Impact of open education resources in nursing education

An open book

This post is written by Filipa Da Silva Miranda who is a nurse educator who recently completed the module EDM122. The essay is licensed under CC BY-NC-SA. She writes…. 

For the purpose of assessment on the module EDM 122 (Digital Literacies and Open practices), I will be reflecting on the importance of open education practices. Because of my role as a practice development educator in nursing, I will focus more specifically in the use of open education resources and their impact on nursing education and consequently, on better provision of care.

Open education as a term had its origins in the 1960s, as part of an effort to make education universally available through the creation of open universities, sharing of educational materials and democratizing access to educational opportunities (Blessinger and Bliss, 2016). In the following essay I will define open education and open educational resources; reflect and critically analyze the use of open educational resources and factors that might prevent this, while linking it to education in the healthcare sector.

The Open Education Consortium (cited by Cronin, 2017) defined open education as the resources, tools and practices employed in a context of open sharing in order to positively improve educational effectiveness and educational access around the world.

Open education resources (OERs) are defined as teaching and learning materials presented in a medium or digital format that can be used, re-used or repurposed by others with no cost (Hersh, 2020). The use of such resources is rooted in the will to democratize and make education universal. Ossiannilsson (2019) supports this view by highlighting the fact that OERs expand access to learning opportunities, increasing quality in education and promoting social justice and collaboration, while being useful for continuous professional development and lifelong learning. The advantages of using OERs, highlighted by Commonwealth of Learning (COL) and United Nations Educational, Scientifical and Cultural Organization (UNESCO) (2016), are the fact that these can be repurposed by educators to adapt them to a specific context; they can also enhance lifelong learning opportunities by providing ease of access to leaners, irrespective of time or place. Jung, Sasaki and Latchem (2016), add the lowered costs associated to using OERs, the share of best practice for collaboration between institutions or countries (with gains in time for educators, as it makes it unnecessary to reinvent the wheel), increased access for diverse and non-traditional learners, also breaking geographical barriers. With such advantages, it is easy to see why the adoption of OERs is viewed as crucial to provide lifelong education opportunities within many sectors, including healthcare. Ease of access is a crucial point in increasing social justice and inclusivity in accessing such resources.

The Covid-19 pandemic posed a crucial moment for the use of OERs across the globe and in various settings, at a time where physical classrooms were impossible to use and urgent measures were needed to spread valuable knowledge. For the healthcare sector for example, a wide range of free open access online materials was made available to all frontline healthcare staff and students (regardless of workplace or university). Some examples of important online materials included e-learning modules dedicated to teaching correct procedures for putting on and removing personal protective equipment used by healthcare workers caring for patients with Covid-19.  The aim of such materials was to increase knowledge around Covid-19, treatments and infection control measures, particularly on websites such as E-learning for Healthcare, an initiative from Health Education England (HEE) whose purpose is to ensure quality in training and education (HEE, n.d.).

Despite its importance and the increase in knowledge such resources provided, it is important to note that being “open access” does not mean such resources are OERs. For resources to be considered OERs, they must be made available under an open license, such as The Creative Commons License (COL and UNESCO, 2016), so that they can be retained, reused, revised, remixed or re-distributed by others (Van Allen and Katz, 2020), in a culture of collaboration and inclusivity for teachers and learners. If such permissions are not in place, then even “open access” materials are bound by copyright laws to prevent distribution and repurpose, such as the materials made available on E-learning for Healthcare.

