Approaches to Effective In-service Education of Clinical Nursing Home Personnel - Term Paper Example

Approaches to Effective In-service Education of Clinical Nursing Home Personnel Approaches to Effective In-service Education of Clinical Nursing Home Personnel Abstract The care for the elderly in nursing homes has increasingly become significant due to the rising numbers of this population, expected to triple in the next 30 years in the US. The simultaneous rise in nursing homes and staff employed has elevated the number of problems that are seen in nursing homes which have reduced the quality of care. Researchers have explored the subject and suggested various methods of improving the competency of staff and raising the quality of care for the elderly. The educational approach had been suggested by many. This researcher is exploring the methods of overcoming the shortfalls in elderly care through educational approaches. Approaches to Effective In-service Education of Clinical Nursing Home Personnel Nursing homes are on the rise in the US to accommodate the rising elderly population which is expected to triple within the next 30 years (Gabrel, NCHS). The elderly who would be in nursing homes for a long term are prone to debilitating illnesses and disabilities which require the vital services of nursing homes and their staff. The US Census Bureau indicates that 1401718 people were residing in 15700 nursing homes (US, 2010). The large number of people to be looked after indicates the number of people required to care for them. The gravity of the situation highlighted the extent of competent services necessitated. “Quality of care in nursing homes has been defined both as an input measure and as an outcome” (Kruzich et al., 1992). The care in its traditional manner or transitional or integrated aims at providing safe and quality care to the elderly and the care administered is overlapping in that the different carers provide same services. Hayes (2006) had found that the staff turnover for the nursing homes was extremely high resulting in poor competence development, raised levels of work strain and stress with reduced work satisfaction. The licensed nurse practitioner, recreations supervisor, geriatric nurse, nutritional assistant, student nurse and nursing assistant or aides were the different workers in the nursing home (Paulus et al, 2006). Social activities and the delivery of services had to be shared by the workers in the different disciplines, the nurse being involved in all facets of activities. The job definitions of the care-givers had become less definite and their activities were coordinated into inter-professional relationships which allowed them to perform each other’s tasks in demanding situations. The issues at work had kept all these staff on tenterhooks as they were not capable to handle the various problems. They needed educational guidance in order to be sincerely performing their jobs. Much had to be done by way of equipping the staff to manage their responsibilities as best as they could and converting them into competent managers of care for the elders in the nursing homes. Hanson and Arnetz (2008) had indicated that future interventions needed to overcome or prevent work-related exhaustion and initiate the progress in competence with the aim of raising work satisfaction among the nursing staff in care settings. This paper is exploring the reasons for the incompetent care management in nursing homes and the approaches that could be adopted to educating the staff for changing their level of competency to better management of the elder care. The work in nursing homes. The services provided by most of the nursing homes as indicated in the survey of 1997 were 99.2% nutrition; 98.3 percent social services and physical therapy of 97.1%. This included assistance for families to manage their socio-environmental and emotional problems. The issues which were least managed were home health problems and hospice services (Gabrel, NCHS). The work involved in nursing homes was representative of several disciplines. Catheterisation of the urine, management of psychiatric patients and dementia including Alzheimer’s where patients become totally dependent on carers were some of the requirements. Catering to the social activities of the residents was another. Problems of delegation On many occasions, staff who were not qualified for injections had to do the work. This type of delegation due to shortage of nurses could not be accepted by the qualified nursing staff (Gabrel, NCHS). Nursing personnel felt the strain of such delegation. Direct clinical care was provided by the registered nurses, licensed practical or vocational nurses and nurses’ aides and orderlies. Registered nurses constituted only 15 % while nurses’ aides and orderlies constituted 66 % of the nursing staff (Gabrel, NCHS). There was no option but to delegate work to the less informed and untrained other nursing staff. This delegated work stressed the small number of registered nurses (Laamen et al, 1999 in Hasson and Arnetz, 2008). Good catheter care Urinary catheter care, for short-term and long-term care, was one common issue in nursing homes. Recommendations were available for the best catheter care. However nurses and aides did not know about the indications of catheter care even when the insertion and care of catheters was being done. In-dwelling catheters had been found in 12-13% of admissions into the nursing homes (Mody et al, 2010). Urinary catheters were usually used for retention urine and for allowing the healing of large wounds or pressure ulcers. The complications that were seen were urinary infection in 50% of the catheterized, asymptomatic bacteruria in 95% catheterized patients and resistance of certain microbes to multiple drugs (Mody et al, 2010). Good catheter care practices could have prevented all the three problems. Recommendations had been made by the Center for Disease Prevention and Control for safe urinary catheter practices to prevent associated disease. Mody’s study evaluated the level of knowledge in the nurses and the aides. Hand hygiene practices were sound in 88% of health care workers while 97% of them knew about the use of gloves while manipulating the catheter. The aides did not know about indications for long-term use. Both groups were unaware about the recommendations