Demographic questions and confirmation of consent.
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TA: Thank you. So just to start then, maybe, I'm thinking about some of the learning that you have done, I am looking to relate it to your experience, but I'm looking to find out the skills and knowledge that nurses need, to be able to use open education resources really effectively. So I'm firstly interested in how you found the open education resources you were signposted to, or how you came to know about them?

P23: Well, mainly through, my employer, really. It was my, during the pandemic, it was a lot of, so I'm quite proactive in learning, so I took on a role, where I needed to know a little bit more about long term conditions, so I went on nurses, ‘Learn With’ Nurses. I did my CPD points, so that was really researching around companies that were offering online courses.

TA: Okay.

P23: So, I did quite a few courses through there. I did quite a lot on COPD, diabetes, and asthma. I then have done courses with the [clinical speciality] team, where I was their team lead, and I was doing quite a lot of courses online with them as well, on wound care and wound management. So, that was signposted by the employer. I've recently, well not long completed my asthma foundation course, which was with online learning as well. So, and that was directed by my current employer.

TA: Right, so it sounds like you are quite, maybe driven is not the right word, but you said you were proactive about learning. So, some of that's because you wanted to know more.

P23: Yeah. If ever I was given an area, to look at. So, I went for a job where I was chronic disease nurse, and I researched all those long term conditions, and found webinars, that I could go on, and download information, and you know, get a certificate at the end saying I've attended the webinars, yeah.

TA: Okay, so nurses, is that a specific site?

P23: It's, I think it's ‘Learning, Learn With Nurses’ or nurses. Yeah, Learn With Nurses. I can't actually remember the name.

TA: That's okay. I'll look it up. It's just not, I wasn't familiar with that, but it's obviously a portal of information. It's obviously a portal, or a place where you can.

P23: Yeah, so it's a collection of doctors, and nurse specialists, that will offer webinars, and for you to, you would log in, like I am with you, and you, you know, you'd be able to speak with them, and interact with them. You just ask questions, that type of thing, and download handouts.

TA: Okay. And that was all free?

P23: Yeah.

TA: Okay. And have you used things like e-learning for health and things as well?

P23: Yeah. I use that a lot in my workplace now. So, I do a lot of my, mandatory training, on there, and I've done my sepsis training on there. I've done all the things like diversity, all those mandatory trainings and then, some extra on top. I also did death, my verification of death was also an online course through my employer.

TA: Okay.

P23: So, lots of online courses, to get my certificates, because a lot of it came in that pandemic, but I continue to use online learning as much as I can.

TA: Okay. And would you say that that's quite common amongst the people that you work with? Would you say that you use online learning about the same, or more, or?

P23: I would say that I would fall probably middle to more, because I've got a bit of an enquiring mind.

TA: Yes, and that's a beautiful thing, an enquiring mind.

P23: So, yeah. So, if there's anything, I'm really particularly interested in, I'll go and seek that out, probably. To make me a little bit more, have a little bit more knowledge in that area.

TA: Okay, so when you are doing some mandatory training and some, CPD, more interesting stuff, stuff for your own learning, what's the difference between, how you engage with it, or what it feels like, when you're doing those different types of learning. Would you say they're different, or are they roughly the same?

P23: The online courses. Some are more interactive than others, so some will have like question and answer times, so they would do like an hour and a half of learning, and then they would have a question and answer time, which I quite like because I can ask anything I probably hadn't got that, got the full idea of. I could ask the questions, so I quite like interactive learning.

TA: Yeah.

P23: So, I'm more, I go towards more the interactive learnings.

TA: Yeah. And did that happen then when you were at the webinars? Was that more like the webinars that you referred to, when there were lots of people, face to face, there were other people on at the same time?

P23: Yeah. So that you'd say where you came from and that type of thing, and then, you know, and people, if I was, I had a question, I would type it in, and then they would come back and ‘oh, I can give you this answer’. It's yeah, that sort of thing.

TA: Yeah, okay. I know, I can visualise what you're referring to, having that experience, different styles of learning. When you're looking out for things for yourself, what kind of skills and knowledge do you think you use, when you're judging whether the learning is relevant, or not relevant? Do you ever look at something and then, stop and think, ‘oh, actually, I'm not going to use that, or maybe think I could use that, if I did something different with it, or?

