Stay Awesome
Ramblings
Phlebotomy
The top 5 phlebotomy tips for those who ‘learned on the job’
8 Rookie phlebotomy mistakes (and how to avoid them) when starting out
Common debates in phlebotomy: What has your experience taught you?
Best practice in phlebotomy. Practice Nurse 2025;55(2):9-13. (First published in Practice Nurse https//:practicenurse.co.uk and kindly given permission to share here)
Immunisation
Can nurses work in a vaccination setting without a doctor on site?
Shingles vaccination changes: Transitions ahead! – New Green Book chapter – are you prepared?
Really picky debates around correct intramuscular injection technique
Ten reasons to do an immunisation update
Ten tips for dealing with appointments that involve injecting children
Should we use alcohol swabs before injections? A look at the arguments.
Delegation of Injections: When Is It Appropriate and What are the Risks?
Alcohol swabs and intramuscular injections: where do we stand? Practice Nurse 2025;55(1):8-11 (First published in Practice Nurse https//:practicenurse.co.uk and kindly given permission to share here)
Travel Health
Could my job have saved my life? My experience as a post-exposure rabies case.
Don’t ask me what travel vaccines you need!
If you subscribe to the BGTHA you will notice many articles in their wonderful journal 'Travelwise' by me. I have enjoyed writing bits and bobs for this journal since 2017
From the Psychology days
Turnbull, O., Evans, C., Bunce, A., Carzolio, B. & O’Connor, J. (2005). Emotion-Based Learning and Central Executive Resources: An Investigation of Intuition and the Iowa Gambling Task. Brain and Cognition. 57(3) 244-247
From the PGCE days
Bunce, A (2006) Inclusion – The Impact Of Individual Attention In The Classroom. Through The Looking Glass: Reflective Research in Post Compulsory Education. 1(1) 20 -27
Pandemic reflections on other ways of learning: Lessons learned from being a virtual educator during a pandemic.
Written during lockdown, whilst trying to have a go at creating an e-course for the first time.
I’m an adult educator with a Post-Compulsory PGCE. I started my career teaching Psychology on A-Level and access courses for those age 16+. I then became a nurse and started to specialise in the wonderful world of Travel Health. These days, I have amalgamated my two careers and now I teach clinicians, mainly in the field of travel health, but I dabble in a few other areas too.
Most of my teaching experiences prior to 2020 were in the classroom or clinic, with the occasional live Skype session to nurses in remote locations. The Skype sessions mainly followed the same general structure as in-person lessons, but just transferred to a virtual environment.
But another way of teaching has become of huge interest to me in the last year while the pandemic has forced learning largely into the online space; the e-course - with no teacher available at the point of delivery.
So why am I thinking about this?
I had a conversation not so long ago with my friend and fellow educator, Euan (of Health Academy), about the last year reverting mainly to remote teaching during the pandemic- and how it has transformed most courses. Euan basically said;
“What changes?”
Euan has long been designing remote e-learning courses and I guess he is entitled to feel pretty smug right now while all of us old-school face to face (F2F) teachers uncomfortably writhe about, learning to use Zoom and buying decent webcams from Amazon.
Euan’s attitude to e-learning is that not only is it comparable to F2F teaching, but it is in fact even better. After all, e-learning is not without tutor input. Some very experienced teachers, like Euan, spend a lot of time getting their e-course just right.
So why does it come as a surprise to most people to think of online learning as better?
It’s easy to dismiss online learning as inferior. For starters, online courses are often cheaper than classroom-based ones due to less overheads, which instantly perceptibly puts them in the ‘low-budget-therefore-lower-quality’ bracket. So, the battle to ask people to accept the comparable quality begins with the association between ‘cheap’ and ‘low-quality’.
Another, perhaps faulty, perception is that learners think they need other people to guide them through a learning process, and to be there to answer questions and check learning.
But Euan rightly asks, why can’t an online course do this?
A well-designed online course will guide someone through the subject matter in arguably an even more structured way than a physical trainer. Computers don’t get distracted when the cat walks across a keyboard or a parcel appears at the door. Computers don’t have ‘off days’ (well sometimes mine does) where they forget what they are meant to be doing and miss out entire sections because they didn’t get enough sleep the night before.
As for answering questions, an e-course enables the learner to rewind, pause and go back over the material at the individual learner’s own pace to revisit something that didn’t make sense the first time around. Instantly too. So, the logical creation of knowledge is not disrupted. Surely this is better for consolidation of learning, than the learner waiting until the coffee break for clarification on a key point from the beginning, while the rest of the topic sails over their head?
A (conscientious) online course designer will not only be an expert in the field, but will have piloted the course and worked out what common questions people ask and answered them in advance. But ultimately, any good course, whether with or without a tutor present, should ideally not leave learners with questions about the content in the first place.
