Reflection on Open access to Literature in Nursing Practice.

Posted on March 25, 2025 by Lorna Luy-Kenny

This post was written by Lorna Luy-Kenny as part of her final assessment for the module EDM122: Digital Literacies and Open Practice.

Introduction

Nursing practice has changed and improved significantly over the years primarily because of individual research and scientific studies (Hedges,2006). The advent of the internet has fundamentally transformed the pace at which clinical knowledge and practices are disseminated on a global scale.

However, despite living in a digital era, many institutions and underdeveloped countries still lack adequate access to even half of the available research and international journals (Georgiou and Dave, 2023). In this essay I will be reflecting the broader implication of open access to literature in nursing Practice.

Description

As a Clinical Practice Facilitator, my responsibilities encompass training and development of staff and students within the operating theatre. Additionally, I also engage in teaching sessions which necessitates preparation and exploration of pertinent evidence-based studies and guidelines. Accessing high-quality research literature is crucial for my role as we oftentimes encounter new procedures, surgical equipment, and clinical challenges requiring current and credible evidence to guide and improve my practice. Due to constant evolving in medical knowledge, nurses need to regularly access literature to stay informed about new advancement in treatments, guidelines, and best practices. (Fossum, Opsal and Ehrenberg, 2022). By having free access to literature, I could provide an in-depth knowledge to help educate nurses and student in the clinical area. However, it is important that I can cite credible sources to support my teaching and training as they are more likely to trust the information and follow the recommendations which are crucial for their clinical training and development.

Challenges of Paywalls in Nursing Research

One significant obstacle I encountered during literature searches has been the prevalence of Paywalls, which limit my ability to access crucial medical research and scientific studies unless I pay subscription fees. I had previously subscribed to these services hoping in obtaining more efficient and timely access to the latest resources vital for my perioperative practice (Quick, 2022). Fortunately, throughout my postgraduate studies, the availability of Library access has provided me with much broader accessibility to journal articles. However, I frequently pondered the sustainability of this access once my affiliation with the institution ends. In my situation, the temporary relief provided by free resources through the university library addressed these challenges, yet this solution is not viable in the long term. This reflection has led me to consider the wider implications of restricted access, especially for professionals in resource-limited countries, where paywalls can significantly worsen existing disparities (Bautista & Aranas, 2023).

Upon learning the concept of Open Access and Paywalls, I experienced a sense of frustration and injustice regarding these limitations. It appeared inequitable that 78% of essential research (Khabsa and Lee Giles, 2014), frequently financed by taxpayer contributions and charity organisations, remained concealed behind Paywalls (Torok, 2024). The absence of universal open access means that obtaining the latest information on advancements in specific fields for research or teaching is contingent upon an institution’s ability to afford increasingly costly journal subscriptions (Lariviere, Haustein, and Mongeon, 2015).

My sense of frustration intensified as I recognised how these barriers not only restricted my own professional development but also hindering the nursing profession to deliver evidence-based care, which can consequently affect nurses’ decision making in clinical (Saunders & Vehviläinen‐Julkunen, 2016)

The Global Knowledge Gap

The restricted access to scientific literature highlights a broader issue within global nursing practice. I felt concern for healthcare professionals and students in under-resourced settings, who might face even greater barriers to accessing research especially Nurses in developing countries, such as the Philippines where I was originally trained. Nurses from underdeveloped countries can face challenges accessing up-to-date research, limiting their ability to contribute to international policy discussions and clinical debates (Langer et al., 2004). Teaching hospitals and institutions in low-income countries can also experience similar constraints. Without OA, nurses in resource-limited settings will struggle to stay informed on advancements, limiting their capacity to enhance global healthcare standards. Perhaps without Paywall causing the barrier, Nurses experiences from underdeveloped countries can be shared contributing more to improving global nurse’s standard of clinical practice (Ramage and Paula, 2023).

Equity in Knowledge Sharing

Research suggests that open access is beneficial only when individuals have the digital literacy skills to navigate and interpret scholarly articles (Tenopir et al., 2020). My role as a Clinical Practice Facilitator (CPF) is to ensure that all staff members, irrespective of their diverse backgrounds, have unrestricted access to vital knowledge and resources necessary to support their practice in a clinical setting. Even if educational resources are OA, clinical staff especially the new joiner and students may struggle to find these educational resources or finding complex medical or clinical information. Failure to obtain this information can have fatal consequences to health. Hence the WHO recommended sharing research data through OA.

To support equitable learning, one of my roles includes mentoring and training practitioners how to search or signposting educational resources available that can help them engaged in high-quality and continuous learning aligning with UNESCO’s advocacy for bridging knowledge gaps, thereby fostering an environment where every individual can thrive.

Advocating for Open Access Initiatives

I felt inspired after learning about initiatives such as Sci-Hub and the Open Access movement, which aim to make research freely available (Elbakyan, cited in Milova, 2017). These feelings motivated me to advocate for equitable access to knowledge by supporting the idea of Creative Common licensing allowing lawful use, reproduction, and distribution of creative work which would make them ideal for my teaching and training purposes (Creative Common, 2001).

This level of accessibility facilitates easy dissemination of nursing literature ensuring that nurses remain informed about current practices, emerging technologies, and advancements in surgical techniques (Ramage & Foran, 2023). Nurses worldwide would also benefit having the freedom to read, download, copy, distribute, print, or link to full-text articles without encountering any financial, legal, or technical barriers to the latest scientific research. (BOAI 2001),

Similarly, Gotzsche (2011) highlighted the challenge of selective research reporting by publisher which impedes healthcare professionals from making optimal treatment decisions. This disproportionately also in large affects teaching hospitals and healthcare institutions especially in developing countries (Quick, 2022).

The Role of Open Access in Clinical Practice

Many scholars and institution believed that Paywall creates global knowledge gap is a transgression of a human rights issue as exclusion from accessing research literature can harms global public health according to Yamey (2013). In situations where there are gaps in evidence, Scantlebury, Booth and Hanley, (2017) highlighted the importance of nursing research to address these deficiencies. However, without OA to scientific literature, (Smith et al.,2017) argue this knowledge gap can suppress future innovation and collaboration among students and professional. OA can level up this gap and facilitate scientific conversation between those in the rich and underdeveloped countries in which clinical evidence or new clinical reports is critiqued and discussed according to Connor and colleagues, (2023). In contrast, limited access can significantly hinder both students and researchers, as it restricts their ability to obtain the necessary resources for conducting primary research or pursuing their educational objectives. Although Publishing companies often justify Paywalls as necessary for sustaining operations, critics argue that this practice prioritises profit over public good (Smith, 2006).

One of the interesting blogs I have read was Jack Andraka’s blog on the necessity of eliminating Paywalls in scientific journals, which he profoundly influenced my perspective on open access. In his discussion, Andraka emphasises the significant progress that could be achieved through broader public access to medical research, illustrating his own experience of navigating the limited availability of non-paywalled articles online to develop an award-winning early detection test for pancreatic cancer (Andraka, 2013).