P23: Yeah, I do tend to. I do tend to look into who's presenting them, and whether they're well known, that type of thing, whether I've heard of them before, where they've come recommended. And quite often I've gone to line managers and said, you know, I'm thinking about using this site, and they say, yeah, absolutely, that that's a good resource, to home in on and collect information from. So, I don't go in blind. I do a little bit of research, either from my peers, or do a little bit of research around those people.

TA: Right.

P23: And companies.

TA: Yeah, because companies are quite good, and especially in COVID times, there were so many webinars, weren't there? It was a really rich time.

P23: Yeah, it was, and I did my spirometry. So, I did my spirometry course, and that was an all on an online course. So, I did all my theory online. I had to submit work and then, which I never got to do, unfortunately, because, there was no staff to show me, I needed ten, to have ten face to face spirometry sessions, to sign me off on my practical. Which, I was quite sad, when I started this new job, and although they wanted me in that role in respiratory, they said that they couldn't really, take me out of my job to allow me to have those ten sessions, which was a shame because I put a lot of work into it, and the company had paid it, and it was over £600. And when I left my job, they didn't ask for the money back. They said ‘take it forward into your new role, which I did do, but then they never carried it over for me. Now that I'm their, one of their respiratory nurses, I can’t help the out with spirometry! I've got the theory, but I've not the practical.

TA: Oh gosh, that's really frustrating. So, did you get written feedback on your academic work then, for that programme?

P23: Not all. No, I didn't get a lot of awful lot of written feedback because I submitted it in sections, and then I had to sort of basically, and this really sounds awful, but I had to walk away with it, because I wasn't getting the practical support, to back up some of my answers, because they tied in together. It was, yeah, I felt quite disheartened, by that side, to be honest. Yeah.

TA: Yeah. So, you've so you've just identified what I would call a blocker, I suppose, there, to some online learning, is that you can't always get answers to questions, or access to opportunities. 

P23: No.

TA: You've talked about how you've left it in that sense, but have you ever come across any kind of online learning resources where you've been left with questions, and it's had an impact on how you've engaged with it or anything?

P23: Probably not. No.

TA: Okay.

P23: That might be down to me, because of asking, or going back and asking somebody. Yeah.

TA: Yeah. So, if you imagine you're doing an online resource on e-learning for health, or the Learn With Nurses, and there's something in there you've got a question about, but there's no tutor, or no facilitator, where do you go with your questions?

P23: I would probably research myself or I would go to somebody that I know. So, like an example was, when I did my asthma foundation course, I worked closely with the respiratory nurse specialist, or two of them. The two that I closely work, alongside, so if I have any problems I will always ask them, so anything I wasn't sure about, from it, I would take back to them. I would make notes, then take back to them and they would probably answer my questions for me. 

TA: Yeah.

P23: Although there was, on the online course, there was the facility to ask questions, which was really good, but for my learning, sometimes I need to have that one-to-one with somebody to have that understanding.

TA: Okay. And were there ever any discussion boards, or any kind of collaborative learning spaces on any of the, resources that you've used, that you can remember?

P23: Yes, there was. There was, I think the discussion, there was discussion boards on the Learning for Nurses. There was a discussion board on there, and I think e-learning for health has discussion boards on some of them, I believe, but I've never gone to them. I've had courses where I've like, had to say, well, where they bring up in my, I think that was the safeguarding that I did, where we had to give. I did my level, so you get one, two and three, don't you. I did the advanced one. We had a discussion forum going on there, which was really good, because we could give in circumstances where we were in that position, and we didn't know what to do, and people were giving their examples of how they managed that situation.

TA: Okay.

P23: So that that was quite nice, but it was all typing in, and answers coming back up.

TA: Yeah, yes. And then with those answers, would you check them out, or research them further, or just?

P23: Well, if I got the answers and I would, I would sort of, it would be there in my mind. I would know that if I ever come across that situation, I may not address it then, because what I would take what they were probably telling me as face value. But if I was to come across it in the workplace, which I have on a couple of occasions, I would still go to my safeguarding team.

TA: Yeah.