As for checking learning, a computer will be ruthless in its ability to tell you if you are right or wrong. No pussyfooting around where computers are concerned.
So, a computer CAN guide learning, CAN address questions or misunderstood parts, and CAN provide feedback. And in each case – perhaps BETTER than a human…?
Really makes one think eh?
What about the human connection? I hear you thinking.
Lots of online courses now include actual humans, live or pre-recorded. An actual human making a live appearance is, in theory, terrific. But what if you don’t like your teacher? What if you don’t understand their accent or can’t hear them properly or they just don’t teach in a style that works for you? What if one does not like their classmates or can’t hear because of someone’s noisy washing machine in the background who hasn’t figured out where ‘mute’ is yet over Zoom, or the person next to you in a classroom who constantly fidgets and asks to borrow paper. What if you are painfully shy?
What if actual humans can make the learning experience WORSE?
And face to face courses whether online or in person rely on people being present. And we know that humans all have very different circumstances. Most people have many time-pressures, commitments, and distractions. If you have ever organised a stag or hen do, you will know that getting a group of people together all at once and expecting everyone to be at their optimum levels of functioning is as virtually impossible as it is physically.
Humans have ‘off-days’.
E-learning wipes the floor with all those issues.
It makes training flexible, accessible, cost-effective, learner-directed, repeatable and lets the learner set the pace entirely. There is usually 24/7 access to materials so the preciousness of those few classroom hours are not as significant if one is not at their best that day (teacher or learner).
Euan sets any teacher the challenge to tell him why F2F courses are better - and not only that, but he also then promises to recreate that feature (even better) in an e-course.
He’s a pretty confident guy. But credit to him; no one yet has convinced him why having a tutor present is better than a well-made, tutor-designed, e-course.
I am going to do the ‘back in my day’ thing now.
When I did my teacher training back in what my kids now refer to as ‘the olden days’, I didn’t know what PowerPoint was. It was just starting to become this fancy new thing that teachers were experimenting with. All my fellow trainee teachers were looking at each other going ‘what is this futuristic technology, wow’. We were all naturally terrified of it like most people are when they are faced with something new and rather technical.
All my lessons at this point were designed on a paper lesson plan (had BINDERS full of the stuff). My teacher toolkit was comprised of resources such as a wipeable board of some sort or a flip chart, and the beloved overhead projector. I spent a fortune on acetate sheets and printing for that bit of tech (the OHP WAS classed as ‘tech’ back then). I made fancy handouts and workbooks and had stacks of files and paper and whiteboard pens - and chalk!! No teacher was without a fancy range of personal chalk back then.
I’d spend hours editing and labelling video tapes (with actual tape in them) and would spend the night before rewinding and pausing so they were at exactly the right point. Then I’d proudly wheel the big rear projection screen TV to the middle of the room and show a grainy video from the 80’s about some rather dodgy social psychology experiments. I remember how sophisticated I felt having a remote control in my hand and being able to control it from the back of the room. And I remember being a student myself in school where looking at a screen was ironically the most exciting bit of a lesson.
Once my lessons were ‘taught’ they disappeared forever more. Only to be experienced by those in my class that day. If the class was missed then that was it. No chance of a replay. The learning continuum disrupted for the rest of the syllabus. A piece of the puzzle missing.
These days, I drop my daughter off at school and see the interactive flat screen and all the children happily dancing away to You Tube videos. Even remote controls seem a bit past it now when you can touch the thing you want to watch on the screen itself. And I think back to when I was in the very same school (with the very same teacher no less) and this would have seemed like a miracle.
It felt weird initially making the move to clinical teaching to not have the comfort safety of an actual classroom with posters up, and designated seats, and a register anymore. But I adapted. And now there is a pandemic which is again prompting a change to the teaching and learning environment, forcing teachers into the online space, some more willingly than others. Most of my courses are done over Zoom now and I don’t even know where half my learners are in the country while I’m teaching them. It’s taken me some time to adjust to trying to get in ‘teacher-mode’ when I’m at home.
Likewise, it’s taken me a bit of time and perseverance to realise the benefits of having to adapt to this new way of teaching, but I’m realising more and more that this has been a phenomenal development opportunity. I have learned more about teaching in the last year than I have in the whole time since I qualified as a teacher in 2006. I have to THINK more about how I design courses, I’ve had to review my assessment strategies, my activities, my learning outcomes and my content. It’s given me the shake-up that I needed to bin some old ways of working and gain some new ones. Doing things just because it’s the way you have always done them is not always the best strategy.
How things have changed. And, I agree with Euan, for the better.
