Demographic questions and confirmation of consent.
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TA: Thank you. Can I start by asking if you have you heard of the term open education resources?

P19: No, I haven't heard of it, but obviously from like looking at the list and stuff, and I've used e-learning for health. I've watched TED talks. I use the RCNi resources. So yeah, just not obviously realising what the overall term was.
TA: Yeah. You're not alone. Nobody's known what the term is yet, which is why I refer in all my latest recruitment about e-learning, or online learning.

P19: Yeah.

TA: Which is free. That's one characteristic really, of open education resources. So, my first question is what sort of resources have you used for your CPD and how did you come across them, or?

P19: So, I know my Trust that I work in, they use e-learning for health as part of our mandatory training, like on our online VLE. But, I've done like some extra ones. I've done the Oliver McGowan learning disabilities one because of my ward area is in acute medicine. We do get a lot of learning disability, so I use that. It is now becoming mandatory to be fair. So, I've done that one. I've done a couple on autism. Again, it's a neurodiversity, because there's a lot more patients coming in with it, a lot more patients coming in with like, ADHD and like the meds that they come in with and stuff. So yeah, it's all good.

TA: Okay, so how did you find out about those resources? Did somebody signpost them to you, or did you just go look for stuff?

P19: Yeah. So, I'm really lucky we've got a practice educator within my ward, department. So, she signposts away, and she knows that I'm one of these people that I constantly like to be learning. Even now, I always miss uni and things like that. So, now it's keeping my knowledge up with the free, open ways to do it.

TA: OK, right. So, how is it different then, do you think, doing the mandatory training to doing the actual, stuff that you've looked for, yourself, or you’ve been signposted because of your interest?

P19: I think it is because you're interested. So, like, your mandatory training, you know your fire safety, your infection control, the stuff that you do year after year, or every three years, it's very repetitive. Whereas when you're seeking out, new, to find new information, you, you're wanting to learn. So, I think there's, that's a big, a big difference is that you want to learn. You want to find out the information, so you have a bit more of a vested interest in it.

TA: Yep. You talked earlier about having used TED talks and things like that as well. Is that stuff that you've looked at for yourself, or found on your own, or that you've just done through a search?

P19: Yeah. So I find a lot of TED talks like on YouTube and things, and I just find them really useful to listen to. And like, if I've had a rough day at work as well, so not necessarily nursing ones, but like just like well-being ones and personal mental health, and how to look after yourself ones, because like, my induction into the ward has not been easy, like. And we've had some like, really horrific cases and stuff that's going to stay with me, like I've gone through TRiM risk, TRIM things [trauma risk management], just to be able to like, cope and manage with some of the cases that we've had on the ward. So, actually just being able to, yeah, YouTube, TED talks, not just necessarily on nursing stuff, but like well-being and that. It's been really useful as well.

TA: Do you think you'll include that as part of your CPD evidence, the things on well-being and stuff, for your first revalidation?

P19: Yeah. So, it's been, yeah. So, as part of. Obviously, I've completed it, I'm literally going to complete preceptorship next week. We've done, with Live Well, Dorset as well, we've done the level one courses for well-being for you, and well-being for others. So, we've got certificates for that and stuff, so that's good to be able to, put in, obviously for my CPD and then yeah, anything that I can obviously evidence that I've done it, then. I definitely will be.

TA: You'll have loads! Already, you've got loads. You'll have absolutely loads. You'll have to just like trim it down to the bare minimum when it comes to the time.

P19: Yeah.

TA: So, when you're looking at those resources that you found yourself, what sort of questions are you asking yourself as you're going through them, maybe about the content, or the relevance or?

P19: Yes. I think for me, I think it's, I think it being fresh from like university and stuff, it's like is it reputable? Is it? You know that, like TED talks I know, that are reputable, like they were obviously used quite widely throughout university, and then obviously like the RCNi resources that I know that they're very credible. So, it's just knowing the background of where they've come from, and who's also endorsing them.

TA: Would you use anything that's not necessarily endorsed by big platforms like that?

P19: I think I would, if I had enough time to research my own, to know myself, that I felt it was credible.

