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This shift in nursing education needs to revise curricula to ensure nurses are culturally competent in the patient care provided (Sankar, 2024), with The Code (NMC, 2018) setting the expectation that nurses need to be culturally sensitive when providing care.  The absence of indigenous considerations risk students feeling learning disconnect and misunderstand the importance of community and cultural intricacies.  Students feeling unprepared in practice application, as well as struggling to connect with peers and teaching material can be a reality (Iheduru-Anderson et al., 2024).  The underrepresentation of community healthcare needs in student specific contexts, jeopardises the application and success of social constructivism, they are less likely to engage with interactive work if they cannot confidently link to practical reality (McGibbon et al., 2014).  Disempowerment of indigenous knowledge because of Western epistemologies dominating, risks providing a disconnect and lack of understanding of the community needs, limiting the ability for students to build confidence in cultural competence and navigation of the diverse healthcare needs.   

The reality of a colonialised nursing curriculum can cause students to feel under-represented, undervalued and irrelevant, which in turn can reduce their engagement and reluctance to partake in sharing lived experiences.  This also risks student’s learning lacking depth, Vygotsky (1978) discusses the importance of building social interactions and context within the learning process, however if a student is feeling disconnected, they are less likely to create new knowledge or connect it to their own experiences.  White superiority is described as a social construction of power, privilege and social status (McGibbon et al., 2014) causing an unconscious hierarchy, potential divide and with over 76% of nurse educators identifying as white women (National League for Nursing, 2023), highlighting the need for teachers to acknowledge the differences in cultural experiences in the classroom between themselves and the students and utilise social constructivism to balance the power dynamic by creating a democratic environment conducive to inclusive dialogue and student participation.  Sharing the power and being open and honest about your own cultural limitations helps to combat the risk of a white dominance that feeds a non-inclusive learning environment risking a reality of student nurses not feeling culturally aware or competent, struggling to connect theory to practice.  This impacting their success in practice, failing to address social determinants of health relevant to marginalised communities and healthcare approaches that do not reflect community needs.  Risking patients' mistrust, leading to non-compliance and disengagement with the service.   

Decolonialising the nursing curriculum includes more than adding diversified learning material, nursing curriculum must explore previously excluded nursing knowledge and content to ensure a move away from a Western dominated platform (Sankar, 2024).  With 46% of London residents identifying as Asian, black or ‘other’ ethnic groups (Gov, 2022) as nurse educators it is imperative that students see an equal footing as co-learners with the teacher to share sensitive experiences, creating space for open dialog, affirming of student experiences to equalise the student/teacher power dynamic (Heduru-Anderson et al., 2024).  It can be an emotive learning journey to understand the history of what contributes to the inequality and injustices for them and their communities.   

Social constructivism supports a learning environment where space is provided for open dialog and reflection.  Freire (2000) discusses a transformative educational approach rooted in critical consciousness, supporting students to critically reflect and empower students through their education journey relating to individual student contexts (Valderama-Wallace et al., 2020).  Freire’s (2000) aim with this is to support students to not only engage in critical reflection, but to be competent and confident to proactively confront and challenge social injustices experienced.  It’s important to note that decolonialising the curriculum doesn’t mean excluding western experiences, it’s about instilling a balanced curriculum with diversity that enriches nursing education and influences the care provided to patients (Sankar, 2024).  It’s important that educators foster an environment where students feel valued and able to meet the needs of the health needs.  Though it’s important to diversify content, it’s about shifting the underlying assumptions shaping nursing curriculum, thus ensuring the workforce is equipped to provide culturally competent care of the diverse population. 

Social constructivism pedagogy aims to obtain knowledge in context with students social reality (Adams, 2006 and Applefield et al., 2000), in post registration nursing studies this not only supports the concept of learning being a social process to co-construct new knowledge. It also aims to be respectful of the students existing knowledge, experience and expertise using these as a platform to build new knowledge, which readily includes social and cultural factors to support practical application and students understanding (Pritchard et al., 2010 and Adams, 2006).  Knowles (1990) agrees that it is important that students are in control of their learning and using individual experiences to support their and their peer's development.  However, this is reliant on the student’s individual confidence and social engagement levels (Granle, 2022), a lack of social engagement can provide a barrier to effective social constructivism, it cannot be a passive process, or developed by external sources alone (Branch, 2015).  Social constructivism promotes the student's own truth, influenced by background, experiences and culture (Branch, 2015), however it is important that this is balanced by the teacher with the objective necessity of nursing practice. It is therefore important to not assume that the social constructivism pedagogy removes the teacher from the learning process (Adams, 2006), teachers remain necessary to moderate the provision of a safe environment for conducive learning and moderation of new knowledge created (Adams, 2006).  An initial method is to set expectations and agree class rules, thus supporting the ownership of learning, promoting a democratic classroom scaffolding students to be active collaborators and harness self-belief in prior knowledge and experience (Brough et al., 2014).  However, whilst social constructivism supports a democratic classroom, it can assume confidence and a digital fluency baseline that may not be possessed by all students (Granle, 2022), the risk with this is possible marginalising the quieter or less digital confident students.  

