Topic outline

  • Guidelines for teachers - final version

    These guidelines have been developed in the context of the ENhANCE project, funded by the Erasmus+ Programme, and aim at supporting teachers to design innovative online teaching and learning activities in the field of family and community nursing education. 

    More specifically, they contain indications and methodological recommendations for teachers on how to use and customize the technological tools proposed by the project, as well as how to identify the most adequate teaching and learning methods for the delivery of the activities. 

    In the project the Guidelines have been conceived as a package to be used along with the "Guidelines supporting the design of local curricula" (D3.2,2), so to drive the design of an entire course from the "European Curriculum for Family and Community Nurses" (D.3.1.2), down to the localized curriculum and then to the specific teachings of the course. In this sense, these Guidelines represent the final step of the design (micro-design level), for teachers to plan, deliver and evaluate innovative online learning activities.  

    Note that in these Guidelines we will often refer to the Open Online Tool (OOT), i.e. this platform, which was developed in the project and equipped with specific functionalities aimed to support family and community nursing education. The OOT is free and open and any teacher can consider taking it up. In any case, given that it is based on Moodle, many of the indications contained in these Guidelines are valid if you are using Moodle or other similar Learning Management Systems. 

    Even if conceived in the project framework, the Guidelines have been generalized to support the design of innovative online nursing education in any contexts; so they are also an independent toolkit that can be a reference for any teacher willing to improve online learning provision in online nursing education. 


    The European Commission's support for the production of this publication does not constitute an endorsement of the contents, which reflect the views only of the authors, and the Commission cannot be held responsible for any use which may be made of the information contained therein.

    • Introduction

      These Guidelines contain a set of practical instructions to support teachers in the design and delivery of innovative online teaching and learning activities in the field of Family and Community Nursing (FCN) education.

      At the micro-design level, we expect you will need to take decisions regarding a number of aspects: some of them will directly derive from the macro-design level (i.e., curriculum level), others will be more specific and guided by the peculiarities of the knowledge domain concerned. In particular, these decisions might regard several topics.

      For the purpose of these guidelines, we have identified eleven topics as it follows:

      1. What are the main features of an online course fostering collaboration and meta-reflection?
      2. How can I support online communication?
      3. How can I support collaboration among Family and Community Nurses (FCNs) in my online course?
      4. How can I support practice sharing among FCNs in my online course?
      5. How can I design an effective student assessment in my online course?
      6. How can I facilitate personalization for my students?
      7. How can I pave the way for the valorisation of my students’ prior (non-formal/informal) learning, in such a way that my institution can validate and then recognize it?
      8. How can I support non only formal, but also non-formal and informal learning?
      9. How can I promote self-regulated learning and FCNs’ continuous professional development?
      10. How can I support my students’ motivation and engagement?
      11. How can I create Open Contents for my FCN training?

      Topics are independent from one another, so you can choose to start from any of them and none of them is mandatory.

      Within each topic, you will find some introductory theoretical explanations about the concept(s) addressed. Moreover, you will find a number of scenarios, containing suggestions on how to practically implement the theory into your own teaching/module.

      In each scenario, you will also find  video tutorials explaining the technical functionalities of the Open Online Tool (a specific e-learning platform created for Family and Community nursing training). Note that the Open Online Tool is free and open and you can choose to take it up in your course. In any case, the tool is based on Moodle, so many of the functionalities proposed in these guidelines will work even if you are using Moodle or other similar Learning Management Systems. 

      If you want to know more about one (or more) topic, just follow the related link through the navigation bar above using the numbered buttons (each number corresponds to the related topic in the list).

      • 1. What are the main features of an online course fostering collaboration and meta-reflection?

        Within the Technology Enhanced Learning research field, many researchers have pointed out the importance of an accurate design process when a teacher proposes online learning activities, especially if s/he wants to foster collaboration and self-regulated learning. Particularly, in the last decades the field of Learning Design has devoted considerable attention to the variables at play when a teacher plans and manages online learning activities [1] [2].

        Without any ambition to be exhaustive, in the following you can find very practical suggestions you might take into account, when designing your online course. 

      • 2. How can I support online communication?