Challenges to Open Access to Literature

United Kingdom Copyright law is designed to safeguard creative works and prevent unauthorised use by others. However, my task involves sharing or downloading education material for staff training and development purposes. With copyright, I encountered difficulties either the material is not downloadable or are restricted copy making my supporting documents and teaching materials challenging to prepare. Stilglitz (2006) has described this act as a facade for monopoly power, allowing individuals or corporations to exert exclusive control over and restrict access to essential knowledge. The core of the ongoing crisis regarding limited access to research literature is fundamentally rooted in this publishing arrangement (Yamey,2013)

Many scholars such as Alexandra Elbakyan, the founder of Sci-Hub, has also expressed the same view expressing that copyright law obstructs the free exchange of information and dissemination of knowledge on the Internet. Although this idea has roused some dissenting opinions amongst some academics (Belluz, 2016). This issue highlighted the tension between intellectual property rights and the ethical principle of equitable knowledge dissemination.

According to Bhattad and Pacifico (2022) Open access is not only be about bringing down paywalls or building repositories, but also understanding and addressing wider accessibility issues, such as IT skills required to navigate the publishing platforms as well as discoverability of the content. An article may be freely available digitally, but this is no help to someone without online access and technical ability. As a CPF, I always ensure that theatre practitioners and students are not just being provided OA to education and training resources, but they are also supported with the skills to access, understand, apply, and engage with research resources effectively in clinical practice. Bloomberg et al, (2018) argue that without OA, nurses will be stuck in their old practice, which can potentially compromise patient safety. By utilising OA, error can be minimised as nurses are currently updated with scientific and clinical evidence to support their practice.

Another challenges Gotzsche (2011) has pointed out facing evidence-based healthcare is the selective reporting of research findings by the publisher which may impact healthcare professionals from making optimal treatment decisions for their patients.

After viewing the documentary “Paywall: The Business of Scholarship,” I felt a deep sense of injustice regarding the plight of scholars who relinquish their work to publishers without compensation, only for those publishers claim ownership and copyright over the researchers’ contributions (Baverstock, 2019). I can’t help pondering why scholars would send their work to big publishing company like Elsevier and consequently losing their right to their scholarly work. According to Elbakyan, scholars feel pressured to do this, because Elsevier is an owner of so-called “high impact” journals. Researcher who wanted to gain recognition and build a career are left with no choice but hand in their work to big publishing company such as Elsevier (Elbakyan, 2015).

Sustainable Solutions for Knowledge Access

While university and institution library access temporarily alleviate these challenges through paid subscription, long-term solutions are needed. OA resources, licensed under Creative Commons can offer a viable solution. Creative Common platform not only provide Open Access to education but also attributes the work of the scholars.

Advocating Creative commons redistributes power from the hands of the few to the minds of the many and leverage global view of knowledge as a public good and a human right (Creative Common 2001). As a CPF, this can greatly benefit my work as I can actively share free articles and journal on legal platforms with colleagues, without fear of copy right infringement, promoting an equitable environment where not only nurses or other health professionals or students benefiting from this free access to education but also the entire global community aligning with global health and educational agenda of UNESCO.

Conclusion

Reflecting on my experience, I recognise the importance of OA in advancing nursing education and practice. While university access provided a temporary solution, systemic reliance on Paywalls persists. As a CPF, I advocate for OA models that promote equity and inclusivity (Day et al., 2020). With OA, we can create an environment where healthcare professionals can easily access research, ultimately aligning with global health agendas and equitable healthcare practices. Supporting OA not only enhances our nursing practice and educational development of students but also ensures that knowledge remains accessible for the betterment of humanity and society.

I fully support and advocate for creative common licencing and I share the organisation ethos that Knowledge must be accessible, discoverable, and reusable. I will be publishing my essay under

CC BY-NC 4.0

Creative Commons Attribution- 4.0 International@ https://creativecommons.org/share-your-work/

This license requires that reusers give credit to the creator. Allowing reusers to distribute, remix, adapt, and build upon the material in any medium or format, for noncommercial purposes only.

References:

Andraka, J (2013) ‘Why science journal paywalls have to go’, PLOS Blogs.

Available at: https://yoursay.plos.org.( Accessed: 27 December 2024)

Bautista, M and Aranas, V. (2023) ‘The learning crisis in Philippine education: An overview’, Philippine Institute of Development Studies.

Available at: https://edcom2.gov.ph (Accessed: 20 January 2025)

Baverstock, A. (2019) “5. Who Takes Legal Responsibility for Published Work? Why Both an Understanding and Lived Experience of Copyright Are Becoming Increasingly Important to Writers”. Whose Book Is It Anyway, edited by Janis Jefferies and Sarah Kember, Open Book Publishers.

https://books.openedition.org/obp/8299. (Accessed: 20 December 2024)

Belluz, J. (2016) ‘Meet the woman who’s breaking the law to make science free for all’, Vox, 18 February.

Available at: https://www.vox.com (Accessed: 22 December 2024).

Berlin Declaration on Open Access to Knowledge in the Sciences and Humanities BOA (2003). Max Planck Society.

Available at: https://openaccess.mpg.de/Berlin-Conferences. (Accessed: 30 December 2024)

Blomberg, A.C., Bisholt, B. and Lindwall, L. (2018) ‘Responsibility for patient care in perioperative practice’, Nursing Open, 5(3), pp. 414–421. doi: 10.1002/nop2.153.

Bhattad PB, Pacifico L. (2022) Empowering Patients: Promoting Patient Education and Health Literacy. Cureus. 2022 Jul 27;14(7):27336. doi: 10.7759/cureus.27336. PMID: 36043002; PMCID: PMC9411825.

Connor, L. et al. (2023) ‘Evidence-based practice improves patient outcomes and healthcare system return on investment: Findings from a scoping review’, Worldviews on Evidence-Based Nursing, 20, pp. 6–15. doi: 10.1111/wvn.12621.

Creative Common (2001)https://creativecommons.org/ (Accessed 15 December 2024)

Day, S., Rennie, S., Luo, D. et al. (2020) ‘Open to the public: paywalls and the public rationale for open access medical research publishing’, Research Involvement and Engagement, 6, 8. doi: 10.1186/s40900-020-0182-y.

Elbakyan, A. (2015) ‘Case 1:15-cv-04282-RWS Document 50’ (PDF). Archived at: https://torrentfreak.com (Accessed: 15 November 2024).

Fossum M, Opsal A, Ehrenberg A. (2022) Nurses’ sources of information to inform clinical practice: An integrative review to guide evidence-based practice. Worldviews Evid Based Nurs. doi: 10.1111/wvn.12569. Epub 2022 Mar 4. PMID: 35244324; PMCID: PMC

https://pmc.ncbi.nlm.nih.gov/articles/PMC9790517/#wvn12569-bib-00239790517. (Accessed: 27 December 2024)

Gheorghiu, C. and Dave, M. (2023) ‘Promoting inclusivity in research’, British Dental Journal, 235, pp. 11–12. doi: 10.1038/s41415-023-6073-5.

Gøtzsche, P.C. (2011) ‘Why we need easy access to all data from all clinical trials and how to accomplish it’, Trials, 12, p. 249. doi: 10.1186/1745-6215-12-249.

Hedges, C. (2006) ‘Research, evidence-based practice, and quality improvement’, AACN Advanced Critical Care, 17(4), pp. 457–459.

