Demographic questions and confirmation of consent.
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I had forgotten to press record. Responses to the first questions noted down immediately after the interview.

TA: Thinking about learning you have used for continuing professional development in the past, how did you find or come across the free Internet learning materials?

P18: Partly through secondment to academic roles in the university, and access to different learning materials within that role.  Also, through e-Learning for Health, during Covid, for own use and to find resources to signpost to others helping out in the pandemic.  Noted that there were ‘lots of high quality’ materials available, however these were not all wholly relevant and having something quicker and easier to use, in preference to being very high quality, would have been better for those completing them.  Purposeful access to free Internet learning has also been through finding resources for teaching.

TA: How is using free Internet-based learning for continuing professional development different from using them for mandatory training?

P18: Using free Internet-based learning for continuing professional development is different from using them for mandatory training because you (I) feel engaged and the learning is relatable, because you have a choice about what to learn.  I don’t have to spend a lot of time completing the whole content and I do skip pages that are not so relevant or if it is something that I know.  I feel focused when completing online learning for continuing professional development and have a purpose in completing it. The reality is that online learning is rarely done for continuing professional development, by clinical nurses, as they are not given time in practice to do it. Continuing professional development in the clinical setting is usually focused around completing mandatory training, and even then there is not time given to complete it within clinical hours. If not mandatory training, then learning is usually practice-based, delivered through continuing professional development sessions, or spoke days.

TA: Thinking about the free Internet-based learning that you accessed, how did you assess the relevance and accuracy of the materials?

P18:  I have ADHD and that impacts on the selection of learning to complete and the choice about what to complete. It is not just about the content/perceived relevance but is related to engagement and accessibility.  If the presentation is not accessible, then I lose focus very quickly and skip content.  I lose focus very fast so it is better when the learning materials are very focused.  When planning teaching I take this into account when deciding what Internet-based resources to use.

TA: Thinking about finding and using free Internet-based learning as continuing professional development, what skills and knowledge do you feel nurses need to use them effectively?

P18: The average nurse has no time, unless they are specifically accessing learning to prepare for a job interview, or because they are using them for their (academic) studies. There is no way to get feedback on your learning with the online learning, which isn’t great.  It’s not directly about skills and knowledge, but I lose focus very quickly if I have a question about the materials, as there is nobody to ask, so I have to go and do some more searching to find the answer. That causes me to stop doing the learning and then I can also forget what the question was, which is really frustrating. There is no time at ward level to ask those questions of colleagues. I can use AI, such as ChatGPT to ask for the answer to a question, but the quality of the answer depends on the wording of the question.  Again, the e-Learning for Health is more focused on high quality than getting the information across quickly. Since working in academia I have developed my critical analysis skills and I use these skills when using AI/ChatGPT when considering the wording of questions I ask and when reviewing the answer provided by AI/ChatGPT.

TA: Thinking more broadly about nursing practice, what preparation do you feel nurses need to work, in the context of rapid technological advances?

P18: It needs to be driven by the university, about how to use AI, and what wording to use. We need to create independent learners, through the use of practical actions, and through time and exposure to other learners. It helps when the students are learning so they have motivation and they have deadlines (for assignments). To foster critical analysis we need to develop students who are challenging and double check the information so that they can defend their ideas, perhaps in the classroom as two groups given problem-based learning. They have a solution, or several solutions, that may be right, but one is more right. They should use Internet-based learning to find the evidence to support the ‘most right’ answer.  They need to be taught to use a quality assessment, seek peer reviewed learning materials and access them using accredited platforms. They should always refer to the national guidelines to back up their argument and defend their ideas.

TA: I’ve just noticed the recording is not on! I'm switching it on now.

P18: No worries.

TA:  So, you were going, you were saying about these groups in the classroom, trying to find the better idea of the most correct answer. And that is all about discussion, so when students are now qualified, and they go to look at these, resources, for themselves. You mentioned earlier about not being able to ask the questions straight away. You might have to look somewhere else, or maybe you could go to practise and ask for an answer to a question.