There are many different modalities for learning, for the purpose of exploring the effectiveness of using Miro as a learning tool, the focus will be on asynchronous learning and the fostering of a positive learning environment (Ding et al., 2022).  Asynchronous learning involves activities that happen outside of the classroom to extend the students learning opportunities (Northey et al., 2015).  It is impossible for all learning to happen within the classroom and to support student engagement and accountability, establishing control of their learning and supporting their peers', asynchronous activities create space for dialogue not only with the tutor but also between the students themselves.  The aim of using asynchronous activities is to compliment and extend classroom learning, thus providing a collaborative space, socially constructing new knowledge, in addition providing transferable skills into clinical practice of self-efficacy, critical thinking and collaboration (Abualhaija, 2019).   

The technology tool Miro aims to support students to engage and share creative ideas outside of the classroom (Allah, 2023).  Miro’s whiteboard function was used to support students to collaborate and feedback on their assessment plans.  The brainstorming of ideas with Miro’s digital sticky notes enabled students to collaborate, create mind maps and plans with minimal input from the tutor and maximum support from each other, championing the democratic learning environment.  Students were tasked with sharing a plan of their assessment idea and comment on a minimum of two of their peer's assessment plans.  Miro enables versatile feedback for example the ability to share book suggestions, websites, images and videos (Allah, 2023), offering flexibility for diverse education requirements and learning needs, allowing for alternative formats and promotes social constructivist pedagogy encouraging group led dialogue, peer feedback and the ongoing co-construction of knowledge.  This collaborative platform has allowed the students to use social interaction with others to build on their knowledge and understanding (Prasetya, 2017).  The utilisation of Miro with the district nursing students provided not only an additional space for collaboration but also promoted the students independent problem-solving skills, externalising thinking and building on each other's ideas.  This promotes co-construction and aligns with Vygotsky (1978) theory of the effectiveness of social engagement for learning.    

It is important to acknowledge the challenges to using Miro, which have the potential to impact its effectiveness and translation into practice.  It was important to ensure students were able to access and use the platform unsupervised, considering digital literacy differences and disparities caused by unequal access to the platform (Allah, 2023).  This was actioned by demonstrating and troubleshooting queries and ensure confident usage of the platform, to support accessibility Miro is available via internet browsers, an app via a computer, tablet or phone (Chun Hun Chan, 2023), time was allocated in the teaching schedule to ensure campus computers were available, to mitigate digital disparities.  Miro without direction can be perceived as vague and lack direction; to support the success of the tool, clear objectives were set on the pre-set format, it was important to set expectations to maintain focus and the important value of giving and receiving feedback.  Students discussed constructive feedback having the potential to develop them as leaders, improving confidence and competence and the sharing of peer experiences (Hardavella et al., 2017).   

Using Miro highlighted certain skills to be worked on, which the students found beneficial, and teachers found timely and informative for future course development.  This enabled the cohort to change direction temporarily to brainstorm and problem solve barriers to providing each other feedback (Hardavella et al., 2017).  As a group it was found that Miro was supportive of diverse learning requirements.  For example, students were able to document in their first language, allowing flexibility in feedback, facilitating a collaborative, relevant, reflective learning environment.  It is important to ensure that post-registration students feel their existing knowledge is validated and by utilising Miro within social-constructivism pedagogy, students are active in growing skills and knowledge, facilitating group dialogue with Miro supporting collaboration and engagement for critical reflection and shared understanding.  A benefit of Miro was to provide a low stakes environment to aim for students to not see this as a performance related task but one that feels supportive and relevant (Abualhaija, 2019).   