P23: I wouldn't just take it from an online course, I would still, which I have done in the past, I've gone, I've had to go to safeguarding team, think ‘this is what I've found’, this is what I'm thinking. Am I doing this correctly? So, it's always trying to go, getting that sort of reinforced that yes, you're on those right lines. This is what you need to do. So, I'll always look for support.

TA: Excellent. Okay, thank you. So, you've said a few things there, about the way that you approach the learning yourself, by doing the research first, and maybe that's one of the reasons that you haven't really found courses or programmes that aren't relevant, or don't seem to be.

P23: No, they've normally been courses that are relevant to what my job role is to be honest. It’s training.

TA: Yes, and you've researched them as well, so. 

P23: Yeah.

TA: You've gone yourself, to these resources. What kind of professional skills do you think you had that helped you use them, or do you think there aren't any necessary skills for using these type of resources?

P23: I think because, for me, I think I went to them because I had a background of knowledge, I just didn't have that extra, probably, of what I needed to enhance my skills, so I knew the background of what, as a nurse, you know, you're Jack of all trades, aren't you?

TA: Yeah.

P23: So, if I wanted to know a little bit more, so like with asthma, I went. I decided that, ‘can I do the spirometry course’, ‘can I do the asthma foundation course’ to start me off? I've been to evening, face-to-face sessions, in my own time, and sat in evening seminars.

TA: Right.

P23: And also, for heart failure patients, I've gone on online, I've gone to evening seminars, that are spoken by professors, and had an evening meal, and discussed it as well. So, if I had a choice, I'd probably, regards to online learning, I would, I'm probably a person would rather do face-to-face, or see a person. If I had that choice, but the choices are few and far between now.

TA: Yes.

P23: So, you know, I, the practice educator course, I've recently completed,  that, you can do that online now, and I said ‘no, I actually want to do this face-to-face. So, you know, I am, if those face-to-face choices are there, I would take the face-to-face every time.

TA: Yeah. And COVID has made a change, hasn't it, because it means more is available online, than it used to be.

P23: Definitely. And nothing has come back really, like it used to, you know. Yeah. You used to have to do your IV updates face-to-face, but I think they can all be online now.

TA: Yes. There's a wide range of things, that you wouldn't imagine could be done online, that are done online, aren't there? 

P23: Exactly.

TA: Yeah, and not just mandatory. Some of the CPD stuff as well. So, I'm just interested, could you tell me about whether you you've used any of your online learning as part of your CPD for revalidation?

P23: Yeah.

TA: Can you give me an example?

P23: So, yeah, I've learned the, those webinars, because I've got certificates that are CPD points. I also did my asthma course. That was a that was a 15 hour course and it was CPDs. I got certificates after it. So, my practise educator was six hours. I added that to it. My, what other ones have? I've done my TV courses, tissue viability. I've added those, because they all put how long it takes you. They give you the times that it's done. 

TA: Yeah. 

P23: And some of the mandatory training that never, because you can't put your mandatory training in twice, usually, but there's a lot more mandatory training that has been added now, that wasn't originally there. So, they're quite new, so I'm all ready for validation next year, already. I've got over what I need.

TA: Yeah. And some of it has to be like, collaborative with other people, doesn't it? But then I guess your webinars and things that you're doing are with other people.

P23: Your webinars, yeah. You got other people, that are all talking, so you can talk, and then you can hear the people talking, and then, that's how it goes. And then obviously, I've got, for my seminars that I've actually gone to face-to-face. My heart failure course was a whole day, cardiac doctors and nurses. That was a whole day course. You get, you know CPD points for that, for attending. Question and answer times. So that's how I've got all my, a lot, most of my courses done, really, and my revalidation.

TA: Yeah, okay. And that's mostly through the in person events and things, rather than strictly, online learning?

P23: Yeah.

TA: Yeah. And if you've done something really interesting, or found something really interesting, in your online learning, can you tell me about how you might share that with your colleagues in practice, or managers, or?

P23: Yes. So I've, because of the position I'm in, at the moment with my job I'm currently in, I'm the team lead, so I cascade, down a lot of information, and I will signpost them, to, and even with the HCAs, are signposted, because a lot of these are also suitable for HCAs, some of the courses. So, I'll hand down by adding in the websites in their PDR's [staff appraisal system], in my one-to-ones with them, and any clinical supervisions are passed on the relevant websites, where you can find these too. 