Khabsa, M. and Lee Giles, C. (2014) ‘The number of scholarly documents on the public’, PLoS One. doi: 10.1371/journal.pone.0093949.

Lariviere, V., Haustein, S. and Mongeon, P. (2015) ‘The oligopoly of academic publishers in the digital era’, PLoS One, 10(6), p. e0127502. doi: 10.1371/journal.pone.0127502.

Langer, A. et al. (2004) ‘Why is research from developing countries underrepresented in international health literature, and what can be done about it?’, Bulletin of the World Health Organisation, 82(10), pp. 802–803.

National Institute of Health and Care Research, NIHR (2021) Knowledge is Power: Public perspective on Open Access publishing.

https://www.nihr.ac.uk/about-us/who-we-are/policies-and-guidelines/open-access-policy/knowledge-is-power-public-perspectives-on-open-access-publishing#Appendix%20A (Accessed: 15 January 2025)

Piwowar, H. et al. (2018) ‘The state of OA: a large-scale analysis of the prevalence and impact of Open Access articles’, PeerJ, 6, e4375. doi: 10.7717/peerj.4375.

Pogge, T. (2005) ‘Human rights and global health: a research program’, Metaphilosophy, 36(1–2). doi: 10.1111/j.1467-9973.2005.00362.x.

Quick, J. (2022) ‘Evidence-based practice: The cornerstone of clinical decision making’, Journal of Perioperative Practice. doi: 10.1177/17504589221133933.

Ramage, B. and Foran, P. (2023) ‘Evidence-based practice in perioperative nursing: Barriers and facilitators to compliance’, Journal of Perioperative Nursing, 36(2), Article 6. doi: 10.26550/2209-1092.1265.

Saunders, H. and Vehviläinen‐Julkunen, K. (2016) ‘The state of readiness for evidence‐based practice among nurses: an integrative review’, International Journal of Nursing Studies, 56, pp. 128–140. doi: 10.1016/j.ijnurstu.

Scantlebury, A., Booth, A. and Hanley, B. (2017) ‘Experiences, practices and barriers to accessing health information: a qualitative study’, International Journal of Medical Informatics, 103, pp. 103–108.

Smith, E., Haustein, S., Mongeon, P., Shu, F, Ridde V, and Lariviere, V (2017) Knowledge sharing in global health research – the impact, uptake and cost of open access to scholarly literature. Health Res Policy Sys 15, 73.

Available at https://doi.org/10.1186/s12961-017-0235-3d (Accessed: 27 December 2024)

Smith, R. (2006) ‘The highly profitable but unethical business of publishing medical research’, Journal of the Royal Society of Medicine, 99(9), pp. 452–456. doi: 10.1177/014107680609900916.

Stiglitz, J. (2006) “Scrooge and Intellectual Property Rights,” British Medical Journal 333 (2006): pp. 1279–1280.

https://pmc.ncbi.nlm.nih.gov/articles/PMC1761163/ (Accessed: 15 January 2025)

Tenopir, C., Christian, L., Kaufman, J., & Nicholas, D. (2020). Seeking, reading, and use of scholarly articles: An international study of perceptions and behavior. Library & Information Science Research, 42(3), 101034.

Torok, E. (2024) ‘Who loses when scientific research is locked behind paywalls?’, Gates Foundation.

Available at: https://www.gatesfoundation.org (Accessed: January 5 2025)

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UNESCO Open Access Publications. https://en.unesco.org/open-access/what-open-access

https://www.budapestopenaccessinitiative.org/read/( Accessed: 29 December 2024)

Yamey G. (2013) Excluding the poor from accessing biomedical literature: a rights violation that impedes global health. Health Hum Rights. 10(1):21–42.

Healthcare Publishing in Open Access Journals

Posted on April 24, 2024 by Asma Ashraf

This post is written by Asma Ashraf, a Lecturer in Adult Nursing at City University of London. This is part of Asma’s assignment for EDM122 and is licensed under CC BY. Asma writes:

Publishing in open access journals – to do or not to do!

I clicked on a link to read an article on the university library website. A message appeared asking do I want to ‘Get Open Access version’ and to click on the red button. I wondered if it is correct, surely this is not a ‘paywall’. I laugh nervously as I think to myself, I do not need to worry about this, I have access!

As an academic, I am privileged to have access to most journals. As I proceed, I think to myself, is this a test? Are the module leaders trying to point out the challenges that others face? This is not a message I have seen before and I decide that it is reminding me that there are free versions available to access.

This is very telling about the challenges that those wanting to access academic journal articles experience. I have been on the receiving end of hitting ‘paywalls’ and it invokes stress. In this essay, I will be exploring whether healthcare workers should only publish in open access journals. The United Nations Educational, Scientific and Cultural Organisation (UNESCO) in their ‘Recommendation on Open Science’ guide want scientific research to benefit all globally (UNESCO, 2023).

Let me rewind a little and explain what I mean by ‘paywall’. Paywalls are also known as digital subscriptions. It is where you make regular payments to gain access to digital content (Myllylahti, 2019). A paywall in the academic setting is when you must pay per article or choose to have a digital subscription to access peer-reviewed articles (Open Society Foundations, 2018). Paywalls are used by online news sources such as newspapers and have been used in journalism since 2010 when the phrase was coined (Myllylahti, 2019). In journalism, the reasons for paying for news are not quite the same as open access for scientific knowledge. Paywalls preventing users from accessing scientific publications are denying access to scientific knowledge and not fostering an open science culture (UNESCO, 2023).

As a nurse lecturer, I am interested in knowing what the Nursing and Midwifery Council (NMC) website say about open access to support nurses and nursing students. There is no direct discussion about open access; however, the NMC do discuss modernising of education for nursing students. This has become more relevant particularly since leaving the European Union and new standards dictating nurse education require access to evidence and best practice (NMC, 2023).

My Hunger for Knowledge

As a nurse working in the National Health Service (NHS) since the late 1990s, I can remember attempting to access journal articles and there was a limit to the access. I wanted safe and evidence-based health research, so I was constantly searching for free access through Athens. Now called NHS OpenAthens, this provides free online access to NHS funded resources including journals and e-books to healthcare workers (Health Education England, 2024). Although the NHS funding will have paid for the research through publicly funded research (National Institute for Health and Care Research [NIHR], 2021). The cost to the NHS to access medical literature is steep. I was not able to find exact costs; however, in my search I came across an example from Daly et al.’s (2020) research discussing the merger of the library and knowledge services within one hospital NHS trust project. The cost to access one database was £11.5K (Daly et al., 2020), this is the cost for one hospital trust. There were 215 NHS hospital trusts in England alone in 2022 (The King’s Fund, 2023), and if they are all paying individually for open access this cost runs into the millions just for access to one database.

Open access was propelled internationally in 2001 after a meeting in Budapest which was sponsored by Open Society Foundations. The outcome of the meeting was to encourage researchers to publish and disseminate their findings outside of the billion-dollar academic publishing industry (Open Society Foundations, 2018). The UK NIHR in 2021 published the Open Access publication policy setting out key principles to ensure that publicly funded research is available openly (NIHR, 2021). However, this does not mean that it is entirely free, because an open access fee is paid by the NIHR to ensure the publisher allows open access.

