Steps in the right direction

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In this post Alison Smart & Deirdre O’Neill reflect on embedding self care into the nursing curriculum and introduce the all school walking challenge.

It isn’t too long ago as a deputy charge nurse that I remember struggling to sleep knowing that our staffing levels the next day were not met and wondering how that ICU patient was doing after their surgery. We as a profession of Nurses & Midwives can often deal with very difficult situations and forget about ourselves amongst the maelstrom. This issue has resurfaced in a profound way over the last 12 months of the pandemic with working from home making it very difficult to switch off – I’m sure a lot of you can resonate with this. 

In addition to our career pressures, you are the go-to person for friends and families. Therefore, it is imperative that we, staff, students and the profession as a whole start to look after ourselves and carve out time on a daily basis to fill that cup so we can pour from it in the future. This couldn’t be more true in Northern Ireland – we have a workforce crisis within nursing, so we need to do all we can to manage our well-being and in turn increase recruitment and retention. 

With the introduction of the new curricula, I thought this was the perfect opportunity to embed and promote “Self-Care for Health Care” within the School of Nursing. Due to the new NMC proficiency of ensuring you are in good health this seemed like an ideal opportunity to put this into practice in Year 1 Professionalism in Nursing. 

Each week the students discovered a new activity to undertake, placed visibly within the module material for the week (see Box 1). Students were then asked to reflect and identify how they felt before the activity and how they felt after. 

The feedback received from staff & students was overwhelmingly positive with one of the standout highlights being the step challenge. 

“It is easy, effective and we can all do it” 

“Loved it, got me out and about again” 

“I felt so good after my morning walks”. 

We virtually climbed Mont Blanc and Jo Mc Mullan stormed in front when we headed to the Mediterranean and raced up Corsica (220,000 steps in January). We used a clever and easy app (SQUADS) that allows a forum to message, input steps, share motivation and a healthy dose of competition. 

After speaking with colleagues & sharing the app. Deirdre O’Neill tried it out with Year 2. Let’s hear how they got on: 

After hearing the success of the walking challenge in year one I could not wait to pitch the idea so the students on their return to phase five. With the help of Chloe Gardiner (year two student nurse) a challenge was set up each week for all of us to complete. We divided into three teams and competed against each other encouraging each other to win the weekly challenge.  Initially the challenge was only too last six weeks but because we all see the benefit of not only daily exercise, but we were also able to connect with each other in this virtual platform.  Students were encouraged to share photos of their walking sceneries, so we had pictures of forests, beaches and country lanes.  We saw snow falls and the beginning of the touches of spring.  Each week at the start or end of class we would share our walking stories and because of the laughter and connection it has brought us we will continue the challenge when the students begin their next placement.  

Due to popular demand and with momentum on our side we are holding a walking challenge for staff and students alike as part of QUBbeWell week. The challenge will consist of a Race up Corsica Canyon (69,750 steps) from Monday to Friday. We invite you all to come on board and join the fun. All you need to do is open the link on your phone and join the squad. 

We have also secured some great prizes including a six-month PEC membership in collaboration with Queens Sport and a two-week meal supply kindly donated by Primal Fox Nutrition. In addition to the first 3 people to reach the virtual summit, we have also got a prize for the best picture from all your walks, so get snapping! 

Any questions regarding the app, well-being material or if you fancy a chat, just get in touch a.smart@qub.ac.uk or d.m.oneill@qub.ac.uk

All in this together….staying connected

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In this post Pauline Cardwell, Year 2 Lead and Lecturer in Children’s and Young Peoples Nursing, reflects on the difference connection can make.

It is hard to believe we are almost 10 months into this pandemic event, which has caused each and every one of us to review and reflect on every aspect of our lives, personally, professionally and as a community.  This evolving and uncertain period of time has challenged us as individuals and has also afforded us some real opportunities to create and deliver on new ways of working, providing engaging and inspiring learning activities, whilst being mindful of the human cost individually, whilst ultimately remembering we are all trying to navigate this difficult and unpredictable time.

Essence of nursing

Nursing has always prided itself on being a caring and compassionate career, where at the heart of its DNA is the privilege to care for individuals and communities at vulnerable, challenging, difficult and joyous times in their lives. This act of caring is the essence of ‘what we do’, to hold the hand of someone who is frightened or scared of the journey ahead or celebrating the end of a successful treatment plan, a newfound independence, a recovery made, or a new life delivered. Whilst this may be the essence of nursing it can sometimes require a heavy payment. We have all seen so many images of those heroes after a demanding, draining and sometimes devastating shift and still we come back and do it all again.

