I was delighted to be nominated and come second in the Gastrointestinal/Inflammatory Bowel Disease Nurse of the Year category in the British Journal of Nursing Awards 2021.
My current role is running gastrointestinal nurse education at St Mark's Hospital, part of the London North West University Healthcare NHS Trust. Over the past 12 months, I have revised all the nurse education that I organise. My role predominantly involves the education of post-registration nurses, although it also includes training student nurses, healthcare assistants and other members of the multidisciplinary team. I have had time to reflect on my passion for nurse education. I strive to have high standards and improve the care of patients through the education and empowerment of my colleagues.
As part of my role, I run courses for internal staff, as well as study days for the Trust-based and external health professionals interested in gastrointestinal topics. In addition, I am the module lead for several university modules that are accredited by Birmingham City University.
As a result of the COVID-19 pandemic, all face-to-face teaching was cancelled in March 2020. Although I recognised that education could not always be a priority during such times, it was nonetheless important to ensure that nurses still had the opportunity to learn.
Moving to online learning
To enable learning to continue, it was necessary to revise how teaching was provided to ensure that the safety of teachers and learners was maintained. This meant that the classroom was no longer a viable option for teaching and other educational opportunities needed to be explored. I have never been a technophobe, but I now realise that I had limited technical skills before the pandemic. Little did I know that I would need to rapidly improve my communication and computer skills. I did this in a number of ways.
‘So much has changed in such a short time and credit should be given to everyone for adapting so quickly’
Birmingham City University, which accredits the modules that I run from the hospital, put on some training so that I could improve the quality of the educational resources available on Moodle. Moodle is an online learning platform, an area where the module lead creates an online learning environment tailored to the needs of the learners on a particular module. This was a great opportunity for the four modules that are run with the university. The university Moodle sites for which I was module lead developed from 20th to 21st century in style, in just a few months!
Providing essential information
I realised that it was important for nurses to be able to improve their knowledge and skills in innovative ways. I recognised that there would be fewer opportunities for nurses to visit a library during the pandemic, for example, but that knowledge still needed to be gained by other means. It was essential that they were able to gain access to a greater range of training that would fit around their work and family life and that I could assist by adding more information to the Moodle site. This included, for example, providing more links to information on the main university website, where there were guides to writing assignments and searching the literature.
One of the training sessions enabled me to write more user-friendly modules, with simpler navigation tools to other educational links. Having organised the online information, it was important to adapt the face-to-face sessions I and my colleagues usually provided.
Virtual training
Face-to-face training ceased for a short time but once training resumed it could not be undertaken in the classroom environment. Traditional training needed to evolve and was now provided via an online platform. The hospital quickly adapted by installing Microsoft Teams on the staff computers. Around me the world was changing, and in my small world things were changing too. I had to learn how to use Teams and encourage and, at times, teach my colleagues to use it too. Some colleagues were very proficient but others needed more support and training, both to give and attend virtual training. So much has changed in such a short time and credit should be given to everyone for adapting so quickly.
There are a number of significant differences in teaching on an online platform such as Teams or Zoom. Interaction is different for both presenters and learners. Traditionally, the presenter will usually face the learners and can interact in a number of ways, such as using groupwork and discussions. Discussions in groups can work well in small training sessions. However, initially Teams' facilities such as ‘breakout rooms’ were not available to the presenters. Breakout rooms are the online version of small group discussions, enabling people to discuss a topic and then return to the larger group to share their findings. Breakout rooms can help interaction and participation in the training session.
Online discussions in larger groups can be difficult to manage. It is not always easy to see who wants to talk and people can talk over each other. This can be overcome by using facilities such as ‘reactions’, which involves raising an electronic hand and waiting to be invited to speak by the presenter. This works well, but it is a skill that needs to be learnt to facilitate successfully.
I also learnt the importance of setting boundaries with the learners, such as advising them that they should be on mute during a presentation, otherwise a variety of noises or inappropriate conversations can intrude on a session and be disruptive for the rest of the group. However, people often forget to unmute to ask a question.
A way to avoid this problem can be the use of the ‘chat’ function to write questions to the presenter. These can be written while the presenter is speaking without interrupting the flow of the session. There is, however, the problem of spelling and misinterpretation of questions. Once a speaker is proficient with the chat function, it is possible to address comments as they are written. I needed to learn how to use these functions so that I could disseminate this learning to both presenters and learners to ensure that the process was as positive as possible.
Presenting skills
I and many of my colleagues needed to learn to present to a computer screen. The first time I did this I felt I was talking to myself and it took a while to get used to it. I found that having two computer screens, so that I could still see the learners and the chat function, was helpful.
I also learnt that it is important to have breaks away from the screen. When planning study days, I soon found that having an increased number of breaks was necessary. Eyes become tired looking at a computer, laptop or other electronic device. I now try to plan for a break every 90 minutes or so; this enables eyes to rest and comfort breaks to be taken. I did not expect that sitting at home looking at a screen could often be more tiring than being in a classroom environment. Assessing the understanding and interest of the learners is also more difficult when using the online format. Thus, it becomes important to periodically check with the learners that they are understanding the session and that the pace is suitable. Another way that I have learnt to achieve this is to use different forms of assessment such as the use of polls. Learners can interact with the presenter by completing a pre-set poll. Polling works well with larger groups taking part in webinars and conferences.
Without the opportunity to interact in face-to-face situations, many scenarios have moved to online platforms. I have been involved not just in the online Awards ceremony organised by the British Journal of Nursing but also an educational webinar.
Recording presentations was another new skill to learn. It is important to try not to sound wooden when there is no audience providing feedback. I like to think that I am quite an animated presenter in face-to-face scenarios, but it is difficult to have the same range of movements when sitting in front of a computer screen. While some people carry off a seemingly effortless session, for others it can be more difficult, and more support is required. The benefit of webinars is that they can be viewed later, which was never a possibility if a learner missed a face-to-face session.
I have also been involved in a number of online conferences, which have the potential to reach a much wider audience as no travel is required. One conference was so successful that the number of people who attended was tenfold the number that could have been accommodated in the traditional face-to-face set-up. I was even able to teach a group of nurses live in Australia without needing to be on a plane for 24 hours—although I did need to get up early to attend!
‘I believe that it is not enough to teach others, I also need to improve myself’
A productive time
I also enjoy writing for publication and during the pandemic I still tried to write for various nursing journals. This included being involved in an online consensus forum about skin health around the stoma. I have in the past been involved in chairing face-to-face meetings, but chairing online events can be challenging—especially ensuring that everyone's voice is heard.
It was also important to ensure that peer review still occurred and, with many of my colleagues redeployed, I reviewed almost one article a week for a variety of journals.
I believe that it is not enough to teach others, I also need to improve myself. I am part of the way through a part-time PhD, looking into the changes to bowel function that occur in people after treatment for rectal cancer and trying to find ways to help with these problems. Unable to get permission to undertake research, I learnt new skills such as how to undertake a scoping review. This I did and I have submitted a scoping review for publication, with fingers crossed for acceptance.
There have been many difficulties in working during a pandemic. I have learnt so much in such a short time about education, and it has changed education and my role in many positive ways. I am able to reach further from my computer than I have ever been able to do before. I would also like to take this opportunity to thank my colleagues who have been supportive and knowledgeable and who are always ready to present on the modules and study days that we run. I am proud of my role as an advocate for gastrointestinal nursing, education and St Mark's Hospital.