        In online learning, the technology mediates communication between all the actors involved in the learning process. Thus, technologies can be used to support at a distance both traditional teaching activities, such as lectures, and also more innovative teaching practices. As to the latter, recent research on the way learning takes place has determined a shift from a vision of teaching as knowledge transfer, to one where learners take an active and even proactive stance and thus build their own knowledge by interacting with peers and experts. In this “socio-constructivist” vision of learning, people learn by negotiating meanings and sharing practices [3] [4]. This vision of learning is important not only for formal learning contexts, but also for informal, lifelong learning. In particular, it is at the basis of a modern conception of continuous professional development in many fields, including medical science. The affordance of today's technologies, and in particular of the Web, lend themselves very well to implement teaching and learning processes aligned with socio-constructivist ideas, because the web augments people’s ability to reach out for peers, colleagues, experts and other resources, thus giving rise to new forms of collaboration.

        Roughly speaking, web-based communication can be synchronous or asynchronous. These modalities have distinct features that lend themselves to different types of teaching and learning scenarios, ranging from transmissive scenarios, to collaborative ones. Depending on the learning outcomes set for your students and on the contextual constraints, you will need to choose when to use the one or the other. The following two scenarios will support your choices.

      • 3 - How can I support collaboration among FCNs in my online course?

        Simply put, collaboration entails working together toward a common goal”. Based on this simple definition, [5] engages in a discussion of how collaborative learning takes place, how teachers can scaffold collaborative learning processes, and how the differences between online and offline communication affect collaborative learning processes. However, according to [6], designing an online collaborative learning experience is a “daunting challenge”. The reason is that “truly collaborative” learning processes are not easy to achieve. Especially if by “truly collaborative” we mean that there should be not only a joint enterprise (the “common goal” mentioned above), but also a mutual engagement of all participants to achieve that goal. This difficulty is corroborated by the experience of many online teachers and students who have witnessed failed attempts to start up online collaborative learning processes. Sometimes, collaboration simply does not take off due to lack of participation, some other times, people participate but contributions to the discussion are too shallow or efforts are too isolated so that there is no negotiation of meaning and no convergence towards the goal. The truth is that in most cases setting up a forum to host a discussion is not enough to ignite collaboration. There must be a clear definition of the common goal, i.e. the artefact that participants should produce together, and a clear plan about how to proceed. In other words, each participant should know, especially at the beginning, when, where, how and with whom they should work [7]. In time, research in learning design and collaborative learning has come up with the definition of a number of "collaborative techniques", i.e. structured methods to scaffold group interactions, in terms of time, social structures, technology to be used and task to be performed. These collaborative techniques have been derived from similar methods already consolidated in face-to-face settings. Some of the most well-known are: Peer Review (see Scenario 3A – Peer Review), Jigsaw (see Scenario 3B - Jigsaw), Role Play (see Scenario 3C – Role Play), Pyramid (see Scenario 3D – Pyramid), and Debate (see Scenario 3E – Debate). 

        Even when none of the above techniques is used, the decision making process about the Task to be accomplished, the Technology that can be used, the Time needed for each phase of work and the structure of the Team is the core of the learning design process for collaborative learning. The “4Ts model” describes how decisions are made, considering the reciprocal influence of these 4 variables [8]. 

        In the following scenarios you can find the description of a number of collaborative techniques, as well as indications on how to design them.

        Note that - in any case - online collaborative activities need to be launched and monitored, by an online tutor, a person who is in charge of triggering the discussion, facilitate the communication and in general help the groups to achieve the objectives. 

      • 4. How can I support practice sharing among FCNs in my online course?

        Practice sharing is an essential element at the basis of continuous professional development, especially in knowledge-intensive fields, i.e. fields where declarative knowledge is not sufficient to be a competent professional, because complex problem-solving abilities and other high-level cross-sectional competencies like ethical conduct are also essential. Medical practice is one such field, as doctors, as well as nurses, everyday face challenging issues that require not only up-to-date evidence-based medical knowledge, but also the ability to fully understand the complexity of the patients’ health conditions and well-being to make decisions about how to deal with them. Family and Community Nurses (FCNs) are no exception to this, with the additional difficulty determined by the potential isolation of those who work “alone in the field”. Web-based technology, however, can be of great help in practice sharing because it allows the creation of virtual “communities of practice” [9] of FCNs who can keep in touch and share their experiences, discuss the problems they face and the solutions they adopt with peers, as well as experts who can support them remotely.

