Story boards offer mobile canvas for competencies

Faced with a busy, mobile staff and a desire to beef up knowledge of competencies, Mercy Medical Home Care in Fairhope, AL, designed a series of portable storyboards perfect for self-study in the agency’s two offices.

Previously, Mercy Medical had relied on an orientation checklist and mentoring in the field to ensure that its new nurses were caught up on all the necessary competencies, says Starr Flynn, RN, C, staff development instructor.

"We weren’t catching everything in the time frame we wanted because we wanted to get it all done within the first 30 days," she says. "This will probably be an ongoing type program for our annual competency assessments."

PCCs develop new ways to educate

The agency’s patient care coordinators (PCCs) met to develop a way to address the subjects efficiently for staff in the offices in Mobile and Baldwin counties without having to duplicate efforts. In addition to basic home health, Mercy Medical offers hospice, rehabilitation, psychiatric services, palliative care, and pediatric care in a region that Flynn estimates stretches 100 miles.

The PCCs settled on storyboards — tri-fold hinged boards that fold out to a 4'x3' teaching surface. On the boards are sheets printed on colored paper and highlighted with clip-art drawings. They can be transported to an office, unfolded, and left up for hours at a time, either for a group of nurses or for individual self-study. Sign-in sheets and quizzes keep track of who has attended and finished the training.

The PCCs handled the project, first drawing up a list of competencies that could be handled through storyboards. "You couldn’t do catheters as a self-study, none of the hard skills other than the nursing judgment type skills," Flynn says. "I think that more of these are apt to be some of the knowledge that the nurse already has or needs to have."

They settled on about a dozen topics, including rapid physical assessment, telephone triage, a Fall Risk Assessment Tool, patient education, pain management, symptom management, identifying abuse and neglect, nutrition, and multiple medication management. The PCCs worked on the boards, asking staff to help on topics with which they were familiar. Flynn says the boards were designed to be clear and inviting.

"We used print that’s large enough for most people to read," she says. "There are pictures and cut-outs and [features] you can lift up and look at. We tried to be creative with that and keep them interesting."

An important aspect of each board is an accompanying quiz, a feature that Flynn says the agency has fine-tuned since the program began in May. "We all needed to use the same format [for the quiz]," she says. "You need to have more than just five questions because that would skew the results. If you missed one, it could really lower your score."

When the storyboards are set up at an office, nurses are given blocks of time in the mornings and afternoons during which they can attend with other staff. They go from station to station, looking over the information and answering each quiz. At the end, they sign the sign-in sheet and turn in their quizzes.

"That way, we know everyone has an across-the-board knowledge, that no one has slipped through the cracks. We just put it together, and it’s ongoing. The boards rotate between the counties."

In one competency, age-specific care, the nurses viewed a 20-minute video that Mercy Medical purchased, then answered a similar quiz afterward.

Flynn says the boards are left up for a while, so nurses can get to them when they have time. They’re also used as an orientation tool. New staff use them in a self-study format; they can review the information when they’re not out in the field. Staff are given 30 days to complete all of the boards. "If they have any questions, they can always ask, and we have resources for them."

Although not all topics are suited to the format, Flynn says Mercy Medical is looking at ways to incorporate more hands-on skills. Any other necessary competencies will be performed in the field with mentors.

Agencies interested in duplicating the agency’s idea should take care to standardize the format across all of the storyboards, Flynn says. Also, make sure each board has the key to its quiz ahead of time.

"Make sure that one person is typing up all of the quizzes so the same format will exist," she says. "I really prefer a multiple choice combination with critical thinking [questions]. That way, you actually know that they’re applying their knowledge."

All this preparation doesn’t just ease the learning process, it improves the documenting process as well. Names from the sign-in sheet can be sent to the education department as well as human resources for individual files.