Instead of sulking that I can’t be in a classroom (well, ok so I’ve done a BIT of sulking) I’ve tried my best to embrace technology. These days I can whip out a PowerPoint, edit it without having to re-print a load of acetates, deliver a presentation to people anywhere in the world and record it to be watched again - and when you’re recording a session, you can guarantee more thought goes into the presentation. Plus, I can mess about with computer code and not even be there to teach a session now. How incredible is that? I can watch my teaching back (cringe) and take notes on how I can improve. I never knew I blinked so much and now I have reduced my ‘um’s’ by about 70%. I pause for breath more now (while I’m figuring out how to share my screen with 20 people who are scattered around the country). When I’m live teaching over zoom, I sit up straight, I get to meet my student’s children and cats and dogs, and get to see how they have designed their kitchens. I know what their favourite coffee cup looks like. I get to really know THEM.
But I’ve gone beyond just transferring my physical teaching to Zoom.
I recently had a go at creating an e-course which was designed to be purely done self-directed. At first, I thought this was going to be impossible. It was on a highly practical skill (phlebotomy) and I had already been struggling a bit with having to teach it over Zoom. Designing it to be delivered without any tutor input on the day I just thought would be inconceivable. But I did it, and it’s far from perfect. But what a lesson it taught me!
Having to make something that shows someone else how to do something without ME present was a massively revealing (and humbling) exercise in attempting to make sure things were crystal clear. I gave it the kind of attention I SHOULD give my face-to-face teaching but often don’t because I have myself there to rely on the day to clear up any misunderstandings. You haven’t got yourself to rely on to clarify things for learners in real-time when you design an e-course, so it makes you extra vigilant in the first place. But it made me realise that this should be the case with ALL modes of delivery.
F2F classroom teaching sure did make me complacent about clarity.
Even since teaching the highly practical skill of phlebotomy face to face but online, I have come to realise that I’ve improved my theory teaching no end. I’ve had to think more carefully about what videos to use, my activities, how to get to know the learners. What I look like when I’m teaching and how Mancunian I sound (again, cringe). Making the move to remote teaching was on one level, but it reached insurmountably new heights when designing a purely online course with no tutor. I really felt pushed as an educator. The self-reflection and revision of teaching materials really made me look at my teaching skills.
For instance, the first thing I always do in a session is to get a feel for who I’m teaching in order to make the rest of the course as relevant as possible for them. So, my first hurdle was how do I get a learner to feel like the computer is getting to know them? How do I make them feel like this course is tailored to them? The activities that arose from this I now use in my F2F teaching too! Designing it for e-learning actually made me enhance my F2F teaching. I never expected that.
It helped to separate me from my content and take a good step back to look at it all objectively. To let go of any ego about being an ‘instructor’ and get on with the most important stuff – the learning.
Plus, there’s something about having designed a session and brain-dumped it all into a few megabytes of storage space that is quite satisfying. Thoughts forever preserved. Those best bits of teaching where you come home and think, “yeah, I did a great session today”. Still right there in perpetuity.
And another thing I found is that because an e-course is designed to be replicable and enduring (with updates here and there of course), it really makes you think about planning it to be as simple and straightforward as possible. It helped me to focus on the ‘how’ of learning rather than the ‘what’: Linking the learner to current resources instead of listing the results of those resources, offering a quiz or things to look up instead of listing points, providing scenarios to work through instead of teacher-talk. Focusing everything on helping the learner to independently know how to grow their expertise in the subject.
Whilst I can’t wait to get back in the classroom (mainly due to my anxiety about the internet connection failing me) I have developed as a teacher in this lockdown period no end this year. There are lessons I have learned from the online-learning world that I will continue to embrace when face to face returns. For instance, I now have a comprehensive selection of YouTube videos to show in class which offers way more variety than the old-school style of purely demonstrating techniques. Oh, the irony of making a course virtual, yet for the first time, learners actually now being able to see a real blood draw rather than a simulated one! I will now think more carefully about who goes in which group (for some reason I did this a lot more conscientiously using breakout rooms than ever before). I will make more use of quizzes and regular short bits of downtime (zoom teaching does hurt your neck a bit at times so the health-and-safety-enforced-breaks are fabulous consolidation of learning opportunities for learners).
So, what are the downsides of e-courses?
Potentially the feedback loop might not be as fast or nuanced with e-courses if a question hasn’t been anticipated and addressed already on the course. In the F2F setting students would grab me on the break and I could sit there stereotypically eating my obligatory apple while answering a few random questions. Questions from learners usually enables me to gauge understanding and form the basis of formative assessment as well as provoking feedback as to whether something was properly explained (or learned depending on how you’re looking at it). But a computer can’t read these same nuances that a real-life tutor can (not YET, I’m sure Euan would say).