for catheter practices (Mody, 2010). Educating them all would produce beneficial long-term effects. End-of-life care decisions End-of-life care decisions were to be made by the patient’s family. The staff had to maintain good relationship with the families to help them make these decisions (Gjerberg, 2011). Quality end-of-life decisions required family members to make these decisions as patients could be too ill or having cognitive impairment. The family needed empathetic support and information. Occasionally the relationships could be challenging especially when issues of limiting treatment arose (Gjerberg, 2011). Oral care Oral care for the residents of the nursing home was a significant aspect of the nursing care. Educating the staff on dental hygiene repeatedly produced a vast improvement on oral hygiene in the residents (Kullberg et al, 2010). Poor oral hygiene had been implicated in nursing home residents who developed aspiration pneumonia which was a serious outcome. Repeated dental hygiene education and evaluation enabled the residents to have a notable improvement in their oral hygiene (Kullberg et al, 2010). Palliative care information Registered nurses identified eight topics in palliative care which needed to be taught in the education classes (McDonnell, 2009). The imparting of palliative care education with understanding of various subjects was essential: of the dying process; appropriate pain management; better communication skills; issues of nutritional assessment; practical skills; the appropriate use and management of syringe drivers (McDonnell, 2009). The role of complementary therapies was also to be taught. Health care assistants wished to have classes which could enhance their communication skills (McDonnell, 2009). McDonnell’s study concluded that the registered nurses and health care assistants needed continuing education for palliative care management by their own requests (2009). The education was especially useful to health care assistants who were closer to the residents of nursing homes who needed palliative care (McDonnell, 2009). Issues at work which needed attention The complexity of nursing home care for the elderly had initiated the beginning of integrated nursing home care arrangements (Paulus et al, 2006). The difference in the integrated care was that the activity profiles could be extended to include extra care, handling of food or club activities or recreational activities (Paulus et al, 2006). The nursing home care as integrated services was demand-oriented. Residents indulged in daily activities like cooking, washing and cleaning. Only a few residents were in the wards. Considering that activity profiles included more activities than was defined by the job profiles due to the differences arising in the nursing care, the risk that the staff could miss out on their actual jobs while performing the integrated care was high. Another notable point was that exhaustion at work and incompetence could be reasons for the dissatisfaction at work (Hasson and Arnetz, 2008). The residents in the nursing homes included patients with psychiatric illnesses and dementia, illnesses which needed some amount of knowledge and competence for management. The staff could have incompetence in dealing with the situations involving the patients or to threats and violence in their workplace (Hasson and Arnetz, 2008). Leadership issues could also be troubling them. Another major drawback noted by the staff was their inadequate knowledge of the ethical and legal aspects of health care delivery (Hasson and Arnetz, 2008). Medical and technological sophistication had crept into the care for the elderly (Hasson and Arnetz, 2008). Staff competence was not in comparison to the work required (Brodaty, 2003 in Hasson and Arnetz, 2008). The workload and emotional strain took a toll on the carers (van den Berg et al in Hasson and Arnetz, 2008). The elevated time pressure also contributed to the high stress levels. Higher turnover rate of staff had also inversely affected the work satisfaction. Stress and burn-out were related outcomes for the staff (Hayes, 2006). The work in nursing homes ranged from mere help with housework to advanced care. Computer skills were currently automatically required in most nursing homes. Staff needed to be computer knowledgeable. Points to be remembered when education processes were planned Educational training could be implemented after gauging the perceptions of the nursing staff. Work strain, stress and job satisfaction could be assessed before and after the intervention of education to assess the benefits accorded. Training needed to include attempts to reduce their exhaustion from work. Strategic planning for training needs before training or education was essential to the success of any education program (Rowan-Szal, 2007). Recognition of the preferences and barriers helped to guide the training programs. Evidence-based techniques could be transferred into clinical practice more successfully. Rowan-Szal indicated 7 domains and 54 items for the needs assessment: “Program Facilities and Climate, Program Computer Resources, Staff Training Needs, Preferences for Training Content, Preferences for Training Strategy, Training Barriers, and Satisfaction with Training” (2007). The tool for needs assessment that had been used by Rowan-Szal are suitable for identifying the needs of staff in a nursing home (2007). Shaping up the nurse’s aides The executive summary of the Department of Health and Human Services for Nurse Aide training indicated that quality care to nursing home residents was mainly administered by nurse aides (Nurse Aide Training, 2002). The nurse aides constituted the biggest care-giving personnel in the nursing homes. They were involved in the bathing, dressing, meals and toileting or the daily activities of the residents. The elders thereby depended upon them and were in close contact with them if the aides had good communication levels (Nurse Aide Training, 2002). The training and certification made the nurse aides more skilled following their training. They obtained an insight into the behavior and cognitive disorders in their patients. They became trained in catheter and colostomy care. The scientific manner of safely lifting patients was another achievement (Nurse Aide Training, 2002). Hygienic feeding, maintaining