        However, the attitude and ability to participate in these communities cannot be taken for granted. The self-regulated learning skills needed to take advantage of technology for professional learning must be developed during FCN training and are as important as the medical competence because they ensure life-long learning. Some authors [10] have proposed a framework to describe the type of behaviours that are adopted by self-regulated learners in knowledge intensive professions: the 4Cs framework. This framework distinguishes between 4 types of behaviours: “Consume”, “Create”, “Connect” and “Contribute” behaviours (see also T9 “How can I promote self-regulated learning and continuous professional development of FCNs?” and the related scenario 9A “The 4C framework” for details about the 4Cs). These are the behaviours FCNs should develop to practice during your course, in order to become able to self-regulate their own learning in their profession. These behaviours represent the actions that are at the basis of practice sharing.

      • 5. How can I design an effective student assessment in my online course?

        The issue of assessment is central in view of outcomes achievement. Assessment should be considered from the very beginning, therefore from the moment the teacher starts designing his/her teaching; assessment should be aligned with the learning objectives and the teaching method adopted.

        Here, we do not intend to tackle the discourse about assessment from a theoretical viewpoint, our purpose is to provide practical suggestions related to online learning assessment.

        The first aspect to be considered can be the adoption of formative and summative assessment, in this sense we can give these general recommendations: 

        • Formative assessment is always valuable, in case of on-line learning it allows the student to get a clearer perception of his/her progression in the course (strengths/weaknesses) and the teacher can adjust the subsequent activities accordingly. For this reason, we suggest the introduction of formative assessment activities in your online course.
        • Summative assessment in on-line courses can be carried out in several ways (e.g., assignments, quizzes, etc.); the result of the summative assessment usually compounds the results of the (oral and/or written) final exam and is thus taken into consideration to draw the student’s final marks.  

        Another important aspect to be considered is the alignment between assessment and the envisaged learning outcomes (knowledge, skills, competences): even though in most online courses quizzes are used to assess the student’s learning outcomes, this method can provide limited information, especially if the course aims to develop also skills and competences.

        In the following scenarios, you can find practical suggestions about how to design assessment in your course.

      • 6. How can I facilitate personalization for my students?

        Personalised learning is a potential approach to meeting educational needs and may provide new alternatives that foster the learning capacity of individual learners [11] [12].

        There may be different levels of personalisation within a training intervention. Personalised learning should be considered in terms of its multiple dimensions: the personalisation of why something is to be learned, of how it is to be learned, of what is to be learned, of when is to be learned, of who is involved in the learning, and of where the learning takes place [13].

        Technologies can be effectively used for providing individual support and guidance to students, especially with respect to what is to be learned, that is the flexibility of the learning pathway and the access to the learning content.

        Without any ambition to be exhaustive, in the following you can find very practical suggestions you might take into account, when designing your personalised learning.

      • 7. How should I pave the way for the valorisation of my students’ prior (non-formal/informal) learning, in such a way that my institution can validate and then recognize it?

        Validation of non-formal/informal learning can be defined as "the process of confirmation by a competent authority that an individual has acquired learning outcomes acquired in non-formal  and informal  learning settings measured against a relevant standard and consists of the following four distinct phases: identification through dialogue of particular experiences of an individual, documentation to make visible the individual’s experiences, a formal assessment of those experiences and certification of the results of the assessment which may lead to a partial or full qualification” (European Commission, 2020). 

        In this context, we will mainly tackle the former two stages, which envisage your students to provide evidence of their prior knowledge and you reviewing and possibly recognizing the related learning outcomes. To allow this, some e-learning platforms (such as the OOT) allow your student to submit evidence with respect to one or more Learning Outcomes. Subsequently, you as the teacher - in the case of a positive assessment of this evidence - may decide to totally or partially recognize the achievement of their Learning Outcomes. This can help you better understand your students’ prior knowledge and actual needs, thus supporting you to create personalized paths for them (to learn more about Personalization, see Topic 6.)

        To provide you with practical suggestions, in the following we drew some scenarios regarding the points mentioned above.

      • 8. How can I support non only formal, but also non-formal and informal learning?

        When you are teaching the course, you and your students are mostly engaged in what is called "formal learning", namely a situation that was conceived and structured specifically for learning, with established goals and objectives, that usually happens in (or is organized by) a training institution, in a structured way, often with the issue of an official certificate.

        Nevertheless, learning may also happen outside the formal learning environment, in other daily-life situations. Here we talk of ‘non formal’ and ‘informal’ learning.  

        According to ECVET Glossary: “Non-formal learning is not provided by an education or training institution and typically does not lead to certification; however, non-formal learning is intentional on the part of the learner and has structured objectives, learning time and learner support”. On the other hand, “Informal learning results from daily activities related to work, family life or leisure, it is not structured and most often does not lead to certification; in most cases, informal learning is unintentional on the part of the learner.”

