Practicing learner-centered training
When it comes to staff education, we all know the usual routine: pop in a DVD and voila!—everyone has reviewed universal precautions. Or perhaps your company has advanced to individualized computer instruction, where a staff member watches a video and answers the questions that follow to prove their competence on the subject matter.
These techniques are cost-efficient, but how much of this knowledge is retained and actually translates into daily practice? And are these methods of staff training going to work if your desire is to create a new kind of nursing home, one in which care meets the individual needs of each resident?
The movement to change the culture of nursing homes to create environments that are real homes, not institutional warehouses, is also changing approaches to staff education. There is now greater interest in education that actively involves participants in the learning process, which makes sense, as evidence shows that this type of learning is more effective than when we treat learners as passive recipients of information.
So what types of learning activities support culture change? The ideas are endless. For example, The Pioneer Network’s excellent manual, Getting Started: A Pioneering Approach to Culture Change in Long-Term Care Organizations, contains learner-centered activities that encourage staff rethink every aspect of their organization’s culture.
One of the fundamental principles of culture change is “self-determination.” Residents should have control over their daily lives, not be subject to an institutional routine. Getting Started suggests following learner-centered activity to begin thinking about the true meaning of “self-determination.”
Observe this simple exercise from the manual, which is more of a discussion of self-determination to deeply engage participants:
Ask each participant to imagine that they are moving into the nursing home today. Ask them to write down their own morning routine. From waking up through getting dressed, what do you use, what do you do, where do you go? Read the sample routine:
Some days I wake up at 5:00 AM, other days I sleep until 9:00 AM. It all depends on what I have planned that day and how tired I am. The first thing I do when I wake up is go to the bathroom. Next, I put on my bathrobe, sit on my front porch, smoke a cigarette and drink a cup of coffee. After this I take a shower and wash my hair. I blow-dry my hair using styling gel and hair spray to get it neat and in place. I get dressed after this, and I like to wear jeans and a pullover shirt most days. I listen to the morning news on my TV. I do not eat breakfast; I just drink coffee. I will drink a full pot before lunchtime.
Write these guiding questions on the flipchart for participants to use as a guideline in thinking about their own morning routine:
● When do you wake up?
● How do you wake up?
● What do you use in the morning?
● What rooms do you go into?
● What do you eat?
● Where do you go?
Give participants 10 minutes to write their morning routine. After everyone has completed the assignment, ask for volunteers to share what they wrote with the group. After the volunteer shares his/her routine, ask the group: What choices were made? Facilitate a discussion that sheds light on the number of choices that were made in that short part of the day. Debrief the activity using the following discussion questions:
● What would your day be like if you could no longer start it with this routine?
● Has anyone experienced a recent disruption in his or her daily routine? What was that like?
● How does that routine demonstrate self-determination?
● Do you always follow the same routine every day?
● If you moved in to this nursing home today, would that routine be possible? Why/Why not?
What seemed routine—waking residents at pre-determined times, requiring them to get up and dressed for breakfast—all seems a bit disturbing. Our own experience tells us that we would not like to have to conform to the institutional schedule. Why should our residents?
Deep learning has begun.