P18:  Yeah.

TA: But how do you think the students should be discussing what they think? Say you go to e-learning for health and the students see something that they're not sure about.

P18:  Yes.

TA: And two students doing the same resource see things which are different for them and less relevance, or more relevance. How do you think they should then, try to use that resource in the way that is accurate for them? Are you aware of any copyright around free Internet-based resources at all?

P18: I got lost. Can you rephrase that?

TA: Okay. First of all, then, when you've got the free Internet based resources, you've got e-learning for health, you've got ChatGPT, you've got other things which are on the board.

P18: Yes.

TA: You could go to YouTube. You could find some worksheets on the Internet. Are you aware of any copyright or, licences that restrict or enable you to do things with that materials?

P18: For me as a lecturer, or for me as a nurse?

TA: Well, for you as a lecturer, or it could be for you as a nurse, because we have the same. Technically, the materials on the Internet have the same copyright licences for everybody, whether we're educators or in practise. I just wondered if you're aware of any licencing?

P18: Oh well, of course I would imagine they are all copyright protected, so I like. But like, even if you were to use those, that material, you wouldn't copy and paste it anyway. Like, you wouldn't like, it’s just beyond the copyright. Like, you wouldn't copy and paste that. But it depends on what you use it for. For example, if I am using ChatGPT, for example, for a process or something, then I will look at the process, but then if I want to put it down on the material then I will look for other sources of information too. I will get the process broken down by ChatGPT, but then I will get the resource, like a piece of evidence to then justify that, or if I need to put it down as a material, of my own understanding before going to that resource, which might be a little bit too disengaging, then ChatGPT would be the good start. I'll get my understanding first, and then I will go to the piece of evidence which are then like in my material, if I have to, put it down. Yeah, but, from a student perspective, if, like, I wouldn't see how they would be in breach of the copyright unless they are plagiarising? 

TA: Okay. I'm asking because this is some of the knowledge that we need to teach students, because a lot, if they're truly open resources, then that, they often come with a Creative Commons copyright, so that you can actually adapt them. Often, you have to just attribute the original author.

P18: Yeah, yeah.

TA: But then, how do we know how many times something's been changed, and how like the original it was in the first place, so this is one of the things that links back actually to the critical analysis, discussions about being able to like really understand the sources? And where they come from, and who's written them and things like that, so I suppose that's part of.

P18: And with historical context as well, I would say.

TA: Yeah. And the historical context, because you need to understand, and things need to be up to date, don't they, for practice? And if you don't have a date on something, or if you don't know who created it, then, it is difficult. Sometimes the student might come with a really good resource and say ‘I’ve found this, this looks really good’ and you might look at and say ‘ah, but actually, that's inaccurate, or not relevant, and they might not realise that it's inaccurate, or not relevant.

P18: Oh yeah, absolutely, absolutely. I have, I think very often, actually.

TA: Yeah. And what would you do if that happened?

P18: If they don't understand whether it's accurate or not, or it's relevant or not, well, I will. I would always suggest to the students, to go through the national guidelines, or to a piece of published evidence, and peer reviews. So that's what they should be aiming for, but I always say to them, like you can use the artificial intelligence to break down what you can't understand? 

TA: Yeah.

P18: But then again, you have to have some degree of critical analysis there as well,  because when you ask ChatGPT for example to, … I don't know, make that writing dyslexia friendly, or ADHD friendly. I would fear to blindly rely on them, because you don't know if it's going to change the, overall sense? Or, it makes sense what I'm saying? Like, if for example it’s changing the initial meaning of something, so I would always like compare. But it's difficult. It's time consuming as well.

TA: Yeah. And then you've already said there's not much time in practice, for people to do, to do more extensive searching, or to do CPD. Obviously we do have a deadline as such, because every three years we have to submit some CPD. 

P18: Yeah. 

TA: In your experience, what type of things have you used for your CPD, for your revalidation?