hydration and infusion therapies were other information gained. However the necessity for more training on honing their inter-personal skills, communication skills, the skill of teamwork, coping with end-of-life and death, managing time and becoming familiar with new technologies were added necessities (Nurse Aide Training, 2002). The nurse aides were therefore essential tools for the successful care for the elders and their inclusion in the training program was inevitable. The benefit of self-made action plan The setting up of an action plan by the participants following the education program on care practices had been shown to have better results or outcomes (Rodriguez, 2010). Rodriguez et al evaluated medical and associated health care professionals after providing education on how to care for patients with dementia. The outcomes following the chalking out of action plans improved skills and led to attitudinal changes in the health professionals (Rodriguez, 2010). The action plans needed to be prepared in the education fora. Examples of action plans needed to be presented for the participants to emulate. A survey of the information obtained at the education classes needed to be gauged after the education. Classes needed to be planned and implemented with the close collaboration of the participants and leaders from the nursing homes (Rodriguez, 2010). Communication skills Communication skills could be learned and enhanced when necessary (Bosse, 2010). Peer role play and standardized patients could be used as tools for educating the staff of nursing homes. These two tools had been described as specific for teaching communication skills to staff. Achievement of a suitable transfer of communication skills was possible through continuous clinical supervision (Bosse, 2010). Standardized patients were good potential for effective training and were effective for formative and summative assessment of communication skills. Training acceptance was noted for both role play and standardized patients (Bosse, 2010). The curriculum for education Introducing the participants to the computer and sophisticated instruments formed an essential segment of the training. The ability to care for the urinary catheter and colostomy wounds was essential. The management of dementia patients through comfortable caring methods was a major job in the nursing home. Psychiatric patients needed to be managed with special care taking care not to trigger them into manic or depressive episodes. Palliative care and end-of-life decisions were to be discussed to sort out the legal implications and ethical management. Pressure ulcer management served to relieve many bed-ridden patients from a horrible end-of-life. In general, education was to address all job activities aimed at elevating the quality of life of the residents. Oral care was to be exceptionally good. The administration of injections and medicines was to be stressed and the participants other than nurses were to practice the method of injection under sterile precautions; the nurses would be less stressed out during delegation activities in the bargain. The staff was to improve the communication skills and participate in all club or social activities. All staff would also learn to enjoy their work being more confident and competent. Frequent follow-up evaluations would keep the staff well informed and competent on a continuous basis. Conclusion The large number of the elderly who would be in nursing homes for a long term are prone to debilitating illnesses and disabilities which require the vital services of nursing homes and their staff. The care in its traditional manner or transitional or integrated aims at providing safe and quality care to the elderly and the care administered is overlapping in that the different carers provide the same services. Social activities and the delivery of services had to be shared by the workers in the different disciplines, the nurse being involved in all facets of activities. The work involved in nursing homes was representative of several disciplines. Delegation of work was a form of stress for the minimal number of qualified nurses. Both nurses and aides were unaware about the recommendations for catheter practices. The staff had to maintain good relationship with the families to help them make end-of-life decisions (Gjerberg, 2011). Educating the staff on dental hygiene repeatedly produced a vast improvement on oral hygiene in the residents (Kullberg et al, 2010). McDonnell’s study concluded that the registered nurses and health care assistants needed continuing education for palliative care management by their own requests (2009). The staff could have incompetence in dealing with the situations involving the patients or to threats and violence in their workplace among their many problems (Hasson and Arnetz, 2008). Staff was not competent to handle the medical and technological sophistication in the elder care. Strategic planning for training needs before training or education was essential to the success of any education program (Rowan-Szal, 2007). The tool for needs assessment that had been used by Rowan-Szal was suitable for identifying the needs of staff in a nursing home. The nurse aides constituted the biggest care-giving personnel in the nursing homes and their education was essential (Nurse Aide Training, 2002). The setting up of an action plan by the participants following the education program on care practices had been shown to have better results or outcomes (Rodriguez, 2010). Peer role play and standardized patients could be used as tools for educating the staff of nursing homes (Bosse, 2010). The curriculum for education needed to include the needs as assessed prior to the intervention. Frequent follow-up evaluations would keep the staff well informed and compete References: Bosse, H.M., Nickel, M., Huwendiek, S., Jünger, J., Schultz, J.H. and Nikendei, C. (2010). Peer role-play and standardised patients in communication training: a comparative study on the student perspective on acceptability, realism,and perceived effect. BMC Medical Education 2010, 10:27 http://www.biomedcentral.com/1472-6920/10/27 Gabrel, C.S. (2000). An Overview of Nursing Home Facilities: Data from the 1997 National Nursing Home Survey. National Center for Health Statistics. 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