Be In the Know!

Everyone has heard of Goodwill, right?  You may have dropped off some clothing or furniture that you no longer needed at a local Goodwill store.  But, if you’re like me, you might not have heard of the free online learning offered by Goodwill Community Foundation.

Recently, I happened to see a TV commercial about their online learning program.  My first thought was, “What…?  Goodwill has online training?” It turns out that this program has been in effect for more than a decade and has served over two million learners around the world.  And, it’s all free!  How great is that?

The GCFLearnFree website offers “quality, innovative online learning opportunities to anyone who wants to improve the technology, literacy, and math skills necessary for them to be successful in both work and life.” Their list of classes is extensive and includes:

• Computer basics…even explaining what all the buttons do!
• Internet basics such as email and how to “surf” the web for information
• How to apply and/or interview for a job
• Math skills…from brushing up on fractions to counting change
• Reading skills for people who would like to enhance their literacy

They also have a broad range of “Everyday Life” classes, such as:

• Using an ATM
• Reading a bus map
• Depositing money
• Reading a food label
• Making a grocery list
• Using a microwave
• Paying bills

…and many more!

All together, GCFLearnFree offers more than 750 free classes.  Many of them are also offered in Spanish on their sister site: GCFLatino.

On the website, I read dozens of wonderful testimonials so it’s clear that the classes are having an impact.  Here are what just a few people had to say:

“I just tried out the Everyday Life section of the GCFLearnFree.org website and it’s my new favorite! What a great way to teach life skills! It’s fun, interactive, and practical. “

“I just heard about your website and I love it!  I’m a teacher and it will be great to use with my ABE and ESL students.  Thank you! ”

“These courses will enable me to get a better job and be computer literate with up-to-date skills for today’s computer world.”

“Wonderful class and great boost to my confidence. As an older student, I find your classes easy to understand and use. Thank you!”

“I learned some things in this class that I probably should have learned a long time ago in school but I just didn’t get.”

Here at In the Know, I shared the GCF link with all my employees and the response has been nothing but positive.  For example, one employee wants to learn more about Excel.  Another just upgraded to Office 2010 and needs to learn the “bells and whistles”.

So, please take a few minutes to look over GCF’s list of classes.  Like me, I bet you’ll think of a number of ways you might utilize them with both employees and clients!

Happy Teaching!

Linda

Much of the day-to-day work of a nursing assistant has to do with competencies.  For example, does the CNA know how to make an occupied bed, transfer a person safely from a bed to a wheelchair or take an accurate blood pressure reading?  But are task-based competencies enough to ensure quality client care?

If you ask Daniel Goleman, the answer would be no.  In the 1990s, he researched and wrote the book, Emotional Intelligence.  His theory was that people could enhance their personal and professional success by mastering five key emotional competencies.  How do you think your nursing assistants rank when it comes to emotional intelligence?

1.      Awareness of Self and Others.

People with a high “emotional IQ,” also called “EQ,” should be able to identify their feelings accurately.  Imagine your CNAs are working with a difficult client.  Can they tell if they are feeling irritated, hurt or angry when the client is unfriendly?  Can they look past their own emotions and realize that their actions affect how other people feel?

2.      Managing Their Moods.

Emotional intelligence includes controlling impulses and handling anger constructively.  Let’s revisit that scenario with the combative client.  If your nurse aides feel angry when caring for a disruptive client, can they manage that anger without taking it out on the client—even in subtle, non-verbal ways?

3.      Motivating Themselves.

Having a high emotional IQ helps people set goals and work towards them with a positive attitude—even when faced with setbacks.  Do your nursing assistants have an inner drive that keeps them inspired and determined to do their best, no matter what the challenge?

4.      Empathy.

Can your nurse aides put themselves in someone else’s shoes—to see and feel the perspective of a client or a co-worker?  For example, when it comes to a grouchy client, can they see past the angry surface to understand the fear and loneliness that is fueling the client’s hostility?

5.      Managing relationships.

Working as a CNA is all about relationships—with clients, family members, co-workers and supervisors.  How skilled are your nursing assistants at resolving conflict?  Do they cooperate with their clinical team members?  Can you count on experienced aides to share what they know with new employees?