For those with access to the internet that can look up information themselves, open access to journals means more people have access to good quality evidence-based research. This is important as a healthcare provider; however, it is important that patients can have open access to scientific information too (NHS England Workforce, Training and Education, 2020).

I believe access to information should be a priority and open access can support equity and inclusion for those that produce and use knowledge by enabling knowledge to be shared in diverse ways (UNESCO, 2023).

Blinded by Ego

Since 2012 I have published several peer-reviewed articles. In the beginning in my naivety, I was blinded by the grandeur of being a published academic. The prestige of publishing research results that I worked hard to write up in a journal with a high impact of dissemination (Chang, 2017), or so I thought.

Until recently, I did not understand the importance of publishing in an open access peer reviewed article. Whilst undertaking the Digital Literacies and Open Practice module (EDM122), I was so shocked when I learned how much money the academic publishing companies make. I watched Paywall: The Business of Scholarship. The Movie (2018) and I am still feeling angry that public money goes into funding research, yet access is restricted to the public, including those who conduct the research (Moore, 2014). Publishers receive public money. For example, the NIHR provide funds into grants they provide to ensure evidence-based research is published and available. Unless the researchers have access through their academic institution, someone is still paying and if you leave and your next organisation does not have access you lose access to your own work.

It is unfair that publishers are exploiting researchers (Moore, 2014). Researchers who submit manuscripts for publication want to have their work peer reviewed so they will pay a fee to the publisher. A group of experts will look at your manuscript and essentially proofread and provide feedback. The scam here is that those reviewing the manuscript do this for free they do not get any remuneration for their time. The publisher is taking money from those that want to publish and commissioning free work to others.

Benefits, Challenges and Limitations

I have been approached by publishers requesting me to publish and write for their journals. I remember the first time I got an email I was so excited. When I inquired further there was mention that I would need to pay money. My colleague recommended that I not entertain these publishers because they were not looking to improve evidence base (Logullo et al., 2023). Although I am now more aware of such scams, it does leave me with a bitter taste. As someone who wants to share knowledge and support nursing care, I feel sad at the manipulative nature of the publishing industry (Logullo et al., 2023). Golden open access is an approach used where authors pay the publishers fees, meaning that only those who have the funds can afford to pay. Open access journal publication still does not benefit those in lower income countries because you need access to the internet (Logullo, 2023).

On a positive note, I have worked with stakeholders including patients and advocacy groups who benefit from open access. They are better informed when making decisions and supporting others. Behind a paywall these important stakeholders would not have access to vital information. Open access journal publication also enables findings to be looked at critically (Logullo et al., 2023). This is essential to developing and evolving evidence-based healthcare practice. Logullo et al. (2023) have published their article under a CC BY comms licence, which provides others the opportunity to build on their work.

Open access journal publication also ensures that people are not duplicating work, because when they search for publications, they can see the detail of what has already been studied (Logullo et al., 2023).

Enlightened or not really!

I have developed awareness and feel that I only want to publish in open access journals going forward. Although my last four articles were all published in peer-reviewed open access journals. I did not realise the significance of this until now. I had become part of an unfair system that goes against my idea of social justice to access free resources (Bali et al., 2020).

As a nurse, equality, diversity, and inclusion plus equity are crucial for me and this is part of the UNESCO (2023) recommendations. I would like nursing colleagues and nursing students to be able to embed evidence-based practice in their day-to-day work. However, if scientific knowledge is behind a paywall this can only mean inequity and limited access for the majority (Moore, 2014).

Having previously worked in research and now academia, within the last 10 years my access to published research has been unlimited through the academic institutions have been employed with. This is great for me, however, there is a huge cost to the university.

Working as a lecturer, I do not need to have too many publications at this stage of my career. However, if I want to progress in academic rank there is a requirement for me to engage in scholarly activity and publishing in peer-reviewed journals (Cade, 2022). On a positive note, it is important that knowledge is shared openly (Cade, 2022), and I am keen to do this.

Honing My Skills

I have spent some time trying to understand where open access fits in the wider context of publishing. Is it open educational practice or part of open educational resources? Is it just about publishing in peer-reviewed journals, or does it include books? I realise now that it is both (Bali et al., 2020).

My experience is limited to publishing in peer-reviewed journals; however, having access to textbooks is important too. I have learnt whilst completing this module that public scholarship can also be done from writing blogs, using social and professional networking. These are powerful tools for disseminating knowledge such as X (formerly Twitter), LinkedIn (Bali et al., 2020; Ross, 2020) and other open platforms (Logullo et al., 2023). In terms of social justice, access to a blog or a social media post is available to more people than information that is guarded by a paywall. This means that information from these sources is not restricted to only those with enough capital to view it. However, quality needs to be considered and can be opinion rather than evidence based (Bali et al., 2020).

In terms of licensing for this essay, I looked through the different choices and considered the options used by previous students before me for their blog. During the game, ‘The Publishing Trap,’ which we played in class to help us better understand publishing in academia. I was nervous and reluctant to contribute because I was concerned my academic thinking would be challenged and felt I didn’t know enough. This is odd because I am usually happy to talk about my experiences and give permission for others to use my stories and examples. Yet during this game, I found that I did not want to yield, mostly because I feel like an imposter in academic publishing (Berna, 2020). This is not out of fear that someone will steal my idea, but more that I am concerned about my knowledge being questioned. This is called imposter syndrome and it is well known that this psychological block is a coping mechanism (Berna, 2020).

What will I do?

In summary, I will ask students to consider how they access publications and if they go onto publish to prioritise open access so their work can be available to everyone. I encourage students to strive for evidence-based practice in healthcare and ensure they have open access wherever they work.

Now that I have more knowledge, I will continue to promote open access and share what I have learnt. This is to ensure peer reviewed scientific information is shared and it will in turn promote digital literacy through its use (UNESCO, 2023).

The learning for this module has enabled me to delve further into my own practice and to understand the political and social need for open access publications.

References

Bali, M., Cronin, C. and Jhangiani, R.S., 2020. Framing Open Educational Practices from a Social Justice Perspective. Journal of Interactive Media in Education, 2020(1), p.10. https://doi.org/10.5334/jime.565

Berna, J. S. (2020). Unblocking scholarly writing – Minimizing imposter syndrome and applying grit to accomplish publishing. Scholar Chatter, 1(1), 1 – 7, https://doi.org/10.47036/SC.1.1.1-7.2020

Cade, R. (2022). Publishing in Peer-Reviewed Journals: An Opportunity for Professional Counselors, Journal of Professional Counseling: Practice, Theory & Research, 49(2), 61-62. https://doi.org/10.1080/15566382.2022.2157595

Chang, Y.-W. (2017). Comparative study of characteristics of authors between open access and non-open access journals in library and information science. Library & Information Science Research, 39(1), pp 8-15. https://doi.org/10.1016/j.lisr.2017.01.002

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Logullo, P., de Beyer, J.A., Kirtley, S., M Maia Schlussel. And Collins G.S. (2023). “Open access journal publication in health and medical research and open science: benefits, challenges and limitations”. BMJ Evidence-Based Medicine https://ebm.bmj.com/content/early/2023/09/28/bmjebm-2022-112126

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Myllylahti, M. (2019). Paywalls. In The International Encyclopedia of Journalism Studies, pp 1-6. Wiley Online Library. https://doi.org/10.1002/9781118841570.iejs0068

‌National Institute for Health and Care Research (2021). NIHR Open Access publication policy – for publications submitted on or after 1 June 2022. [online] www.nihr.ac.uk. Available at: https://www.nihr.ac.uk/documents/nihr-open-access-publication-policy-for-publications-submitted-on-or-after-1-june-2022/28999 [Accessed on 13 January 2024]

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Ross, P. (2020). “Blog it: Free open access to nursing education (#FOANed)”. Australian nursing & midwifery journal (2202-7114), 26 (9), p. 40.

