Demographic questions and confirmation of consent.
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TA:  Thank you. I’m just going to start by asking you to tell me a little bit about how you might find free Internet-based learning, that you want to use either for CPD, or for teaching, or whatever purpose?

P20: Okay. So, I'm on LinkedIn, but I don't necessarily use it as such.  E-learning for health. I've accessed, when I was doing the COVID vaccinations, and I did all the training then. And I've also developed a work package for e-learning for health, and I've been involved in evaluating that with [name of organisation] University around [clinical speciality] resources. NHS professionals, I don't think so. Open Learn and Future Learn courses [reading off the list on background]. TED talks. Yeah, I use them all the time.

TA:  Okay.

P20: RCNi resources, possibly. Yeah, workshop, YouTube videos, yes. I use a lot of BOB, box of broadcasts.

TA:  Okay.

P20: They broadcast recorded TV programmes and edit those to have snippets of things, and they're really, really effective. I always signpost people to ‘fake it till you make it’ TED talk.

TA: Okay. So, I'm just checking that basically you would have been, from what you're saying, you would have been signposted to the COVID stuff, because there was a requirement, wasn't there, that you had to do specific modules and things, but you go off and you find things like using BOB?

P20: Yes.

TA:  Which I’ve not really heard of, so I'll go. I'll go and look that up [brief laughter TA].

P20: It's amazing. It's a database in the library, so it's not free for everybody. So, it’s one of the databases, so it's good. Look at the [clinical speciality] stuff, it's fantastic.

TA:  Right. Okay, I will do that. Thank you very much. Okay, so that answers the first question, and about mostly being signposted to the learning. So, if you were thinking about that learning that you did for COVID, it was probably mandatory, wasn't it, really?

P20: Yeah.

TA:  So, have you ever done anything that you've gone off on your own to look up, something to support teaching, or for your own development around areas that you're going to teach about?

P20: Yeah, predominantly, that’s what I've done, you know, to go. I search around, to find things, to inform my teaching, or to inform the signposting that I will give to others.

TA:  Yeah. So, you signpost to others as well. And what is it that makes you decide whether to use a resource or not, when you found something, like from BOB?

P20: Accessibility. Ease of use, and impact. So, for example, we developed some train the trainer, simulation, training, which is now online. We've also then developed to be online, for acute hospitals in England. And, because I love this clip from a documentary, [documentary name], and I've done edited bits of it, it's really impactful, because it's real people, it's not actors. But that wasn't as accessible, for everybody, and so that made that challenge for people to buy the video, and we had to find out how we could pay for the video and. It, you know, so accessibility, so I can use it really. And then we found a way, and I can't remember how we did that, so that other people could access it. But that was a challenge, that accessibility is really important in the cascading and dissemination. So, within the university setting, I can use these things really easily, but if off site, even at [name] campus, I have struggled sometimes to access those things.

TA:  Yeah. So, our staff who are in practice, who've been qualified with us, so looking to update about something like that, couldn't necessarily.

P20: Not necessarily, so, we have to think of different ways to do that.

TA:  Yeah. Okay. And is that on e-learning for health, that simulation training, is that the training you're talking about?

P20: Yes, it is. It's on [organisation name]. It's not on e-learning for health, so the stuff that I developed, is on e-learning for health, and on [organisation name] is the [resource name] material.

TA:  Thank you. When you were choosing things to go in that learning, what was it that made the difference about whether you included it or not, or whether you thought it was useful? You've said about the impact, but was there anything else, that you considered, when you were thinking about what kind of learning you should put in?

P20: I suppose it reflected practice, is that it relates to practice and so, if I'm teaching any healthcare professionals, I want it, to them to think ‘ohh yeah, this makes sense. I see this’, so it's relatable, as opposed to. You know, sometimes we see management modules and it's someone in an office. It's got nothing to do with, you know, you might be talking about delegation, for example, but they, people sometimes can't make that leap. Yeah, but how does that relate to a ward, or a community setting? So, it's, I think it's relatable to healthcare professionals and students, to their practice.

TA:  Okay. Thank you very much. My two core questions are about how we prepare nurses, so that they can use all of these resources, and everything else. My first question I suppose is what kind of knowledge or skills do you think nurses need in their own right? If they were to look for some learning independently, so you're not signposting them, what sort of knowledge and skills do you think they need, to be able to do that effectively?

