The present contribution represents a contextual study to identify general design characteristics as well as components of a digital teaching and learning ecosystem (Hecht, Crowley, 2019; Reyna 2011) for nursing profession education. In concentrating on an introductory contextual study as the beginning of the design process, the present study identifies relevant aspects of educational practices concerning the education of nurses. These aspects become relevant for pedagogical engaged design decisions with regard to digital educational ecosystems supporting and improving teaching and learning practices in vocational nursing education. The major teaching practice to be investigated by this conceptual study are use cases of worksheets. Assuming that vocational nursing education mostly relies on traditional and non-digital teaching practices, worksheets represent instructional documents aiming a self-directed learning and therefore are interesting for digital learning environments. The mixed method approach combines a qualitative and quantitative analyses of 119 worksheet use cases in vocational nursing schools during the pandemic situation in Germany. It covers practices of creation and editing of worksheets by teachers as well as their actual layout, distribution, use and follow-ups. Regarding the results, this study identifies four major areas of design decisions in order to shape a digital educational ecosystem. Drawing on the investigated teaching practices, the study proposes pedagogical engaged improvements for each major area, that might be addresses by educational technology. These areas comprise: a) improving collaborative editing of educational media by a digital community of sharing teachers, b) improving digital distribution and use of educational media as self-directed learning embedded in an enriched and transparent context of learning processes and c) enable teachers to reveal and discuss the lack of addressing central concepts of nursing and d) improving learners reflection and discussion of self-directed learning with educational media by digital communication tools.

In general, design research for technology enhanced learning focuses on educational practices and aims at improving this practices by educational technology (Wang, Hannafin, 2005). In doing so, the practice becomes relevant for design. Within this design process, contextual studies explore the socio-cultural context of learning in order to define preliminary design aspects (Leinonen, 2010). The current approach further relies on the assumption, that instead of being pedagogical neutral, educational technology shapes certain kinds of pedagogical engagement (Friesen, 2004; Laanpere u. a., 2014). Accordingly, the contextual study also shapes an evidence based ground for proposing kinds of pedagogical improvements fostered by designing decisions.

Education for nursing professions aims at skills and competences in a field of activities characterised by physical and emotional presence. Enhancing learning and teaching in vocational nursing education by digital technology must consider those characteristics and find appropriate designs of instructional technology to both technologically and pedagogically improve those particular learning processes. As a first approach towards designs for technology enhanced nursing education, a closer look at learning practices and artefacts holds the opportunity to unveil characteristics. The approach draws on an investigation and analysation of frequently used, traditional learning artefacts and their context within formal learning and teaching scenarios in order to deduce pedagogical engaged design criteria for a digital transformation of those learning environment. Focussing on nursing education in Germany, worksheets represent a frequently used, mostly analogue learning and teaching practice, that is transformable.

The mixed-method study consists of a quantitative survey as well as a qualitative artefact analysis (Froschauer, Lueger, 2018). Previous research on worksheets in primary schools highlight that worksheets as media use in classrooms often come along with other media (Schümer, 1991). Accordingly, the survey focuses on media use in combination with worksheets, but also investigates teaching practices with worksheets like editing, distribution and curricular concentration. The survey consists of binary items to inquire use cases as well as the worksheet itself as file upload for artefact analyses. During the pandemic situation in June and July 2020, we collected 119 worksheet use cases. In this situation, learning in classrooms was limited due to infection regulations. Accordingly, only 36% of worksheet use cases actually occurred within the classroom. Further, worksheets are self-created or -edited by teachers (71%), shared among teachers (44%), and distributed as physical copies (80%). Follow-ups mostly focus on learners results (36%) and sometimes on questions (9%) and discussions. The quantitative analysis focuses on significant Pearson's correlations as statistical aspects of interrelations of use case characteristics, performed using R. Regarding significant (p<0.05) pairs of worksheet accompanying media we found correlations between data projectors and movies (r=0.21, p=0.02) as well as blackboards and overhead projectors (r=0.2, p=0.03). Concerning the use of supplementary media in online learning environments, we found correlations between self-running audio-presentations and videoconferences (r=0.27, p=0.00) as well as simple Powerpoint slides and videos (r=0.27, p=0.00). This correlations analysis of supplementary media use in online learning environments is limited due to the low number of cases using online media (16%). There are also interesting correlations between the use of media and the fields of the German nursing curriculum. Regarding offline media, worksheets within the field of situated and personal care as well as interdisciplinary cooperation correlate with the use of blackboards (r=0.20, p=0.03; r=-0.21, p=0.02), interdisciplinary cooperation further correlates with data projectors (r=0.20, p=0.03), own health prevention correlates with the use of books (r=0.19, p=0.04) and acting in an emergency correlates with movies (r=0.24, p=0.01). The qualitative artefact analysis on a sample of 14 selected use cases unveil the linear learning sequence and the schematic knowledge representation of the worksheets. Learners typically are instructed to write text individually. Here, references to online videos as well as to textbooks are present. Often worksheets do not give any instruction on how to continue after finishing the sheet.

This analysis underline that teaching practices with worksheets in German nursing education draws on different kinds of media creation and usage. Even against the background of a general pandemic situation and the regulation of physical presence in classrooms, physical distribution of worksheets is predominant and only a few use cases draw on online media. This might be an indication for sparse experiences and infrastructures concerning online teaching, but also characterises worksheets as offline media. Nursing teachers tend to create own worksheets and to cooperate here. Further, correlations of media use in combination with worksheets unveils practices of using presentational medias to prepare and follow-up self-directed learning phases. Follow-ups appear to focus on results instead of learning processes. Identified design issues: • Collaborative editing and sharing of worksheets is a common practice among nursing teachers. Regarding digital educational ecosystems, this refers to using, revising and sharing open educational resources (Kerres, Heinen, 2015) as well as to collaboration networks for teacher professionalisation (Rehm, Notten, 2016) • Worksheets are distributed and used individual while appearing fragmented in the larger context of learning processes. Regarding digital platforms within educational ecosystems, this tendency might be complemented by collaboration among learners and improved by more embedding them into learning sequences and learning units. • Tasks in worksheets primary address rules and facts rather then central concepts of nursing didactics (Dütthorn, o. J.), e.g. an hermeneutic perspective on nursing recipients. This neglect might be revealed and discussed in a protected online exchange environment for nursing teachers as part of a digital educational ecosystem. • Worksheets tend to focus on results and feasible knowledge. This might be complemented by competences and processes in offering discussions and communications of learning processes. Accordingly, digital educational ecosystems might include abilities for statements, comments and discussions on learning artefacts.

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