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https://www.kingsfund.org.uk/audio-video/key-facts-figures-nhs#:~:text=How%20many%20NHS%20hospitals%20are,trusts%2C%20including%2010%20ambulance%20trusts. [Accessed on 27 January 2024]

UNESCO (2023). UNESCO Recommendation on Open Science [online] Available at: https://www.unesco.org/en/open-science/about [Accessed on 27 January 2024]

Impact of open education resources in nursing education

Posted on March 23, 2023 by Filipa Da Silva Miranda

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.

References

Blessinger, P. Bliss, T.J. (2016) “Open education. International perspectives in higher education”, Open Book Publishers: Cambridge. Available [online] at: https://books.openedition.org/obp/3539#:~:text=Open%20education%2C%20which%20began%20in%20earnest%20in%20the,part%20of%20a%20wider%20effort%20to%20democratize%20education (accessed on: 17.12.2022)

Creative Commons (2019) “About CC licenses”, Available [online] at: https://creativecommons.org/about/cclicenses/ (accessed on 09.01.2023)

Cronin, C. (2017) “Open education, open questions”, EDUCAUSE review 52, no.6. Available [online] at: https://er.educause.edu/articles/2017/10/open-education-open-questions (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: https://www.researchgate.net/publication/306285861_Open_Educational_Practices_Unleashing_the_power_of_OER (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: https://www.hee.nhs.uk/about (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: https://link.springer.com/chapter/10.1007/978-3-030-53813-2_20 (accessed on: 17.12.2022)

Jung, I. Sasaki, T. Latchem, C. (2016) “A framework for assessing fitness for purpose in open educational resources”, International Journal of Educational Technology in Higher Education, 13:3. Available [online] at: https://educationaltechnologyjournal.springeropen.com/articles/10.1186/s41239-016-0002-5 (accessed on: 07.01.2023)

Keating, S. Berland, A. Capone, K. Chickering, M.J. (2019) “Establishing global nursing education equity by developing open access resources”, Nursing Educator, 45:2. Available [online] at: https://pubmed.ncbi.nlm.nih.gov/32106148/ (accessed on 07.01.2023)

Kurelovic, E. K. (2016) “Advantages and limitations of usage of open educational resources in small countries”, International Journal of Research in Education and Science, 2:1. Available [online] at: https://files.eric.ed.gov/fulltext/EJ1105180.pdf (accessed on 16.01.2023)

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: https://www.researchgate.net/publication/336583044_Designing_open_access_educational_resources_Developper_des_ressources_educatives_en_libre_acces (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: https://www.oecd-ilibrary.org/education/giving-knowledge-for-free_9789264032125-en;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: https://journals.lww.com/nurseeducatoronline/Fulltext/2023/01000/Aligning_Nursing_Ethics_With_Critical_and_Open.19.aspx (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: https://unesdoc.unesco.org/ark:/48223/pf0000244365 (accessed on 18.12.2022)

University of Maryland Global Campus (2020) “Pros and Cons of using OERs for Instruction”. Available [online] at: https://libguides.umgc.edu/c.php?g=23404&p=138771 (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: https://www.emerald.com/insight/content/doi/10.1108/JME-04-2020-0027/full/pdf?title=teaching-with-oer-during-pandemics-and-beyond (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: https://www.sciencedirect.com/science/article/pii/S026069171830635X (accessed on 08.01.2023)

Impact of Open access: healthcare, public health, and own practice

Posted on March 14, 2023 by Pia Sebastian

This post is by Pia Sebastian who recently completed my module in February 2023 and is a nurse educator. Her essay is licensed under CC-BY NC and she writes….

Today, the marvel of technology and digital advancement has led us to believe that all information can be accessed through the snap of our fingers, or in this case just a few clicks (Arakelyan, 2021). The accessing of information in digital landscape has evolved tremendously throughout years and is still evolving at this present age, it has made easier and more open, however in previous years this was not the situation. This essay will seek to explore the implication of Open Access in healthcare, public health industry and my own practice.

Growing up, I tend not to notice how I access information, although what I knew back then was that it was more tedious, and it required more effort. Most of the time, information I would gather were insufficient and inadequate especially in terms of research for schoolwork, there were not enough printed journals, articles, or books to dig myself into for knowledge and information. I never realized that most of those that I required was because most journals and articles would need to be retrieved through subscriptions. Access to research data has always been limited to journal subscribers and this implies that those people and organisations engaged in research who cannot afford the cost of a subscription do not have access to these journal articles. According to traditional subscription-based publishing models, authors must either transfer their rights to publishers or allow them the sole right to publish their works. Publishers may govern the reuse of a work once it has been published, but writers may still have some restrictions on how, where, when, and with whom their work may be shared (Research Publications and Open Access Policy – Staff Home, University of York, n.d.). However, there is a progressive shift towards accessing journal through electronically, consequently there is also an increase in number of journals existing globally (Strydom et al., 2022).

Impacts in Public Health and Healthcare

Publishing literacy and research works, journals and articles may it be printed or in digital form can be a profitable industry due to subscriptions. Lawton and Flynn (2015) stated that most of the peer-reviewed scholarly research are published journals which can only be accessed by institutions willing to pay for subscription fees or those individuals that can afford to do so. Further, these subscriptions can be exorbitantly expensive only a well-funded universities libraries can pay for it and primarily this are in developed countries (Open Society Foundations, 2018). Tennant et al. (2016) indicated that access to 75% of articles is not directly possible unless one has the privilege to work in an institution that has subscription access to these articles or has enough money to pay on a per-article basis subscriptions to all peer reviewed journals.

I believed that this generated a huge predicament for researchers and academics who are in need most of these important and vital sources of information essential to their work, innovation, and research. Ellison et al. (2019) recognized that each year huge amount of money by hundreds of billions of dollars are being utilized to finance medical research by government and different commercial and charitable organizations and institutions with the primarily objective is to improve and prolong lives. Publication plays a vital role in dissemination of scientific invention, yet translation of medical research into clinical practice is slow. In connection with this, application of research published via the conventional subscription publication model is hampered by copyright limitations that prevents reusing the published content and paywalls that forbid public use.

For instance, according to Open Society Foundation (2018), this meant that those doctors who treats HIV and AIDS in Africa will not be able to have access to the medical results on treatments even when the research upon which these articles were created were embarked on locally. Thus, impacting adversely to patient’s care. Moreover, emailing request for articles across the time zones does not offer fast solutions when these are necessary the most. This also impedes researchers not to study their found pursuits and interests due to no free access to information and or limited literature.