As a practice development nurse working in a critical care unit of a teaching hospital, I believe in the many potential advantages of using OERs to support staff in their lifelong journey of professional development. Despite this and my short journey through the education world, I confess that the term OER was quite foreign to me until I started undertaking this module, and while I intend to use such resources in my future practice, I have never used them before. Such feelings are not unusual in the education world. Van Allen and Katz (2020) mentioned many educators are still unfamiliar with OERs which prevents their widespread use. The multitude of repositories and distribution channels for OERs, confusing process to obtain them, unclear licensing and uncertainty of adequacy of contents are further factors for under-usage of such resources pointed by Jung, Sasaki and Latchem (2016). Factors associated with educators are not the only ones preventing the use of OERs. Institutional factors, such as support for creating, using and distributing OERs is needed to comply with the principle of universal access to knowledge and build on the already existing knowledge by saving educators the time to create new contents, thus contributing to improvements and innovation (Organization for Economic Co-Operation and Development (OECD), 2007). Kurelovic (2016) describes other important limitations to using OERs which are cultural and language barriers. After observing that a large number of OERs available in popular repositories are in English language, this author pointed out that their adaptation and use for different languages or cultural contexts would require organizational resources, time, ICT skills or even access to special software, which might not be a possibility for some institutions. The University of Maryland Global Campus (2020) highlighted other important limitations linked to the use of OERs, such as being shared in static formats (difficulty in modifying and adapting such resources) and sustainability issues (lack of incentive for creators to update their materials and keep them available). The first point may result in the need of having to use expensive software, inaccessible to certain institutions, while the second may cause the materials to go outdated or unavailable; both points can be linked to institutional circumstances that may affect the rate of usage of OERs.

A paper by Lapum et al (2019) described a project where OERs were created in a partnership involving educators and students, with benefits in quality and advancements in nursing education, featuring open pedagogical approaches. Similar outcomes have been shared by Keating et al (2019), who also highlighted that the shortage of nursing staff around the world has an impact in nurse education and access to evidence-based study materials, thus proposing OERs to be a feasible solution in supporting an over-stretched education force. Petrovic et al (2023) further advocates for the use of OERs in distance education courses for example, which could help resolve shortages of nurses.

Part of my activities as an educator in one of the country´s largest Trust, is attending regular meetings with educators for other departments and giving contributions and views on educational activities being carried around the Trust. I believe that sharing educational resources with other fellow educators would be beneficial as it would help develop and improve the ways in which we support staff, particularly an over-stretched workforce. In a healthcare system where staff is often asked to provide care to patients under other specialty of care (for example redeployed staff during Covid-19), it is important to share resources within the education community and rearrange them to face specific needs and contexts. The challenges previously mentioned, such as the formatting of such materials, licences in place or lack of adherence of educators or support from the organization might prevent this from happening.

The involvement of students in the production of OERs can also present advantages to their own learning and development process. Describing a project involving co-creation of OERs by faculty and students, Verkuyl et al (2018) mention the transformational experiences for both parties, as well as a resulting expanded understanding for students of distinct career opportunities and professional prospects beyond direct patient care. Having seen all the potential and positive contributions of OERs for both students and educators, I will be better equipped to use them in my practice. As an educator facing the many challenges and pressures of current healthcare system, I see the use of OERs as something that might facilitate the learning for both educators and students in an ever-changing sector, with benefits that go beyond providing better care to our patients, but also increment professional satisfaction and inclusivity in all staff and students. For the students I teach in particular, those completing their specialty studies in Intensive Care Nursing might particularly benefit from enrolling in projects for co-creation of OERs, as it would be a unique opportunity to share their own experience and bring innovations to a specific aspect of nursing care, as well as broaden their career perspectives.

It is important to highlight that the adoption of open education practices goes beyond accessing and using OERs. Ehlers and Conole (2010) argue that in open education practices there is a shift of paradigm to one where knowledge is freely available and learners are co-creators of knowledge, assessing, modifying and sharing resources – open educational practices are a call for innovation with a modified pedagogical approach. The use of OERs is a step towards open education practices and it should not be feared by educators, but rather used to build upon each other’s experience leading to improved quality in nursing education (Lapum et al, 2019).

As a conclusion, the use of OERs have important advantages, especially in the face of the current healthcare crisis. However, it is important to note that certain limitations to their use still prevent the full potential of a truly open sharing culture. This limitation in use is due to several factors, such as lack of knowledge from educators or lack of trust in such materials, not to mention the multiplicity of sources and at times, confusing licencing practices or organizational factors. I must admit I used to share that same lack of knowledge of such resources or licencing practices for repurposing them to particular contexts. However, I intend to make use of these adequately and when possible, as well as participate in projects where such resources are created and shared at my current workplace in the future.