Every one of us has paid the cost in a plethora of ways. The worry of supporting each other, hoping we can deliver a curriculum fit for the future and as educationalists caring for our students. I experienced this acutely one day in November where I unexpectedly was contacted by a student in distress, they were overwhelmed at the acuity and challenging clinical environment they were currently working in. The student was upset, tearful and visibly distressed, the wise ward manager had asked them to take a break and suggested taking a walk outside to assist in reducing the stress they were feeling.

The power of connection

It was a bright, clear day and I reassured the student I was here to listen and asked them to explain what they were feeling. I felt the need to assist the student to achieve some grounding and perspective of what they were feeling, and I asked them to describe what they could see and if there was any greenery around. The student allowed me to view their surroundings and I noted a tree nearby and asked them to do something for me, I asked the student to go to the tree and rest their palm against the trunk of the tree. Initially, they were reluctant to carry out the activity, I reassured them I was with them and encouraged them to go ahead and trust me. We then both closed our eyes and I asked them to focus on their breathing. I then began to talk quietly and calmly to the student asking them to consider how the tree had lost its leaves and looked ‘dead’ essentially but also consider that come spring the tree would bud again and burst into life once more. I noted their breathing patterned had calmed and their speech was not as rushed as previously. Eventually we concluded the conversation when the student felt able to return to their shift.

Making a difference to others

Reflecting on this event, I feel grateful I had the opportunity and privilege to support this student at such a personally vulnerable time for them. On further consideration I truly appreciate that this is truly a momentous time for our professions, we are courageous, we are caring, we are compassionate but ultimately, we are human. So, my wish for us all as we move forward and hopefully to a more ‘normal’ way of life is to; be kind to ourselves and others, be keen to learn, develop and progress and to be confident we are capable of delivering, growing and most of all making a difference for others.

#proudofourstudents #IloveNursing

Susan makes a reflective start to the New Year!

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In this first post of the New Year, Dr Susan Clarke, in her role as module co-ordinator considers the value of reflection.

I’ve been enjoying the Friday ritual of reading Maggie and Iain’s Connected Learning blog so thought I might share some of my thoughts on the importance of reflection- not the students’ reflection, but our own reflective practice as educators, and specifically as module coordinators.

A record of real time feelings

Most of you know that I was one of, and am now solely, the module co-ordinator for EBN2. Most years, I keep a reflective diary on my experiences through the module. I do this for several reasons, primarily because my memory is really bad and I want to make sure when we come to run the module for the next intake that I know which bits need tweaked but also because it is a record of my real time feelings and reflections. We all internalise this, right? So I’m just putting my thoughts to paper.

Justifying the need for action

I don’t write reams of text and it mostly consists of bullet points, but I write notes to myself of what worked and what didn’t work and why that might be. The why is very important and I don’t think you remember that if you don’t write it as you experience it. Another important aspect is the action points- suggestions for what I can change that will address the problem. Again, too easy to ignore these suggestions if I haven’t made a note to myself of the “why” to justify the need for action. We are all busy and have competing priorities in this incredibly varied job we do so we could be forgiven for not instigating change if we didn’t need to!

This year, more than most, with the new curriculum, the move to online/remote delivery and the fact that EBN2 is now totally delivered in one teaching phase (will I even remember what a PICO is by the time it rolls around again never mind the nuances of timing the delivery of key messages?!), my ritual has been invaluable. Just a few moments at the end of each week to write my reflections meant that, when we had our debriefing meeting at the end of the module, I was able to identify key learning points for our team and to make suggestions for modifications when delivering it to the February cohort.

Another tool to maximise our teaching practice

This is an entirely new curriculum. We expect too much of it and ourselves if we think it will work perfectly straight out of the box so, dare I say it, evidence based modifications for future cohorts are not only necessary but essential to make it work as well as it can. We teach the students action cycles of plan, do, study, act and that can equally be applied to our education setting as to their healthcare practice. Combining our personal reflections with student feedback, external examiner feedback and team debriefings means we have a well-rounded view of our modules and is just one more tool in our armoury to maximise our teaching practice.

‘Practicing what we preach’: Teaching mental health and wellbeing in a pandemic.

In this post Karen Galway, Pauline McCarthy, Debbie Duncan and Aine Aventin (with contributions from the module teaching team and Sept ’19 nursing cohort) practice what they preach and reflect on an initiative to protect their own and their students mental health.

Picture the scene: It’s September 2020 and a second wave of Covid-19 pandemic has started impacting our health Service in Northern Ireland. Semester one of 2020/21 in the School of Nursing and Midwifery starts in a few short weeks. Our students face continued uncertainty about the future of their degree programme. Teaching is now online with students on campus for essential skills only. Whether the programme will follow the usual pattern of six weeks on campus and six weeks of placement is anyone’s guess.

