The corona era changed our perceptions of teaching and learning in many ways. Surely everyone who experienced the first corona spring remembers how challenging it was to change everything we were used to and work remotely. This was also done in teaching, and we learned a lot doing so.
Nursing education relies on traditions
The nursing profession likes to stick to traditional ways of teaching and implementing nursing care. I can say this because I am a nurse and a nursing teacher myself. Nurses are required to have broad and diverse skills. Nurses must be able to guide, act ethically and based on evidence, ensure the quality of services and develop nursing practices. Caring for patients and mastering various manual skills are often considered to be the core competence of a nurse. These are part of the clinical nursing work complex, which forms a large part of the nursing degree. Students seem to find these studies particularly motivating and important from the perspective of their own professional development. They like to practice various clinical skills and patient care, for example in simulations.
Clinical nursing teaching traditionally emphasizes face-to-face teaching with mandatory attendance. There is a lot of good in this. When the teacher is in the same physical space as the students and authentic tools are used, the teaching situation is intensive and authentic. However, there are also some challenges in these lessons, not the least of which is the mandatory attendance. If a student can`t participate in teaching, it may take months before it is possible to make up an absence from a lesson. However, if a student can participate in teaching remotely, this challenge does not arise.
Distance learning works
During the pandemic, everything that was possible was taught remotely. It was easy to change lectures to distance teaching, and this way you could enjoy your own voice. Fortunately, there were few lectures in my own teaching. Instead, a large part of the teaching consisted of simulation exercises, which are usually carried out at KAMK in environments designed for that purpose. In simulations, students examine a patient (a human or a computer-controlled simulator), think about things together, consult and practice interacting with the patient. Simulations are an essential part of all professional studies, and forced distancing brought a big challenge to implementing simulations: there was no simulator, we were not in the same room and the students did not have any equipment. However, when we stopped to think about it, we realized how much could be practiced without being present. The answer was and still is: a lot.
We started with a low threshold. Teams was still quite new to many, and it was quite challenging to open a camera or microphone. However, when the atmosphere that is important for learning was in place, i.e. safe and error-tolerant, we dared to challenge the students to something new. The participants in the simulation were selected in advance and they were sent instructions for preparation well in advance. The simulation exercises themselves proceeded as in face-to-face teaching, i.e. the instructions and objectives were reviewed, the tasks were distributed, the initial situation was explained and the simulation began. Those acting in the roles opened the video and audio connections and the others participated in the simulations according to the instructions. Finally, a debriefing took place. By doing this, we were able to practice quite convincingly, for example, remote care of a patient with mental health problems and an acute abdomen patient. The key was not what was being done by hands, but the professional encounter and guidance of the client.
As if I were at work
In addition to simulations, one of the biggest challenges for me in distance teaching was how to implement the escape game I had developed for classroom teaching remotely. In previous game sessions, I had seen how students threw themselves into the game and acted like nurses: working in teams, thinking and solving puzzles together. The solution was ultimately quite simple: a digital version of the game had to be made. So the students got to play the exact same game, just in a different format. They worked in small teams in Teams, solved the puzzles in Moodle and were able to use all the tools they found, just like in working life. The first time playing remotely was certainly nerve-wracking for both the teacher and the students, but everything went really well in the end. In the discussion after the game, a student working at an emergency clinic gave the best possible feedback about the game:
“It felt like I was at work and solving a patient’s situation with my colleagues.”
The feedback left me speechless.
Back to campus
After the easing of corona restrictions, we were able to return to face-to-face teaching, but there were many mandatory absences. Students may have been fully capable and willing to study, but they could not participate in face-to-face teaching due to quarantine or a child being sick. Because of these situations, we switched to hybrid teaching, meaning that some students participated in face-to-face teaching remotely. This was also new for both the students and us teachers.
My colleague and I moved to hybrid teaching a bit by accident. Our distance teaching skills were not special at all, but we had certainly learned the principles of distance teaching. What we did have, however, was an attitude. We didn’t feel too much pressure to do things in a way that was different from what we were used to. We also didn’t panic when something was forgotten or not understood. We were also so student-friendly that we wanted to give students the opportunity to participate in the teaching that they really missed. We had several conversations with students who wanted to learn and receive instruction, but couldn’t come to campus. We decided to try out how hybrid works, and it worked, surprisingly well. We ended up with an operating model where someone participated remotely in almost every class. This was natural for the students and they took great care of their remote friends. We teachers opened remote connections at the same time as we turned on the computer. In the end, we didn’t even think that someone was participating in the class remotely, because they were so actively participating in the activities.
Thank you for letting me participate!
What were these hybrid classes like? Of course, they weren’t lectures, and listening to a speech remotely probably wouldn’t be very innovative way to learn. Even if it was efficient. The classes studied the traditional core subjects of nursing that are traditionally practiced only and exclusively in the classroom. There were a lot of simulation exercises, we practiced using nursing equipment and played games. When the students went around different operating points to practice using catheters, for example, they brought distance students with them, who asked to bring the camera closer if necessary. The conversation with them was just as lively as if they had been in the classroom. In the simulation exercises, it was easy to give distance students various tasks, such as acting as consultants. This is actually a quite demanding role, so they didn’t get it easily. We also received clear evidence of how a good video and audio connection allowed remote participants to stay up to date with the situation and notice things that students sitting nearby or working in the situation missed. These experiences also led to excellent discussions.
The best indication of the importance of enabling remote participation was the gratitude of the students. They were immensely pleased that they did not drop out of the rest of the group’s trip just because a child got sick or they themselves were in quarantine. They also felt that they had truly learned while studying remotely. These experiences are well illustrated by the comment of a nurse who graduated during the pandemic about hybrid education:
Summa summarum
So, distance and hybrid learning definitely have their place in nursing education. Effective distance learning requires a lot, but it also gives. Students must be motivated and courageous, ready to work for their learning. Teachers may have to manage more than just in the classroom, but the reduction in compensated absences eases the workload. Sometimes students can also learn better remotely than in the classroom, and teachers can be motivated in their work by diverse teaching methods.
On the other hand, not everything can and should be taught remotely. However, when the essential conditions are met, remote teaching is a viable option. This is understood in KAMK’s nursing education and activities have been actively developed even after the pandemic.