        In order to support non-formal/ informal learning, in your course you can:

        • value non-formal and informal learning within your module/teaching; to do so, you can consider promoting students’ submission of evidences of their prior (non-formal and informal) learning (see Topic 7).
        • promote the practice of both non-formal and informal learning among your students; this may hopefully lead to the construction of a professional community (not only outside your module/teaching, but even outside the formal learning environment), thus fostering professional development and sharing professional experiences. To do so, you can consider inviting your students to “attend” the informal spaces of the Web (in social media) which can be used for non-formal/informal learning, with a view on professional development.

        To provide you with practical suggestions, in the following we drew some scenarios regarding especially the last of the points mentioned above.

      • 9. How can I promote self-regulated learning and continuous professional development of FCNs?

        Self-regulated Learning (SRL) has been defined as the process through which an individual actively and consciously controls his/her own learning in terms of cognition, motivation and affect, and behaviour [14] [15] [16].

        Arguably the most well-known model of SRL is Zimmerman ‘s model and it concerns how SRL takes place in in academic contexts, i.e. in formal learning. This model sees SRL as a cyclic process entailing three phases: forethought, performance and self-reflection.

        However, SRL takes place in informal learning contexts too. Professionals learning, in fact, increasingly relies on the individuals’ control of their own learning, up to the point that - besides making decisions about the how and when to learn - they decide in full autonomy what they want to learn. Some authors, in this case, prefer to use the term “Self-Directed Learning (SDL)” [17].

        In informal contexts, learning often intertwines with work, as people develop their competence through practice in real contexts. Professional development in the workplace is radically different from learning in academic contexts, and so is SRL. Regardless of whether they use the term SRL or SDL (the distinction between the two is still quite blurred in scientific literature), studies of how SRL takes place in professional learning communities acknowledge the fact that the process is mostly based on practice sharing and make heavy use of today’s technology [18]. 

        The 4Cs framework [10] [19], for example, distinguishes between 4 different types of behaviours which take place when the individual participates in professional learning networks: these are called “Consume”, “Create”, “Connect” and “Contribute” behaviours.

        In your course, you can promote the enactment of these behaviours, so that students introject them and will then continue putting them in practice when at work. 

      • 10. How can I support my students’ motivation and engagement?

        Motivating and engaging students is important especially in online learning courses, where relationships with the teacher, colleagues and contents are mediated by technology, and are experienced as less ‘direct’ than in face-to-face contexts.

        Gamification, that is the application of game elements in non-gaming contexts [20], is recognized as able to affect these two aspects mentioned above, even though cannot be considered a sort of panacea.

        To provide you with practical suggestions on how to implement gamification in your course, we have drafted two scenarios.

      • 11. How can I create Open Contents for my FCN training?

        The notion of “Open Content” describes a creative work that others can copy or modify freely, without asking for permission. Usually, such kind of content is released by the author under a “Creative Common” (CC) license. Translating the concept of open content into education, we can more properly speak of “Open Educational Resources” (OERs). OERs can be defined as teaching, learning, and research resources that reside in the public domain or have been released under an intellectual property license that permits their free use and/or re-purposing by others.

        In your course you will need to prepare teaching materials for your students. You can prepare them by yourself or you can re-use materials created by others. In this latter case, you must be aware of the licenses for the use of these materials, especially if they are copyrighted materials. Are you sure you can reuse them? How? With what limitations? 

        In addition, you can ask the students themselves to produce learning materials, individually or as a group, and these outputs could become learning materials for future students in other courses (so Open Contents in themselves). All these materials produced by you or by your students could be organized and collected in a digital archive, freely and openly accessible, which would facilitate sharing.

        To provide you with practical suggestions, in the following we drew some scenarios regarding the points mentioned above.

      • References

        [1] Dalziel, J., Wills, S., Conole, G., Walker, S., Bennett, S., Dobozy, E., ... & Pegler, C. (2016). Learning design: where do we go from here?. Learning design: Conceptualizing a framework for teaching and learning online, 256-261.

        [2] Persico, D., Pozzi, F., & Goodyear, P. (2018). Teachers as designers of TEL interventionsBritish journal of educational technology, 49(6), 975-980.

        [3] Anderson, T. (Ed.). (2008). The theory and practice of online learning. Athabasca University Press.

        [4] Wenger, E. (1999). Communities of practice: Learning, meaning, and identity. Cambridge university press.