Our brand new undergraduate nursing curriculum, developed pre-covid, rubber stamped by the Nursing and Midwifery Council, now needs fleshed out under totally new and by now, clichéd unprecedented circumstances. Learning curves are steep, tensions are high and energy is [at times] low.

One teaching team is focused on a new module; Working inter-professionally to improve mental health and wellbeing. This module isn’t presenting a new topic per se, but it presents a consolidated approach to teaching mental health to nursing students, during the toughest of times. With two Lecturers co-ordinating plus eight teaching staff, the module team must now place a new level of focus on mental health and wellbeing for all nursing specialties; adult, children’s, learning disability and mental health.

Week one focuses on models of mental health and wellbeing, stigma and discrimination along with self-care. We introduce mindfulness, self-care principles for nurses and an overview of how covid-19 may be impacting on nurses’ mental health. Week two considers social epidemiology and inequalities to address risk and protective factors for mental health and wellbeing. We also address communication skills and the basics of a mental state examination. Week three addresses issues related to self-harm and suicidal ideation and prevention. It’s challenging content, for lecturers and students alike, in challenging times, taught under challenging conditions.

We worry about how the students and the staff will manage the online environment. We worry about whether we will recognise who is struggling or indeed over identifying with the content. Beyond our self-care content, we also provide links to support, across the university and in the community and we consistently remind our students to reach out and to practice self-care.

Despite our efforts, there seems no easy way to maintain our connections to the students while we all get used to these new technologies and grapple with a new societal normal. Meanwhile three other modules are in full swing for these year two students. We are still groping about awkwardly with a lot of the processes such as developing a meaningful attendance monitoring policy. The timetable can feel brutal, with students and teaching staff online, in classes for up to 6 hours straight. Still ahead in our module specification is week four, focused on physical and mental health interactions, week five addressing trauma informed practice and adverse childhood experiences, with the final week explaining the symptoms of common mental health problems and an understanding of the stepped care model and other useful supportive responses.

Something about this feels very wrong. We are teaching the students about mental health and wellbeing in the middle of a pandemic, while expecting staff and students to perform as normal. In reality, nothing inside or outside of university life is feeling anything like normal.

Day one and week one involve shell shock and eye strain. The materials are well received but the challenge of online delivery intensifies. After two weeks of teaching at ‘business as usual’ pace, we stop to consider this rock of necessary progress against the hard place of exhaustion, frustration, worry and potential disengagement. We brainstorm on how to give ourselves and the students some space to breathe. Can we alter our timetabling? Can we switch live content to recorded content? Would that help? Can we provide adequate breaks and importantly can we identify students who are struggling?

A few actions were tabled and adjustments made to the format for week three. We decide to cut back screen time. In our mental wellbeing module we replace a live online tutorial with a self-care activity.

Students were notified that the two-hour session would now involve a discussion board, instead of a live session. We sent a simple request that the students go and “practice what we’ve been preaching”. The instructions were to take the time to do something to protect and maintain their mental wellbeing, to post a photo or video and comment about the activity on a discussion board. That amounted to a small concession to the Covid-teaching challenge, but it had a big impact.

Within 10 days the discussion generated 546 posts, 250+ photos of stunning autumn scenes, a variety of video clips, poetry, art, music, pet appreciation, baking and a huge amount of shared joy!

A selection of photos and comments from the discussion board

We can confirm that the Sept 19 students are a cohort of dog-lovers, walkers, runners, sports stars, artists, empathetic and caring parents, siblings, children, flat mates and all round philosophers. Contributions were authentic, honest and entertaining personal accounts of how each individual took care of their mental wellbeing, in two hours of me- time, designated for self-care. Reading and commenting on the joy of free time, downtime, the positivity and the creativity was more than a pleasure. It was addictive! Perhaps the discussion board felt like a surrogate for the missing sense of community that the pandemic has taken away. Perhaps it should not be surprising that such a simple idea was embraced in such complicated times.

Acknowledging student contributions
Sept ‘19 undegraduate nursing students: Leon Daly, Shannon Campbell, Cliodhna McIntryre, Marianna Donahue, Deirdre Boyle, Siobhan Duffy, Emma Shields, Chloe Truesdale, Edelle Brown, Caroline Devlin, Roisin McCann, Holly Brown, Megan Elloitt, Roisin Byrne, Orlagh Carson, Santina Campbell, Heather Gould, Caitlin Duffy, Grace Espie. Thanks for allowing us to share your discussion posts and photos.

It would be great to hear how you have managed your own mental health or that of your students since the beginning of the academic year. Comment below- or send us a photo!

In this blog, Alannah Curran, a PhD student with dyslexia, shares her experience of becoming connected using her Dragon.