P18: So, for example. I would normally like have been like, … on university courses as well, because even when I was like first registration, I was on the critical care course. So that would have given me enough hours for the revalidation, and because it was during the pandemic, my first course was late, like the second course was delayed as well, so I had to complete on the following revalidation. Outside of the University I was, for example, other training that I would have done in other hospitals? But everything was practice related. I would tend not to use online resources, because it's not, it, it doesn't. You know, when you do the revalidation, you would have like 20 hours that has to be like, participatory, so the online one wouldn't count as participatory. So, I would tend not to use them if I can avoid, and rather use something which is face to face, because then that will feed more into the revalidation criteria.

TA: Yeah. I'm just thinking you could always take the e-learning to a setting, couldn't you, and use it as a team based activity? 

P18: This is what we were thinking as well, but then two things should happen from my own perspective. So, first of all, the NMC should recognise the power, of the CPD online courses, and the discussion. But then also, the healthcare employer, the healthcare provider should recognise the importance of having teams-based, with a structured agenda. Aim for learning and group discussions. Unfortunately, from my own experience, when we had team days, we had them like the, yes, like the politics behind it was ‘we need to have them, but they're going to be well-being based’, and we had people who were not well-being trained, to come and talk to us about well-being, which made no sense whatsoever. So, just to give you an example we had. We had an episode where somebody from the organisational development came to talk about the squared breathing? And she got so slow in doing it, that a couple of us like, nearly fainted in the session, because of how long she asked to hold the breath for. She hadn't realised that people can't really. That's not compatible with life. So, you feel like? And, so I do wonder like, rather than, you know, trying. I understand like the purpose was great, because you're doing well-being, ok, so it will be very hard to well-being, a lot of people have, you know, left the profession, because the work life balance and stuff. But, there are other stuff that we should be doing to avoid people leaving, rather than asking non-professionals to come and talk about well-being, because that's not helpful. That's not helpful. But, also like for example, we can use that time, to actually have targeted learning, through discussion? So like, bring something that you learn, and then discuss it with the group, and everybody will get their own idea. 

TA: Yeah.

P18: Does it make sense? And then it also using the group potential, but then it comes down to as well, like how do you organise that? Because how can you organise group learning where you need to ensure that the shift is covered? 

TA: Yeah.

P18: How can you send like all that staff, on a training day, at the same time? Do you see my point? It gets so complicated. 

TA: Yeah.

P18: And then you may well organise these days, and then like it, fell off the plan, because you'd have to recall some of the people in practise, because you have two off sick, and people who are on trainings are the first one who gets called in, so.

TA: So, it’s complicated.

P18: It's largely, yeah, it's complicated. But like, from the logistic perspective as well, like there's no time allowance to begin with. When there is time allowance it’s not protected, because the people who are on training are the first one who got called in, because most of the time the training would be held in the hospital. But in any case, you are directly asked to bring your uniform, just in case.

TA: Right.

P18: And that happens all the time, and especially if you work in a very specialist area, like for example, like [clinical speciality]. It's not like you can cover it with the ward-based nurse. So, you do need an [clinical speciality] nurse, to call for an [clinical speciality] nurse.

TA: Yeah, yeah.

P18: So you are called in, while on training, because you're technically paid for that day, so they don't have to call an agency. I can get the point. But then we can't blame you know, the nursing culture for not making much learning by themselves.

TA: No. The NMC have said that they think this is an appropriate way for, that Internet based learning is an appropriate way of doing some education, for CPD. But it is easy to make that statement, isn't it? And then, in a sense, not put any value on it, and it gets over the problem of us not being able to run courses anymore, for staff. And it gets over the problem for employers, because they [nurses] can do this all in their own time, and it's very flexible. So that's the approach from the NMC. It's very flexible. You can just do it whenever you want to do it, but then that takes some of the responsibility off the employer, which is obviously a tension, and your points about the employer being on board and valuing it is really important.