Apart from this, the Ebola’s 2014 outbreak was terrible for countries like Guinea, Sierra Leone, and Liberia. Although there was an article in Annals of Virology published in 1982 indicating that Liberia had a high potential for endemic Ebola and warned health authorities of the risk of probable outbreaks however it was only accessible by subscription. Since these results were published in a subscription journal and were therefore buried behind a paywall, local public health officials were probably unaware of them. Limiting access to such information may have prevented information from reaching public health professionals who were caught off guard and unprepared by the 2014 endemic (Smith et al., 2017).

Open Access Movement proposes to remove price and permission barriers for accessing peer-reviewed research work and making research work freely available to anyone who wishes to see it (Elle & Gray, 2020). Open Access refers to the practice of producing scholarly research freely and permanently accessible instantly for anyone to gain access to globally. Research results can be downloaded, reviewed, shared copied and printed within legal requirements, as long as the authors and original sources are properly cited under the Creative Commons licenses, for which articles and journals can be legally used, built upon, and adapted without permission (What Is Open Access; Its Benefits & Other FAQs | BMJ, n.d.). Greenberg (2019) pointed out that authors can retain copyright licensed under Creative Commons. Further, under open access there is high standards of production and rigorous per review with promotion and publishing quality research.

Consequently, because there is an immediate and unlimited access to content research findings, producing breakthroughs and innovation especially in health sciences, paved way to better the lives of people and for humanity. Barbour (2006) acknowledged that open access makes medical knowledge widely disseminated and freely accessible to all, including academic researchers, medical professionals, policymakers, and laypeople. This data can influence the laws and practises that affect population health. In addition, increasing the reach and use dynamically influences how medical research is conducted and disseminated in a wider global audience by supporting innovations and advancing discoveries. Ross-Hellauer et al. (2020) stressed that the distribution of other open science outputs that would typically be kept secret not only contributes to increased reproducibility and transparency of research, but it also results in the release of more research components that may have an effect on others by generating network effects through reuse.

In his study Tennant et al. (2016) stressed out that open access does not only beneficial to academics but also impacts the other domains in society. It makes research available to everyone with an internet connection, therefore it exceeds academic affiliation and strengthens lifelong learning. For instance, anyone who uses information from open access can lead to possibilities for knowledge to be used in unexpected creative and innovative ways beyond the mainstream professional research. It surpasses all other potential alternative modes of access to scholarly literature because it allows for unfettered re-use and long-term stability independent of the financial restrictions of traditional publishers that limit knowledge exchange.

West (2015) stressed out that in Médecins Sans Frontières (MSF), a medical and humanitarian organization, access to research evidence is vital for MSF health staff to be able to make the best informed decisions in field programmes. Not only that, it is not only the MSF, but there are also several organizations that conducts research, and the vast majority are in low- and middle-income countries or developing countries stricken by conflicts, natural disasters, and poor access to healthcare. By open access sharing of experiences can be accomplished with other authors and experts worldwide, building collaborative findings thus, making a great impact to society.

In addition, World Health Organization (WHO) observed a policy wherein all WHO authored and WHO funded articles that are presented for publication in peer-reviewed journals must be distributed in an open access journal or an open access platform ensuring that it is freely accessible and reusable to the public. Further, WHO believes that having a universal access to publicly funded research as well as research data is indeed essential to addressing public health challenges of the 21^st century (WHO | WHO Policy on Open Access, n.d.).

Moreover, Day et al. (2020) by enhancing patient empowerment and their capacity to avoid receiving false information that could harm their health and wellbeing are two benefits that could result from increasing access to primary sources of medical literature through open access publishing. Thus, has a result for the population’s overall goal of promoting public health. For instance, those patients looking for information about complex or unusual medical illnesses such as rare diseases or genetic disorders for which there is little information available outside of academic journals may find open access to be especially valuable with to the most recent medical research without being restricted by a paywall.

Another impact of open access was described in the article written by Strydom et al. (2022), this recent pandemic brought about by SARS- COV 2 and COVID- 19 have emphasized the benefits of open access in dissemination of the research results as swiftly as possible, researchers embraced open access platforms rather than utilizing traditional methods of publishing thereby accelerated research and scientific collaboration and partnership by data sharing and by hastening the replication of investigations and expanding data reuse. Essentially with this, there has been more information readily available about COVID-19 and thereby saving lives of millions of people throughout the globe and mitigate further health threats brought about by the pandemic.

Impact on Personal Practice

The nursing profession faces a variety of challenges in the twenty-first century, including an ageing nursing workforce, an increase in the proportion of elderly and seriously sick patients, rising healthcare costs, and a shortage of nursing personnel (Fawaz et al., 2018) and as a profession that rely on evidenced-based practice through research, open access plays a crucial part on this. Nick (2011a) had emphasized that accessing recent literature is necessary in the evidence-based practise environment of today. However, it can be difficult to maintain and acquire enough current reference materials. The culture of evidence-based practise is challenging to establish under these circumstances and reference collections are frequently decades out of date.

Attributing to the open access that it is freely available online and provide professionals, like me all across the world a greater level of information proficiency especially in light of the emphasis on achieving evidence-based practise. Networking, collaborations in nursing research, and the use of new and improved therapies could all benefit from universal access and to create urgently required nursing systematic reviews, clinical practise guidelines, critically acclaimed topics, or best evidence topics, completed research from several nations can be integrated as these can affect and improve my practice and benefit patient’s care. Thus, would help clinical practise match more closely with the objectives for evidence-based practice (Nick, 2011a).

Nick (2011b) had also stressed out that by providing access to Open Access resources, there is a reduced in financial burden and improved online information access, which would ultimately aid in adopting evidence-based practise. Increasing access to academic resources can have a positive impact on my clinical practise, useful for student learning and teaching content, and to patient care results. These encounters brought home to the value that Open Access may provide to healthcare professionals who struggle to get access to up-to-date knowledge and research on practical challenges. In essence, Open Access gives the chance to align information gathering on a global scale.

The Future of Open Access

It is imperative that results of publicly funded research should be accessible to stimulate discovery and innovation. In UK, it has been mandated in National Institute for Health and Care (2021) requiring all peer-reviewed research activities arises from NIHR-funded research studies made open access under open license. This meant that the research output funded by UK government are freely available to taxpayers who funds research, regardless of institutional affiliations by health and social practitioners. Further, this new policy ensured it works for the diverse stakeholder community as it impacts on patient and the public by empowering for further drive to innovation and discovery globally.

CC-by-nc 4.0 Foto: Pay Numrich / KohleerSetzen!
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This license allows reusers to distribute, remix, adapt, and build upon the material in any medium or format for noncommercially purposes only, and only so long as attribution is given to the creator. It includes the following elements: BY – Credit must be given to the creator; NC – Only non-commercial uses of the work are permitted (Creative Commons, 2019).

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Developing Digital Literacy Among Nurses in Critical Care Unit

Posted on March 10, 2023 by Reena Antony Samy

This post is written by Reena Antony Samy who is a Practice Development Nurse and nurse educator who recently completed the module EDM122. Her essay is licensed under CC-BY NC SA and she writes about digital literacy in critical care:

Introduction

The use of Digital Health Technologies in the healthcare sector is rapidly increasing, and the expectation is to keep up the pace, adapt and maintain a high level of Digital Literacy. Technology was thought to be more confined to technically proficient people in the past. However, now everyone must have sufficient digital literacy to perform their jobs. Moreover, since the Covid 19 pandemic, technology-enhanced learning has become integral to teaching and learning.

