E-learning in health profession

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CHAPTER ONE: INTRODUCTION

Health professionals are working in a technology driven workplace, there are high expectations that nurses develop skills in information and communication technologies (ICT); (Connecting for Health, 2008). E-Learning has a significant role to play in the future direction of nurse CPD within the organisation, with constraints on funding for staff development activities (Rivers, 2007), together with the increased promotion of self directed learning within CPD activities and an increase in digitised resources being made available online via inter and intranet, investigation into this area of professional development within the organisation is essential. Given the demands for an IT literate workforce within the NHS the author considers e-Learning to be a valuable medium for CPD activities and recognised a need for further exploration in this area of continuing practice development.

The Nursing and Midwifery Council (NMC) require nurses to continually update themselves through CPD, commonly referred to as PREP (Post Registration Education and Practice) (NMC, 2008b). This poses a particular challenge in today's workplace where there are fewer funds available to meet the demands of the diverse range of staff development required, budgets are frequently set aside to provide little other than the 'mandatory' training and as a result nurses often perceive the need to self fund 'non compulsory' CPD activities (Rivers, 2007). Additionally nurses also face the challenge of finding time to update, being released from practice is often a challenge; these challenges were recognised by Bahn (2007) in her study into nurse orientation towards engaging in formal and informal learning within continuing education and lifelong learning. Regarding access to e-Learning in the workplace, Wright & Bingham present several barriers: "workforce reticence to the use of ICT for learning, combined with lack of basic ICT skills, the limitations of local IT infrastructures, and lack of staff time to undertake learning" (2008,4-5). They go on to state that the lack of skills and expertise to develop and deliver e-Learning and blended learning (learning comprised of a combination of traditional and e-Learning approaches (JISC no date)) is a further significant barrier within almost every organisation they surveyed.

The publication of the National Framework For Lifelong Learning (DH 2001) and later the development of the strategy Supporting Best Practice in e-Learning across the NHS (National Workforce Group, 2005) work together to shape the development of C&IT expertise within the NHS workforce; the National Programme for Information Technology (NPfIT) delivered through local implementation by Strategic Health Authorities (SHA) (Connecting for Health, 2008) and results of the E-Learning Scoping Exercise for NHS South Central region (Wright & Bingham, 2008) are expected to further support the delivery of NHS Improvement Plan and the Standards for Health through more effective training and development progress at a local level.

There has been substantial investment in increasing the provision and availability of IT resources to support work based learning & CPD. Many collaborative projects saw the emergence of resources developed by the former NHS University (NHSU), abolished in 2005, whose aims were to create and improve opportunities for learning; create high quality learning environments, and lead research into future learning needs. This developed into NHS Institute for Learning, Skills and Innovation (DH 2005), and later NHS Institute for Innovation and Improvement. The Core Learning Units (CLU) developed under the NHSU were transferred to the Skills for Health organisation and hosted within the NHS Core Learning Unit website (CLU, 2008).

Concurrently there has been evident growth and development within the National Library for Health (NLH) which in April 2009 was transferred NHS Evidence and rebranded The NHS Evidence Health Information Resources (NICE, 2008) with an increased provision of e-books, and online journals, together with increasing availability of staff development resources within organisational Intranet or virtual learning environments; including digitised learning materials, videos, CD-ROM and audio files; frequently delivered on-line via Internet synchronised with Learner Management Systems (LMS) for monitoring and recording staff development activities.

Research into e-Learning has increased in recent years with a growing number of reports focusing on developments within Higher Education Institutions (HEIs) namely Higher Education Funding Council for England(HEFCE) (2005), JISC (2007), Sharpe et al (2006), Waite & Bingham (2008) and developments focusing on implementing e-Learning within the NHS examined by Farrell (2006), Gill (2007), National Workforce Group (NWG) (2005) and Wright & Bingham (2008); the findings and recommendations from these publications will be considered within the design and implementation of the research project.

