The nursing profession globally has found itself in unprecedented circumstances due to the outbreak of COVID-19, caused by the novel coronavirus. The gravity of the situation has prompted the World Health Organization (WHO) to declare a pandemic, a term that describes significant, ongoing spread of an infectious disease person-to-person across multiple countries around the world at the same time.
The education of nurses is also facing unprecedented circumstanes, with schools, colleges and university closures, and many people, within the UK and globally, working from home, having to self-care or care for others. Within this context, the delivery of nurse education is more challenging than ever.
Undergraduate nursing programmes across the UK generally offer a range of teaching and learning strategies, recognising that learning and assessment will take place in both practice and academic settings, and will involve working and learning with students from other disciplines as well as their own. Indeed, the Nursing and Midwifery Council (NMC) and the European Union are explicit that undergraduate nursing programmes require proportions of theoretical and practical components of study, totalling a minimum of 4600 hours, and that each proportion is assessed (NMC, 2018). Examples of approaches to teaching and learning are presented in Box 1.
Box 1.Examples of approaches to teaching and learning
| Lead lectures: to provide foundation material for further study, as well as exposure to notable guest lectures by key individuals from practice, service users, carers and academia and to ensure that students are exposed to the wider national and international context of nursing |
| Group tutorials and seminars: to enable students to further explore key topics with their peers and engage in open discussion, debate and collaborative learning activities |
| Enquiry-focused learning: to expose students to real-world problems and scenarios by engaging in an in-depth exploration and discussion. This may take the form of a theoretical exercise or a skills-based or simulated activity |
| Clinical practice experience: teaching and learning will include exposure to a range of practice learning opportunities across a range of care settings within the NHS, private, voluntary and independent sectors. Students' learning will be facilitated by experienced practitioners in specific fields of practice, and will include interprofessional learning experiences, as well as simulated activities |
| Virtual learning environment: a blended learning approach that makes effective use of university information technology to support and facilitate learning off site. This includes online discussions and collaborative working tutorials using video conferencing and projects related to module assessment requirements, such as evidence-based practice |
| Critical reflection: reflection on practice experience and ongoing personal and professional development to develop and enhance both professional and ethical behaviour |
| Self-directed learning: essential for development of key skills and independence in choice of learning material, as well as future autonomous practice |
| Independent study: to enable students to act as independent, autonomous learners who can utilise experiential learning to develop their professional practice |
More recently, the NMC has produced emergency standards for nursing and midwifery education, aimed at providing education providers and practice learning partners with the flexibility to enable students within their final 6 months of their preregistration nursing and midwifery programmes to complete their training within clinical placements, while ensuring that all learning outcomes are met (NMC, 2020).
The normal practice of higher education institutions (HEIs) has been challenged owing to the sudden closure of universities as a result of the coronavirus pandemic. This closure has disrupted teaching and learning as we know it. Overnight there has needed to be a shift in the way that nurse education is delivered, with nurse academics having to adopt a facilitator role, getting to grips with digital technologies as the sole means to deliver the theoretical component of the nursing curricula. Indeed, Standard 7 in the new NMC Emergency Standards states that theoretical instruction can be replaced with distance learning, where appropriate, to support student learning, which meets the required theoretical hours and learning outcomes (NMC, 2020: 10).
Distance and flexible learning, ‘flipped classroom’ and independent learning are not new concepts in the educational world. The key challenge faced by HEIs is readapting overnight to a completely virtual approach, in that educators must revisit the process of delivery, the digital tools available, and their own identity as a lecturer. And, more importantly, they must be aware of the importance of self-care and the care for students, colleagues, family and community.
The authors of this article offer a few tips based on our experience at the University of Salford of using digital technologies to deliver the theoretical component of the curriculum. This includes a box of tools to support the process of, for example:
- Choosing which tool to use: the decision-making process
- Exploring the role of the lecturer as facilitator
- Creating the support processes for academics who are working and delivering remotely
- ‘Buddying’ with colleagues from technical disciplines to maximise programme delivery success.
These are set out in Box 2.