According to author Daniel Goleman, the mastery of these five competencies results in enhanced emotional intelligence. You might be thinking, “So what?” Well, studies show that emotionally intelligent employees communicate more effectively, manage change better and have higher levels of productivity—all great qualities for anyone who works in health care.

In an ideal world, it would be great to have a system in place at every workplace to assess for emotional intelligence during the hiring process.  However, it’s never too late to develop and improve the emotional intelligence of your current employees. You can find a number of resources—both in print and online—to assist you with EQ training.  Or, you can avoid reinventing the wheel by sharing some of the following In the Know inservices with your nurse aides.  Each one offers knowledge and skills that promote a high “EQ.”

Customer Service in Health Care (It’s free! Just fill out the registration form.)

The CNA/Nurse Relationship

Building Trust & Confidence with Clients

Working with a Team

Stress Management Skills

The Caring Qualities of a CNA

Conflict in the Workplace

Dealing with Difficult & Combative People

Being Assertive

Professionalism & Work Ethic

Happy Teaching!

Linda

Have your heard about the study of 780 Medicare patients that was released today?  The study focused on adverse events during hospitalizations.  As reported by USA Today, the study found that:

• Of the 780 patients, twelve died as a result of hospital care.  Five were related to blood-thinning medication.
• Two other medication-related deaths involved inadequate insulin management (causing hypoglycemic coma) and over-sedation (causing respiratory failure).
• About one in seven Medicare hospital patients were harmed by their medical care.
• Another one in seven experienced temporary harm because the problem was caught in time and reversed.

Patients in the study suffered adverse effects such as bed sores, infections and excessive bleeding from blood-thinners.  Overall, the researchers estimate that 15,000 Medicare patients die each month in part because of care they receive while hospitalized.  Some of the adverse events were medical errors; some were unforeseen complications.  Still, the federal Agency for Healthcare Research and Quality called the results “alarming.”

Peter Pronovost, co-author of the book Safe Patients, Smart Hospitals, declared medical mistakes to be “an enormous public- health problem.” That should come as no surprise to anyone who works in nursing!  Mr. Pronovost also said, “We spend two pennies trying to deliver safe health care for every dollar we spend trying to develop new genes and new drugs.” That’s pretty shocking, right?  Especially since adverse events are so costly…to health care facilities and, most importantly, to patients.

Whether you work in acute or long term care, you can arm your nursing assistants with the knowledge they need to prevent adverse events.  The pennies you spend educating your aides may well save your organization thousands of dollars…and maybe even save a patient’s life!

Some ideas for inservice topics to promote patient safety include:

Preventing Medical Errors.  Teach your nursing assistants about the types of medical errors, the factors that contribute to mistakes and how they can take an active role in reducing medical errors at your workplace.

Understanding Drug Resistant Bacteria.  Review common drug- resistant bacteria (such as MRSA and VRE) with your CNAs and give them tips for how they can protect themselves and their clients from these deadly bugs.

Understanding Fall Risk Factors.  Remind your nurse aides about the factors that put clients at risk for falls including age-related factors, medical factors and environmental factors.  Be sure to include ways that your employees can help keep high-risk clients safe.

Preventing Pressure Ulcers.  Consider conducting an inservice on the causes of pressure ulcers and tips for preventing them.  As with other adverse events, make sure your CNAs understand how much easier it is to prevent a pressure ulcer than to cure one!

Providing Cost Efficient Care.  Preventing adverse events and saving money go hand in hand.  For example, how about reviewing the relationship between nosocomial infections and wasted dollars?  Give your CNAs practical tips for how nursing assistants can save money throughout their daily client care.

Client Safety Tips.  Give your nursing assistants an overview of client safety–whether their workplace is a facility or a client’s home.  Be sure to include information on fall prevention, nosocomial infections, faulty equipment, pressure ulcer prevention, medication and food safety.

By taking the time to educate your CNAs, you can help prevent adverse events such as the ones outlined in today’s new Medicare study.   Your relatively small investment now may save countless dollars later!

As you know, one of the primary roles of the nursing assistant is to collect and communicate information.  The information is collected by observing clients and communicated by reporting to the nurse and/or documenting in the client’s chart.  So, how good are your CNAs at observing and communicating important information about their clients?