Given the demands within the NHS for an IT literate workforce, from the evidence presented, e-Learning proposes to be a potentially valuable medium to enhance CPD activities. Locally it is recognised that further exploration of the factors that influence the decisions of learning disability nurses integration of e-Learning into their CPD is needed.

Assumptions:

This study assumes that e-Learning (definition, see appendix 1) poses a significant advantage in providing nurses with the opportunity to meet Continuing Professional Development (CPD) (definition, see appendix 1) requirements in a more flexible way than through the more 'traditional contexts' i.e. 'campus based face-to-face delivery, alone. Flexible learning and delivery were recognised by Sandars who stated that e-Learning has enormous potential, he predicted that advances in technology would "allow rapid access to high-quality resources, both on- and offline, from work and home, and at a time and pace to suit the individual" (2003:3). Ease of access is still a key component for the success of e-Learning for professional development. The 'Martini' catch phrase is still evident today with any time, anywhere, and any pace learning (JISC (Joint Information Systems Committee) 2008). With this flexibility there is also the potential to bring together the traditional contexts with e-Learning to provide a richer learning experience; commonly this is referred to as 'Blended Learning' (Sharpe et al, 2006). Flexibility is one of the key advantages of e-Learning recognised by the National Workforce Group (NWG) and Department of Health (DH) (2006) who recognised the value of investment in workforce education delivered through e-Learning to support the modernisation of the NHS and the ongoing development of its workforce.

Research question:

What factors influence the personal decisions of learning disability nurses' to integrate e-Learning into their Continuing Professional Development (CPD) activities?

The study aimed to identify and explore factors which encourage and support the inclusion of e-Learning within CPD activities and factors which discourage and inhibit the inclusion of e-Learning within CPD activities.

Recommendations and findings of the study seek to inform the development and delivery of CPD activities within the Ridgeway Partnership (Oxfordshire Learning Disability NHS Trust).

Structure of the study:

Chapter one, presents the study focus, identifying influences from national government; the professional body for Nurses and Midwives practising in the United Kingdom (UK) the Nursing and Midwifery Council (NMC); and influences from the Department of Health (DH); the National Health Service (NHS) and social policy issues.

Background information is then presented followed by a rationale for undertaking the study. The research question is presented together with the aims and objectives for the study, essentially these guide the whole project.

In chapter two, contains the literature review. Existing literature pertaining to the themes of E-Learning, Continuing Professional Development (CPD) and Learning Disability Nurses.

Chapter Three, presents the methodology and methods of the study, exploring the philosophical concepts that inform the overall approach of the dissertation; presenting the theoretical framework, design of the study and related ethical issues.

Ethics Committee approval was sought for the study, the ethics proposal process will be presented and explored. Finally the methods of the study will be presented and discussed.

The results of the study are presented in Chapter Four, accompanied by data analysis.

Chapter five presents a discussion of the salient points which emerged from the analysis of the results.

Chapter six offers the conclusions drawn from the discussions with key findings of the project. Recommendations for changes in practice relating to e-Learning and CPD activities are put forward. A reflection on the experience of conducting this study utilising the reflective framework of (Reference) brings the dissertation to an end.

CHAPTER TWO: LITERATURE REVIEW

While carrying out the literature review; it became apparent that there is a lack of published work relating to the experiences of learning disability nurses' engaging in Continuing Professional Development (CPD) activities similarly there is a lack of published work focusing on learning disability nurses' engaging in e-Learning.

Structure how I under took the lit review...

CHAPTER THREE: METHODOLOGY AND METHODS

The research question requires the assumptions about nurses' involvement in eLearning within CPD activities be explored. A study to provide such answers would require an exploration of the thoughts and experiences of nurses planning and engaging with CPD activities; therefore a qualitative approach will be adopted for this study. Qualitative research permits an exploration of the lived experience and is viewed through the eyes of the person under study (Bryman, 2004). The study will employ an inductive, descriptive methodology comprising of aspects from both phenomenological and ethnographic approaches. According to Creswell (2007) these are most appropriate approaches to consider when studying experiences as lived by the study participants. To achieve this it is necessary that that the experiences of nurses engaging in CPD activities are collected, described and then analysed before conclusions are drawn. Therefore a mixed approach has been selected as it appears to be the most appropriate in answering the study question.

