Analysis

Can virtual placements compare? The realities of blended learning during COVID-19

Nursing courses moved classes online amid the pandemic, but some changes might be here to stay

Nursing courses responded quickly to move classes online amid the pandemic, but some changes might be here to stay

  • Universities adopted a blended learning approach for preregistration nursing courses, with much of the theory delivered online
  • Many clinical placements were disrupted and, despite innovations that enable virtual learning, some students are behind on their practical skills
  • Students and university staff consider the impact of these new ways of working, and what learning will look like in 2021

COVID-19 has radically changed the way preregistration nursing courses are being delivered.

As the first semester of this academic year comes to an end, how

Nursing courses responded quickly to move classes online amid the pandemic, but some changes might be here to stay

  • Universities adopted a blended learning approach for preregistration nursing courses, with much of the theory delivered online
  • Many clinical placements were disrupted and, despite innovations that enable virtual learning, some students are behind on their practical skills
  • Students and university staff consider the impact of these new ways of working, and what learning will look like in 2021
Online learning became a necessity in 2020. Picture: iStock

COVID-19 has radically changed the way preregistration nursing courses are being delivered.

As the first semester of this academic year comes to an end, how well are ‘blended learning’ approaches – where the majority of theory moves online – working for students and universities?

The benefits of online learning

For third-year adult nursing student Joy O’Gorman, who is studying at the University of Plymouth, it has been a ‘mixture of positives and negatives’.

The positives include reduced travel time and fuel costs and the fact that nurses from all three of Plymouth’s campuses now attend online lectures together.

Joy O’Gorman: ‘A digital module helped me embrace online engagement and learning’

‘We get different perspectives and it adds depth to the learning experience,’ she says.

However, she says Zoom seminars can be ‘tiring’ for both students and lecturers.

Ms O’Gorman, who has been accepted onto a dual adult and mental health master’s degree, says some of her course mates were thinking about not doing the extra year ‘because they’re not coping with online learning’.

She says a digital professional module offered as part of her course helped her ‘embrace online engagement and learning’ and develop strong support networks via the nursing community on Twitter.

Ms O’Gorman, who is a member of union Unison’s student nurse and midwife network, says perhaps the biggest concern in general for nursing students is that many – especially second years – are behind on their practice skills.

34,190

people were accepted onto preregistration nursing programmes in the UK as part of the 2020 intake

Source: Universities and Colleges Admissions Service

‘Many of my peers are about 1-3 months behind in practice areas, which means they’re starting their final year under a lot of pressure,’ says Ms O’Gorman.

These include students who had to shield and missed placements or did extended placements but felt they did not get as much out of them due to the pandemic, she explains.

Ms O’Gorman attends regular regional meetings between training body Health Education England (HEE), universities and other providers and says institutions are looking at ways to solve current issues including ensuring students can access placements remotely if they need to self-isolate.

Coping with placement disruptions and financial pressures

RCN head of practice education, learning and development Nichola Ashby says nursing lecturers and universities have worked hard to keep courses on track.

One of the main concerns the college is hearing from students is ‘making sure they get the experience they are used to in clinical practice’.

There are also financial concerns, she says, with some students now unable to earn supplementary income that would normally keep them going through their course.

The RCN has pushed to ensure students remain supernumerary and have protected learning time on placement.

It is also vital to ensure their physical and mental well-being is protected, stresses Ms Ashby.

She says the college is working with universities across the UK to ensure all students receive robust risk assessments before going into practice, as well as proactive mental health support.

‘For some it is their first time away from home and they’re in lockdown in a new city. That is really difficult from a mental health perspective,’ says Ms Ashby.

Nursing Standard’s well-being centre: free resources and podcasts for nursing professionals

Creativity and innovations: some changes are here to stay

These are undoubtedly challenging times for universities and students alike, says executive director of the Council of Deans of Health Katerina Kolyva.

