HCGNE - Using the GMHTS: Description of Program Materials

• Introduction to the Training Materials
• Personalize the Materials to Your Facility
• Individual Program Components
• "Generic" Program Design
• Program Implementation
• Getting Started
• The Physical Environment
• The Social Environment
• Incentives to Change
• Materials and Supplies

Introduction to the Training Materials

We are pleased to introduce you to this series of educational programs designed specifically for education in long-term care settings. We are hopeful that these educational programs will improve the knowledge and skill of your staff, which in turn will enhance the quality of care for older adults in your care. To gain the best understanding of the materials provided at this website, and get the most for yourself and your staff from the training programs, please read the following information carefully.

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Personalize the Materials to Your Facility

Although many long-term care settings experience common problems and concerns, each has unique characteristics (number and type of residents served, number and education of staff, physical and monetary resources, etc.) that necessitate your "personalization" of the program content. That is, you will need to review the training modules and think about how the content applies to your facility, your residents/care recipients, and your staff. Because we believe this personalization process is critical to the success of these educational programs, we provide specific recommendations for each module in “Notes for the Instructor.”

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Individual Program Components

To facilitate your use of these educational programs, we have organized each program in the same way. The "generic" format, and what you can expect to find under that heading, is described below. Some sections are combined in files and provided in alternative formats to promote use. The table below summarizes the content of files provided for each topic. We strongly encourage review of the Supportive Materials file for each module, no matter what format is used (PDF or PPT) in training.

STATEMENT OF INTENDED USE. Guidelines for use of these free training program materials are provided in each program as a reminder to users. In short, credit to the HCGNE is requested and use for personal profit is prohibited.

PURPOSE, OBJECTIVES, and CONTENT OUTLINE. The purpose statement provides a brief overview of the program content and what we hope to accomplish. The list of objectives provides a basic framework for what we hope participants will achieve by the end of the program. The content outline offers a brief review of the main points and themes covered in the program. If your facility is an approved provider for nursing continuing education (or you are able to collaborate with an approved provider for CEU credentialing), you can use the statement of purpose, objectives and outline to apply for CEU's for your nursing staff.

NOTES FOR THE INSTRUCTOR. For each module, specific information is provided for the “trainer,” including our rationale for teaching this particular content, tips and ideas for preparing for the actual training session, and ways that you might reinforce your staff's understanding and application of the content. Suggestions to personalize the content to your facility and audience are offered, along with ideas to help staff apply interventions in practice. We encourage you to consider methods to help staff take new learning from the classroom into their daily practice, a process you and other leaders must facilitate to promote change in caregiving strategies.

LECTURER'S SCRIPT. Each program offers a word-for-word manuscript from which you can lecture. We have written out all the things that we think are important to say about the topic, but recognize that there's always "more to say" and in some situations, "better ways to say it." As a result, we encourage you to personalize the manuscript with your own experiences and examples and NOT to read the content verbatim.

POWERPOINT. Each module is provided in PowerPoint format that may be viewed and used in a variety of ways: 1) slides may be shown in Presentation View using a projector, 2) lecture content is provided in Notes View, and may be printed for use to lecture, 3) slide content may be printed as handouts, and 4) individuals may read and review the program on a computer as an independent learning activity. Because some users may not have PowerPoint, the slides have also been converted into a PDF file which allows you to print a hard copy and make overheads or 35mm slides to accompany the training program.

HANDOUTS. Each program is supported by a variety of handouts that summarize important content for the participant. In some instances, the handout actually provides more detail than is covered in the lecture. Consequently, we encourage you to review these materials carefully so that you are comfortable with the topic and can provide illustrations that will be meaningful to your staff. If you use the PowerPoint version, a handout of the slides may also be printed and provided to participants.

BIBLIOGRAPHY. There is much to know about these various topics. As a result, a bibliography is provided for each topic. Get in touch with your local librarian to see if she/he can help you locate additional articles that are of interest to you and your audience.

GLOSSARY. You will find a glossary of terms in the linked document. We have included an assortment of medical terms, psychological jargon, and other words that may present problems for participants. We invite you to copy and provide the glossary to participants to use “as needed” if you are teaching several programs from the Series.

SLIDE/OVERHEAD COPY. Although many individuals have access to PowerPoint software and may choose to show the slides in presentation format, others may elect to print the slides from the PDF file. This hard copy of the slides may then be used to make either 33 mm slides or overheads for use in training programs.

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"Generic" Program Design

Although specific instructions about the use of the individual training modules are included for each unit in “Notes for the Instructor,” we would like to review the basic "structure" of the programs and offer some general recommendations about how to implement the programs. We hope that these suggestions will enhance your understanding of the materials and assist you in finding ways to personalize the content to your facility.

Each of the modules has a "theme" which relates to some commonly encountered problem behavior that is typically linked to a mental or emotional disorder. Some of the problem behaviors are linked to a diagnosable mental illness, like depression or dementia. Other problem behaviors are more closely tied to loss, life change, maladaptive coping patterns, miscommunication, or even the effects of longstanding personality traits.