On reading this title you may be thinking of Game of Thrones with Daenerys Targaryen and her dragons conquering Westeros or the Viking Hiccup training his dragon Toothless for the greater purpose of changing perceptions of dragons. Well, my dragon is not a real one as such, it is a software called Dragon Professional Individuals by Nuance which is a dictation technology that essentially types what you are speaking. But, like Daenerys and Hiccup I am using my own dragon in conquering my own PhD journey with dyslexia and throughout that journey changing perceptions of dyslexia within academia.

So, let me tell you how I came to be where I am today. I am Alannah Curran, a second year PhD student within the School of Nursing and Midwifery here at Queen’s University Belfast and, I am dyslexic! A lot of people ask me when did you first realise you had dyslexia? The answer to this question is, from first entering the education system however, I was not officially diagnosed with dyslexia until I entered Queen’s University as an undergraduate nursing student. Growing up with dyslexia through  the education system was challenging but I always managed to see the funny side, like when I read out ‘orange-ootan’ instead of orangutan and this humour allowed me to develop a coping strategy, giving me  the determination to achieve the grades I needed to enter the undergraduate nursing program within Queen’s University, after two failed interviews may I add. 

When the revolution of social media began in my teenage years, I also had many experiences of miss spelling words on my social media posts. You can imagine how this felt as a teenage girl. A lot of people found it humorous, including myself, however I still struggle writing posts on social media which to this day impacts on my engagement with connected learning in using chat functions on Microsoft teams, group forums, posting on twitter and even writing emails. 

The turning point for me was in disclosing my disability to Queens and being told through my assessment I had dyslexia, so I finally understand why my brain works the way it does and why I find specific tasks such as reading, spelling, recalling information and talking without stumbling on words a challenge.  Student Guidance Centre then put an individual reasonable adjustment plan in place and collaborated with the School of Nursing and Midwifery, so I received the support I needed such as: extra time in examinations, a dyslexic support tutor, adequate consideration given to oral presentations, and access to dyslexic specific software mainly read and write gold, mind view maps and recording devices for lectures. This support allowed me to develop and adapt to academia to reach my potential, graduating as an adult nurse with a first-class honours degree and then completing my masters in advance professional practice with distinction. This brought me to my current status as PhD student where I have learned I read better on blue paper. Yes such a strange concept, but I discovered dyslexics experience a glare of white paper which negatively effects reading, and explained why when reading I would squint at the page regardless of having 20/20 vision. However, the downside of this was (Pre COVID-19), I would mistakenly leave my blue paper in the printer, meaning my PhD colleagues would come along to print important protocol documents on my bright blue paper!. Everyone knew exactly who the culprit was but I like to think I brought a bit of colour to their day. 

But where is my dragon, I can hear you asking! No, I did not emerge from the ashes of a flaming fire holding my dragon like Deanerys. I was introduced to my Dragon in a more conventional, but still exciting, way through the Student Guidance Centre.  

How do you train a Dragon? 

One of the most challenging but entertaining aspects of training was asking the Dragon to get to grips with the Northern Ireland accent. If you are an international faculty member or student or even from another province in the UK or Ireland am sure you will understand the challenges my Dragon faced. My dragon would interpret the word ‘now’ as ‘neagh’ and ‘how’ and ‘high’. Being in its infancy, like a toddler when picking up new words, my Dragon had a tendency to repeat, let’s say, comments of frustration which I had to ensure were not included in documents sent to my supervision team. However, after only a few days of training my Dragon the software adapted to my accent allowing me to talk freely without correction. 

How do I use my Dragon to remain connected in my learning? 

I am using it right now; I have written this entire blog using my Dragon Software. By embracing this technology, I have developed digital capabilities giving me the skills and therefore the confidence to overcome challenges I face day-to-day with my dyslexia in PhD journey. Specifically, I now have the skills to use Dragon software to facilitate me in adequately engaging with connected learning such as, chat functions on Microsoft teams and posting on twitter as I am confident that the dragon software will provide the correct spelling allowing me to overcome my previous experience. I have also embraced my Dragon software to write my systematic literature review and methodology chapter for my PhD.  I am now adapting my systematic literature review for publication. This is not without its challenges, but by collaborating with my supervision team, Student Guidance Centre and my dyslexic support tutor in continuously assessing and reassessing my abilities. 

What are the benefits and changing perceptions?

So what does all this mean? I would like you to take a moment to think about dyslexia as a faculty member, student nurse or indeed your dyslexia yourself… What do you think about dyslexia? Mixing up b’s and d’s?; difficulties reading and spelling?; if indeed you are a dyslexic yourself a lot of people report the feeling of being stupid. How, I want to ask you did you think of many positive attributes of dyslexia during this time? Maybe you did, but most likely you didn’t. Yes, mixing of b’s and d’s and challenges with reading spelling is a part of being a dyslexic but dyslexia is much for than the misconceptions society has of it. We need to move away from thinking of dyslexia negatively and think about the significant cognitive advantages that dyslexics have and identifying those. Dyslexia is a different way of thinking not a disadvantage and empowered dyslexics do amazing things.

