Clinical placements

Learning without paper: tips for nursing students to get the best out of e-PADs

How to embrace the use of e-documents in practice assessment

Transition from paper to e-PADs is complex, with clinical pressures, varying levels of digital confidence among nursing students and clinical staff, and poor IT access among the challenges to overcome

With advances in the use of information technology in healthcare and the growing move towards the use of electronic care records, the introduction of electronic practice assessment documents (e-PADs) for nursing students was a natural next step.

When the Nursing and Midwifery Council (NMC) launched a new curriculum and new assessment approaches in pre-registration nursing in 2018, the University of Worcester took the opportunity to implement the transition from paper assessment documentation to an electronic platform.

Electronic documentation is ideal because it can be accessed by students, practice and academic assessors. It

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Transition from paper to e-PADs is complex, with clinical pressures, varying levels of digital confidence among nursing students and clinical staff, and poor IT access among the challenges to overcome

Picture: iStock

With advances in the use of information technology in healthcare and the growing move towards the use of electronic care records, the introduction of electronic practice assessment documents (e-PADs) for nursing students was a natural next step.

When the Nursing and Midwifery Council (NMC) launched a new curriculum and new assessment approaches in pre-registration nursing in 2018, the University of Worcester took the opportunity to implement the transition from paper assessment documentation to an electronic platform.

Electronic documentation is ideal because it can be accessed by students, practice and academic assessors. It also ensures a digital footprint, enhances security, and has financial and environmental gains.

Understanding resistance among some students

In 2019, we trialled using the document in clinical practice with a cohort of 250 first-year students and 175 second-year students. But the change met resistance from most of the year two students, who preferred the original paper practice assessment documentation.

Changing from a paper document to an electronic one means potentially changing your approach to learning and assessment. Students come to university with varying levels of digital confidence, and while some of you will have no issues navigating different IT platforms and apps on mobile devices, others need additional support.

‘One of the major challenges to using an e-PAD is access to technology’

Before using the e-PAD in practice, it is vital you are provided with adequate information and the time to understand its functionality. It is natural to need reassurance and clarification that you are on the right track, particularly when you are getting to grips with something new.

Feedback from our students during the 2019 pilot showed that when this is not readily available, there is a temptation to revert to using the paper document rather than waiting for support and solutions.

With worries about signing-off proficiencies, and the fear of not meeting the requirements to pass the placement, many preferred to get paper documents completed so they could ‘get the job done’.

Benefits of using e-PADs

  • The ability to gather and collate evidence all in one electronic document, without the risk of accidentally leaving it on a bus or spilling coffee on it
  • The password-protected e-PAD offers an added layer of security, with any identifying data accessible only to those with permission to read it
  • Nursing and Midwifery Council Standards for Student Supervision and Assessment require students to receive input from a range of professionals, as well as patients, service users and carers. The e-PAD offers improved access to the team collectively, so they can record feedback in a timely and enable a team approach to student supervision and assessment.
  • Environmental sustainability because large, hardback paper versions of documents are no longer needed

Reassurance for clinical staff who have varying degrees of digital confidence

Another reason the students said they were reluctant to use the electronic document was because practice staff were ill prepared to use it.

Like you, staff in clinical practice are new to the e-PAD and need reassurance and clarification they are on the right track. They will also have varying degrees of digital confidence, with initial feedback suggesting some find it difficult to navigate at first. Some also find it too onerous when they are already challenged by clinical pressures.

In their preparation to supervise and assess you, staff should be trained in how to use the e-PAD, with support from practice educators, IT departments and digital learning specialists.

Addressing an overwhelming level of student dissatisfaction

Despite our best efforts to prepare our students and encourage them to persevere with the e-PAD, the level of dissatisfaction was overwhelming. After listening to their concerns, all were given the option of reverting to a paper document, with only 20 students from the second-year cohort continuing with the e-PAD at that time. A collective decision was made to revert to paper documentation for all year-one students.

After taking on board the feedback from the focus groups, we relaunched the e-PAD in September 2020 with a cohort of 350 first-year students. We worked closely with practice partners across eight NHS trusts and the private, independent and voluntary sectors to help prepare practice assessors and supervisors to use the document in practice, including developing ‘how to guides’ for nursing staff.

Formal evaluation of this relaunch is currently underway, but anecdotal evidence so far suggests the need for ongoing education and support for all involved.

Barriers to e-PAD implementation

One of the major challenges to using an e-PAD is access to technology. Placement allocations include several NHS trusts and the private, independent, and voluntary sector, ranging from hospital inpatient to community settings. These organisations have different IT systems, and a lack of uniformity and incompatibly with the e-PAD software can be an issue.

‘Ask questions and seek clarity – there is no such thing as a silly question’

The competing demands for computer access in clinical settings can also cause anxiety, particularly in acute hospitals where demand for use is high, with those on placement in more rural areas having the additional problem of sporadic wifi access.

Tips for students learning to use an e-PAD

Picture: iStock
  • Attend any training sessions in advance of a placement to familiarise yourself with the e-PAD
  • Ask questions and seek clarity – there is no such thing as a silly question so don’t be afraid to ask
  • Seek support and guidance from peers who have already used the e-PAD. They may have experienced similar issues and found solutions, so share your ideas and support each other
  • Don’t panic if your document is not completed instantly. Seek support from your personal academic tutor or practice supervisors and assessors if you have concerns about this
  • Volunteer to get involved in promoting the e-PAD and be a champion for change. For the e-PAD to be successful, students and practice staff need to embrace it

Acceptance of mobile phone use for clinical purposes

The e-PAD has a companion app that enables you to capture evidence in real time using your own smartphones, which we encourage our students to use.

Many placement areas now promote the use of mobile devices, with posters displayed to let people know it is acceptable practice. But if patients and visitors ask why you are using your mobile, an explanation and reassurance that it is work-related will help alleviate any concerns.

Practice supervisors or assessors can help you explain this to patients if necessary, and you also need to be aware of, and adhere to, any local policies related to the use of mobile devices.

Advances in technology make the increasing use of e-PADs inevitable. By working together – students, academic and clinical staff – we can embrace their use and make the change successful.


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