Theoretical perspective:

A qualitative design has been selected for the study as it is highly suited to exploring the lived experiences of the participants to determine which factors influence them when planning their CPD activities. The study asked participants to share their thoughts and experiences to discover any potential barriers or constraints they have encountered when planning within CPD activities; through individual interview it will identify which factors discourage and inhibit the inclusion of eLearning within CPD activities and which encourage and support the inclusion of eLearning within CPD activities. Thematic analysis will establish themes from which actions cane be identified for service development.

Paradigm - The paradigm of the study consists of the following; the ontological perspective is relativist, the author believes that there is no single answer to the challenge, the outcome is dependent on context and is different among individuals. The epistemological perspective is subjectivist, it would be difficult to be objective in such a research project as the author has an established and visible presence in learning & teaching in particular in e-learning in their employing organisation, it is essential that this is taken into consideration as it may influence upon the research project and the methodological perspective is hermeneutic.

Methodology:

The study is interview based and will employ an inductive, descriptive methodology seeking the experiences of learning disability nurses engaging in CPD activities.

The study focuses on the experiences of registered learning disability nurses, employed in a specific NHS Trust in England, UK. The inclusion criterion is intentionally broad to ensure nurses from any area of the Trust could participate. It is also important to collect the views of nurses who have not yet engaged in CPD activities using e-Learning as well as those who have. Therefore for pragmatic reasons purposive sampling was employed.

Purposive sampling (Polit & Hungler, 1999: 284) was utilised to attempt to find a more closely defined group for whom the research question will be significant. Polkinghorne (1989) and Ryan & Bernard (2003) advocate that sampling continues until theoretical saturation has been reached. This is advocated by Guest et al (2006) who identifies in health science research, that saturation has become the 'gold standard' by which purposive sample sizes are determined. It was therefore important to ensure that a sufficient numbers of participants are recruited to provide the volume of date required to reach 'theoretical saturation' and remain manageable within the time scale of the study. A sample size of six has been chosen for this study, this figure is suggested by Polkinghorne (1989) as a suitable figure for data collection via interviews.

Figure 1 Outline of the methodology.

  • Draft survey/ interview schedule (open and closed questions);
  • Informal testing;
  • Revise draft survey/ interview schedule;
  • Pre-test revised draft using interviews;
  • Revise survey again;
  • Carry out main data collection interviews;
  • Transcribe interviews;
  • Send to participants for 'respondent validation';
  • Code data and prepare data files;
  • Analyse data and write report.

(Based on Robson 2002:229).

A Trust administrator will send a letter inviting participation in the study to each first level, registered Learning Disability Nurse employed within the Ridgeway Partnership (Oxfordshire Learning Disability NHS Trust).

The invitation will include an outline of the study identifying aims and objectives and time-scale and demands on participants. The participant information sheet and reply slip will be sent as enclosures to the invitation letter, they will be asked to return their completed reply slip. Correspondence will be sent via the Trust internal postal system, respondents will be provided with a return self addressed envelope for their use.

If the full sample has not been recruited within four weeks then a second invitation to participate will be extended via the Trust 'Nurses Newsletter'. This is a bi-monthly electronic newsletter produced within the Trust and sent by a Trust administrator via email to all registered nurses. Potential participants will be invited to contact Jill Pawlyn for more information on the project and to request the participant information sheet.

Enquirers will be sent a copy of the participant information sheet and reply slip, they will be asked to return their completed reply slip. Correspondence will be sent via the internal postal system, respondents will be provided with a return self addressed envelope for their use.

Follow up letters will be sent two weeks after responding to the initial enquiry. If no response received then the participant will not be contacted again. Participants who complete and return the reply slip will be invited to attend an individual interview.

Although the focus of the study is on e-Learning activities, the initial invitation to participate is not being made electronically as this would immediately restrict the sample to participants who have a work email address and are users of technology at work.