TA: One of the comments you made was that you were doing something in your own time, a lot of the things you've done in your own time. I was just a little bit interested in that. Maybe you could tell me a little bit more, like do you get any time in your work time, to do online learning, or is it only the in person?

P23: Yes. So, where I currently work, we get what we call PLT [protected learning time]. So, we'll get, I think it's every ten to twelve weeks, we get a whole afternoon, blocked out. So, we get from 3 o’clock, well, whole afternoon, you get like 3 till 6.

TA: Yeah.

P23: And that is your time.

TA: Right. And that's on a specific day?  

P23: Yes.

TA: I interviewed somebody else, who's part time, and they were saying about a similar setup where they work, but they were disadvantaged if they don't work that afternoon.

P23: Yes, they are. So, you don't, get any alternative. If you don't attend them, you don't get anymore. So, some of my asthma course. I had to actually do in my own time.

TA: Right. Okay.

P23: They gave me some time, but, I didn't feel it was enough. I would be rushing it, and I didn't like rushing it.

TA: Yeah. In terms of time, do you think, or what's your impression of the value that your employers put on CPD, per se? It sounds like they're, from what you've said, it sounds like they're quite supportive and you get the opportunity to do quite a lot of in person things, which is more unusual, now.

P23: Yeah. They do give you this time [referring to PLT]. They do give you the time, but, you also have to do, so an example is, that I was booked on to do my advanced physical examination course with [name] University. And you’re in uni, every Monday, for so many weeks, and then you have your OSCEs with it, but they don't offer you any study time outside of that university time.

TA: Right.

P23: Unless you ask.

TA: Right. And if you ask, might they give it?

P23: Well, it all depends on the workload. Yeah.

TA: Okay. And what about your mandatory training? Do they give you time? Do you use that three hours basically, to do that?

P23: Yes, they do. They do give you time to do that. So, with me, you get your PLT time and then, if you say right I need, I've got like two mandatory training that is outstanding, I need time blocked off, then I will block my own time off. They don't ask me, I will do it because I'm in that role, where I can, and I'm also in that role where I can allow others to do it, with my permission. So, I'm very lucky in that point of view. I run quite a significant sized team, and I'm involved in having to keep making sure they're up to date with the mandatory training so, this week's been chasing people, saying right, block out some time, or I'll block it out for you. It needs to be done.

TA: Yeah. So, you're at a level where you can make that decision and be the support, if you like, rather than. So, what's evident is that you place a high value on that time, whether it's mandatory, or otherwise.

P23: Yes, exactly. Yeah.

TA: And so, would you say there was much online learning when you did your training?

P23: No. Not when I did it, it wasn't so prevalent, when I did my training it wasn't.

TA: Yeah. So, nothing that you'd have been taught at uni, would have prepared you really, for finding online resources, and using them.

P23: No. I did use online learning resources, but I went, and when you have your handouts that you need, and that, you are given resources aren't you, so you do have to be proactive in getting them. They just signpost you. So, when they signposted me, I did use them, but I also, looked up some independently, as well. So they were proactive at uni, in giving us those opportunities, but you didn't actually have anything online. You would just be given the websites, and then off you went. Yeah.

TA: Okay. Thank you. Can you think of any specific skills that you learned through during your university? Studies that might have come in helpful for using online learning.

P23: My skills?

TA: Yes.

P23: I find that hard to find, really, because a lot of skills for nursing is, needs to be hands on, doesn't it?
TA: So, if I was to say for example, like searching the literature, or searching the Internet, because obviously you were, what I would probably call an early adopter, because you were going out, looking for online resources, when you were in university, even though e-learning wasn't such a big thing then.

P23: No. When I was in uni, I used to use the library. Because I was with Athens I could use the Clinical Skills Net. I found that really helpful.

TA: Right.

P23: So, you could go on and look at procedures, and how they were done, and why you do them, and things like that. And I used to actually use quite a lot of books. Yeah.

TA: Right. 

P23: So, I used to be in the library quite a bit, and quite a book reader, and pull on books, as well. I probably went to books quite a bit more than others. Maybe it was my age. I was an older student.

TA: Right.