Box 2.Box of tools when using digital technologies to deliver the theoretical component of the undergraduate nursing curriculum
| The technology | With the evolution of technology and digital capabilities, new opportunities emerge daily. Sessions could be delivered either via established methods including webinars on Zoom, Blackboard Collaborate or Microsoft Teams, or you may develop your own YouTube channel. Most of these tools are usable and accessible via a smartphone, tablet or a computer. It is vital to consider the security of these tools and whether they are supported by the institution |
| Planning and designing | To ensure high-quality and student-focused delivery, the classic process of planning and designing a distance-learning programme could last up to one year. Because we do not have a year, it is important to revisit the programme learning outcomes and the student needs, including childcare and special needs. These considerations can help you decide what is possible to achieve within a limited time frame. Define specific, measurable, achievable, realistic and, timely (SMART) objectives. Next, consider how you teach—the length of time, resources (presentations, whitepapers (short academic works with a focus on practical industry application), recorded sessions, activities) and the technology at handThe technology in this situation might decide the type of resources you create. For example, if you are choosing a webinar, using Zoom, Teams or Collaborate, you might only require a presentation and activities to prompt discussions and apply learning to practice. Alternatively, if you opt for a flipped classroom, an array of resources might be required, such as a video or audio, with subtitles, or a whitepaper for students with reasonable adjustments, activities and prompts to stimulate discussionAssessment and supervision should be carefully considered, primarily, for example, if the format involves oral presentations or posters. In this scenario, the format remains the same; the method of delivery should change. The presentation and the poster could be submitted via the higher educational institution's (HEI) virtual learning environment (VLE), and the oral exam or feedback could be delivered via Teams or Blackboard Collaborate, because both tools offer options for recording |
| Facilitator | The sudden change to wholesale online learning has challenged our identity as educators. We recognise that being a good virtual educator with limited time and resources brings with it many challenges and remains difficult. We might fear technology, the silence in the virtual classroom, or we may simply not be comfortable with talking to a screen. Using the Socratic method of open enquiry between the student and teacher would allow both educators and students to gain greater confidence in talking to large groups and stimulate critical thinking (Nelson, 2011) |
| Buddy with colleagues from technical disciplines | The authors are very passionate about multidisciplinary working and included is an example from a business degree, which successfully delivers distance learning. University healthcare lecturers could team up and explore solutions with their business school colleagues, and learn and share examples of good practice. The following module is available from Salford Business School. Designed as a flipped classroom module, the taught content makes extensive use of external resources such as bespoke video content created using video creation Screencast-O-Maticc software, video hosting such as Microsoft Stream (or YouTube unlisted videos) embedded into the VLE and exercises carried out on cloud-based eLearning platforms aligned to weekly core module themes. Guided study activities carried out by the student cohort are tested through knowledge reviews in class, achieved through a virtual synchronous team-space; student guided study is coordinated through Microsoft Teams for module and assessment support, which allows students to share screens and talk to the teaching team in real time. Ongoing, continuous assessment (using Blackboard tests) enables the students to progress while understanding their levels of achievement. Synchronous online support through Microsoft Teams digital drop-ins allows them to take part in assessments they have missed and improve their outcomes until the final hand-in datesTeaching of modules is carried out through facilitation of activities where student tasks are aligned to application of knowledge acquired through their guided study. Short video content to support specific technical tasks allows students to revisit core knowledge throughout development of their final assessed deliverables. Peer learning is achieved through synchronous online support with previous students offering guidance to enable successful project deliverables |
| Virtual tea and cake: self-care and caring for others | Take time to enjoy and celebrate what has been achieved. Use the technologies to promote a culture for virtual social gatherings. Technologies such as Zoom, Skype and Teams provide the forum to chat, explore, discuss and to check in on fellow lecturers' wellbeing and reactions to the sudden and wholesale shift in the delivery of nurse education. Remote working can bring with it feelings of isolation. ‘Virtual tea and cake’ promotes that sense of a community, thus minimising feelings of social isolation |
| Students on clinical placement | Most undergraduate nursing students on placement engage with the online practice assessment document, whereby the communication between the practice assessor, academic assessor and student are recorded in the electronic document. In these unprecedented times, students on placement are experiencing nursing in rapidly changing practice learning environments. There are multiple ways that students can be communicated with using technologies, such as the setting up of Teams for students to communicate with their peers and academic assessor/personal tutor. The virtual learning environment such as Blackboard has a discussion and blog facility that can be used to build that sense of community and support students to integrate theory and practice. Electronic tools should also be used to connect the students' practice assessor with key personnel in the HEI |
| Student engagement and measurement | Online tools such as VLEs (Blackboard/Moodle), Microsoft Teams and video hosting have functionalities to gather metrics of engagement. Activation of VLE stats produces statistics on engagement with learning material content. Hosted videos record the number of times a video has been watched and has the facility to leave comments. Creating a team space in which the class can work allows students to share articles and ask questions of the teaching team and their cohort; the administrative functions of Microsoft Teams produces metrics on user engagement |
Box 3 includes examples of digital technologies that can be applied to effectively deliver the theoretical component of the quality undergraduate nursing programme.
