Overcoming education hurdles takes innovation

Don’t rely solely on books or videotapes

Employees spread over a large geographic area, people who don’t like sitting in one place for any length of time, patient visits that don’t always follow a "normal" schedule, and a lengthy list of educational classes that staff members must take — these are just a few of the challenges faced by home health managers as they address staff education.

"Home health agencies also use a lot of per diem nurses, so managers find themselves trying to figure out how to pay nurses for required inservices," says Glenda A. Burke, RN, owner of Alternatives . . . An Education & Consulting Service in Panama City, FL. "Not only are home health nurses and aides required to obtain a certain number of educational credits to maintain licensure and certification, but the agency also has to ensure that certain topics are presented to meet requirements of accreditation and government regulatory organizations," she says. "This means that managers have to be creative as they plan and schedule inservices."

The switch from cost-based reimbursement to the prospective payment system also has meant a reduction in the number of staff members available to conduct educational programs, says Burke. "Not all agencies can afford an educational coordinator, performance improvement coordinator, or infection control nurse on staff to be able to develop and present courses," she says. Because accreditation and regulatory requirements have focused more on performance improvement in recent years, agencies are beginning to add performance improvement coordinators, and those people can be responsible for coordinating education efforts, she adds.

"Don’t expect one person, however, to be able to develop and present courses that meet all staff members’ needs," warns Burke. "It takes a lot of time to create a course, and you can’t present the same class more than once to any group of employees," she says. For this reason, agency educators should look outside for help from experts on different topics, she suggests.

In addition to education consultants such as herself, Burke recommends that home health agencies tap into resources offered by specialists such as wound care nurses, diabetes educators, and respiratory therapists. "To find experts in your area, talk with other home health managers, check with your local home health association, and look at who is presenting topics at national or regional conferences," she suggests.

"Don’t forget to check with your vendors, either," Burke points out. "Many suppliers of wound care or diabetes products offer free educational programs that can address specific needs in your agency," she says. "Some also may include continuing education credits, which is a bonus for your staff members who need the credits to maintain licensure," she adds.

Whether you use in-house staff members or outside instructors to present educational programs, there are a few points to keep in mind to guarantee an effective inservice, says Burke.

Make the class interactive.

"No one looks forward to sitting still for a one-hour lecture," says Burke. The nature of home health means people in the industry are energetic and want to be in control of their schedule, she points out. "You have to find a way to make them enjoy the class, and that means you have to find a way for them to participate," she says.

"In one of my classes on Occupational Safety and Health Administration [OSHA] regulations, I start the class with a demonstration and explanation of some of the safety items OSHA requires for employee safety," says Burke. "After the discussion, I divide the class in two groups and we have a relay race," she says. Each team is given instructions to find items used for certain purposes. Then they have to go one by one to the table and pick up the item. "The first team to successfully find all of their items wins," she says.

Because the interactive component is essential to a staff member learning the material, Burke cautions home health managers not to rely solely upon audio- or videotapes. "If you choose to incorporate a videotape into a class, that’s fine, as long as there is a moderator who can comment upon the content of the video and ask questions to make sure the class understands the material," she explains.

Use real-life demonstrations.

Show students how your lecture applies to their everyday jobs by demonstrating the points you are making in the context of a situation they regularly encounter, says Burke.

In a class on assessments, Burke discusses the need to observe the patient and the patient’s environment closely to make an accurate assessment. To demonstrate how nurses and aides can miss an obvious sign of a problem by relying only on answers from the patient or family member or simply following a checklist, Burke has the students assess a "patient" she brings into the class with her. "I watch nurses ask questions about medications, symptoms, and general health, but almost every nurse forgets to ask about or indicate incontinence on the assessment form," she says. "Although the patient doesn’t volunteer the information that he or she is incontinent, the patient is sitting on a blue incontinence pad during the assessment demonstration," she adds.

Choose instructors with the appropriate professional experience.

Don’t ask a business manager to talk about clinical issues, says Burke. "A nurse wants to learn from a nurse," she points out. An instructor with a background similar to that of his or her audience can use examples and tell stories from real experiences to make the class more interesting and more applicable to the audience, she explains.

"Home health aides love continuing education, but they want to learn from other, more experienced aides or other home health-experienced staff who understand what the aides do on a daily basis," Burke explains.

Look for instructors who are experienced home health nurses, diabetes educators, wound care nurses, or physical therapists, she adds. "If your staff is attending a class on OASIS, make sure the instructor has completed OASIS forms in the home," she says. If the instructor can’t relate to the challenges of working independently and working in a patient’s home, the audience can quickly dismiss the information as irrelevant to them, she adds.

Take advantage of conferences and seminars.

"Too many home health agencies send managers or supervisors to conferences, then never use the information gathered at the conference," says Burke. She recommends that agencies send a number of different employees to conferences rather than the same few managers over and over, and that the agency require the conference attendee to present information from the conference to other staff members as an inservice. She adds, "This approach rewards a variety of employees by sending them to a meeting, and it ensures that the agency gets the most out of its investment by sharing the information with all staff members."