P20: I think it's really challenging, actually. I think a lot, some organisations signpost people to e-learning for health, for some of their mandatory training, because there's so much stuff on that, and I don't think everyone is aware of that. If I think about [clinical speciality], my field, then there's so much material out there. What is good, and what's not good, is really difficult to find, really. And so, I don't know how much people are accessing themselves, and being driven by it. But I think it, people would easily be put off accessing things, if they don't find it on Google pretty quickly. But I think Google, Google Scholar, people access those sorts of things. If they're quick and you can find a resource, but the, how valuable those sources are? You couldn't account for, really.

TA:  Yes.

P20: And I think in Trusts and things, they have an Intranet, where they will signpost people to stuff, and things like that.

TA:  Yeah, so largely it might be signposted, but if somebody wanted to learn more about [clinical speciality] for their setting, they could just do a routine search. I guess.

P20: Yeah. And I think, you know, when I say about resources, all sorts of resources, you know, Guys have done some stuff and, people don't necessarily know about the vast amount out there, because there, it is so vast, really. So, I think that's why I'm really keen on giving people reading lists. If I've come across it, to say ‘look, this is where you can get other’, a bit like SCIE. They have resources as well and I signpost people to SCIE, as well as e-learning for health, because I don't think nursing homes could access that, but I found a way that they could, that sort of thing. So, I think people need to be signposted to those sorts of specifics, otherwise they don't know what they don't know, as a resource.

TA:  Yeah. And the Internet has given us so much, hasn't it, especially with COVID, lots of things have been put online. So, you did talk about knowing whether something is good, or valuable. What kind of skills might we need, to prepare people to use, to do that, do you think?

P20: Personally, I think, that, e learning’s great, but you have to be very motivated to do it, independently, and driven. I think if you're going to do that and be driven, I think it's got to be some sort of interaction with it. That's quite complicated. So, I've developed some stuff, VR film, but I don't want it. I think what I'll be doing is a workbook, to go alongside that, to stimulate reflection, and questions, because otherwise it's ‘yeah, yeah’ [sing song style]. But that's not the learning, that's the stimulus. It's, the other learning comes, often through debriefing, and discussion. I'm working with some people in [faculty name], or with this other company. I can't remember who they are, but a company last week I was talking to, and they're like looking to develop materials, about resus, that people can access, independently, and it builds in the reflection. They're going to have avatars that ask them the reflective questions, because that's what you need. I think it's very difficult, unless you're writing an essay, and even then I find I’m not always motivated to. People have got to have a reason to look it up, and then to use it. Yeah.

TA:  So, in reality, people who are very driven, in practice, will look for things, and they might find ways to find things by talking to other people.

P20: Possibly, I can't say, but that's from my experience of learners, and registrants that come in. It's like I'm talking about referencing and evidence, and they've never heard those phrases, before. 

TA: Oh. Right. And does that range across the scale of how long they've been qualified, do you think, or is that?

P20: Yeah, yeah, I see former students in the room, and I go ‘I know I've told you this’.

TA:  Right. So, they've kind of forgotten it, maybe. 

P20: Yeah.

TA: Or maybe their needs are just different once they're out there?

P20: Yes. I think that people get swallowed in practice, they get absolutely swallowed in practice and you know, if I just focus on dementia a little bit, it's not mandatory that people do education around [clinical speciality], but at least a quarter, if not more locally, of inpatients have a cognitive impairment, so it is a significant learning need, and a fear factor for people, and outcomes for those patients that are poor. So, there does need to be education, and it ranges from an hour of training a year, to a hospital in London that must have loads of money, to two days, of training a year, that they attend. But I think you need to be in the room. I think that's really, you know, so that you can challenge someone, saying ‘no, it's not a [clinical speciality] patient, it's a person with’ to make it impact, to really make that impactful. Albeit, and I know I'm going off a tangent, when with the e-learning for health material that we did, so I developed some packages, and [university name] have developed lots, and we've been involved in evaluating it, and we've got about 800, 900 responses back, about the impact of that, and people said, ‘yeah, it was really useful’. And that was all independent learning. And the resources have got videos. They're not just flat, they are quite interactive, or informative and punchy. They're not too long. I think they're like 20 minutes max. So, that's impactful.