Interviews will be structured using the interview schedule; participants will be asked a series of questions to gather an account of their experience.

To ensure an accurate record of the interview is captured interviews will be audio recorded.

Interviews will be conducted at a time and workplace location which is most convenient to the participants, ideally an interview room on one of the three main Trust sites (Oxford, Marlborough & Aylesbury) which is close to the participants work base, is physically accessible and affords a sufficient level of privacy to ensure the participant can speak freely during the interview. Jill Pawlyn will ensure suitable rooms are booked for each interview.

Interview notes will be transcribed into verbatim 'accounts', a copy of the transcript will be sent to interview participants for 'respondent validation'.

Data analysis will be conducted using quantitative and qualitative approaches comprising of both thematic and descriptive analysis.

Data analysis will commence on receipt of the returned transcripts. Data analysis will be aided using NVivo, this software can handle large amounts of data quickly, and it helps the development of consistent coding schemes and provides single location storage for all data and material for the project.

Data will be analysed using thematic analysis, data within the interview transcripts will be given codes, additional comments and reflections will be noted using 'memos'; similar recurring phrases, themes, experiences etc will be sought.

From the patterns generated from the data a set of 'generalisations' will then be developed these generalisations will be discussed and reported on in the final report (Adapted from: Miles & Huberman, 1994: 9).

Principal inclusion and exclusion criteria.

Inclusion criterion First level, registered learning disability nurses employed in Ridgeway Partnership (Oxfordshire Learning Disability NHS Trust), and of this group the first six who express interest.

Exclusion criterion employees of Ridgeway Partnership (Oxfordshire Learning Disability NHS Trust), who are not first level, registered learning disability nurses; the researchers line manager and those nurses to whom the researcher provides clinical supervision.

No exclusions will be made on the basis of age, disability, gender, race, ethnic origin or nationality, religion or belief, or sexual orientation.

sample size for the research? How many participants/samples/data records do you plan to study in total?

Sample size six nurses drawn from a population of 150 nurses within one NHS Trust.

Participants are all practising nurses in the UK. Written communications within the trust are in English.

How was the sample size decided upon? If a formal sample size calculation was used, indicate how this was done, giving sufficient information to justify and reproduce the calculation.

The study focuses on the experiences of registered nurses, employed in a specific NHS Trust in England, UK.

The inclusion criterion is intentionally broad to ensure nurses from any area of the Trust could participate; for pragmatic reasons purposive sampling is being employed.

What are the potential risks and burdens for research participants and how will you minimise them?

There are no risks or other obvious disadvantages from taking part.

There is a requirement for participants to commit time to participate in the data collection and checking the interview transcripts, across the duration of the study this should not exceed 1 1/2 hours in total.

To minimise the risk of inconvenience participating in the study, interviews will be held in Trust locations as near to the participants' work base as possible and at a time which is mutually convenient to the participant and researcher.

No risk to self esteem arising from the interview, questions are not invasive.

potential for benefit to research participants?

There are no direct benefits to taking part, although participation will provide participants with an opportunity for personal reflection through which they may gain insights into their own learning preferences and identify areas for future CPD actions.

By participating in this study individuals will help us to understand how better to design and support CPD activities delivered via e-Learning within the Trust.

How and by whom will potential participants, records or samples be identified?

A Trust administrator will send a letter inviting participation in the study to each first level, registered Learning Disability Nurse employed within the Ridgeway partnership (Oxfordshire Learning Disability NHS Trust).

Confidentiality of the information provided by participants can only be protected within the limitations of the law. Participant identities will be protected through 'de-identification', participants' will be given an individual unique identifying code which will be know only to Jill Pawlyn. Personal data and the identifying codes will be held separately and be stored in a secure location.

Identities of participants will be held in confidence from other members of staff in the Trust. To do this, data will be de-identified before it is analysed and in the final report participants will be referred to by a pseudonym.

No personally identifying information will be presented in the final report.