TA: Okay, so you would research it yourself, but basically there's not time to do that?

P19: Not with life, and that balance.

TA: So, it's just easier to go to the reputable things, that you just know that they're trustworthy from the start, 

P19: yeah.

TA: Okay. And there was another thing that you mentioned there, about having used them in uni.

P19: Yeah.

TA: So, when you used these things in university, were you, prepared for using them as an independent practitioner, do you think? Or do you think there was anything in uni, that would have prepared you for using them?

P19: No, I don't think so. I mean, up until before I started you know, at the university, I'd never watched a TED talk in my life. I'd heard of them, and I was like, no, it's not for me. And now I find myself most weeks watching a different one, but I, no, I think, for me being an older and mature student, I think it was. I was set with what I what I needed to do, and obviously having like the pre-work set, and the post-work set [reference to flipped learning in academic units], I completed it and found it very useful, but obviously I can't speak for people that are maybe younger than me.

TA: And when we were showing you all those things in uni, so for instance, in therapeutic comms when we were showing you some of those videos and resources, were you made aware at that point, that these are free Internet based learning resources you could use for CPD in the future?

P19: I think so. It was quite a while ago. I think personally like me having a bit more like knowledge and experience and stuff, I kind of like, my husband's very techy, so I know like, a lot of like online like, web versions and stuff.

TA: So, thinking about, my core question that I'm really interested in, is about the fact that obviously technology is developing apace, isn’t it? Both for learning, but also in practice, and I just wondered really, how you think that we should prepare, or that the university should prepare practitioners so that they can use all those tools and technologies, but also, I mean, putting that in the context of e-learning as well, free e-learning.

P19: Yeah, so I think. As long as like the students know that, like I think it's, knowing that they know that it's out there. And finding, different ways to, show us that it's out there. I know my cohort, it was death by e-mail. It was the multiple, I mean, even now like I still have my uni emails pop up and they still come through and it still feels like death by e-mail. But, I think it's, yeah, just finding different ways to let us know. I know like they obviously did like, days, like the service user days as well, so we got like the lived experience and stuff like that. So, maybe like just days like that, where you know. Each, there's a different section, or a different part of the day, that's for a different platform, and maybe a platform that actually none of us had even heard of, that we could then use.

TA: Yeah, because you are kind of thrown out there, aren't you? After completing your training, then you're left to be independent in your CPD. And naturally some of it will come from the [hospital] Trust, and you'll be indicated what to learn and things, but some of it's going to be driven by yourself, so.

P19: Yeah.

TA: You know, if you want to then change your placement area, you might do some specific research into something or whatever.

P19: Yeah. No, definitely. 

TA: Have you ever thought of ChatGPT or anything, as involved in, or useful for free online learning?

P19: No. To be fair, I've never. I've obviously, I've heard of it, but I've never actually used it. I know of an area within the Trust, who used it to write their job adverts, so they can make the job adverts stand out a little bit more, and sound a bit more, fun.

TA: Yeah, thank you. When you're learning, and you've done all your learning you've done on neurodiversity, and learning disabilities and things like that, do you ever share that learning with other people, that you've done?

P19: I mean, I talk about it, like on the ward and stuff, and like, I have quite got quite a good relationship with my practice educator, so I tell her like some really good ones. And then obviously, when she speaks to others, it's like, Chinese whispers effect, obviously in a positive way, which is good.

TA: Okay. So that's a really good thing, that you're sharing. Do you ever talk to the other practitioners about it, or recommend that they look at something, or do you think?

P19: Yeah. I mean, I think me being like the type of person I am, I'm not a, I don't want to gate-keep. I want to, you know, I want everyone to love learning and I know it’s not some people’s thing. There's some nurses that been there and they're like, no, I'm quite happy in my band five role. I'll do the bare minimum that I need to get my registration and revalidate, every three years. And then, yeah, there's me, that’s just like a sponge and wants it all.

TA: So, there may be types of people who might be more drawn to free Internet-based learning anyway. 

P19: Yeah.

TA: I'm just interested that you talked about using the TED videos quite a bit. Is there any reason that you choose those, over another learning method sometimes?

