During the COVID-19 pandemic first-year nursing students had to adapt to unprecedented challenges. For the first time, they were learning practical clinical skills using synchronous and asynchronous approaches to cover theoretical aspects of learning and balancing this with face-to-face learning for practical sessions. Analysing the impact has influenced the faculty to design post-pandemic curricula that prepare students for practical sessions using synchronous and asynchronous approaches in a positive way.
A new approach to learning
University of East London faculty who were designing synchronous and asynchronous theoretical practice learning modules had to consider these modalities and how to combine them with face-to-face teaching of practical clinical skills. This presented a challenge. Synchronous learning involved real-time learning in a virtual space, whereas asynchronous learning provided the students with access to pre-recorded material.
There were advantages and disadvantages to both approaches. Synchronous learning provided the advantage of large group teaching, student interaction and engagement and covered theoretical skills teaching. Asynchronous learning provided the students with access to pre-recorded material, offering flexibility. Students were able to study the material as many times as necessary and learn at their own pace before attending face-to-face practical sessions.
At the same time, practising clinical skills required face-to-face teaching and collaborating with others to create small, friendly, manageable working spaces in simulation laboratories that could accommodate social distancing for COVID-19.
Students would be allocated to small groups, meeting their virtual space peers for face-to-face practical skills sessions for the first time. Synchronous learning was used for theoretical learning, creating supportive networks among the first-year nursing students. They had to quickly adapt to these different learning styles.
Challenges
The disadvantage of both synchronous and asynchronous online learning was that students did not have the chance to incorporate theoretical and practical skills in the same session.
The application of asynchronous learning provided the students with access to pre-recorded material. The intention was to offer them an opportunity to engage with the learning in guided ways to suit their own pace ahead of the face-to-face practical sessions. Our experience was that students did not get the opportunity for peer-to-peer engagement or lecturer–student engagement if they had any questions. There was always the risk of procrastination due to a lack of supervision.
Problems became apparent when students attended their practical classes. Often they would turn up for practical classes unprepared, not having finished studying or understood the theoretical material. Sometimes, students forgot to complete asynchronous activities assigned to them by the faculty members. As a result, faculty members had to send gentle reminders, encouraging students to finish the work and submit it for evaluation.
The theoretical curriculum for clinical practice is mainly created by practice learning faculty module leaders. Module leaders also create skills allocation groups where students are required to work with peers.
Post-pandemic, we have observed how the current first-year nursing students have adapted to different ways of learning, now that face-to-face learning is possible again.
Diversity
Students from East London are a diverse population, so it is important that the technology used reflects this. The university is very proud of the diversity of the high-fidelity manikins and the training videos created by lecturers. Interprofessional learning also takes place, which has involved physiotherapists and physician associates in clinical simulations. Verbal and written feedback has been positive.
Another innovation is the introduction of virtual placements using the Oxford Medical Simulation (OMS) immersive technology. OMS is an immersive technology for virtual reality medical and nursing simulation. The university runs non-mandatory clinical skills drop-in sessions and this has had a huge impact. Students practise skills at their own pace with support from the lecturers and simulation technicians. Students can use OMS before attending clinical skills drop-in sessions.
The dedication, passion and enthusiasm from the nursing team facilitating nursing skills has had a huge impact on student learning.
The diversity of lecturers is also important. The university has seen an increase in faculty lecturers from different ethnic groups, which has had a positive impact on students. This has helped create a conducive learning environment, supporting inclusivity and diversity, to meet students' diverse learning styles.
Positive lessons
Technology such as virtual reality and augmented reality is now part of the curriculum. The positive lessons from synchronous and asynchronous approaches used during the COVID-19 period prepared faculty for the challenges in planning and designing curriculum for learning practical clinical skills. We cannot underestimate the resilience and support of the nursing faculty teams to ensure that students' progress from their first year and mature into final-year students and qualify to register as nurses.