P23: But I did use clinical skills net. That was really good.

TA: Good. And do you think that made a difference then, this, you've talked about being proactive, thirst for knowledge, going and looking at all the resources, having an enquiring mind. Do you think that made a difference in the fact that you did start to go off and look for online stuff on your own, when it became more available?

P23: Yeah. I do think now, because being a [academic role] as well, I think students, that come through, now, have to be sort of prompted more, to use those resources. So, I've signposted them a lot, especially when they're trying to use some of their outcomes and things like that. You know, you need to sit and think what, all you've done here is explained what you did. You haven't told me why you've done it, and what was your rationale for doing it. You've just been descriptive, and I can't sign you off on just a descriptive piece of work. You have to tell me what you learned from this, and how you learnt, and why you learnt, and how you would put it into practice. But I find that sometimes, you have to prompt the students to do that. ‘Oh yeah, I didn't look at it like that’. No, I went in today and I took a blood pressure and blah blah, and the blood pressure was high, so I now know what high blood pressure is. Well, why? Why could it be high? What would you need to do to action that? What have you learned from it? That type of thing, is, I think when you've got an enquiring mind, makes it easier to learn. So, we'll say to the students that come through, just think beyond what you're actually doing. You can go in and do something, but it's why you're doing it, and the outcomes for that. So, that might mean researching as well.

TA: Yeah. Do they ever make any reference to the amount of online work, or reading, or watching videos, or using online learning they have to do?

P23: No. I haven't had any student come through that. No, I haven't. No, they haven't made much comment on that, no. The consensus is, from them, is that they do like the face-to-face.

TA: Yeah.

P23: They like that interaction. I think you're more inclined to ask questions. Well, I am.

TA: Yeah, well that links back to what you said earlier, doesn't it, about it's the webinars that you liked, because you could ask your questions and get an answer to your questions. That felt individual and meaningful.

P23: Yes. Sometimes when you're doing those online courses, like, I did my fire one. That's an example. That's an online course. There was nobody there, saying right, or wrong, other than you've passed by 85%, or something. Well, without going into well, 15% of it means I didn't get it right. You haven't told me why. So, I'll go back again, through it, until I get 100%. 

TA: Yeah.

P23: That's just the way I am. I'm far from perfect, but I, if I'm, I need to know why I haven’t got that, that 15% right. It could be something really important, so.

TA: Yeah, it could be really something important.

P23: You can’t put your hand up, like a webinar and say ‘but why did I get that wrong’, or why? So, it's that interaction I think, benefits people more.

TA: And sometimes the questions are ambiguous, aren't they?

P23: Yes, yes, yes.

TA: A little, obviously designed to. Well, you might think they were designed to trip you up, because they're ambiguous sometimes, but, yeah. But maybe persistence is a skill that you're talking about, that well, that I'm analysing, that you're talking about, because you're persistent with looking for things, researching things, going back and redoing them, to make sure that you do know, properly, and everything else. 

P23: Yes.

TA: And that's obviously really important to you, or it feels like it's really important to you.

P23: Yes. Yeah. Because, you know, when you're when in a position, where you are team lead, you know, and somebody comes with a question, if I can't answer I'll say ‘I can't answer that one now, but I will try and find out for you’. It's better if I can answer that question straight away, so, if I've got a bit more knowledge, it saves them having to, you know, to wait around for me to find the answer.

TA: I can see you've got a lot of certificates there. Do you report all those through to your manager, to say that you've done all that CPD, or not necessarily?

P23: Not necessarily, no. Some of them I do, especially if they're based with [health care provider], because you have to have that, and it goes on to your record of study, and things like the clinical supervision, my JCN study days, they would of, because they gave me time out to go to it.

TA: Right, okay. So, if they were involved in authorising it or supporting it, then you would automatically feed back to them, but.

P23: I've got loads here that have gone through towards, and they're all, they let you know that there's CPD points, and they will actually put ‘CPD pointed’, so they're relevant to your revalidation, because I did check that one out.

TA: Yeah. I can see how engaged you are, with your learning and some of those things that you've done, which is really good. I've just got a couple of final questions to finish, some of the skills that you've used for finding oers, open education resources and e-learning, like being able to search the Internet, being able to analyse who the developer is, or who the author is. Being able to analyse the relevance, or the content. Do you think that's useful for any general nursing practice, in today's NHS, because the technology has gone beyond all bounds, hasn't it, in the NHS?