I work as a Practice Development Nurse (PDN) / Nurse Educator at Adult Critical Care Unit, teaching the novice staff appointed to the critical care unit. Working in the Critical Care Unit for more than 15 years, I have come across many changes both in nursing education and the clinical care aspect, the most important one being Digitalisation. Replacing paper-based documentation with the Electronic Health Record Service (EHRS) is a significant transformation to the healthcare system. As a result, nurses are expected to be digitally proficient in using Information Systems and Digital Technology. Part of my job is to ensure the Electronic Health Record Service is safely implemented in the unit by ensuring that the nurses are confident and competent in using the new system. Health Education England (HEE, 2018) emphasises that every healthcare professional should have sound digital capabilities grounded in knowledge, skills, attitudes, and behaviours that will enable them to provide the utmost effective and high standard of compassionate care.

Digital Capabilities and Digital Literacies.

HEE (2018) proposed a Digital capability framework. However, there needed to be more clarity between Digital Capabilities and Digital Literacy. Secker J (2017) says that Digital Literacy is sometimes called Digital Capabilities. The author further argues that the term capabilities may result partly in acknowledging the problem related to digital literacy. HEE (2018) defines Digital Literacies are capabilities that fit someone for living, learning, working, participating, and thriving in a digital society. As technology evolves, the health and social care workforce should aim to be fully competent, confident, and capable of using the technology so that technology related incidents can be prevented.

Barriers

Implementation of the EHRS faced many challenges in the unit. The main barrier whilst implementing the EHRS was the human factor. Staff’s behaviours and attitudes around digital literacy posed a significant challenge in implementing this project. Lack of confidence, the fear of using the technology and unwillingness to learn can prevent or slow the technology’s pace. The staff’s current digital literacy level impacted the staff engagement in adapting to the new system. The confident and proficient staff in social and digital media embraced this change much more quicker and easier. HEE (2018) states that staff with better digital literacy tend to have more positive attitudes and behaviours in adopting new technology. Moreover, the attitude of the staff towards changes also has an impact on the staff engagement levels, which in turn can affect the safety and quality of patient care (Kuek and Hakkennes, 2020). HEE (2018) declares that organisational policy can sometimes create barriers. Like the employer’s unwillingness to use personal phones and learning devices in the workplace. Sometimes Wi-Fi and appropriate internet speed within the organisation may hinder access to digital facilities. For example, though the unit agreed for staff to use their devices, the speed of the internet posed a significant challenge, which affected the staff’s learning experience in adopting the new system.

Healthcare is said to be traditionally slow in adopting new digital tools and technologies, with some staff feeling nervous and sceptical about the digital revolution (Pearce, 2017) and sometimes due to technical factors in the organisation. It is essential to develop and improve the digital literacies of an individual and the organisation to transform how healthcare professional’s practise.

Role of the nurse educator in digital literacy

-Curriculum Change

The nurses must use technology effectively in the clinical setting to provide a high standard of patient care and decrease clinical errors. With the growing need for nurses to develop these digital skills, it is imperative to embed digital literacy in the nursing curriculum. One of the four aspects of developing digital literacies in practice (JISC, 2014) is ‘Curriculum Change’. The development of digital literacy must start with the pre-registration students. The nursing and Midwifery Council (NMC) have included digital literacy in the 2018 Standards for Pre-Registration Nursing programmes and standards of Proficiency for Registered Nurses. Even though the main challenge is to overcome the financial implications (Peltonen et al ., 2019), Lokmic- Tomkins et al. (2022) emphasise targeted digital literacy education to improve nursing students’ baseline digital literacy before clinical placements. This must be scaffolded across the program to ensure a smooth transition to nursing practice. Even though most nursing curricula worldwide have endeavoured to incorporate the subject, adopting recommended curriculum change has needed to be faster (Cummings et al., 2016).

Further, Kennedy and Yaldren (2017) argue that curriculum modifications do not necessarily reflect the needs of workplace digital literacy. Therefore, in addition to the pre-registration education, continuing professional development and on-site training are needed to build the knowledge further. Brown et al. (2020) state that digitally literate nurses can better embrace and use new technology in various ways in clinical settings. The Adult Critical Care Unit’s staff ranged from brand-new graduates to well-experienced nurses. Though the newly qualified nurses with some digital literacy adopted the changes readily, others have trouble grasping the EHRS technological changes.

-Supporting the staff.

User engagement and training are vital in successfully implementing electronic health record services. It was evident that complex digital skills were necessary for this digitally-driven work environment. It was necessary to know the staff’s digital literacy level and attitude towards new technology to tailor training to the need (Jobst et al., 2020). Paul Gilster (1997), in the use of the term digital literacy, said it is about ‘mastering ideas – not keystrokes’. Being digitally literate is an ongoing process, and becoming more confident and proficient over time. The learning literacies and development framework (JISC, 2014) adapted from Sharpe and Beetham (2010) emphasise the development of digital literacies from access and functional skills to higher-level capabilities and identity.

Though the readiness assessment was carried out to identify the barriers and facilitate the successful adoption of EHRS, an individual’s self-assessment to assess the level of digital literacy should have been performed. Therefore, identifying the staff’s digital literacy level and customising the training according to the need was challenging. However, generalised training was provided for all the staff prior to the introduction of EHRS. As a result, some staff could accept it effortlessly while others had difficulty adapting to the new system.

It is not about introducing a new change to the system; as a nurse educator, my role was to incorporate and facilitate the changes in the best possible way and develop the staff to be more proficient. Familiarisation with the new system beforehand was initialised, which acted as an icebreaker. This enhanced the individual’s willingness, self-efficacy, and positive attitude towards the changes. Those already exposed to technology will be more confident using it than those new to digital technologies (Jobst et al., 2022). Moreover, raising awareness and engaging stakeholders in discussion is essential to develop shared understanding and goals. JISC (2013) gives a key message, ‘Involve Students’, as this will help focus on developing the technology, making the system more usable, and meeting the end user needs.

The most significant factor in achieving digital literacy and effectively implementing the EHRS is to identify digital champions who will support and develop the digital skills of the front-line staff. Digital champions were mainly enthusiastic volunteers willing to take up this role. Pearce, L. (2017) says that healthcare needs staff who are enthusiastic about technology and willing to embrace the changes. Digital champions acted as a bridge, provided feedback information, and enabled two-way conversation.

This project enhanced the digital literacy skills of the nurses. Digital literacy is a multi-layered, dynamic set of knowledge, skills and attitudes which shifts according to individual goals (HEE, 2018) that will enable them to improve the quality of care. Health Education England (2018) categorised digital literacy under the following domains.