P19: Yeah. I think it's because it's, you can just listen to it. So, like, I can have it on driving home, I can have it on whilst I'm cleaning the kitchen after cooking dinner, I can have it on when I'm just trying to, like, spend five minutes peace, just for me. I just think it's, then you're not, I'm not having to read. I'm not having to try and engage my brain. It's just, it's just easy. After a 13 hour shift, it's just, yeah, easy.

TA: Yeah. And I'm sure you've looked at your learning styles and things during your time in uni. Does that reflect the type of learning that you like to do?

P19: Not at the start, not at the start. 

TA: Okay.

P19: At the start I was a very visual, like notes, whereas now I've gone definitely to very auditory, and actually then be able to then put it in like, put it into my own words and like decipher it my way. So yeah, I think it has. It's definitely changed.

TA: Yeah. Okay. Have you been involved with any of the simulation learning or anything, in the Trust?

P19: No. I'm on [clinical department] and they run their own foundation programmes, which is like a preceptorship. So, we did a few simulation sessions as part of that. So, it's with all the other newly qualified on [clinical department], between [hospital name] and [hospital name].

TA: Excellent. I'm sure that was awesome, but do you think you needed any special preparational skills to engage, really effectively in that learning?

P19: No, I don't think so. I think university, because we did quite a lot of SIM work, at Uni. I think, that prepared you enough, and like when I was a student I had lots of opportunity to like do the STEPS training [simulated Training Education Programme] with the F1’s, and work alongside them. So, I think no, I think there's plenty of opportunity to know about it before you start.

TA: I'm just going to come back to the skills and knowledge that we need to prepare. Can you think of any particular skills or knowledge that you developed, over your training, that you're able to use, when you're using free Internet-based learning?

P19: I think knowing like, obviously we're taught how to research, and how. I think knowing that, before I would have just Googled it and gone for the first, picked the first, the top choice. Whereas now, knowing like more about how to effectively research and like not, it's like narrowing your search terms down and stuff. It definitely helped, and it made it, yeah, a bit easier. And then I'm getting more saturated content, rather than just willy nilly picking the top choice.

TA: Yeah. So those skills, actually are quite useful then, about focusing.

P19: Yeah.

TA: And the things that you're thinking, is this really relevant to my training at all, are now the things that you're using quite a bit.

P19: Yeah.

TA: Okay. What about when you're using materials, have you ever come across anything that you've not agreed with, or that you've thought wasn't relevant, or you'd like to ask a question about, while you're doing the e-learning, especially if it's learning that you're engaging in, like maybe the neurodiversity courses, or the learning disability courses?

P19: I don't think so, but I feel like if I really didn't agree with something, that I could like do some further research, like I feel confident to be able to do it. Yeah, do the research to then expand my knowledge, and, you know, prove myself wrong, so to speak.

TA: Okay. And then confidence is obviously a big, thing.

P19: Yeah.

TA: That you've just said about feeling confident, so that means you could just get on and do it, without worrying, or whatever. It's just some people have talked about maybe reading something and thinking ‘actually, I don't agree with that answer’, or else maybe thinking about stuff like safeguarding, although that's more mandatory. Like having questions, and not knowing where you could go to get answers.

P19: Yeah.

TA: So, I don't know if you've ever had something like that where you found there were questions based on the learning, and then what? Where did you go for your answers if there were?

P19: No, but I suppose, in something like that, I know especially like something like safeguarding, I know that we've got, like, a really in-depth safeguarding team within the Trust that I work in. There are actually no questions, or stupid questions. I could go to them and ask them. I suppose that would be quite simple for any of them. We have specialist nurses for like, most conditions, so I suppose, yeah, if I had any questions, I could definitely feel like I could go to them.

TA: That's good then. That's a clear line, because one of the things that people say that they miss, in this kind of learning, is talking about the learning with other people. Have you ever had to do any discussion forums, or anything like that, in any of the free online learning that you've done, sort of connected with people?

P19: No, I haven't. No, I suppose actually, thinking about it, yeah, it’s like, especially if I'm the only one that's done it and I have got nobody to, like, talk to about it, my husband gets bored to death.