P23: I think now, moving forward, because I'm a bit old school maybe, I think there's a place, definitely a place for online learning, without a doubt, because I wouldn't have got as many skills as I've got without it. But you have to, as an individual, you have to be proactive. You have to be responsible for your learning. I do however, feel it would be really sad to lose these face-to-face learning, because I still think, for me, and lots of others like me, listening to nurses talk, and trainee nurses coming through, they are missing the face-to-face learning, and that interaction, for me.

TA: Yeah, and you're probably still seeing some of the students come through who were working in COVID, aren't you, I should think. We must be on probably the final year, of the ones who were there for their first year, in COVID, when it was pretty much all online.

P23: Yes. And amount of students who come through saying ‘so much is remote now’. So much is remote.

TA: Yeah.

P23: And I think they're feeling it. They feel, remote from everything, that you know, that there’s sort of some, you know. One student said to me, on one occasion, she said ‘I feel sometimes that I'm like drowning, and I don’t know who to go to’. And I said, well, that's really, really sad, and I said, you've got your tutors, that you've got their names and everything. Tell them how you're feeling. You know, you're feeling like this, just because you're learning a lot of it remotely, and you're having to do that, online, learning, a little bit more, doesn't mean that they're not there. They are there. It's just sourcing them out, and seeking them.

TA: Yeah.

P23: But yeah, I think it will be sad, if we resort purely to online learning.

TA: Yes, I think we'll move more away from online learning, so it will be more balanced, generally I think, but the NMC are advocating online learning, obviously. The 2015 Standards, suggest that online learning is a good way to go for CPD, which is part of the reason for my study, really. But again, you've given me some more skills there, like actually being discerning and finding somebody to go to for help, is a skill in itself, isn't it? To know that you want some help, and to go for help, is something as well. So, there's just one more question then, which is a really broad one. Is, there anything else you want to tell me, about what skills and knowledge you think nurses need, or how we might help support nurses to be able to use online learning effectively?

P23: I think some technology stands in people’s way, sometimes. And I think generally, that with some nurses coming up through the system now, that, they don't always work well, with online study. I think they would rather have that interactive study, from feedback, that I've got, and all I can do is sort of say to them, well, you know, if you can try and base yourself that if you want to learn, you have to seek this out, and if, it might not be the way you would wish to do it, but times are going to change, and I think they already are, right with the NMC. 

TA: Yeah.

P23: Doing it. But I just think, moving forward, it's going to be a thing that, it would be sad, to see our students not having that interaction, and feeling remote, from learning.

TA: Yes. Because after all, we are a people based profession. If you had to do all of that online, where would they learn that from? Where would they be able to express themselves. That online learning, you can't always express yourself, and how, can you? But also, the way that you said you signpost them to go and look for help. It gave the sense that you are also suggesting you might go to a person for help, whether, as a student might go to their tutor, but also if it was another colleague in practice, or somebody who was on a placement, then you wouldn't necessarily look for it online. You can be proactive, but ask somebody who knows as well. 

P23: Yes, it is that balance. You have to get that, because not all online learning, will suit every learner.

TA: No. Indeed.

P23: There's data, and people learn in many ways, and as teachers, and as nurses, and as professionals, we try and impart that knowledge onto others, and some find this e-learning, knowledge, isn't so easy to understand. I mean, I'm not against it. I'm not in that era where I'm against it. But what I am in, is the era, and please don't make it all online, because it's not going to reach every learner. 

TA: No.

P23. And I think probably, they would get, probably get a little bit, not, bored is the wrong word. It would probably not help, to keep them interested, because they can't ask those questions. You know, they can't interact, like you can interact. 

TA: Yes. All those things that you've talked about are trusted sites, or portals, or companies. Have you ever, just as a quick one, have you ever gone and looked for anything that's by somebody you don't know, or by a company you don't know, or would you automatically just say why bother, because, I know this company?

P23: Probably I would go with companies that have been recommended, or yeah, that I've been signposted by, or spoken to somebody that's used them and recommended them.

TA: Okay. Thank you.