TA:  So, that interaction is one person viewing something that's interactive and moving, but the resource itself doesn't necessarily encourage interaction through discussion?

P20: No. No, no, not discussion. Reflection, but I'm only talking to myself.

TA: Yeah. So, individual reflection. So, I'm just asking because one of the things that has come up is about, obviously, sometimes people stop if they're doing a resource and looking at some learning, and then they have a question, there's nobody to answer that question, because it's a written resource, or a video resource or whatever. 

P20: Yeah.

TA:  There's nobody to answer that question. And then they've lost the question by the time they go into practice. So, therefore, that learning's kind of lost really. 
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TA: Q8. And are you intending that to be available as a free resource, for lots of people, or is it going to be for a specific audience?

P20: Yeah.  No, no, it will. It's on YouTube.

TA:  Okay.

P20: You have to know it's there, and it's, it was our first attempt. We've started a brand [Brand name and clinical contexts]. That sort of thing. And that's based on student feedback. ‘What other films should be made?’ And they said, ‘oh, yeah, about [clinical context]. And [university department name] here, helped me do it because I was going to pay an outside company, but they did it, and I got [volunteers] to be patients in one of the beds. It was really good, really good experience, but we could improve, you know. There's certain things.

TA:  So, the students are aware of you doing that work. Q9. Are they aware this is going to be essentially an open education resource, that they could access later? Do they understand that, or?

P20: Yeah, because they know that.

TA:  Okay, so that's all really important in thinking about how we share it, because some people have started to say that university should maybe lead [raised tone of voice as if questioning] on teaching people about open education resources, because, you questioned earlier, you don't know how many people use them. From my research, so far,  not many people use them, except for mandatory training. So, it's much more limited, this stage of data, that people actually go out and find things on their own.

P20: Yeah.

TA:  And so I'm really interested in how then, the university starts to prepare people. So, maybe you could tell me your thoughts, about how we begin to prepare nurses to know that all these things are there?

P20: Would that be when they're here with us, and we say ‘there's all these other resources? So, we don't teach enough about [clinical speciality], but I'm sure [colleague name] has said we don't teach enough about [clinical speciality]. We'll all have our thing. Obviously, I think [clinical specliality] is more widespread, but there we go. We'll all have our drum, that we want to beat, and so whenever I teach it, because I'm teaching the [student group] tomorrow, I give them an up-to-date reading list. This is to have more, if you want more information about [clinical speciality], if you want to find out more. And I might say, and on the e-learning for health, there's things about end of life care, medication management, you know, things that people have brought up. So, I signpost people to it. How many access it? I haven't got a clue.

TA:  No.

P20: So, I think all we can do is signpost people to, it. Our curriculum's really tight, so I think, it's really. We haven't got enough to do the face to face stuff, let alone signpost. You know, we might signpost them to the e-learning. I don't, and it's encouraging students to realise that they are full time students? And you're reading for your degree.

TA:  Yeah.

P20: And I signpost people, they go ‘ohh I’m just not very good at reading’, it's really boring’. I said but look on these various sources to help stimulate your reading. And like I might signpost them to Brendan McCormack, because he's done a TED talk. He's done other lectures. You know, he's a really inspiring, presenter. 

TA: Yeah. 

P20: But I will then do short clips, because they won't sit and watch it. I wouldn't sit and watch an hour lecture. I wouldn't do it. And when we had to do all the stuff for the [student group], all the videos. It was like, painful. Painful, hours of work to do, which I've not retained.

TA:  Yeah, because it's not impactful?

P20: There's a patient there and a nurse, you know, I mean, like, it's, but it's, yeah. So, there's loads of things, like films and things like, that I've used. And there's [Name] story that [Hospital Trust name] developed, and it's someone's. It's acted, but they've done a resource to go with it. They're short films. They're short, impactful. Yeah.

TA:  And those appeal to different learning styles as well, don't they? 

P20: yeah.

TA: So, you know, put a slide on the screen for a student, that's got loads of words on, who doesn't read quickly, or easily, and that's just a switch off, isn't it, really?

P20: Exactly.