In addition to describing the behavior itself, the programs focus on looking for the "chain of events" that leads up to the problem behavior. This is just our way of saying that there is often a "cause and effect" relationship to be discovered. We make the assumption that, in many cases, the problem behavior is actually a symptom of some other, underlying problem that needs our attention. The goal, then, is to identify the "real" problem so that it can be dealt with, or at least understood. Consequently, we encourage staff to "get the facts," which simply means assess the problem, so that they can help the person cope more effectively, which also has the added benefit of making their work life more pleasant.

The most common illustration of how this might be observed is with a resident who is in the early stages of dementia. The person may conceal the fact that their memory is failing by being accusing, contrary, or flippant. Fluctuations in the person's abilities may be wrongfully attributed to "moodiness" or "manipulation," both of which are under the person's control. Staff may think that the person is "uncooperative" or "nasty" intentionally, as an act of aggression. But the cause of the behavior is cognitive impairment. The person is not purposefully trying to make staff feel bad or look stupid. Instead, they are trying to "cover up" the fact that they don't know the answer to the question, or that they forgot that they were told what to do. The behavior is an effort to maintain a sense of dignity. When the problem is put in that perspective, the response to the behavior often changes. Staff don't feel that they have been "assaulted." They are better able to tolerate the difficult behavior because they have an understanding of "why" it occurs. This understanding also introduces an opportunity to respond differently: a pathway to new interventions.

After looking for the "chain of events" and discussing factors to consider in assessment, the program typically concludes with a set of recommendations about how to best respond to, or manage the identified problem behavior. We have tried to describe the interventions in terms that are understandable to your staff, and to give illustrations of how and when these strategies might be used. However, these descriptions will be more meaningful if they are accompanied by your personal experiences.

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Program Implementation

Although the training manuscript provides a "word-for-word" account of what might be said during a training program, we hope that you will eventually be able to teach from the outline and slides, rather than needing to read the script. To reach that level of comfort, you will need to review all of the materials carefully, personalize the content with anecdotes from your caregiving or individual experiences, and practice giving the lecture.

While you are reviewing the lecturer's script, pay special attention to the information that appears in bold print. You will note that there are three different types of information in bold print. These include:

1. >>slide content -- which slide to show
2. **Refer to handouts -- which handout to look at
3. //Trainer: -- instructions to guide you through this part

The notes designated by the marker "//Trainer" signal you to read the directions that follow. These instructions typically provide you with tips on soliciting information from the audience or suggestions on the use of audiovisual aids. In some instances, they may refer you back to the handout to review definitions or behavioral illustrations of the concepts noted in the lecture. This is important to do so that you can offer an explanation or a behavioral example if you are asked to clarify the concept.
 

You will also find information in BOXES in some of the manuscripts. We use boxes for several different purposes. In some instances, the box signals a discussion point or question. In other cases, we placed boxes around the list of information that is being shown on the slide or that is found in the handout. This means that you don't need to read the list verbatim, but should illustrate or define the points that are less familiar to your staff.

The best way to learn the material is to make your own detailed outline and use that to lecture from. As an alternative, write notes to yourself in the margin of the Lecturer’s Script (Word/PDF version) or Notes View (PowerPoint version). Consider Highlighting the parts of the lecture that you want to see more easily, and think about personal experiences that could be offered as illustrations.

You may elect to use past experiences with residents that may be familiar to the staff, or even personal experiences with family or friends. However, we also request that you "try out" the interventions in advance of teaching the program so that you can relate, from your own personal experience, how the intervention may work out, in a real life setting with a real life resident. If you do not provide "direct" patient care as part of your role, recruit a staff nurse to collaborate with you. Seek out someone who is supportive of the project and enlist his/her cooperation to gain "personal experience" which can be shared with the rest of your staff when you teach the program.

We believe this type of "hands-on" experience is needed to

• Inspire staff that these methods are more than "book learning" -- that they do, in fact, apply to their work roles;
• Verify that the trainer does, indeed, "know what she/he is talking about;" and
• Discover both the need and the practicality of the interventions in your facility with your resident population.

This "first hand experience" provides you with real-life examples that your staff will surely relate to. And by identifying a resident within your patient population that exhibits the target behavior, you are able to help the staff "make the jump" from "theoretical" to "practical."

For example, in Part II of the dementia program, we describe "word-finding" problems and other language difficulties that make it hard for staff to communicate with the resident. These problems are followed by some very specific communication strategies. Identify a resident who exhibits the language losses described in the program and spend some time trying out the recommended strategies. First, give the person a long, complicated command or other "don'ts" which are typically unsuccessful. Then try simple, short commands for contrast. Predictably, the person will perform better when you follow the recommended interventions.

This procedure accomplishes two important tasks. First, if you have difficulty understanding or implementing the intervention, you have the opportunity to review and consider what may have contributed to the problems and consult with others within your facility before you teach the program. Second, the experience offers you a specific and meaningful illustration to make your point during the lecture. Illustrations and experiences that are drawn from your facility about your residents or staff are ABSOLUTELY the most meaningful!!