P18: But also, I think what could happen there, and I would say that from my perspective. So, if the employers, if you were for example, to say you’d go there. I've thought I've learned on this module, for this much time, ok, so can I have this time back as time owing? OK, so where's the certificate? To get the certificate, you have to go through the whole learning. So, you need to go. So, at the moment you need the certificate. You can't go through YouTube, or you know, other courses, so a lot of materials already gone. Do you, like see, if they want to see, some people, you might have to go through the whole material and then going back to what I was saying earlier, if you, for example, have a focused learning session, you can't, because to get that certificate, perhaps you have to go through a whole module [extended emphasis]. So, imagine that from the perspective of somebody with a difficult attention span, or attention deficit span.

TA: Yeah.

P18: Perhaps they might need a little bit extra time to do that, and stuff like, so, you're like, if you talked about it from the employer perspective, they wouldn't consider, that you might need extra time as well. So, how can you go to your employer and say ‘actually, I might need a little bit of extra time, to make that learning mine, to sink in, to allow it to sink in. They don't have that reasonable adjustment, or understanding that you may have like an invisible disability. So, there's a lot of unawareness about it, as well. But then, again, like going back to what I was saying earlier, you may disengage with that learning, because you have to go through a path of other topics, before you can actually get to the one that you wanted to learn.

TA: Yeah.

P18: So, it's like, it makes life a lot more complicated. And then like, if the NMC obviously would also ask you like, what's the evidence that you've done that learning like, what's the evidence of the discussion you have? 

TA: Yeah.

P18: Do you know what I mean? And then you would go through. But no, they haven’t, I think at for the time being, there isn't much attention, or, they haven't put like too much values in the online resources. They have to be structured in a way, and not appreciating the value of. For example, I've learned a lot from YouTube videos as well. You know, you have to take it with a pinch of salt, because you know, it's not like it's publication based, but if you want to get it broken down, for somebody who's a visual learner, or a kinaesthetic learner, and seeing something which is animated is really helpful. For example, I learned a lot from those when, to us with, that have got a black background, with highlighted writings. 

TA: Yeah.

P18: So, I learned a lot from them, because I would struggle with black, sort of white background and black. 

TA: Like on my background [indicating Zoom background]. 

P18: Yeah.

TA: Yeah. Like the slide, yeah [both laugh].

P18: I don’t want to, yeah.  It’s more accessible, possibly having a different background and a different writing. 

TA: Yeah. 

P18: This is like, for your own perspective, to be aware there's a. It was released, the dyslexia, British dyslexia guidelines, for accessibility of the resources. So, they are trying, they're asking to avoid white background and black writing. Not because of your writing behind now, but it's just like to be aware of. I'm saying this because, most like, for example. If you are asking the students to go through a publication, all the publications will be black and white. The problem is, if you don't have access to the funding, then, you don't have access to the software to change. And we, like, as students, you don't get induction for accessibility. So, if you want to change the layout of an article, you can't because you're not equipped with the knowledge that you need, to change it, and make it more accessible. So, for example, if I'm, so the reason why I'm saying this, is because if I say to the students, go and look at the publication, they will get disengaged if they have any difficulty, because like, it's a lot of pages, all text, black and white, you would disengage quite easily. Whereas if you're watching a video on YouTube and it's black background, with shiny green writing, that it's. It's like, even in front of you, as you read it there, it will make you focus on that, because it's happening here and there. For somebody who's visual and kinaesthetic learner, that will work quite well. 

TA: Yeah.

P18: So, there's a lot of competition between that learning, and the learning in publications. 

TA: Yeah. 

P18: Does it make sense? So, it's.

TA: Yeah. No, that's right.

P18: There is a lot of value. There is a lot of value in the external resources which are not publication based, or that you can't see that they are clearly publication that is. But they're not really valued, and you don't know what value you can use them yourself. You need to use critical judgement.

TA: Well, thank you. If there was anything, any single thing you wanted to tell me, just to finish, about using free Internet learning as CPD, that comes to mind, just to finish off?

P18: No, I don't think so. I don't think there was anything I would like to add. 

TA: Thank you.