TA:  So, yeah, so that does link into the way that we teach, really. 
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TA:  Yeah. So, going back to your workbook and your video. Q12. Just tell me about, you know, what you think about our relationship with the organisations, and whether there's anything that they could do, to support the use of things like your resource that you're developing, or other open learning resources, in the Trusts. Do you think there's any potential for that?

P20: [Short pause to think]. I don't think I understand. So, how can we encourage the Trusts to use what we're doing?

TA:  Yeah. Or, do you think there's any way that they could use what you're doing? Because if we look at that package being interactive, but independent at the same time, so you're learning as a sole learner, do you think there's anything that the Trusts could do, to take responsibility for some of the learning of their staff, rather than it, be, just the education.
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TA:  So, maybe tell me about some of the barriers that you think there are, to using maybe, free Internet learning, for either, as an organisation doing it, because that could be a really good thing and an organisation taking the resource, using it with their staff, but there are barriers to that. So, tell me about what you feel those barriers are.

P20: Time. Getting people off the wards. In a nursing home, it's really challenging, to get a group of staff to do education, because we've done work with them, and that's really difficult. But even with the ‘[resource name]’, we tried to evaluate that, in a nursing home, but they haven't got access to the computer, or, and I left them resources and instructions how to do it, and all of this. But them having, finding time in their day, and they're, because they're really busy, and then they're not going to do it in their own time necessarily, because they're not paid to do that. So, it's the, it's those organisations paying people to do that education. So, time is a big factor. And then, and it's not mandatory, some of it, if it's mandatory, they know they have to do it, manual handling,  resus. ‘It's mandatory, I've gotta do it’. And they've made those a bit more creative as well, with simulation.

TA: Yeah.

P20: So, I think, yeah, times a bit, and, I don't know, and post COVID, I think people are, flattened, and not recovering, and. Or, and I think people have also got into a habit of saying ‘we're too busy’.

TA:  Right. So, it's a good excuse.

P20: Yeah, exactly. But I say it's like a light, education’s like a light. You know, it does illuminate things, and makes sense for you, and that's, you know, empowering. But that's why they like coming into the university. It's away from the workplace. They've got time to think. They've got time to reflect. I think in practice they just don't have time in a day to do it.

TA:  And that is reality.

P20: And the days are long. You know, 13 hour days, which I think is insane. They're never going to go back to shortened days now, but it's insane. And hard. You know, I don't, and people can't maintain their motivation for that long, in a busy, clinical environment. It's just crazy.
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P20: So, they get burned out, and, quite quickly. Knowledge is power, but they go in there and they just do their job, and I think nurses have, I can only speak for nurses, have become disempowered by the slog, as opposed to the thinking. You know, I had registered nurses the other day, in a GPN, and they, we were talking about delirium, and would they identify that in their practices? And I said, yeah, that somebody was definitely, had, a delirium the other day, and I was worried that it was sepsis, and the GP said ‘no, it's just their [clinical condition]’. And she, they didn't feel that they could challenge that decision, whereas in hospital you would, you'd have other people to go to. So, nurses have become a bit disempowered, I think, in their practice, let alone in empowering them to find out more where's the evidence. Unfortunately, and so you're right, and I think Trusts need. I think they need to think, you know, the majority of our clients are older people. How do, and it isn't, it you know, and I was a senior nurse at a hospital where there, it was mainly older people, but it was like the Cinderella part of the Trust. It wasn't A&E, it wasn't the sexy part. And so, when I was at, you know, went through what we're going through here at the moment, ‘why do you need a registered nurse on at night’ was one of the questions when I was asking for. I had to get permission from someone off the golf course, to book a bank nurse. And their lack of understanding, but then our job as nurses is to educate upwards, about what's needed and nurses need to be a bit more mouthy I think.

TA:  Yeah. And I suppose that's difficult when, they are under a lot of pressure time wise and all the changes put since COVID, you know people are still burnt out since COVID, aren't they, and they're just getting on with things. Even our newly qualified graduates who are going out are still, they're still in that group, who are working through COVID, and they're all exhausted, before they've even.

P20: And we have an ageing workforce, too, haven't we? We have got an older workforce, especially in primary care, yeah.