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Getting Started

Before you actually "kick-off" your training program, there are a couple of general considerations that we'd like you to review. First of all we'd like you to think about the ENVIRONMENT in which the program takes place -- and that includes both the physical environment and the social environment!! We'd also ask that you consider INCENTIVES that may be offered to staff for actually implementing these patient care strategies. And finally, we'll give you a rundown of MATERIALS and supplies that you'll need for each training program.

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The Physical Environment

You may or may not have a lot of choice about where in your facility you offer the educational programs. Usually there are real-life limitations to deal with. But DO take time to consider your meeting place and make as many adjustments as are feasible to increase participant's comfort. Think back about the educational programs you've attended. Were you really paying attention when you were "freezing" cold? Or dozing off when it was too warm? What happened to your train of thought when an announcement was made on the P.A. system? Have you ever planned to use the dining room for a program, at the same time that activities scheduled a bingo game? There are all kinds of possibilities. We suggest that you think about the following:

• Do you need to "reserve" the room you plan to use for training purposes? Will other groups "accidentally" plan to use it at the same time?
• Is it large enough to comfortably accommodate your group?
• Are there enough chairs in the room? Or will you need to arrange this in advance of the program?
• Can the room be arranged so that everyone can see the slides and you at the same time?
• Think about the location of the room. What's going on in adjacent rooms or in the halls? Will those activities interfere?
• Will the P.A. announcements be heard in your room? Is there any way to eliminate them? If not, how will you manage these interruptions?
• How's the temperature? Remember, it's hard to pay attention if it's too cold and difficult to stay awake if it's hot and stuffy!!
• Can the lighting be decreased so that the slides or overheads can be easily seen? Will you still be able to read your script if the lights are dimmed? What about the effect of windows and natural light?
• Is there an electrical outlet for your LCD, slide or overhead projector? Will you need an extension cord?
• Do you have a screen or a light-colored wall to project images on to?

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The Social Environment

It's also important to think about the social environment. By that, we mean the "mix" of people who are taking the program together. How many and what kind of people (e.g. peers, supervisors, administrative personnel) are taking the program at the same time? These factors also affect what the typical learner gets out of the program. For example, how willing are you to venture an uncertain answer if you think that someone (e.g. your supervisor) might think that you should know that? How comfortable are you when you're asked to offer a personal experience in front of a group of superiors? Do you think it's easier to talk in front of a small group? Or in front of a large group?

Because we believe that the social environment is really important, we ask that you do not train more than 25 people at one time. A group larger than this becomes "unmanageable" in terms of group discussion and participation, and in terms of keeping everyone's attention. We ask that you also think about the composition of the group, and how you can increase their comfort during the training session.

• Are you training a combination of nurses and nursing assistants together as a group? Or can you break them into two groups?
• What do you know about the members? Are there any existing competitions or alliances that you need to be aware of?
• Who in the group is a natural leader? Can you gain their cooperation in trying out some of the interventions in advance of the training program?
• What can you do to increase a sense of cohesion, or "we're all in this together" among the members?
• Can you arrange for coffee and snacks to make the experience more pleasant?
• What can you say or do to promote a sense of trust among members? What will encourage their full participation?

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Incentives to Change

We also recognize that attending the training session, all by itself, isn't really enough to change the learner's behavior. The knowledge that they gain during the program IS THE NECESSARY FIRST STEP. But that knowledge needs to be reinforced, over and over again. Likewise, that knowledge has to be "translated" into their day-to-day, on the job experience. It is one thing to "understand" or "know" what to do, it is quite another thing to actually DO IT. You, as the trainer, are charged with the responsibility of taking the material out of the classroom and into the facility.

Ask yourself, your Director of Nursing, and/or your Administrator, "What can we do to promote the use of these new concepts and patient management strategies in our facility?"

• What kind of incentives can you offer staff for trying out these interventions?
• What kind of reminders can you place throughout the facility to help staff keep those concepts in mind as they work with the residents?
• What kind of administrative support do you have to implement the strategies described in these programs?

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Materials and Supplies

Finally, think about the materials and supplies that may be needed to provide training. For example,

• Comfortable chairs, and tables if possible – makes taking notes easier!
• Flipchart and markers or chalkboard and chalk – These are needed for nearly all group discussions or problem-solving exercises: to note key responses, for emphasis, and to record suggestions or ideas that result from the session.
• Extension cords if using a slide projector.
• Handouts – Include both handouts from the “supportive materials” and if possible, from the PowerPoint version of the program.
• Lecturer Scripts – Prepare a set of notes from either Notes View of the PowerPoint version or the Word/PDF version of the Lecturer’s script with personalized notes, illustrations, and experiences.
• Attendance Sheet – If presenting the program as an inservice education program, you may want to maintain a list of participants’ names and their attendance.
• Snacks and beverages – Both are highly recommended.
• Notepaper and pencils – Making these available for participants encourages taking notes during the program and may facilitate for group discussions.

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