At the same time she believes the crisis has sparked creativity and innovation – including in the use of digital technology – that will continue to shape nursing courses.

She welcomes the fact students on placement in England have been added to the list of ‘essential workers’ and they are prioritised for regular testing.

Meanwhile £8.2 million in funding for placements, announced by Health Education England (HEE) in the summer, should help some students catch up on the clinical component of their studies. The funding was earmarked for 7,000 nursing and midwifery clinical placements across all regions for the September 2020 intake.

£8.2 million

of funding has been set aside for nursing and midwifery clinical placements for the September 2020 intake

Source: Health Education England

‘We’re working closely with HEE in the regions to make sure the money goes to the right place,’ says Dr Kolyva.

All universities in England were told to stop face-to-face teaching by 9 December so students can go home for Christmas, but healthcare students on placement can stay until the end of term.

Dr Kolyva says in the main students are reporting positive placement experiences or even that they are learning more.

Early starts, self-discipline and no commute

For Alex Emerson-Cox, a final-year mental health nursing student at the University of Derby, the experience of being a nursing student now feels ‘incredibly different’.

Alex Emerson-Cox: ‘In some ways there are more learning opportunities’

The blended learning approach, which involves a more self-directed learning process at home, means ‘there is definitely more of an element of self-discipline’.

Work-life balance has also shifted. One positive is being able to get work done before the university day starts. ‘It’s nice to be able to get up early and do some work without having to think about the commute,’ says Mr Emerson-Cox.

Like many other nursing students, he is concerned about gaining all the required practical skills. ‘We can talk around the theory of chest oscillations but actually going out there and doing it is another thing,’ he says.

He believes there must be some allowances made for the fact students may not have been out on placement for as long as they usually would.

‘We can talk around the theory of chest oscillations, but actually going out there and doing it is another thing’

Alex Emerson-Cox, final-year nursing student

He has just completed a five-week placement at a dementia assessment and treatment inpatient unit, where he experienced the real-life challenges of social distancing and personal protective equipment, including communicating wearing a mask.

‘In some ways there are more learning opportunities because you’re using skills you wouldn’t have used before and learning new things like how to do COVID swabs,’ he says.

Before that, he also undertook a ‘virtual placement’ involving full days of talks, exercises and discussions on areas not normally covered in detail on his course, including learning disabilities and child and adolescent mental health.

‘We covered different skillsets we wouldn’t necessarily have covered in our usual placements,’ he says.

Introducing a new curriculum during a pandemic

Queen Margaret University in Edinburgh has faced additional challenges, with the pandemic arriving just as the institution launched a new curriculum and switched from offering an undergraduate BSc to an undergraduate master’s programme.

The university has committed to giving first-year students up to six hours of face-to-face contact per week and the feedback on its blended learning approach has generally been positive, says head of the division of nursing Brendan McCormack.

About a third of students access face-to-face content online, while the rest come into the classroom.

‘We thought we might have an immediate attrition but we haven’t lost people yet, although some did choose to go home,’ he says.

Placements focus on developing students’ practical skills. Picture: iStock

Professor McCormack believes one positive has been a shift away from a ‘didactic lecture mentality’.

‘Many students say they really like that lectures are online because they can go at their own pace, watch them again and it’s not a one-off where you’re trying to take notes,’ he says.

‘It also means we can focus much more of our time on support and engagement in small groups.’

First years at Queen Margaret would normally go on placements in the first semester, but placements for all except third years have been delayed until next semester.

‘At the moment, we expect all four years will be able to access placements next semester,’ says Professor McCormack.

Queen Margaret already offers research placements and one step it has taken to expand placement opportunities is to ensure more research labs and institutions are ‘placement ready’.

Making the most of technology to maintain learning

Anglia Ruskin University has invested in expert learning technologists – experts in the technology used in teaching, learning and assessment – to work alongside academic staff.