The data will be kept securely in the Trust, for two years from the date of completion, before being destroyed.

How and by whom will potential participants first be approached?

Initial approach will be via a letter inviting participation in the study. This will be sent by a Trust administrator to each nurse employed within the Trust. The invitation will include an outline of the study identifying aims and objectives and time-scale and demands on participants. The participant information sheet and reply slip will be sent as enclosures to the invitation letter, they will be asked to return their completed reply slip.

The follow-up invitation will be achieved via the 'Nurses Newsletter'. The administrator to the Director for Performance, Information and Nursing compiles and distributes the Nurses Newsletter, every two months. Distribution is via the trust email and internal post systems. Potential participants will be invited to contact Jill Pawlyn to request further information about the study or to request a copy of the participant information sheet.

Invitation letters will be sent to Nurses by a Trust administrator who has access to the database of registered nurses. On enquiry, potential participants will be asked to provide personal information for future correspondence within the reply slip giving; name, work address, email address and work phone number.

A follow up invitation to participate in the study will be included in the Trust 'Nurses Newsletter', the invitation will include an outline of the study identifying aims and objectives and time-scale and demands on participants.

Consent

Potential participants will be sent a copy of the participant information sheet and reply slip, they will be asked to return their completed reply slip.

Correspondence will be sent via the internal postal system, respondents will be provided with a return self addressed envelope for their use.

Follow up invitations will be sent two weeks after responding to the initial enquiry.

If no response received then the participant will not be contacted again. Participants who complete and return the reply slip will be invited to attend an individual interview.

At the start of the interview Jill Pawlyn will confirm details of the Participant Information Sheet with the participant, providing an opportunity to ask any further questions they may have. The consent form will be issued and the participant will be asked to sign the form to signify consent to participate.

The participant will be given a copy of their signed consent form for their records. The interview will commence.

Should any participant decline to consent, they will thanked for their attendance.

Participants will record consent on a consent form. Consent received will be recorded in the study records.

ensure the confidentiality of personal data?

Participants will be given an individual unique identifying code which will be know only to Jill Pawlyn. Participant name and work contact details will be kept in an encrypted password-protected computer file held separately from any data supplied during interview and audio recording; accessible only by Jill Pawlyn.

Identities of participants will be held in confidence from other members of staff in the Trust. Data will be de-identified before it is analysed and in the final report, participants will be referred to by a pseudonym. No reference to personally identifying information will be presented in the final report.

Relationships between researcher and participants

There are personal relationships in the organisation sponsoring the study:

The chief investigator (Marion Waite) is an employee of Oxford Brookes University, the sponsoring HEI. Other investigator (Jill Pawlyn) who at the time of commencing the syudy was an employee of the Ridgeway Partnership (Oxfordshire Learning Disability NHS Trust), the site of investigation and a part-time student at Oxford Brookes University, the researcher is also sub contracted as a part time employee of Oxford Brookes University.

inform participants of the results?

Findings will be disseminated individually to participants and more widely through the Nurses Forum to Trust stakeholders in the form of an oral presentation and paper; Presentation and report to the Trust R&D committee;

Presentation at relevant conference;

Publishing of findings in relevant journal or text book;

The project report will be located in the Trust Library and Intranet as a reference resource;

A copy of the final dissertation is retained in the University library for reference.

Sample:

Access to data/sample:

Data collection:

Data analysis:

Data will be analysed using a thematic approach, theme identification will be achieved utilising the techniques of Ryan & Bernard (2003).

CHAPTER FOUR: RESULTS and ANALYSIS

methods of analysis (statistical or other appropriate methods, e.g. for qualitative research) by which the data will be evaluated to meet the study objectives.

Data analysis will be conducted using thematic analysis, coding individual responses for emergent themes and issues. To assist the process data analysis software will be used (e.g. NVivo 8). Interview notes will be transcribed into verbatim 'accounts', a copy of the transcript will be sent to the interview participant for 'respondent validation'.