Threats 

Time constraints in clinical practice due to clinical demand, can hinder the ability to fully engage in collaborative tasks (Runciman, 2014), this demonstrates a tension between social constructivist ideals and the reality of professional education.  Social constructivism requires continuous interaction to enable the co-construction of new knowledge between learners (Vygotsky, 1978), however with time constraints its viability can be impacted.  To counter this tension collaborative tasks can be designed to be embedded within practice rather than as an addition.  For example it’s possible to utilise Miro to create tasks relating to practice scenario’s, linked directly to clinical caseloads.  This ensuring learning is authentic by being reflective of practice circumstances, enhancing high-ordered thinking strategies to problem solve (Bae et al., 2022).    

Linking collaborative tasks to the formative or summative assessment, supports students to see the value and purpose in using collaborative tools (Abualhaija, 2019).  To embed peer feedback in formative tasks it’s important that this goes onto inform the summative assessment.  Utilising this teaches a depth of professional communication, leadership skills in line with ‘The Code’ (NMC, 2018) expectations of peer learning in practice.   

Opportunities 

To promote inclusive pedagogy the need to move away from westernised care models, euro-centric theories and practices, counter-narratives must be incorporated to decolonise the curriculum content (Freire, 2000; Sankar, 2024).  Supporting students to develop skills and confidence in critical consciousness will provide confidence to discuss in class the historical circumstances, allowing the challenge of the norms to meet the needs of the 21^st century (Freire, 2018).  In relation to nursing, education teachers need an understanding of social reality, relating to communities and empowering students to examine causes of inequalities, social injustices and barriers to patients accessing equitable care in relevant communities (WHO, 2018).  To support the development of critical consciousness and a democratic learning environment Macedo and Freire (1995) discuss ‘dialogue’ being an imperative component in the process of learning.  Here, challenging any teacher and student power hierarchies, fostering open discussion and the respectful exchanging of knowledge and ideas, supporting students to co-author their learning using lived experience by providing the space to examine, challenge and dismantle oppressive practices (Freire and Macedo, 1995).   

The integration of the technological tool Miros supports students to be co-authors in their individual learning journey.  This mind-mapping platform enhances the democratic learning environment to support students to collaborate utilising the technological platform, including peer feedback skills and digital literacy education.  Literature shows that democratic approaches to learning supports the development of essential skills including, critical thinking, enhanced communication, digital literacy and culture awareness (Brough et al., 2014), scaffolding essential skills for nursing in the 21^st century.  The imperative implementation of the democratic classroom means giving students agency, a voice and an equal responsibility for their own learning, mirroring the collaborative, independent and person-centred actions of a district nurse.  To support the already mentioned co-created group ground rules, flexibility from the teacher in tools utilised and tasks set is required to produce intentional co-construction.                 

Weaknesses  

Disparities in digital literacy holds the potential of disadvantaging the diverse nursing students when incorporating digital tools into learning, due to varying technology confidence and differing access to digital platforms.   Whilst technological educational tools support the co-construction of knowledge (Vygotsky, 1978), it’s imperative to consider and mitigate inequalities and barriers that risk the unintentional marginalisation of student groups.  Practical actions to mitigate potential inequalities include embedding digital sessions into the teaching schedule, referring students to library workshops and specific guides relating to the platform being used.  In-line with a democratic learning environment, encouraging students to support each other's digital literacy development (Macedo and Freire, 1995), supporting peers to scaffold each other's skills and reduce the risk of not all students feeling fully equipped to succeed.   

Strengths    

Social constructivist pedagogy promotes collaborative practice and application in context to a students practice (Vygotsky, 1978); however, this does risk a baseline of digital skills and communication confidence being assumed, where digital inequity remains a major issue for many (JISC, 2022).  Though these are essential skills for district nurses to develop, it cannot be assumed that all students will commence studying with these skills.  To reduce any potential participant anxiety and aim for an inclusive learning environment, a group agreed definition of ‘a safe, inclusive learning environment’, will be established.  This encouraging democratic activities to build student confidence in having a voice and form a safe space for collaborative interaction, aiming to empower students in shared decision making and agency (Brough et al., 2014).  The initial purpose of Miro will be used to conduct low stakes collaborative tasks to build familiarity, whilst promoting peer feedback and flexibility in formats used by individual learners, for example, audio recording, written content or drawings, to meet varying communication needs.  Debrief and reflection, a core nursing skill will support students to establish their individual needs and potential barriers, leading to the development of developmental strategies.