Communication, collaboration and participation.
Teaching, learning and self-development
Information data and media literacies.
Creation, innovation and scholarship
Technical Proficiency
Digital identity and well being

Nurses are vital in introducing and implementing technology in clinical practices, such as using patient-related sensors and monitoring equipment. Though these are widely used in the critical care unit, using technology to input patient data is new. The expectation of the staff to use the technology effectively to ensure quality, safety and efficiency in health care services (Gonen et al., 2016). Therefore, technological literacy is crucial in the nursing world. The staff were exposed to a wide range of technologies like wristband scanners and were trained to use and troubleshoot when needed. Nes et al., 2021, emphasise that nurses should learn to use the technology and actively participate in developing it.

Another significant learning curve for the nurses in implementing the EHRS is information and data literacy. The nurses are to input the patient’s data, collate, and analyse the information and formulate a nursing care plan for the patient. Bergren and Maughan (2020) argue that nurses should be able to use computers and information systems and apply data and evidence to inform practice. Though the staff are so used to the paper system, this project paved the way to acquire the knowledge to collect and analyse the data digitally. Furthermore, Li et al. (2022) state that Information literacy is an essential foundation for evidence-based nursing, which is imperative in health and social care to provide the best possible patient outcome.

In addition, implementing the EHRS enabled the nurses to communicate and collaborate with many people using the digital platform. Therefore nurses should also be able to recognise and act on situations that might compromise personal, professional and organisational security. HEE (2018) states that nurses must develop the ability to develop, promote and safeguard appropriate digital identities to support both personal and organisational reputations. Digital identity is one of the aspects nurses should take on as they enter into this digital age.

Moreover, nurse educators must be digitally competent and confident to impart knowledge to learners. The competencies nurse educators must impart to their students are highly significant, and the nurse educator should remain abreast of this new technology. Developing the clinical educator’s digital literacy is equally important so that they can support students more effectively. In implementing this project, the nurse educators were given the ‘Train the Trainer’ (TTT) sessions, so that nurse educators would act as a champion in promoting the new technology. HEE (2018) recommends that digital champions must be able to teach confidently and proficiently, coach, mentor, and train using different technologies.

Commencing on this Digital Literacy and Open Practice module revealed the importance of being digitally literate. It empowered me to implement EHRS in our critical care unit, which enhanced my digital literacy skills. I learnt to use different types of technologies to train the staff. We were constantly participating in online meetings and discussion forums, sharing files, and sometimes working online with others. Though the TTT was thoughtfully arranged, some nurse educators needed more help acquiring the knowledge and skills. Jobst et al. (2022) state that nurse educators must be digitally competent to promote learning among nurses. This project served as a base to scaffold digital literacy not only for the nurses but also for the nurse educators at different levels of digital literacy.

Conclusion

Implementing Electronic Health Record service is a significant aspect of the digital health and social care transformation. The necessity for current and future nurses to be digitally literate is eminent. This essay explored the importance of nurses’ digital literacy in safely caring for patients using different technologies. It also identifies that equally; nurse educators must be competent to embed the knowledge among the nurses. Assessing the digital literacy knowledge among the staff before the training is crucial so the training can be customised to the need. Therefore, a self-assessment tool and a comprehensive digital Literacy training programme for the nurses are highly recommended as the way forward for the safer implementation of EHRS.

Reference

Bergren, M.D. and Maughan, E.D. (2020) ‘Data and Information Literacy- A fundamental Nursing Competency’, NASN School Nurse, 35(3), pp: 140.

Brown, J., Pope, N., Bosc,A.M., Mason,J. and Morgan, A. (2020) ‘Issues affecting nurses’ capability to use digital technology at work : An integrative review’, Journal of Clinical Nursing, 29, pp: 2801- 2819.

Cummings, E., Shin, E., Mather, C., and Hovenga, E. (2016) ‘Embedding nursing informatics education into an Australian undergraduate nursing degree’, Studies in Health Technology and Informatics, 225, pp: 329–333.

Developing Digital Literacies (2014) https://www.jisc.ac.uk/guides/developing-digital-literacies

accessed on 07/01/2023

Gilster, P. (1997) Digital Literacy. New York,NY: John Wiley & Sons, Inc.

Gonen,A., Sharon,D., Offir,A. and Lev-Ari, L. (2014) ‘How to enhance nursing students’ intention to use information technology: The first step before integrating it in nursing curriculum’, Computers, Informatics, Nursing, 32 (6), pp. 286-293.

Health Education England (2018) ‘Digital literacy Capability Framework’, https://www.hee.nhs.uk/sites/default/files/documents/Digital%20Literacy%20Capability%20Framework%202018.pdf Accessed on 8/1/2023

Jobst,S., Lindwedel,U., Marx, H., Pazouki, R, Ziegler, S., Konig,P., Kugler, C and Feuchtinger, J. (2022) ‘Competencies and needs of nurse educators and clinical mentors for teaching in the digital age – a multi-institutional, cross-sectional study’ BMC Nursing, 21(1) https://doi.org/10.1186/s12912-22-01018-6 Accessed on 10/01/2023

Kennedy, S., and Yaldren, J. (2017) ‘A look at digital literacy in health and social care’, British Journal of Cardiac Nursing, 12(9), pp. 428–432.

Kuek,A . and Hakkennes, S. (2020), ‘Healthcare staff digital literacy levels and their attitudes towards information systems’ Health Informatics Journal, 26(1), pp: 592-612.

Li,X., Zhang,J., Zheng,Y., Wang,Y and Hao,W. (2022) ‘Factors associated with information literacy of nursing undergraduates in China’, BMC Nursing, 21:81. https://doi.org/10.1186/s12912-022-00855-9 Accessed on 15/01/2023

Nes, A.A.G., Steindal, S.A., Larsen, M.H., Heer, H.C.,Laerum-Onsager, E. and Gjevjon,E.R. (2021) ‘ Technology Literacy in Nursing education’, Journal of professional Nursing, 37(2), pp: 320 -334 https://doi.org/10.1016/j.profnurs.2021.01.008 Accessed on 15/01/2023

NMC (2018) ‘Standards framework for nursing and midwifery education’ https://www.nmc.org.uk/globalassets/sitedocuments/standards-of-proficiency/standards-framework-for-nursing-and-midwifery-education/education-framework.pdf

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Pearce L. (2017), ‘Digital Literacy’, Nursing Standard, 31(48), pp: 18-20.

Peltonen,L.M., Nibber,R., Lewis,A., Block,L., Pruinelli,L., Topaz,M., Perezmitre,E.L. and Ronquillo, C. (2019) ‘Emerging professionals’ observations of opportunities and challenges in nursing informatics’ Nurse Leadership , 32, pp. 8-18.

Secker, J. (2017) ‘The trouble with terminology: Rehabilitating and Rethinking Digital Literacy’. In Reedy, K. & Parker, J. (eds.) Digital Literacy Unpacked. London: Facet Publishing, pp. 3-16.

Sharpe, R. & Beetham, H. (2010) ‘ Understanding students’ uses of technology for learning: Towards creative appropriation’. In Sharpe,R., Beetham,H. and de Freitas,S. (eds.), Rethinking learning for a digital age: how learners shape their experiences. Routledge Falmer, London and New York, pp. 85-99.

This essay is published under common creative licence ‘Attribution- NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0).

EDM122: Digital Literacies and Open Practice

Part of City, University of London's MA in Academic Practice

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Developing Digital Literacy Among Nurses in Critical Care Unit