People with dyslexia are: dynamic achievers, innovators, creator’s problem solvers, and possess so many skills and attributes to contribute in society, the workplace and indeed Universities. Don’t believe me… well let me tell you a few facts. 40% of self-made millionaires and billionaires are, yes you guessed it, dyslexic. Many of you may be reading this blog on an iphone or an apple Mac, Steve jobs was dyslexic. How many of you drive a car? Henry Ford was said to be dyslexic. There are so many others, Orlando Bloom, Keira Knightley we all know Richard Branson. But my favourite statistic is you know all them insanely intelligent people at NASA, one in two scientists at NASA are dyslexic. 

The cognitive advantages of dyslexia are being viewed as those needed to thrive within the current technological revolution, which COVID-19 has now escalated.  As I have shown, my academic journey with dyslexia has really been about unlocking my potentials as a student. One of the keys to unlocking my potential has been learning to embrace digital technologies like my Dragon and developing my own digital capabilities which has allowed me to gain confidence to overcome challenges. However, we need to think not only about developing digital capability for students with dyslexia but for all student nurses who are the future workforce of the ever-digitalising healthcare system. And indeed, providing opportunities for faculty to be equipped with the digital capabilities provide nursing students with these skills. How do we do this? How do you think this could be done as a student nurse or a member of staff? This thinking has led to my current PhD study: Exploring digital capability within nursing curricula in Northern Ireland; the perceptions of pre-registration nursing students and nurse educators.  I don’t have all the answers and would love to hear what you think! 

If you wish to know more about my PhD study or to register your interest in participating please see links below OR alternatively please email me at acurran21@qub.ac.uk 

Nurse educator link to register interest  

www.NEinterest.com 

Pre-registration Student Nurse link to register interest 

www.PreregNSinterest.com 

Fo more information on the Student Guidance Centre, please visit https://www.qub.ac.uk/directorates/sgc/disability/studentinformation/

The Positive Power of Connections

In March 2020, nursing and midwifery students found their studies interrupted as a result of the Covid pandemic. They were given a choice to opt in to finishing their programme in clinical practice with online classes as required, or to pause their studies. This week Hannah Angus, Eimir Martin, Jenna Doherty and Tina Adams, who decided to pause their studies, reflect on that decision and discuss how the QUB Connections initiative worked to support them.

When the news broke that we were going into lockdown in March due to the Covid 19 pandemic, we all had only five months left of our training to become nurses and midwives. Because of this, the remainder of our nursing and midwifery training would be concluded in clinical practice and whatever classes we had left would be online. There was an “opt in” or “opt out” choice to this arrangement but to some of us there didn’t feel like there really was a choice at all as the option to opt in was not viable due to personal or family commitments or health conditions that would inhibit some of us from going into the clinical area which was deemed too unsafe. 

So whilst there was Zoom call after Zoom call with our lecturers understandably sorting the arrangements of what opting in meant – our classmates entering the unknown and clinical areas during a pandemic, whilst being a part of the meetings we couldn’t help but feeling isolated as the things talked about were nothing to do with us as we couldn’t and wouldn’t be entering the clinical area and didn’t know when we would be either. The whole unknown and uncertainty was extremely hard and unsettling as we couldn’t help but going down the rabbit hole of thinking, when will be we able to re-join practice? Will it be safe? Will we re-join in time to finish the course and graduate with our peers? Will we finish in time to take up the posts we had already interviewed for and been offered jobs for? Although we were at home surrounded by family and connecting to friends and classmates through video calls and texts etc we felt alone. 

As the weeks passed it seemed our classmates were moving on without us and we were stuck at home, alone and feeling worthless as our personal circumstances were stopping us from entering and helping the workforce and society during a global pandemic. After all , one of the reasons why we want to be nurses and midwives is to help people but yet here in a global pandemic when help was needed we had to face the reality – we couldn’t enter the front line to do what we were made to do and it was heart breaking. As the weeks went past there was nothing but a sense of loneliness. We were made aware that when we were spoke to individually that there were other students who were also in the same situation but not knowing who these students were made things that bit harder as that feeling of being alone was still there and we couldn’t support each other because we didn’t know who also had to pause.