In the subject of openness, would like to publish this essay on the course blog (“EDM 122: Digital Literacies and Open Practice” blog) under one of the Creative Commons licences. The chosen license will be CC BY-NC-SA. According to Creative Commons (2019), this licence allows for distribution, adaptation, remix and build on the materials as long as the creator is given credit and adaptations are shared under the same licencing terms, not allowing for commercial uses. I believe this is a fair licence to use, as it protects authoring rights, at the same time allowing for a build-up of knowledge and ideas in a fair way to future users as it needs to be shared under the same terms and in a non-commercial way.



Blessinger, P. Bliss, T.J. (2016) “Open education. International perspectives in higher education”, Open Book Publishers: Cambridge. Available [online] at:,part%20of%20a%20wider%20effort%20to%20democratize%20education (accessed on: 17.12.2022)


Creative Commons (2019) “About CC licenses”, Available [online] at: (accessed on 09.01.2023)


Cronin, C. (2017) “Open education, open questions”, EDUCAUSE review 52, no.6. Available [online] at: (accessed on: 13.12.2022)


Ehlers, U.D. Conole, G.C. (2010) “Open educational practices: unleashing the power of OER”, UNESCO Workshop on OER, Namibia, 2010. Available [online] at: (accessed on: 13.12.2022)


Health Education England (n.d.) “Our purpose as part of the NHS, is to work with partners to plan, recruit, educate and train the health workforce.” Available [online] at: (accessed on 07.01.2023)


Hersh, W. (2020) “Open educational resources (OERs) in health informatics” in Berner E.S. (ed) Informatics Education in Healthcare, Birmingham: Springer, pp 277-285. Available [online] at: (accessed on: 17.12.2022)


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Lapum, J. St-Amant, O. Verkuyl, M. Garcia, W. Tan, A. Freeman, W. Savicevic, N. (2019) “Designing open-access, educational resources”, Quality Advancement in Nursing Education, 5:2. Available [online] at: (accessed on: 07.01.2023)


Organization for Economic Co-Operation and Development (2007) “Giving Knowledge for free. The emergence of open educational resources.” OECD Publishing: Paris. Available [online] at:;jsessionid=lSjRwtOGeMpCoriHFYtgI4TtHfcIkzNGTWJJcdrl.ip-10-240-5-25 (accessed on: 17.12.2022)


Ossiannilsson, E. (2019) “OER and OEP for access, equity, equality, quality, inclusiveness, and empowering lifelong learning”, International Journal of Open Educational Resources, 1:2. Available [online] at: file:///C:/Users/Filipa/Downloads/25058-oer-and-oep-for-access-equity-equality-quality-inclusiveness-and-empowering-lifelong-learning.pdf (accessed on: 07.01.2023)


Petrovic, K. Perry, B. Walsh, P. (2023) “Aligning nursing ethics with critical and open pedagogy in nursing education: a literature review”, Nurse Educator, 48:1. Available [online] at: (accessed on: 09.01.2023)


United Nations Educational, Scientific and Cultural Organization (UNESCO). Commonwealth of Learning (COL). (2016) “Introduction: Open educational resources: policy, costs and transformation” in Miao, F. Mishra, S. and Mcgreal, R. (eds) Open educational resources: policy, cost and transformation, France, pp 1-13. Available [online] at: (accessed on 18.12.2022)


University of Maryland Global Campus (2020) “Pros and Cons of using OERs for Instruction”. Available [online] at: (accessed on: 16.01.2023)


Van Allen, J. Katz, S. (2020) “Teaching with OER during pandemics and beyond”, Journal of Multicultural Education, 14:3/4. Available [online] at: (accessed on 07.01.2023)


Verkuyl, M. Lapum, J. St-Amant, O. Tan, A. Garcia, W. (2018) “Engaging nursing students in the creation of open educational resources”, Nurse Education Today, 71. Available [online] at: (accessed on 08.01.2023)

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