Within the fast-changing landscape of modern health care, there is an increasing need for nurses to continually upskill themselves, yet a decreasing capacity to release the workforce from the clinical area for education sessions and learning opportunities.
The needs of the contemporary NHS demand the nursing workforce to be competent in complex clinical skills, while also being critical thinkers making complex decisions. This is a widely accepted requirement to ensure practitioners provide safe and effective care.
Indeed, the Nursing and Midwifery Council (NMC) specifically focuses on this within the revalidation process by requiring each registrant to provide evidence of 35 hours spent on continuing professional development (CPD) over a 3-year period (NMC, 2019). Where nurses have cumulative demands on their clinical time alongside their needs to balance this with their personal time, education providers must consider the values and perceptions of CPD and what factors influence the individuals.
Qualitative research by Govranos and Newton (2014) explored just this topic with the thematic analysis identifying that, while nurses value the importance and usefulness of CPD, organisational support in collaboration with education departments is essential in order to promote and sustain a culture of lifelong learning.
Acknowledgement of the necessity for CPD and lifelong learning is merely the first piece of the puzzle, so to speak. To truly engage a diverse range of learners, consideration must also be given to the generational differences within the nursing profession. As noted by Gallo (2011), there are, for the first time, four distinct generations of nurses working collectively: veterans, Baby Boomers, Generation X and Generation Y, resulting in a wide range of learning preferences, varying from one-to-one instructional methods to technology-enhanced learning such as webinars and high-fidelity simulations, with each holding certain merits and drawbacks. Although the validity of learning styles is questionable, what is clear is the need for engaging learning opportunities for all that are scaffolded by a strong evidence base and expert professionals so as to create concrete learning experiences that can then be assimilated and transferred into a practical application (Kolb, 1984; McLeod, 2017).
Looking forward, there is a growing trend and evidence base for the effectiveness of work-based learning. Based on constructivism pedagogical theory a learner would build or construct their knowledge based on a range of learning experiences. Combining this theory with Kolb's learning styles (Kolb, 1984), an educator can develop their learner's knowledge and skills through a range of teaching activities.
Within the clinical environment this presents many benefits for both the learner and the organisation; it is convenient and flexible and fits around both the organisational needs and the learner's wider responsibilities. In addition, it is directly applicable to the learner's working environment as the lived experiences directly inform the learning and, as such, the theory is directly linked to clinical practice.
Within the Royal Bournemouth Hospital education and training team, one of our clinical educators, Esther Pierce, implemented a service-improvement project as part of her studies for the Postgraduate Certificate in Education Practice. Being a large tertiary hospital, the demands on our workforce's time were often very high, which could compromise their capacity to effectively engage in CPD activities. Our clinical educators found that, despite learning needs being identified, teaching sessions in the education centre were often poorly attended.
Esther's story
I developed the ‘pick ‘n’ mix teaching’ sessions in response to a request for work-based teaching from one of our medical wards. This particular clinical area had identified various clinical incidents that had occurred, with learning needs identified as a partial solution to some of these issues. On talking to the clinical lead, the remit for the teaching was that the workforce needed to be on or near the ward, and that the teaching needed to be delivered in 15-minute blocks. The topics chosen were ‘lying and standing blood pressures' and ‘documentation’.
This initiative was originally meant for one ward, however word spread quickly and soon several other wards expressed an interest and suggested topics for short talks. Around this time I was looking at the BBC Bitesize online learning site (https://www.bbc.com/bitesize) and decided to use this as inspiration to develop a bank of short talks or pick ‘n’ mix teaching for the wider healthcare workforce across the Trust.
The process of writing a pick ‘n’ mix teaching session starts by establishing the current evidence-base as well as looking on the Trust's intranet site to check for relevant policies and standard operating practices. I also liaise closely with our specialist nurses and teams across the trust to establish if there are already teaching programmes available, and to fact check the sessions.
The structure of the session begins by asking five questions: Who? What? Why? Where? and How? Based on the answers to this, I create a short PowerPoint presentation contained on a maximum of five slides. I then facilitate a short discussion with the group to apply this theory to practice so the total length of the session is no longer than 15 minutes.
As things stand currently, there are over 20 pick ‘n’ mix teaching sessions that we can draw upon. These have either been written by me or other clinical educators in our team, or may be based on longer teaching programmes available from the specialist teams.
As part of my educator training, I also looked into learning differences. I quickly became aware that PowerPoint presentations can be difficult to follow for those with learning differences, such as dyslexia.
With this in mind, I created a process to ensure that our pick ‘n’ mix teaching sessions are more accessible. I looked into the evidence surrounding teaching and dyslexia and found it to be contradictory and somewhat confusing. Consequently, a colleague gave me a guide from York St John University for dyslexia-friendly PowerPoint presentations and this has been used to create our templates (York St John University Student Services, 2003). This has been an interesting conversation piece with my wider colleagues and subsequently we have ensured that the talks are also suitable for people with red–green colour blindness.
The pick ‘n’ mix teaching sessions are delivered in ward offices, nursing stations, empty patient areas or staff rooms. This allows the participants to monitor the clinical area remotely and respond to emergency situations promptly where needed. Furthermore, as the sessions are only 15 minutes in duration, there are rarely interruptions—most messages and queries can wait until the session is completed, leading to a better engagement with the learning process.
I appreciate and acknowledge that the pick ‘n’ mix teaching sessions are not the ideal teaching solution to address all learning needs, particularly as they do not allow for any kinaesthetic or hands-on learning activities to complement the theoretical teaching. However, in the current climate, when trying to disseminate evidence-based, up-to-date teaching across the healthcare workforce is challenging, it does help get across important messages to a large number of staff.
The feedback we have received from this project has been overwhelmingly positive. Not only have many participants expressed surprise that they have learnt so much in such a short space of time, but they have also found the sessions informal, accessible and a safe space to discuss their learning needs. It has also given people an opportunity to sit down with a drink and invest time in their personal development without worrying about their ongoing workload.