or 40 years.

TA:  Yeah. So, thinking about some of the things that are on the board [with reference to Zoom background] and following up on that question, where might you find OERs or how have you found OERs in the past? How did you actually find out about them?

P16:  I've always used the e-learning for health. That is something that each Trust I have actually worked for has always directed us to, e-learning for health for our mandatory training. But of course once you go onto e-learning for health there's a vast array of other educational tools that you can access and look at, and you can spend hours if that is something that you want to do, looking at a specific point in e-learning for health. I think it's a very good resource.

TA:  Okay, so you've talked about being guided to resources and to use them, and also being directed to resources. I just wonder what your thoughts were about the shift from being directed to resources to looking for things on your own. Have you got any thoughts about that?

P16:  Yes. I think that once you've been given a snippet, if you want to continue in the profession and know what you're doing then that spurs you on to look at it more deeply. So, rather than just look at the surface you look at other online resources to find out more information about that little speck that you picked up.

TA:  Okay. So, it's like the start of a process once you're in it. 

P16:  Yes. 

TA:  Thank you. What are your thoughts about the fact that as educators we tend to feel responsible for directing people to appropriate resources. Have you got any thoughts about?

P16:  I think that we do, well hopefully we do direct them to online resources, but they should be online resources that we've already looked at to make sure that they are relevant and that the students are going to get what they need to get from, as an educator. Guiding them to go and access this online resource.

TA:  So, might that be in the context of the programmes that you teach on, where you want them to look at specific things in order to meet outcomes?

P16:  Yeah.

TA:  So, thinking about when they've finished their programmes and they're off on their own looking at resources, how do you think that knowledge is validated? I’m not sure I've made that very clear. We validate knowledge by giving students the resources don’t we. We're in control of that process by directing them. What do you think about letting go of that control so that nurses look for those resources on their own and then engage with them completely independently? Have you got any thoughts about that?

P16:  I think if you see an individual, each individual will decide themselves on what they want to look at and do, and how much work they want to put into it. So, yes, it is individual learning, I suppose.

TA:  Okay. You talked about e-learning for health, how that's really good information. How do you know that's good information that's on e-learning for health?

P16:  Because it's peer reviewed.

TA:  As educators then, preparing your students you work with now for going on and carrying on their education outside, where they don't have an educator directing them to resources. How do you think we should prepare those nurses to find things on their own, and then to think about whether they're relevant, or their quality? You talked about peer review, how do you prepare nurses to go and do that on their own?

P16:  Well, if they’re due to have their NMC revalidation then of course they have to do their five pieces of reflection. As a senior nurse I would direct them to think about where they're getting these reflections from. How are they getting their information? What are they doing about it? Are they just talking to their line managers or are they just talking to other people, or are they actually coming to say look, I want to look at this. I want to look at that.

TA:  OK. Would you have any guidance for them about the things that they might go and look at, things they ought to be looking for, or anything else? Can you maybe just talk through that?

P16:  Yes, if I was reviewing any written notes, medical notes written by a nurse and I thought that there was something not quite right, or I think they could have looked into something further, or why did they decide on that management treatment plan, then five times a year we look at notes. We pick notes, and we say well, you've talked about this but did you know that the guidelines have changed? I suggest you go and look at something, such and such. You haven't made it a wrong decision, but your clinical decision making may be a little bit old and things have now changed. So, therefore go and have a look at this and that and the other and if you'd like to do a bit of reflection for your revalidation, then that would be good idea.

TA:  Yeah. So that's from the perspective not as an educator, but as a clinical manager, so you're still guiding and directing students, or nurses. Not students, but nurses, to what you think would be relevant for them to look at. 

P16:  Yes.

TA:  And if they were to go and search out something on their own, and imagine it's not e-learning for health, so it's not necessarily from a portal or platform that you know, would you have any hints or tips of things that they should be looking out for?

P16:  Well, I would always ask them to look at two or possibly even three e-learning or online learning for the same subject, so that they can compare and contrast, because if they do e-learning for health, say for prescribing, then they should look at another prescribing website like the RPS guidance website. If they were looking at something about a sore eye for instance I would ask them again to look for anything that is to do with sore eyes, but make sure you've got more than one website that you've actually reviewed. I always direct them to the BMJ because they are peer reviewed and it's a good website, or pulse, because again they can look at something like sore eyes and they can get two or three different responses from the different websites. Then it’s up to them as an individual to make their own clinical decision on what they want, or what they've learned from it.

TA:  Okay. So, what would that clinical decision be based on do you think? 

P16: I think critical appraisal is probably key. You need to know what the author’s actually saying and understand what they're saying, but you also need to be able to compare it with another author to get a balance.

TA:  Okay so that's about a balance, which is important.  Have you ever come across any e-learning or open education resources that you've done yourself where you disagree with something that's in the content, or that you've thought was inaccurate or that you would like to remove. Has that ever happened with you?

P16:  No. I think you need to avoid very old online resources that can be misleading because medicine changes all the time. You could be watching an old video and it's got the wrong treatment. Or there's a wrong thing, a current treatment.