A few weeks into being paused on our programme we were invited to join a QUB Connections group for students who were paused on their programme during the pandemic. Whilst initially everyone was nervous it very quickly became a place where everyone could speak honestly, openly and felt safe to share how they were feeling. It really helped to see we weren’t alone, and everyone was feeling the same – alone, isolated, worried, guilty, anxious feeling a sense of loss, feeling left behind and having no control over our current situations. Clare, Deirdre and Monica were fantastic, listened to us, offered support, advice and encouragement and by being there showed they really cared, wanting to help us in whatever way they could. We felt we were no longer alone and there were others out there who cared and knew and understood exactly how we were feeling.

We learnt coping mechanisms from each other and encouraged each other on by setting positive targets/goals to achieve between each meeting. We shared positive stories, sad stories and best of all through our connectedness we had a laugh and felt a sense of camaraderie with each other. The saying goes everything in life happens for a reason and during the worst times in our lives we meet some of the best people, well It is only because of the Covid pandemic did we all have the opportunity to come together, got to know each other and made friends along the way. 

We are extremely thankful to have had the group as it really helped us through the emotional rollercoaster of being paused on our programme during Covid 19 but like riding a rollercoaster it was less scary and unsettling when we had others there supporting us through the bumps and twists and turns. The sense of loneliness, fear, isolation and guilt was all replaced by happiness, togetherness, and a sense of being a part of a team who were full of support and encouragement. 

We were all able to help each other in special ways that no one else would ever understand as they were not in our situation. They were not at home, they were on the frontline fighting for our NHS whilst we were fighting our own battles to better ourselves and support each other’s mental, physical and emotional health. This has then enabled us to become stronger student nurses and midwives that will eventually enter the frontline, finish our courses and do what we love to support the community that we live in. All of this could not have been achieved without the connection group bringing us closer together to fight one battle instead of our own battles alone.

Hannah Angus is student adult nurse, Eimir Martin, Jenna Doherty, Tina Adams are all student midwives. All four are currently finishing their final placements.

Developing a Digital Community in Nursing Education

In this blog post Paul McAleer reflects on his experiences of developing digital communities.

The advent of the Coronavirus pandemic has presented a challenge to the well-established and familiar way of academic life in Nursing Education.  In the short-term at least, it is no longer possible for teachers and students to be ‘in the room’ together as they were before.  In order to assure the safety of both students and staff, social distancing directives have forced change upon the traditional ‘face-to-face’ teaching.  Class sizes have been reduced to support public health guidance and many pieces of the Nurse Education Curriculum have been moved online.  Intuitively, this seems like it may present a threat to our well-established classroom communities however is this actually the case? 

The Classroom Community

Being taught in a classroom is one of the most common and unifying cultural experiences in our society.  From the earliest moments in our lives, these experiences will have served to shape our attitudes, beliefs and how we relate to others in the world around us. 

Anyone who has spent time reflecting on what it’s like to be within the classroom will understand that everyone who is present is having their own, uniquely individual experience.  Everyone in the classroom brings personal fears, anxieties, perceptions and expectations.  In this sense it may be possible to suggest that at any given time there are actually two classes running at the same time…the one that is occurring externally (within the room) and the other which is taking place internally (within the minds of those who are present). 

The familiar classroom experience is a multi-personal one.  Effective teaching moves beyond the didactic delivery of information to the group, by using the taught content as a springboard for discussion and problem-solving.  In these situations, the class becomes more like a community where individual ideas and thoughts are shared and added to so that a higher level of understanding can be achieved. 

Effective teachers will plan and facilitate opportunities to trigger learning through discussion however, the class as a community evolves into an entity which is more than the systems of social interactions which the teacher imposes upon it.  As the individuals within the group share and assimilate ideas, react and respond to each other, agree or disagree, a complex and dynamic matrix of multi-personal relationships are formed and experienced collectively (Foulkes, 1964).  At some level this may seem overly theoretical, however people sometimes talk about instinctively or intuitively knowing what a class wants, or how the class is feeling.  These feelings are often associated with ‘being in the room’ and may be a sign that one is tapping into the classes communal experience.

The Connected Learning Approach

The use of a ‘Connected Learning’ approach may, at least in the short term, help us to maintain our sense of connectedness with our class communities. Connected Learning is a framework for online learning which seeks to replicate face-to-face learning by developing a digital community that is academically orientated, creates shared purpose, is production-centred and provides peer support (Ito et al, 2013).  As Nursing Students are now expected to ‘work from home’ it is anticipated that Connected Learning approaches will facilitate academic learning and also reduce anticipated feelings of isolation, as a result of the limited time the class physically spend in the classroom.  It has been suggested that digital technology can encourage openness and connectivity and can help to construct shared understanding and learning as part of a socially orientated online community. 