Learners might have to wait longer for answers from e-courses if it involves having to email someone. But I guess with the tech enthusiasts who are designing the courses, I’m sure it wouldn’t take long to receive an email reply or chat box response.
Plus, how about this? Having unanswered questions is a fabulous learning opportunity. Any teaching method that encourages self- direction, ‘figuring it out oneself’ and meta-learning is going to equip the learner with valuable tools for life. It’s almost ‘too easy’ if a teacher is at one’s beckon call.
I was once a learner on a course that somehow left me feeling like I knew even LESS about the subject after the course, and I never thought a course could stoop that low. So, I went away and learned as much as I could by myself, in my own time, in my own preferred learning style -and it gave me an excellent grounding in the subject. And now I teach that subject as well. Self-direction and abandoning reliance on a teacher is a marvellous tool to master for the adult learner.
And here I am, drifting into benefits of e-courses again.
Anyway, I have also been an online learner during the lockdowns. And I have been a home-school mum too. (Evidently, I found that teaching nurses is way easier then teaching reception children – credit to the schoolteachers out there who do this). I am a post-compulsory adult educator of health professionals and I’m sure my andragogical teaching looks very different from the perspective of a reception schoolteacher, or a kinaesthetic outdoor instructor. I would be interested to know how other educators have found it all from other specialisms with different demographics in front of them.
I would also be interested to know more about how learners have found the remote-learning experience this year. Anecdotally, many of my learners have commented that they miss the classroom and would rather have tutors and their fellow learners nearby physically. But surprisingly, they have also mainly commented that they have found zoom teaching better than they thought, and have actually rated my Zoom courses similarly to physical classroom teaching. There really has been little or no difference in how they rate their learning and the quality. The summative assessments have concurred.
I suppose this illustrates the critical need to differentiate between the intended outcomes of a course and the non-intended benefits. If the intention is simply ‘to learn’ (which ideally it should be) then the e-course seems to fit the bill on a par with (or indeed better) as any other method. It might not meet the learner’s desire to ‘meet their classmates’ or ‘get out of the house for a bit’, or just seem as appealing in general for whatever reason. But when it comes to pure learning, it’s a hands-down amazing tool.
The main negative feedback I have had (which I think teachers and learners alike share apprehension about) is technology failing them. Over Zoom, I’ve seen numerous blank screens, chat box comments about absent audio, people appearing and disappearing during the course. I’ve seen up many noses, just the top 12% of many heads, and got pretty good at lip reading when people forget to turn on their mics. I’ve lost connection myself -and there is no panic like it when you know these people are depending on you. Sometimes I feel like I’m in a weird séance, especially at the start of a course when everyone is logging on and I’m going ‘are you there?’, ‘can you hear me?’, ‘give me a sign if you can hear me?’.
To illustrate this perpetual threat of the internet ‘going down’ and having to trust an A4 sized bit of electronic equipment to keep working, the other day I experienced a fire alarm whilst teaching over Zoom from a hired office. I left 18 students sitting there looking at my empty chair, listening to an alarm blaring, wondering whether I was coming back or burning to death on the corridor. Normally in these circumstances, we would all be huddled around a fire point (within a metre of each other) getting the register taken, engaging in a bit of speculation about who burned the toast, and feeling a bit excited that we got to have an impromptu break.
This ‘lockdown evacuation’, much like everything else this year, was quite lonely.
(And apparently it was a crumpet that called the halt to my session, not the standard toast.)
But 100% reliance on technology for virtual teaching is not really about a ‘computer’ (or crumpet) problem. This actually illustrates a person problem. In ANY tutor-led, face to face learning we are all forced to rely on just ONE PERSON being there for things to run. 30 people are let down if the tutor has childcare issues, sickness or a particularly bad hangover. Likewise, if a learner is not at their best that day, that one golden opportunity is diminished. An awful lot rests on scheduled face to face teaching.
The e-course sits there waiting patiently for a time to suit everyone. It doesn’t have bad days or get phased if there are 5 people or 500 people watching them. Unbiased, logical, always in a good(?) mood. Every last detail meticulously planned, edited and ready to execute repeatedly with harmonious consistency.
The thing that educators, like myself, have to let go of and face up to with the online world of e-courses now is that courses can still run without them. Learners can still learn without them. E-courses are certainly humbling to those who worked hard to learn how to ‘teach’. But they do the job and they do it superbly if designed properly.
And if a ‘good’ teacher is behind the creation of the e-course, then what a course it can be. I’m not there yet with my e-course skills because I am still navigating this new territory, and evidently, I clearly still have a lot to learn about teaching in general. But one thing I absolutely know for sure is that E-learning is certainly not to be dismissed, and I’m glad that the pandemic has shone the much-needed light on it that it was patiently waiting for.