Box 3.Examples of digital technologies that can be applied to deliver the theoretical component of a quality undergraduate nursing programme
| Purpose | Technology |
|---|---|
| Webinars/virtual classrooms | Zoom, Blackboard Collaborate, Microsoft Teams |
| Video | Screencast-O-Matic, Microsoft PowerPoint, smartphone |
| Whitepapers/blogs | Microsoft Sway, PDF file, WordPress |
| Audio podcasts | SoundCloud, smartphone |
| Group work | Blackboard Collaborate Breakout Groups, Microsoft Teams, WhatsApp, Facebook private groups, Padlet |
| For sharing curated material | Wakelet, Pinterest, YouTube playlists, Sway |
| Activities (independent or group) | Projects, questions and answers, games, surveys using the technology above |
| Engage (games, surveys) | Kahoot!, Mentimeter, Blackboard Collaborate, online whiteboards, chats via Teams |
| Virtual tea and cake | Teams, WhatsApp, Facebook private groups, Twitter |
We have also curated a series of sources for inspiration and additional support:
- A blog from a retired University of Salford academic, scholar and blogger: https://francesbell.com/personal-2/gradually-then-suddenly-caring-and-careful-responses-to-covid-19
- A guide to online learning from digital learning experts Dr Alex Fenton from the University of Salford Business School and Dr Aleksej Heinze from Kedge Business School in France: https://aboutmanchester.co.uk/how-to-learn-online
- Health Education England has produced a free e-Learning for Healthcare course on COVID-19 adapted for the different health professionals: https://www.e-lfh.org.uk/programmes/coronavirus
Another useful online resource is Twitter, for example follow @LTHEchat on Twitter, or view tweets at https://twitter.com/lthechat. Also worth visiting is https://lthechat.com/
Conclusion
It is not clear when universities will reopen, allowing for the resumption of the delivery of nurse education that provides the face-to-face and online theoretical learning opportunities. What we do know is that our students need to develop a clear sense of professional identity and that this is best achieved through nurse educators co-creating with students and other key stakeholders, such as practice partner organisations, a vibrant, active and stimulating teaching and learning environment. This article demonstrates how such an environment can be created through the application of digital technologies used to effectively deliver the theoretical component of the undergraduate nursing curriculum. Our box of tools should be used flexibly, taking into consideration the programme aims and intended learning outcomes, but also considering the wellbeing of both nurse educators and students, all of whom are rapidly adapting to this new world of engaging with nurse education.
Finally, our box of tools extends to using digital technologies when engaging with students and those healthcare practitioners who support students' teaching and assessment from within the clinical learning environment. It is crucial that students feel supported by both practice and academic staff while they are undertaking clinical practice in these unprecedented times. Indeed, the NMC emergency standards make clear that placement allocations should take account of current, relevant public health guidelines, with due regard to the health and wellbeing of individual students (NMC, 2020:9).
KEY POINTS
- The challenges facing undergraduate nurse teaching during the current coronavirus pandemic include shifting to a completely virtual approach to theoretical teaching and learning
- Emergency standards from the Nursing and Midwifery Council have allowed theoretical instruction to be replaced with distance learning for undergraduate nursing programmes
- This article provides examples of tools that can be used to deliver virtually the theoretical components of the undergraduate nursing curriculum
- Students need to develop a clear sense of professional identity and this is best achieved through co-creating a vibrant, active and stimulating teaching and learning environment
CPD reflective questions
- Consider how the NMC Emergency Standards for Nursing and Midwifery Education will impact undergraduate student nurse education
- Plan with your colleagues (university and healthcare organisations) ways in which students will continue to receive the theoretical component of their programme during university campus closures
- Think about your learning needs when using digital technologies
- How will you co-create a vibrant, active and stimulating teaching and learning environment for student nurses? Who will you involve?