TA: Yeah, okay. Well, that's really useful. Thank you. And that leads me on to time, I suppose. You said earlier, you don't have much time. Do you have time? When do you do your online learning?

P19: Normally, yeah, days off. When like, I've taken my son to school this morning, like now I've got like the six hours before I pick him up. So, apart from, like, flitting around and doing the housework and stuff, if I feel like. I had quite a good weekend at work, and it's been a little while since I've had a weekend like that at work. That I don't feel like I need to, but sometimes like, I just need to decompress and listen to a TED talk, or something like that, just to you know, that actually, I'm not alone, and, other people go through the same stuff that like we've gone through on  the wards and stuff.

TA: Yeah. And do you have time in work to do learning that's about CPD, and not mandatory? Do you even have time in work to do mandatory training?

P19: No.

TA: So, it's all done in your own time, basically.

P19: Yeah. So, they give you the time back. So, like, when I started [as an RGN], because I've worked in the Trust that I work in now, for donkeys years beforehand, I didn't have to, like, do an induction or anything like that. So, I was just given 71/2 hours, to complete my online learning, and obviously that, you know, whatever courses it was, for the mandatory stuff, and then I've done a couple of courses since, so I've done like the syringe driver training, and that's been like, within work time, or they've like allocated the hours to do it and stuff. So.

TA: Yeah, but not for learning that's of your own volition, you want to do for yourself.

P19: No. I mean, I say, actually. So, I'm doing a acute oncology study day in a couple of months, because I'm going to become the link nurse for, acute oncology, just because it's another interest of mine.

TA: Awesome:

P19: So. I was like, so, I asked to do that, and then I saw that there are study days. They've put me on it, but that's a study day in their Trust. I'm not too sure what would whether they would for any online learning, whether they'd be happy to or not.

TA: Yeah. And that's obviously linked to you taking on a specialist role as well, isn't it, of that link person. So, they know that they're investing in you for that. I’m just wondering if you think that employers have any kind of responsibilities, around what their, what the nurses are learning, or providing learning for their nurses, especially thinking about ways that we could maybe, get them to use open education resources within the clinical setting. I just wonder if you've got any thoughts about that?

P19: Yeah. I mean, I think it would be good like, for the Trust to, you know. There's obviously, there's a huge drive for well-being, and nurse burnout, and all that. So, there's so much knowledge around like, all the well-being stuff that the Trust offers, or that is available to members of staff. But yeah, I don't think there's much of a push on like, open, like online learning, which there could be. You know, e-learning for health is huge. You could search for anything and find it, and do a unit on it, you know, if you had an interest in it. It's easy. It's easily, you know, linked in to. 

TA: Yeah, and then if you were to choose something from e-learning for health, would you then tell your manager about it, that you've done it?

P19: I probably would. I’d probably want to.

TA: Or would it come up maybe at appraisal or?

P19: Yeah, probably appraisal. So, my ward's been really good. So, I had one at two months, I had one at four months, and then I’ll have one next month when I’ve hit six months in the Trust. And I, yeah, I probably would bring it up then, that I've done this, and add it to my. And they'll be like, okay, well send it over, and we can add it to your portfolio, like the online bit that they've got for us. Yeah. No, it's, I think they would definitely be open to that.

TA: What sort of technical knowledge and skills do you think nurses need to work in today's NHS?

P19: I think you’ve got to have got a high knowledge, like everything's computer based. We do our meds on like, through a computer. We do our observations through an iPad. Even our infusion pumps now, are connected to the Wi-Fi, and you search the drug, and you know. They're brilliant, don’t get me wrong. They're absolutely fantastic, unless you want bolus fluids through very quickly, and then you know, you resort back to the old way of a pressure bag.

TA: Yeah.

P19: But yeah, I think you have got to have some really high technical skills, to be able to be able to yeah, swim in today's NHS, like there's nothing anymore. We still write notes on paper but everything else is done online. Yeah, you need to have some really high technical skills for it.

TA: Yeah. So, do you think those kind of skills get developed in the university, to any degree? And if not, how do you think we might help you to develop them.