Learning and Teaching in Lockdown

During the springtime ‘lockdown’ I had the opportunity to use Connected Learning approaches with a class of Undergraduate Learning Disability Student Nurses.  Admittedly, adopting these approaches was more through necessity than choice, although as Plato so eloquently put it “necessity is the mother of all invention”.  The module lasted for six weeks and to promote wellbeing, the originally timetabled classes were consolidated into four-hour online workshops using a Flipped Classroom approach.  This approach meant that more time could spend on group work activity, discussion and debate.

Various pieces of digital technology were used to help the group to foster a shared and communal online space.  With the exception of online conferencing, students were already familiar with many of the tools, for example, online discussion boards, quizzes, polls and presentations, thus reducing connectivity issues and any hesitancy people might have had when adopting new technologies.  The tools were used to orientate students to the academic content, and to develop a range of co-productive group tasks and activities which offered a sense of shared purpose.

Connecting Through Emotional Experience

To build a sense of community it is important that people can share emotional experiences.  Everyone was asked to keep their webcams switched on so that others could see their facial expressions and emotional reactions.  At the beginning of the workshops, students and teachers took part in icebreakers designed to collectively acknowledge and validate any common feelings or anxieties related to the workshop, or more generally to the pandemic.  For example, people were invited to put one word in the chat box which described how they were feeling.  The group then reviewed each other’s comments.  The emotional themes were summarised so that common feelings could be acknowledged. 

At various points throughout the workshop polls were used to encourage people to express opinions on the session topic.  Students were also asked to make open comments on the topics which related to their own clinical experiences.  This encouraged people to continuously contribute to the collective group task, and to identify and connect with other people’s experiences. Members of the teaching staff were assigned to breakout rooms to support group discussions and work activities.    At the end of the session when the class came together again, people were invited to give each other feedback and share their reflections about their experience throughout the day.

Did People Feel More Connected?

In their evaluations, students provided valuable commentary about their experiences during the workshops and the ‘Connected Learning’ approach more generally.  The feedback was generally very positive, but what was particularly interesting was the language students used to describe their experiences.  Collective pronouns such as ‘we’ and ‘us’ were frequently used to describe their feelings.  One student commented that:

Even in these strange times, we were able to work together with the help of our lecturers through the use of group work”

The language used in the evaluations may represent an important reflection point regarding the students’ ability to development of a sense of ‘community’ or ‘solidarity’ with one another.

Whilst it seems that students and teaching staff were able to establish a shared sense of community on this occasion, it is also worth noting that the group had already spent time together in the physical classroom prior to the lockdown. This will undoubtedly have helped ease the migration of teaching and learning to a fully online medium. 

What will the future hold?

Predicting the future is a difficult task and as a result of the pandemic there is much uncertainty about how the next few months or years will play out.  Approaches to teaching and learning such as Connected Learning will undoubtedly be placed in sharper focus, and it remains unclear whether these approaches alone will be effective in helping new student nurses to develop the collective sense of community that is enjoyed as a matter of course in face-to-face classes.  One thing that is certain however, is the commitment and passion of nurses (students and teachers alike) to solve problems and overcome challenges…even in the most adverse of circumstances. 

Whatever the future holds, we can be assured that Nurses will be at the forefront of any innovative approaches to building communities through online teaching and learning.  As Florence Nightingale said, nurses would rather ‘die in the surf, heralding the way to a new world, than stand idly on the shore’.


[1] Foulkes, S. H., (1964) Therapeutic Group Analysis. London: Karnac Books.

[2] Ito, M., Gutierrez, K., Livingstone, S., Penuel, B., Rhodes, J., Salen, K., Watkins, S.C. (2013). Connected learning: An agenda for research and design. Irvine, CA: Digital Media and Learning Research Hub.

“Paul is a Lecturer (Education) in the SNoM’s Learning Disabilities Team, and has a special interest in Forensic Healthcare and Reflective Practice Groups”

Continuing Professional Development during COVID-19

‘Please remember many of us are working full time, trying to provide a service as well as studying”

I have always worked full time throughout my career, incorporating both work and education which can be challenging. Whether it’s an age thing but to me education should be conducted within university and not on-line. I firmly believe that you learn more within a classroom as it enables you to partake, ask relevant questions and gain knowledge and experience from both the lecturer and fellow colleagues. I don’t agree that this is achievable to the same standard when classes are online. 

My reason for this is as follows, 

I had never heard of Canvas until last year, even though I had completed a recent Intensive Care Nursing course in Queen’s University Belfast a few years previous. Technology constantly changes and unless you use it every day I feel you can fall behind very quickly.

I have worked in ICU and have trained hospital staff on how to use equipment, so I have excellent knowledge on medical devices however I don’t feel confident about Information Technology (IT), simply because I have very little interest! Believe it or not I actually like to communicate face to face, an art which I find sadly lacking in some nursing students and nurses today. To prepare for online classes during Covid-19, which I appreciate is unique and challenging time for all, I asked my NHS employer to ensure I had access to the required platform. Unfortunately my request could not be accommodated by the Trust and the platform could not be accessed from the Trust computers. This caused me a huge amount of stress at an already stressful time. Not only was I still providing a service during Covid-19, I was also anxious that I was going to miss out on valuable information required for my module and exam.  