TA:  I guess sometimes if you're looking at an OER, it might not be right in your context? 

P16:  That’s right.

TA:  So, you might be thinking, oh, that's not quite my context, but what would you do, if that was the situation, if you were looking at that learning?

P16:  I would continue to read it and then I would just think that's very interesting, but I need more or I just don't agree with that. So, I would find another web page. 

TA:  Okay, so you'd find another resource. You’d do critical appraisal against the two?

P16:  Yes.

TA:  Thank you. I'm just going to move on then to another question. What support specifically do you think that nurses need in order to be able to use open education resources? What sort of preparation do you think they need?

P16:  Well, it needs to be done right at the very beginning of their training. They need to know how to do research and the difference between quantitative and qualitative and all of that. And they need to in the classroom, and of course I would of hoped that that they could perhaps get into groups and discuss research that they found on the Internet, and bring it back to the classroom and then take it apart.

TA:  OK, so discussion is important then? 

P16:  Yes.

TA:  Why do you think that's important?

P16:  Because everybody can read things differently and they can interpret things differently. If you've got more than one or two people in the same group you'll get different opinions and different takes on things.

TA:  Right. So that's almost modelling critical appraisal, isn't it? 

P16:  Yes.

TA:  Thank you. So, have you got any thoughts or recommendations on how we should share learning if we're looking at OERs independently as registered nurses, and going off and doing something? How do you think we should share that learning with other people? How could we share that learning with other people?

P16:  Well, in practice we can discuss that and we could tell each other either orally or we could send an e-mail. We could look at when they're doing their appraisals, ‘have you thought about this? Have you thought about that?’ and just try to disseminate the information that you found, especially if it was something that was really, really good and interesting and relevant.

TA:  Yeah. And have you ever found any e-learning resources anywhere apart from e-learning for health, or have you not, because you've found that way in? Have you looked for anything else at all? 

P16:  I usually go to e-learning for health. I probably haven't because I have patients in front of me and I want to make sure that what I'm doing is right. So if it was something that somebody just put up and said oh, do this, that, or the other, and it hadn't been peer reviewed and there was no credible web page behind it, then I wouldn't use it.

TA:  OK. So, you would discount it straight away and is that your context generally when you're looking things up, it might be in the moment when you're working with patients?

P16:  Yeah, it's in the moment. I'm working with patients. If I look up something that's not right, or I can't direct my patient to that web page because that's not right in my opinion. I mean the patient can go and do whatever they like so they can get on the web themselves and look up things, and they often come in with bits of paper saying I found this, and I found that. And I'm saying, whoa, hello. Hang on. Where did you get it from?

TA:  Yeah. And I guess you’d do the same with nurses, if they came to you as your clinical manager and they came and said oh, I've seen this and read it, then you probably do the same with them?

P16:  Yes. 

TA:  So, you'll live in that critical appraisal in the moment. Thank you. So, just to finish then I wondered if there was anything else that you wanted to tell me about using OERs as CPD that you think is important to know for nurses, or relevant for us as educators trying to support nurses as we move further and further towards using these OERs?

P16:  I think it should be directed perhaps from a university. Say, I think of a subject, deteriorating patient. I know that that's a unit. I don't have anything to do with it but I know it is the name of a unit. I think there, you could be directing people to websites and asking them for confirmation that they've completed it if there’s some online learning for it.

TA:  Okay. Can I just ask why you feel we should direct people to it?

P16:  Because I think people would just sit back and think oh, the university can tell me what to do, I'll just go to the lessons? And I can't be bothered to do anything once I've left the classroom. Whereas if you say well, I want to direct you to this, this and this and I want you to bring it back, then they have to do it. They are encouraged to do it.

TA:  Yeah. And also, I suppose just following on from that, that model of being told what to do all the way through your training and through your courses.

P16:  Yeah. It's needed.

TA:  So, how do we then make this change so that students or nurses go out and look for information themselves? Because that's what the NMC is asking us to do, essentially.

P16:  I think that they should go out and look for things for themselves, but I think they also need to bring it back. They shouldn't be a maverick and go off and do their own thing because the NHS is a team. We have to work as a team and if somebody does go off beat a little bit then that could have consequences all around for the Trust people or the patients.

TA:  And as a manager, you probably want them to look at things which you know are going to support.

P16:  Yes, going to support the department, going to support the key workers that are there and not pointing, somebody coming in and saying oh, I've just found this wonderful thing on leg ulcers and I think this is definitely it. We're going to do it this way. Oh, hang on a minute. Whoa, whoa, whoa.

TA:  Yeah. So, it's strategic as well, in a way then. 

P16:  Yes. And that is to stop anybody from going off and finding something, because we can't read everything and somebody else might pick up something that's really, really good. Actually, that's great. Let's look at it again. Let's go deeper into this and let's just see what else has been said about it. 

TA:  Yeah. 

P16: But I would say no, you're not going to change it because you've read one article.

TA:  Thank you. Was there anything else you wanted to expand on or thought about? 

P16:  No.

TA:  Okay. Thank you.
