Video has its place, but it is limited

Find balance between TV teachers, human contact

Peruse the self-help section of your local video store and you will quickly realize how videos have become a medium for teaching everything from firmer tummies to better golf swings to fulfilling relationships. For those with a message or method, video is an efficient way to reach people in need of information.

Death — whether facing it or caring for those who are dying — prompts its fair share of questions from patients, their families, and health care providers. Like the rest of society, hospices use videotapes as a teaching tool. Videos are used to train workers, inform referring physicians, and educate patients and their families.

Used properly, videos can supplement hospices’ new employee training and help patients understand the hospice philosophy. "A new employee is required to be trained in so many things," says Terri Dusek, communications coordinator for the Hospice Austin in Austin, TX. "There are JCAHO [Joint Commission for the Accreditation of Healthcare Organizations] and OSHA [Occupational Safety and Health Administration] requirements. There is so much to learn that we have to use videos to cover everything. Videos are especially helpful in teaching patients and their families about hospice because it is such a new concept to them."

But because we have become so familiar with the medium, hospices run the risk of becoming too reliant on video presentations to get across their intended messages, says Joanne Sheldon, MeD, RN, CRNH, education coordinator for the Hospice of the Western Reserve in Cleveland.

"I’m generally against using videos," Sheldon says. "Person-to-person communication is better. It gives you the opportunity for discussion."

Yet Sheldon admits that from a practical standpoint, training without videos is difficult, given the amount of information that hospices must convey to new employees, physicians, patients, and their families.

"I still believe that person-to-person teaching is the best. I will also admit that this is not always easy to accomplish," Sheldon says.

A few short years ago, Hospice Austin used videos exclusively for its new employee training. New hires took part in training at their convenience. When they chose to undergo training, they were escorted into a room with videotapes and written literature.

"It was horrible," says Jane Scaff, RN, CRNH, education coordinator for Hospice Austin. "Everything was a video, two solid days of video. We have revised our training since then."

Today, videos still play an integral part of their training, but they are used more strategically. Scaff says her hospice has gone from showing eight hours of video instruction to less than one hour over a more structured two-day training period.

"It’s more important to use a lot of varied teaching techniques," Scaff says. "Videos are only an element along with group discussions, overhead [projections], and flip charts."

Nothing, Sheldon says, replaces teaching face-to-face. "I have been in education for about six years with hospice and home care staff," she says. "I find that videos may be a good fill in for someone who is absent, but does not work too effectively otherwise."

Scaff says videos should be used in areas in which a hospice cannot provide personnel to deliver the information or message more effectively. For instance, she uses a video to explain cultural diversity. Despite her reluctance to show the video, she says, there isn’t anyone in the organization who is qualified to discuss caring for people from a wide range of ethnicities, races, and religions.

Videos do have their advantages, Scaff says. If consistently shown, they become standardized sources of information. Trainers can be assured the same information is being given time after time.

In addition, some instructional videos can provide far more demonstrative information than a live instructor. For example, a video about back health and proper ways to lift patients can go over more scenarios involving patients than an instructor in a classroom and a video can do it in less time.

See the bigger picture

The key to using videos is to incorporate them into the larger training or education programs. "Videos should enhance the oral communication in your training," Scaff says. "Use them to improve your learning process."

If you use videos to train new workers or referring physicians, there should always be discussion beforehand, explaining what they will see and what they should expect to learn from the visual medium. A second discussion should follow after the completion of the tape.

Sheldon says hospices should provide:

• A discussion sheet to help students focus in on learning objectives.

• A list of objectives to make clear what students are expected learn from the video.

• A post-video questionnaire or test, to stress the learning objectives pointed out prior to the tape’s showing.

"If I have a questionnaire or have a discussion group after viewing the videos with specific questions, I have found that most need much direction," Sheldon says.

How you use videos in your education programs should be dictated by adult learning principles, says Scaff. Adult learning principles hold the following:

• Adults prefer flexible schedules that respond to their own time constraints.

• Adults learn better when learning is individualized.

• Adults prefer face-to-face learning rather than learning through the use of video or audio communication.

• Adults derive benefits from interaction with others who differ in age, level of experience, and professional preparation.

• Adult learners seem to learn better if there is an atmosphere of mutual helpfulness and peer support.