After numerous conversations with my lecturer, who was very supportive, I was able to connect to the next class although very anxious that I might lose internet connection, sound, video link, etc. Once connected the quality wasn’t great, other class members struggled to get and stay connected and sound quality was poor. 

I had been reassured that classes would be recorded and could be watched at another time, should the technology let me down. However, other than my allocated day at university I unfortunately don’t have the time to go back and re-watch a class. My days off are and will be spent preparing for my exams as well as fitting in normal life activities outside work and study. 

Providing lecture material well in advance of the online class is so important. When presentations are not available at least 24 hours in advance, it causes unnecessary stress. Personally I like to be prepared,and not rely on my printer the night before or morning of the online class. If I do lose internet connection, for whatever reason, having the relevant written material in front of me enables me to work through it and make the most of the protected time.  

Consistency in communication is key and has been challenging throughout my course. Sometimes we would receive emails vis Queens online other times via Canvas, all I ask is pick one and use it, don’t have me guessing!

 I appreciate that Covid-19 is a difficult time for us all,  but to support post registration students through their programme of study please remember many of us are working full time, trying to provide a service as well as studying. The university needs to ensure that staff unfamiliar to studying online receive extra support, to get them through their course successfully and ensure that they actually enjoy learning and don’t see it as a burden, and that information is provided in a timely manner. 

About the author:

Sharlene, has been a qualified nurse for 27years, and has worked and studied in Northern Ireland, England and Scotland.  Her varied career which includes, Accident + Emergency, Surgical High Dependency, Outreach as Advanced Nurse Practitioner, Intensive Care Nursing and most recently as a Cancer Clinical Nurse Specialist. 

Student nurses, Jade and Majella share their experience of moving online in the Covid -19 pandemic

Jade:

Moving online was originally a daunting experience for me. Mainly because I thought I would never get the chance to focus on my work with a 4 -year-old at home! Nevertheless, we quickly developed a new routine and got to it. It really wasn’t much different to getting up and getting ready to go to uni. I got up and got ready but only had to sit at my desk at home! It was quite a novelty.

Participation

At the beginning, not many people went on screen to participate, it was mainly participation from the online chat or the microphone audio. I felt like my learning needs were still being met and I was actively engaging over the chat, there was something satisfying about trying to get your answer typed in first! However, it was evident that some people were not participating perhaps because it was easy to walk away. When we were encouraged to start and go on screen to participate, I thought this was a brilliant idea and might help with the connection of the class and concentration, especially with the longer topics. As we went on screen our learning really was maximised!

It didn’t feel all that different from being in class, and our tutorial lead was able to engage so much better with us, seeing our faces and reading our reactions, and the class operated more smoothly. This was much better than looking at the “… is typing..” bubble on the screen. It was fun, informative and honestly the best thing to happen in a ‘bad’ situation. I do not feel I have missed out on my tutorial classes at all, over the 12 weeks that were online, I definitely engaged more than I would have in class, as it is not as daunting offering your answers when you are in your own home. Overall, I had a really positive experience going on screen to participate in my learning and it 100% made the transition so much better and enjoyable.

Majella

At the beginning the thought of online classes scared me, with a young family I wasn’t sure how this would work.  I soon developed a routine and the lecturers understood the challenge of family commitments.  I attended every online lecture that was available.  When I settled into the new routine, I actually found that online learning suited me! Yes, its not the same as being in uni but the support was there regardless. Perhaps, as a mature student I settled quickly, knowing the demands of the degree were high. I actually found it easier than traveling 2hrs each day to university. I was able to be at home with my children whilst completing my degree.

Engagement

Engaging with the lecturers and having our own group sessions for tutorial was the biggest help throughout.  In the smaller tutorial classes, I knew most of my fellow students better and felt more comfortable.  Being able to interact with my lecturer and to physically see them eased some of my worries.  We all had the same questions or needed the same advice and sometimes just seeing each other spurred us on – it helped with class morale.  I still miss being around all the friends that I made and the hub of a uni environment, but i can honestly say it worked for me.  

About the authors

Jade is a second year student nurse, with 4 year old son. She has experience working in the the community as a Health Care Assistant and as a physiotherapy assistant. Jade has a real interest in oncology nursing and is looking forward to more practice experiences on placement!

Majella is a second year student nurse, with three children, aged, 11, 9 and 5. Starting university as a mature student has been daunting but with amazing support from her husband, children and parents, she has been able to pursue her career.