TA:  So, it's not an easy, not an easy question to do, but I think that's really useful, you putting in the context of, you know, like learning for education, education for their own practice, let alone education for education sake. There may be some context people will go to open education resources, possibly for CPD, maybe for promotion, if they want to look up something about something they're doing, and maybe a change of job if they've changed their role, and it's coming out that people are accessing things because they want to get up to speed with that kind of area, really. The last question is about technology. It's changing so fast. I mean, you know, with the SIM stuff and everything else. Even for practice, let alone for using open education resources, but what sort of technical knowledge and skills do you think that nurses need, and how do we support that in our curriculum as well, to work in the NHS today?

P20: Yeah, I think I can't speak for those working in the NHS, I can only see it when they come in here. But I think accessing the, yeah, there's still people that are, have a phobia about using computers, let alone the. I mean I, you know, when I did the [learning resource], I'd never. I'm not a gamer, or anything like that. I've had to upskill a little bit, and I've had tutorials, but I'm very limited knowledge, and I don't want to know, actually. I don't want to know how you make a film. I just want it to happen. And I just about know how to put on the Oculus and make it work, although that didn't work at [campus site] and I had to ask some students to help me. But be that as it may, I think, and I can't, even with my undergraduate group, that are young, I have a really young intake in my tutor group, and I said, did they want to  have a go and people didn't want to try to put it on. They didn't want to sit the front of the room. I had them all around the room. Because they didn't want to look stupid. Youngsters, with a VR headset on.

TA: Yeah.

P20:  Yeah. And there’s glasses coming out now, that you can look things up, with your eyes. But, not everyone likes it. I get travel sick with them, so I'm not brilliant with them, so people do get a bit nauseous with those. I love learning new. I love and embrace all those things. I don't want to know. I just want to know the output and test it, and that sort of thing. But not everybody can like. I like a new thing on the computer and all that, but people aren't, don't necessarily like that. We've got students coming to do return to nursing, that don't have a laptop, or at home, and we've got some money so that we can loan them a laptop whilst they're here. So, even turning it on, and then, they may ‘return to nursing’, they may not. This, we're not talking about, you know, they still might be in their thirties, but they've had a big gap, because they had family or something. So, it is. Yeah. I think people are a bit technophobes. That's the word I was looking for. There are still those. 

TA:  Okay. So, maybe just one last question to finish then is, obviously you've used some of the SIM stuff and things like that. What sort of, you know, what sort of benefits do you think that has for, learning, as a free tool? If we can have those as free access resources, what sort of things do you think that helps?

P20: Simulation is only as good as the debrief.

TA:  Okay, so it's back to the reflection, really, isn't it? 

P20: Yeah.

TA: The debrief, and it's all about the interactive discussion.

P20: Yeah. And there's lots of evidence about that, about the debrief, and that's why this company that we were working with, talking to last week, said that that's what they want to build in.

TA:  Right. Perfect.

P20: That's so that people can do it independently. 

TA: Finally, have you got anything else that you want to tell me before we finish about sort of how you think we should prepare people, for using free Internet learning?

P20: I'm keen to know how else we can do it. You know, be good to find out, really, because I think it is here, because it seems to be cost effective. They don't have to ship the people off. 

TA:  Yes, for the employers. For the employers, it's cost effective, but not for the individuals, yeah.

P20: Yes, they're going to see it as cost effective, so, we need to think about it, but that's why I was intrigued when we evaluated our e-learning for health and got such a positive response, really. It is here to stay, because they see it as cheap.

TA:  Yes, and the NMC advocate it. They say that it's one of the ways we should be thinking about doing our CPD that they don't. They don't actually assess, or record if people have used open education resources, or anything though. And it would be useful if they did as an audit.

P20: But it's in the assessment, that you learn. Yeah, but it's in the assessment that you, when you have to, this is our catalyst. Now go and read, and if you've got an assignment, I've got to do it and I think ‘ohh yeah, I learn and I go back and discuss’, but yeah, it is interesting. And I can't say I'm a lot different, really. You know, I’ll  look something up, because I've got a lecture to prepare, you know? That's, I won't go say, ‘ohh, I think I fancy looking that up’. I don't.

TA:  No, and that again, probably because of time and things I expect, as much as anything else.

P20: Yeah.

TA:  Okay, Thank you.


