Mobile learning for informal learning and continuing professional development in Australian healthcare environments : the status of nursing

Continuing professional development (CPD) is mandatory for maintaining registration as a health professional in Australia. This learning can be undertaken using a variety of methods including face-to-face, blended and online modes. This flexibility in learning enables nurses opportunities to undertake formal and informal CPD while at the workplace. Learning, while undertaking nursing practice supports knowledge and skill acquisition. As one-third of undergraduate nursing programmes include work integrated learning where registered nurses supervise undergraduate nurses while they are in practice in healthcare environments, it is imperative that nurses are contemporary in their own practice. Nurses are advocates for patients and as frontline health professionals, promote patientcentred care and participatory health that includes health promotion and patient education. Undertaking CPD and informal learning ensures nurses are capable to deliver safe and effective healthcare. The growth of mobile technology for leisure and learning has changed how individuals seek and retrieve information, interact, collaborate and share information. Over time the advent of the smartphone, coupled with access to ‘apps’, reduced costs of hardware and data and increased Internet speed has enabled mobile technology for learning and teaching in healthcare environments to become attractive to nurse supervisors, undergraduate nurses and patients while at the workplace. The opportunity to seek and retrieve information in real-time as an adjunct to traditional learning strategies is appealing because it can be conducted at point of care and include the patient in their own care, if it is appropriate to do so. Additionally, nurse supervisors can harness ‘learning moments’ at the bedside with students by using digital media to clarify or reinforce concepts. Nurses can also confer or check information prior to making healthcare decisions without leaving the patient. There is no longer a wait for a desktop computer to be available at a nurses’ station or need to look up information after a shift concludes. This real-time access and use of mobile learning in healthcare environments challenges traditional learning and teaching paradigms and threatens the status quo, where previously learning was conducted in the classroom, nurses’ station or occasionally at point of care. Using mobile technology for learning in Australian healthcare environments is currently ad hoc and conducted with minimal direction from peak health profession bodies. The lack of clear guidance at a systems and organisation level has led to confusion about safe and appropriate use of mobile technology for learning and teaching, informal learning or CPD by nurses, at an individual level in the workplace. The global milieu reported regarding the use of mobile or portable devices for learning and teaching showed there was a gap in knowledge that needed addressing if mobile learning is to become a legitimate nursing function. This research aimed to develop a comprehensive understanding of the nature and scope of usability of mobile learning at point of care in Australian healthcare environments. The aim of the research was to understand: The nature and scope of usability of mobile learning in situ, at point of care, by registered nurse supervisors and undergraduate nurses, for learning and teaching, informal learning or continuing professional development in healthcare environments. From this aim, the two research questions developed. These questions were: RQ1: What factors have contributed to the limited acceptance of mobile learning, using mobile or portable devices, by nurses in healthcare environments? RQ2: What is the impact of current governance structures on mobile learning in situ, at point of care? These questions each had two further research objectives: RQ1 RO1: To understand the nature and scope of usability of mobile learning in situ, at point of care, by registered nurse supervisors for learning and teaching, informal learning or continuing professional development in healthcare environments? RQ1 RO2: To understand the nature and scope of usability of mobile learning in situ, at point of care, by undergraduate nurses, for learning and teaching, informal learning or continuing professional development in healthcare environments? RQ2 RO1: To understand how mobile learning at point of care is governed at a systems level? RQ2 RO2: To understand the organisation impact on governance of mobile learning at point of care? Understanding the nature and scope of usability of mobile learning at point of care in Australian healthcare environments from different perspectives was the primary aim because current information was fragmented or unavailable. These questions and objectives provided direction for the research design and multiple small projects to elicit the nature and scope of usability of mobile learning at point of care. To capture the current situation, a systems framework was used to describe interrelationships and patterns within the whole domain of interest, and the research was conducted in two phases. Using systems theory within a pragmatic approach, Phase 1 focused on an individual level. Phase 2 of the research focused on organisations and systems levels and how this impacted mobile learning at an individual level. Phase 1 provided quantitative and qualitative information from nurse supervisors and undergraduate nurses in two Australian states. Each of the four studies in this phase contributed to understanding the research domain from an individual level perspective. Both nurse supervisors and undergraduate nurses reported there were barriers, challenges, risks and benefits of using mobile technology at point of care. The main findings were nurses in Australian healthcare environments (New South Wales and Tasmania) are unable to access mobile technology for learning and teaching as a legitimate nursing function. A range of factors precluded its use as an adjunct method of learning and teaching. Reasons included higher education institution, organisation or local policy that prohibited its use, reported lack of proficiency and confidence of nurses in safe and appropriate use, fear of inadvertent inappropriate use, dissuasion by peers and resistance by some nurses. Nurse supervisors and undergraduate nurses that participated in these studies reported they understood the risks and benefits of using mobile devices at the workplace. Participants voiced their frustration of the mobile learning paradox, whereby there is an inability of nurses to access mobile learning, while it is increasingly being recognised that using mobile technology has the potential to improve patient outcomes. Furthermore, the development of digital professionalism as part of professional identity formation was hindered because safe and appropriate use of mobile or portable devices was not being modelled during work integrated learning. Additionally, nursing students reported that nurse supervisors needed to be upskilled in understanding the capacity of mobile learning at point of care. The final part of Phase 1 using a triad model, demonstrated how mobile learning could be deployed in healthcare environments to empower learners and transform learning at point of care. Phase 2 of the research focused on how governance structures at an organisation and systems level impacted mobile learning at an individual level. Analysis of the current nursing standards and codes of conduct found they provided inadequate direction without reform. Revision to overtly describe how mobile learning can be safely and appropriately used is necessary to legitimise the use of mobile or portable devices to advance nursing practice. The final interview study used interpretive description to uncover factors influencing the use of mobile technology for informal learning and CPD from the perspective of nursing profession organisations. Phase 2 demonstrated there was reluctance by nurses within these organisations to advance protocols that legitimise digital professionalism and the use of mobile learning. The outcomes of this research suggest that nurses need to challenge the status quo and lead development of installing mobile learning as a legitimate nursing function at the workplace. Strategies to support this stance at a systems level include ensuring nurses are included in informatics decision-making at a National level. Appropriate governance at a systems level will enable organisation and individual change, which will be of benefit to nurse supervisors, nursing students and patients. A synthesis of the findings of the studies conducted in phases 1 and 2 enabled a comprehensive understanding of the research domain. This research found the growth of mobile technology has impacted the advancement of nursing practice. This research is presented as eleven –peer reviewed publications, one under review and one manuscript ready for submission, will contribute to enabling a standardised approach to embedding mobile learning as a legitimate nursing function at point of care, within Australian healthcare environments. Further research needs to be conducted to provide evidence that mobile learning at point of care can be undertaken when it is safe and appropriate to do so. Trialling for usability of mobile technology for informal learning and CPD is warranted. Furthermore, evidence to support the development of standards, guidelines and policies regarding using mobile learning at point of care are necessary to ensure workarounds and unintended consequences are identified prior to installation of this adjunct learning and teaching strategy. Mobile technology connects end-users in ways that were previously unachievable. Information transfer and digital knowledge management has become ubiquitous in the environment. If nurses are to remain contemporary in their field there is an expectation they will harness the benefits of mobile learning while managing the barriers, risks and challenges. Nurse leaders are vested with stewardship of enabling mobile learning to become installed in healthcare environments as a legitimate nursing function