P19: I think it does. I think it does through placement. But yeah, I don't think it does too much throughout your theory base. I think that's just because of the environment that you're in. So, obviously, yes, we use like computers and stuff for university, but obviously the university doesn’t have access to, like the online system that [Trust name] actually uses. It doesn't have access to like e-OBS and eNA, which that's all done online. There's no access to like EPMA, and you know ‘help the ward’ and the things that I've now had to learn, since, coming out, but then I was very lucky that I had six weeks supernumerary, so I had the time to learn, those skills and have access, because that's another thing is getting access to everything, because you know, it's all individual logins, which you know, is another. Everything's on an E-form as well. There's no, you know, you don't just bleep a different team and ask them to come review a patient. It's inter-professional referral. It's all done online. So. Yeah.

TA: Yeah. So, there's not really any way that we can help garner those skills then, you don't think previous to going out?

P19: I don't think so. I don't think so, not without. I mean obviously every Trust does it different. So, like obviously the university use and have access to obviously different Trusts within the county and that, and every Trust does something different. Like, some Trusts might not use online systems for medication. They might get, you know paper charting. I just think that's, yeah, there's going to be no easy way to do like a blanket learning for everything online.

TA: Yeah. So, saying that, do you think there's anything we can do to prepare you to be able to adapt to all those different systems, within the university?

P19: I don't think so, no. I mean. I think maybe a partnership a bit more, especially for [Trust name] in the Uni, because some students have access to the ePMA, and some students didn't. So, when I started, I didn't have access to ePMA as a student, whereas some students had access. They’d done the training. I think maybe it just needs to be a blanket ‘yes’, all the student nurses have to do the training, or ‘no’, they don't. Wait till they're qualified. 

TA: Yeah.

P19: Obviously you still, then you can log in with your own login and then the nurse will then countersign your notes, as you would do, when it was an old fashioned paper chart and you countersign, you double sign every med that you gave.

TA: And do you ever Google things on, at the bedside, or at, on the ward, about conditions, and things?

P19: Yeah. Conditions. Meds. So, like, again, ePMA is really good, because you can click on the medicine and then it gives the clinical drug information. So, you don't have to sit and scroll through the BNF. I mean, I've still got the BNF app on my phone, but IV's, we've got Medusa, so then we know like, how to correctly dilute the meds and how to give it, how like, how fast to give it. So yeah, and which is all stuff that I learned as a student. I think maybe, you know, we could have had knowledge of Medusa through the university? I only knew about it from being on placement. Especially now, obviously, with the new standards and obviously IV's being, you know, acknowledged that we need, must have as students, so yeah.

TA: Yeah. And do you ever Google anything else, like about patient conditions, or things?

P19: Yeah. So, if it's a condition that I've not heard of before, then yeah, I definitely will do so that, you know, I'm not a master of all trades. I know a little bit about a lot of things, but then I know that, you know, some conditions like, I had patient with Meniere’s, and I've heard of it before, but I just couldn't remember what it actually is. So yeah, just a quick Google to then, to then know a little bit more about your patient as well, rather than just a list, they’re not just a list of their past medical history.

TA: Yeah. And when you go there, what, what decisions do you make about what sites you'll look at for that condition?

P19: I tend to do like NHS ones. Sometimes, like some of the American ones come up first, like Mount Sinai and stuff like that, and I'm like, well, yes, they are very good. But I try and stick to the UK based, NHS ones, not Wikipedia, not Web MD.

TA: Yeah. It's a really simple question, but why is that?

P19: I just think then I know that I'm getting accurate information, not what Mrs. Jones told Mr. Smith, and he decided to put it online, yeah.

TA: Yeah. You've never come across a situation where you found a website's been attacked and got different information on, or where you'd query that information doesn't seem to be right or anything?

P19: No, I don't think sorry. No, no.

TA: Okay. I'll just finish by asking you if there is anything else you want to tell me about using free online learning, that you think we could either help with, or that would have been really useful for you to know, before you started using it as a registered nurse?

P19: No, I don't think so.

TA: Thank you.