The university has 2,663 students on nursing and midwifery courses across three campuses, in Chelmsford, Cambridge and Peterborough.

It has not only bought off-the-shelf online learning packages but also created its own content, explains pro-vice-chancellor and dean of the faculty of health Nigel Harrison.

This includes a scenario of a service user who uses a wheelchair, where a camera follows them as they move around their home, allowing a student to assess potential risks and health issues.

The university’s teaching day now runs from 8am to 8pm, to enable face-to-face clinical skills sessions to be run more frequently with smaller groups.

A virtual placements pilot

As part of efforts to increase the number and variety of placements, Anglia Ruskin is looking to expand ‘virtual placements’, having run a successful pilot with Virgin Care, a private provider of publicly funded community health and social services.

This enabled nursing students to access patient consultations at a children and young people’s service using their laptop and a webcam in the setting.

Feedback from students was ‘really positive’.

‘Students felt really engaged and still learned, developed skills and observed good practice,’ says Professor Harrison.

Anglia Ruskin University students who were in their final year during the height of the pandemic created a socially distanced collage for International Nurses’ Day in May

Well-being support with a buddy system

When it comes to well-being support, students have regular catch-ups with personal development tutors by phone, email or video call.

A ‘buddy system’ that pairs up second and third-year students with those at an earlier stage in their training has continued, with students now meeting virtually instead of face to face. The university has also organised online ‘town hall’ sessions to answer students’ questions and share information.

If students are struggling, they can access face-to-face counselling or online support as well as online packages that focus on resilience, emotional intelligence and coping strategies.

The university has also invested in staff well-being, and the faculty’s health and well-being group has surveyed staff to assess their needs.

‘If we invest in staff and their health and well-being then we get the best for the students as well,’ says Professor Harrison.

NS student: resources, advice and well-being support

Using body-worn cameras to teach practical skills

At the University of Derby, students are guaranteed time on campus and the curriculum is still 50% practice and 50% theory, explains pro-vice-chancellor and dean of the college of health Paula Holt.

Staff teaching clinical skills have been equipped with cameras that are strapped to their chest ‘so they can show the procedure they are doing on screen and we don’t have lots of students crowding round’.

‘I don’t want to send a first-year student out into practice who hasn’t had that human contact’

Paula Holt, pro-vice-chancellor and dean of the college of health, University of Derby

The university has also invested in lots of new equipment. ‘If we were teaching something like venepuncture we would have had several people working around one station, so we’ve had to order a lot more training arms so students can stay apart and practise individually,’ explains Dr Holt.

Students wearing full personal protective equipment are allowed to touch each other for some skills such as taking blood pressure but the contact is minimal. ‘I don’t want to send a first-year student out into practice who hasn’t had that human contact,’ says Dr Holt.

Paula Holt: ‘Students have taken social distancing seriously’

Like other universities, Derby has invested heavily in digital solutions such as virtual learning packages that allow students to have interactions with patients and offer interventions or drugs.

It has also worked with a business partner to develop virtual worlds, including one that reproduces the home of a dementia patient.

Derby has managed to secure placements for the majority of students as normal. Some settings, such as nursing homes, have required students to be tested for COVID-19 before their placement, says Dr Holt.

She is impressed with how ‘professional’ students have been when it comes to social distancing and other safety measures.

‘Nursing students do take it seriously and I haven’t seen or heard any reports of poor behaviour,’ she says.

Recovery standards: keeping university education on track

The Nursing and Midwifery Council (NMC) says it has worked closely with universities and other partners to try and limit disruption for students.

Emergency standards for education were implemented near the start of the pandemic. These were withdrawn at the end of September and replaced with a set of recovery standards.

The regulator has asked universities to report changes made in line with the emergency or recovery standards plus ‘any risks to student learning’, explains NMC director of professional practice Geraldine Waters.

‘We are reviewing these to ensure our standards continue to be met and students are appropriately supported,’ she says.


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