        [5] Haythornthwaite, C. (2006). Facilitating collaboration in online learningJournal of Asynchronous Learning Networks10(1), 7-24.

        [6] Garrison, D. R. (2006). Online collaboration principlesJournal of Asynchronous Learning Networks10(1), 25-34.

        [7] Persico, D., & Pozzi, F. (2011). Task, Team and Time to structure online collaboration in learning environmentsWorld Journal on Educational Technology3(1), 01-15.

        [8] Pozzi, F., Ceregini, A., & Persico, D. (2016). Designing networked learning with 4Ts. In Proceedings of the 10th International Conference on Networked Learning (pp. 210-217).

        [9] Lave, J., & Wenger, E. (1991). Situated learning: Legitimate peripheral participation. Cambridge university press.

        [10] Littlejohn, A., Milligan, C., & Margaryan, A. (2012). Charting collective knowledge: Supporting self-regulated learning in the workplace. Journal of Workplace Learning, 24(3), 226–238.

        [11] Bentley, T., & Miller, R. (2006). Personalisation: Getting the questions right. Schooling for Tomorrow Personalising Education, 115.

        [12] Jéirveléi’k, S. (2006). Personalised learning? New insights into fostering learning capacitySchooling for Tomorrow Personalising Education, 31.

        [13] Holmes, W., Anastopoulou, S., Schaumburg, H., & Mavrikis, M. (2018). Technology-enhanced personalised learning: Untangling the evidence.

        [14] Zimmerman, B. J. (1989). Models of self-regulated learning and academic achievement. In Self-regulated learning and academic achievement (pp. 1-25). Springer, New York, NY.

        [15] Pintrich, P. R. (1995). Understanding self‐regulated learningNew directions for teaching and learning1995(63), 3-12.

        [16] Persico, D., & Steffens, K. (2017). Self-regulated learning in technology enhanced learning environments. In Technology Enhanced Learning (pp. 115-126). Springer, Cham.

        [17] Pilling-Cormick, J., & Garrison, D. R. (2007). Self-directed and self-regulated learning: Conceptual links. Canadian Journal of University Continuing Education, 33(2), 13.

        [18] Dabbagh, N., & Kitsantas, A. (2012). Personal learning environments, social media, and self-regulated learning: A natural formula for connecting formal and informal learning. International Journal on E-Learning, 3(1), 40–47.

        [19] Milligan, C., Littlejohn, A., & Margaryan, A. (2014). Workplace learning in informal networks. Journal of Interactive Media in Education, (1).

        [20] Deterding, S., Sicart, M., Nacke, L., O'Hara, K., & Dixon, D. (2011). Gamification. Using game-design elements in non-gaming contexts. In CHI'11 extended abstracts on human factors in computing systems (pp. 2425-2428).

        [21] Bonnel, W. (2008). Improving feedback to students in online coursesNursing Education Perspectives29(5), 290-294.

        [22] Kulage, K. M., & Larson, E. L. (2016). Implementation and outcomes of a faculty-based, peer review manuscript writing workshopJournal of Professional Nursing32(4), 262-270.

        [23] Buhr, G. T., Heflin, M. T., White, H. K., & Pinheiro, S. O. (2014). Using the jigsaw cooperative learning method to teach medical students about long-term and postacute care. Journal of the American Medical Directors Association, 15(6), 429-434.

        [24] Charania, N. A. M. A., Kausar, F., & Cassum, S. (2001). Playing jigsaw: A cooperative learning experience. Journal of Nursing education, 40(9), 420-421.

        [25] Saunder, L. (2016). On-line role play in mental health education. The Journal of Mental Health Training, Education and Practice.

        [26] Day, L. (2011). Using unfolding case studies in a subject-centered classroom. Journal of Nursing Education50(8), 447-452.

        [27] Dutra, D. K. (2013). Implementation of case studies in undergraduate didactic nursing courses: a qualitative study. BMC nursing, 12(1), 15.

        [28] Benner, P., Sutphen, M., Leonard, V., & Day, L. (2009). Educating nurses:A call for radical transformation. San Francisco, CA: Jossey-Bass.

        • Glossary

          Abbreviations and Acronyms

          • CC: Creative Common
          • ECVET:  European Credit system for Vocational Education and Training
          • FCN: Family and Community Nurse
          • OER: Open Educational Resources
          • OOT: Open Online Tool [see here for further details:]
          • SDL: Self-directed Learning
          • SRL: Self-regulated Learning
          • VET: Vocational Education and Training