BLOG 3 jan 2020 update

Developing two Xertes utilising an ABL approach is part of the project aims. The two Xerte resources should both be independent learning units that are accessed by nursing students, following a trigger in their practice relevant to the learning unit’s content. Underpinning the content of the Xerte is a professional artistry approach in addition to the active learning approach. I felt at this point these two aspects were becoming lost in the development in the Xertes. I met with Anne Misselbrook, the learning designer supporting the project, who helped me review the active aspect of the Xerte design.  The professional artistry approach needed more consideration.   

WHAT IS PROFESSIONAL ARTISTRY?                                                                                                                                                                                                                             The hospital based nurses in my study explained that end of life care was unpredictable. This was attributed to patient’s life course not following the path predicted by the nurse or the clinical team, the changing clinical situation, the changes to patients plans, the changes to the care resources planning. The nurses explained their lack of end of life knowledge caused them to feel uncertain. Fish and Coles (1998 pg 54) explain than practice is messy, and that practitioners have been misled if they believe messiness can be brought under rational control. Fish and Coles argue it is only when professionals recognise the messiness of their practice and learn to understand and accept it will they learn to manage the uncertainty of their practice.

Fish and Coles argue that professional practice is governed by a technical rational approach which is fundamentally the action which one takes, as opposed to a professional artistry approach, which aims to understand better the principals on which their practice is based. A technical rational view of practice determines a set of routines and behaviours using ‘care delivery’ as part of the process. The practitioner activities are prescribed, and individuals are held to account. The professional artistry view argues practice is not simple and predicable and requires the practitioner to make many complex decisions using professional judgements, intuition and common-sense. These activities are not easy to make visible, measure and to teach or research.

In practice the professional artistry view is that only principals can be pre-determined, and the situation may require the practitioner to go beyond them, or to break the conventions to achieve the effect. Reflection is an important part of an professional artistry approach to practice. The unlike a technical rational approach the activities cannot be pre-specified. For this reason, the professional is morally accountable all of their conduct, not just parts of the act.

The TA view emphasises diagnosis, analysis, protocol, guidelines to determine the rules of care and decision along with the knowledge that is required to understand and utilise these. PA uses framework, interpretation of detail, subjectivity and critical appreciation, the dynamic nature of knowledge and an appreciation of the process rather than the facts. The result with regards to knowledge is technical rational approach to skills formation is important, as are clinical guidelines based on evidence to help inform judgements. The addition or building on of a professional artistry approach using principals, frameworks and reflection may help practitioners recognise and manage the uncertainty of end of life care.


As a consequence the two learning units should aim to help learners to understand the principals behind the topics. To develop the use of frameworks and the application of reflection to guide practitioners when making judgements in practice in relation to the topics covered, and accept the uncertainty of the situation.

UPDATE 1: a slow start

BLOG 2  18th Dec

Developing the learning resource has been more intensive than planned. The activity has been developed using XERTE as the platform which initially had some limitations due to my familiarity with some of the resources available with this. Anne Misslebrook has been really helpful in overcoming this. The problem is currently the appropriateness of some of the resources to the level of the learning and the activities. For example, and drag and drop picture does not work in an ethical discussion on DNACPR either as content and at a level of learning. I’m not sure if taking a passage of text and asking students to drag from the list of words the appropriate missing word is also an appropriate way of consolidating learning, however complex the text. These sorts of activities do engage the students which helps to achieve the ‘active’ element of the Active Blended Learning approach of the project. As the project currently stands I do not feel this has yet been achieved.

An important part of the design of the resource is the integration of professional artistry. I am finding this quite difficult to embed within the format of XERTE. Following the lesson plan I designed for the learning unit, I originally felt a none sequential approach would work well for the DNACPR learning activity. I believed the non-linear approach would help define practice principals rather than sequential tasks to be completed. In reality, I found it difficult to explain ethics without first understanding patient rights and how this has been defined in UK case law. This means I now need to rethink the design of the learning resource and revisit the underpinning principals that are driving the project. These are; professional artistry, active and blended learning.   


Start of the Project

Man Dying


The trigger for the project came out of my (currently nearly completed) doctorate. This is exploring hospital nurses experience of providing end-of-life care and one of the findings uncovers issues around nurses’ end-of-life knowledge. End-of-life care is known to be unpredictable due to the fluctuating changes in the patient’s condition, unpredictable events, and constantly changing situations. My study suggests the objective technical rational (TR) approach to knowledge is helpful in end-of-life care as a skills based approach; to know what drugs to give; when and how to use a syringe driver; how to manage symptoms and organise a rapid discharge home. However, there is potential for education in the form of professional artistry (PA) to complement technical rational knowledge. Professional Artistry is based on principals that can be formulated as practice develops (Fish, Coles 1998). Improvisation and refining and updating ‘on the hoof’ are part of a PA approach to practice which makes this approach more suited to ‘messy, unpredictable, unexpected situation’ (Fish, Coles 1998 p.g. 36).

Syringe driver

This project uses Professional Artistry approach with Active Blended Learning (ABL). Active learning is defined as “anything that involves students doing things, and thinking about the things, they are doing” (Bronwell, Eison 1991 p.g. 2).  Blended learning is an integration of different online and face to face methods of learning (Alammary 2019).  Active Blended Learning can therefore be described as integrated approaches to learning that are student centred, focusing on activities that support the development of the subject knowledge. This project aims to use ABL and a professional artistry approach to end-of-life education.

The project will develop two learning units on end of life care. Students may encounter a situation where a patient who is at the end of their life wishes to express their care decisions. These are advice directives and learning in practice may provide a task approach, but students need to be guided by deeper understanding; the legalities; human rights; ethics; principals; communicating any decisions. The project will provide additional learning using an online platform regarding advance care plans and decisions. This will supplement and support the students practice knowledge, developing a deeper, more intuitive and principled based PA understanding of patient decision making in end-of-life. Similarly Do Not Attempt Cardiac Pulmonary Resuscitation (DNACPR) can cause confusion with understanding among students in end-of-life care and a similar approach using professional artistry and ABL will be used to address this.

Revivalist Death


The outcomes of the project will be evaluated using a summative approach to evaluation research. This will investigate the students use and engagement of the education programme as well as the quality of the learning and if the students have had any demonstrable effects on their understanding of the key topics and end-of-life practice.



The learning resources will be developed using XERTE with the aim that they can be accessed by students at any point in their course, triggered by a demand in learning from the student. The support for the development of the XETRE has been given by Anne Misslebrook from the University Learning Technology team. Anne has been invaluable in giving me ideas as to how the overall learning could be structured.