• Since adult learners are reluctant to take risks, the climate should be characterized by a sense of trust and acceptance.

• Adult learners appreciate the invitation to express their views and are open to the views of others.

• Adult learners bring clear expectations to the learning environment and expect instructors to accommodate those expectations.

• Adult learners derive the greatest benefit from instructional methods that assist them in processing their experience through reflection, analysis, and critical examination.

• Adult learners value teaching methods that increase their autonomy.

• Adult learners are motivated by practical how-to learning.

Tailor your program

As important as employing adult learning principles is tailoring your programs to fit the varying audiences you are training. For the most part, hospices will be training employees and volunteers during orientation and inservice; helping physicians understand aspects of hospice care, such as pain management; and educating patients and their families about hospice and its philosophy of care.

Each is a distinct population with different sets of learning objective and learning capabilities. If a hospice uses videos, the same video should not be used for all groups, generally speaking.

Here’s a look at how Hospice Austin uses videos for each of the above groups:

Employees.

While videos no longer dominate their new employee training program, it plays a powerful role in setting the stage for the orientation process. The first thing new workers do on their first day of orientation is watch a short videotape, "Walk Me to the Water," an emotional series of black and white photographs of hospice patients with their fragile voices telling their own story.

"It sets the mood and gets them ready for a whole day of learning about the hospice philosophy," Scaff says.

In this instance, the tape was used to provide an emotional spark in hopes of motivating new employees to enhance the learning process. The impact of the video, Scaff says, is something she could not reproduce with a live speaker.

"Someone always cries when we show this," she says. "I can’t show them that kind of emotion, but that video can."

The rest of the program is dominated by speakers from various departments and videos are used sparingly, mostly has how-to teaching aids, Scaff says. In each instance, videos are accompanied by pre- and post-tests to gauge how well students are learning. Handouts are usually given prior to the video to reinforce learning objectives.

She warns that overuse of videos in employee training accomplishes only one aspect of the training’s intended goals. While providing information is a key element to training, changing behavior is another.

Because hospice care requires an entirely different approach than other segments of health care, instructors during employee training should also be facilitating discussions to effect attitude changes about lofty topics such emotional and spiritual care.

Physicians.

Hospice Austin uses videos even more sparingly with physicians. Because physicians are highly educated, a video must use the same language they use to be effective.

"We’re real selective in what we show," Scaff says.

When choosing a video, hospices should consider how they educate physicians face-to-face. The most effective training includes a physician as the main speaker. "I always have a doctor standing next to me," Scaff says. "They are not going to connect with me, a nurse, but they will connect with another physician."

The same lesson should be applied to video use. The same video used to train workers will likely be without value to physicians.

Still the same principles of adult learning should apply, says Scaff. The purpose, goals, and objectives should clearly stated prior to showing a video with pre- and post tests given.

"I would never have them just watch a video," she says.

You can’t replace human contact

Patients.

Given patients’ and families’ state of mind immediately following word of their terminal diagnoses, they have the least capacity to learn. It is common to have to repeat information before it is internalized.

Videos are perhaps most useful with this group. "Many times hospice is such a new concept, it’s hard to grasp," Dusek says.

To aid in this, Hospice Austin has a 14-minute video in which a bereaved family, physician, and nurse explain hospice care from their unique perspectives, giving prospective and new patients a glimpse at the kind of care they can expect to receive.

The complementary tape can also be shown to out-of-town family members who weren’t present when clinical staff explained hospice care to the patient and present family.

Still Dusek stresses that the tape is only used to supplement information provided by physicians and hospice staff. "Nothing can replace human contact," Dusek says.

She says there is also the danger that the video can do more harm than good. Before showing patient the tape, she allows enough time for the patient to grasp his or her terminal diagnosis, discuss treatment further with a physician, talk with a hospice nurse, and allow for family acceptance.

"When they’re not ready, the video can cause them to go into denial and reject hospice care altogether," Dusek says.

Hospice Austin also uses a videotape series, Facing Death, which it coproduced. The tapes cover the various aspects of dying, clinical, spiritual, and emotional. The tapes were intended for professionals, and patients and their families. However, patients and their families seemed to get the most use out of the series. Nurses, social workers, and chaplains now use the tape to pass along to family members to help them understand the dying process.