Data analysis will commence on receipt of the returned transcripts. Data analysis will be aided using NVivo, this software can handle large amounts of data quickly, and it helps the development of consistent coding schemes and provides single location storage for all data and material for the project.

Data will be analysed using thematic analysis, data within the interview transcripts will be given codes, additional comments and reflections will be noted using 'memos'; similar recurring phrases, themes, experiences etc will be sought.

From the patterns generated from the data a set of 'generalisations' will then be developed these generalisations will be discussed and reported on in the final report. (Adapted from: Miles & Huberman, 1994: 9)

CHAPTER FIVE: DISCUSSION

Discuss the important points that emerge from the analysis of the results.

Limitations:

Limitations primarily arise in the sample method, purposive sampling introduces bias however it is necessary to focus the study on the desired target group. The sample will only include those who responded to the invitation to participate and returned completed consent forms.

Further limitations arise in the bias declared by the researcher, who has a particular professional interest in e-Learning and its application to nurse CPD and possible 'Observer Effect' this is when the observer's study of the behaviour changes the nature of the behaviour, similarly this change can occur during interview. Robson (2002) indicates that habituation can reduce this effect, identifying how a person becomes increasingly familiar with the process of observation and therefore less constrained.

CHAPTER SIX: CONCLUSIONS

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APPENDICES

Definitions

Continuing professional development (CPD)

A First Class Service (DH 1999: 5) defines CPD "as a process of lifelong learning for all individuals and teams which meets the needs of patients and delivers the health outcomes and healthcare priorities of the NHS and which enables professionals to expand and fulfil their potential";

"CPD should be focussed on the needs of patients and should help individuals and teams deliver the health outcomes and healthcare priorities of the NHS, as set out in national service frameworks and local health improvement programmes. CPD should be a partnership between the individual and the organisation; its focus should be the delivery of high quality NHS services as well as meeting individual career aspirations and learning needs. All opportunities should be taken for patients and patients groups to have an input" (DH 1999: 6).

e-Learning

JISC (Joint Information Systems Committee) (no date) indicate that e-Learning can be defined as "learning facilitated and supported through the use of information and communications technology'. It can cover a spectrum of activities from the use of technology to support learning as part of a 'blended' approach (a combination of traditional and e-Learning approaches), to learning that is delivered entirely online".

References:

  • Department of Health (1999) Continuing Professional Development Quality in the new NHS. Available at: http://www.dh.gov.uk/en/Publicationsandstatistics/Lettersandcirculars/Healthservicecirculars/DH_4004315?IdcService=GET_FILE&dID=27906&Rendition=Web (accessed 01/06/08)
  • JISC (no date) e-Learning. Available at: http://www.jisc.ac.uk/whatwedo/themes/elearning.aspx (accessed 01/06/08)

Useful Websites:

  • Interpretative Phenomenological Analysis (IPA) this website outlines IPA and its application to qualitative research - http://www.psyc.bbk.ac.uk/ipa/
  • The NHS Core Learning Unit (NHS CLU) has delivered core learning programmes since October 2005 following the demise of the NHS University (NHSU). The Unit isahosted organisation within the National Health Service. Programmes are funded by the Strategic Health Authorities in England and are, as such, available free of additional charges, to NHS staff. - http://www.corelearningunit.com/

Useful website

  • http://www.nesc.nhs.uk/e-learning__libraries/e-learning/strategy,_policies__documenta.aspx
  • The NHS Institute for Innovation and Improvement supports the NHS to transform healthcare for patients and the public by rapidly developing and spreading new ways of working, new technology and world-class leadership - http://www.institute.nhs.uk/
  • The NHS and Social Care E-Learning Resources Database - contains details of e-Learning programs that have been developed and are available for use within the health and care sector - http://www.nhselearningdatabase.org.uk/.
  • Skills for Health was established in April 2002 with support from the DH, the independent and voluntary health sectors and staff organisations to become the Sector Skills Council (SSC) for health across the UK. Skills for Health takes a UK-wide lead for the development and use of integrated competency frameworks across healthcare - http://www.skillsforhealth.org.uk/

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