For example, do they know the difference between information that is urgent, important or significant?  And do they communicate these three types of information appropriately?  For example, urgent observations are those that are immediately life threatening.  If your aides consider a client going one day without a bowel movement urgent information, you might want to give them a review of this topic.

Do your CNAs distinguish between objective and subjective observations?  When was the last time you reminded them that for information to be objective, they must be able to see, hear, feel or measure it…or have it confirmed by another person?  If the reports from your nursing assistants tend to sound like opinion instead of fact, they may need to brush up on this skill.

In both acute and long term care, things can change fast for your clients.  Your nursing assistants need to be knowledgeable about what is normal so they can recognize what is abnormal.  This applies to vital signs, mental status, elimination, the skin…and so much more.  While most CNAs learned the “norm” in school, it is helpful to give them a refresher on abnormal observations once in a while.

Here are some inservice ideas to help your CNAs hone their observation and reporting skills:

• Spend an hour giving an overview of the human body.  Review each of the body’s miraculous systems…and discuss how important each one is to a person’s overall health.   Then, your CNAs can use what they learn to help their clients live healthier, longer lives.

• Present an inservice about basic human needs.  Remind your nursing assistants that they aren’t caring for bodies, they are caring for people.  And, all their clients have very basic needs, including physical and psychological needs–fundamental needs that are the same, regardless of where or how they live. Review the five levels of Maslow’s hierarchy of human needs.

• Teach them about the normal aging process so they know what to expect when working with elderly clients.  For example, do your aides know that the elderly have fewer sweat glands, so they have trouble keeping their body temperature stable?   Or that the heart muscle becomes less “elastic” so it pumps with less force?  To make up for this, the heart beats more frequently.

• Give your aides a vital signs update.  While many organizations rely on technology to measure vital signs, your CNAs should never lose the basic skills of taking a client’s temperature, pulse and blood pressure.  And, since pain is considered the fifth vital sign, be sure to provide information about pain management.

• Review reporting and/or documenting client care information. During this inservice, remind your nursing assistants that if they are providing care for clients without documenting thoroughly and carefully—your organization may not get reimbursed for their work.  Or, if they are documenting care that they did not perform, your organization may not get reimbursed, and could possibly be fined for the false records.  Both situations result in a financial loss.  And, a loss for the organization is a loss for you, your CNAs and your clients!

If you don’t have the time to put together inservices on one or more of the above topics, remember that, at In the Know, we have done it for you.  You can click on the links throughout this article to see what we have to offer.  And, if you have ideas for inservices that you’d like our team of nurses to write, please send an email to info@knowingmore.com.  We’d love to hear from you!

Have you seen the latest online newsletter from the Joint Commission?  It details a number of the “most challenging requirements” for the first half of 2010…in other words, the requirements for which organizations are getting cited.  This is great information, especially if you expect a Joint Commission survey any time soon.

Here are some examples:

• 31% of home care agencies surveyed this year were found non-compliant in following physician’s orders!
• 23% of home care staff were found to be less than competent to perform their jobs.
• Home care staff failed to reduce the risk of client falls 21% of the time.
• A whopping 24% of Medicare-certified nursing homes were deficient in hand hygiene!
• In skilled nursing facilities, residents were not assessed or reassessed properly 17% of the time.
• 16% of skilled nursing facilities had an ineffective emergency plan.
• Hospitals didn’t fare any better.  47% of them were cited for improper fire safety equipment.  And, 27% of them did not maintain a safe environment for patients.

Armed with the above knowledge, you can take steps now to prepare your nursing assistants for future Joint Commission (or other) surveys.  And, we can help!  In the Know has inservices covering all of the above topics…and much, much more.  If you have pressing issues that you feel might come up during a survey, give us a call.  We can help you put together a pre-survey inservice plan that will help your CNAs sail through with no deficiencies!

And, if you’d like to see the Joint Commission statistics for yourself, check them out here.

If your client population is comprised mostly of seniors, the National Mental Health Information Center has some terrific (and free) resources for you.  As you probably know, mental health is a big issue for seniors.  In fact, people over age 65 have one of the highest suicide rates of any age group in the United States!

At the National Mental Health Information Center, you can download (at no charge) toolkits, fact sheets and staff workshops all aimed at preventing suicide and promoting optimal mental health among senior citizens.  All you need to take advantage of these materials is Acrobat Reader.

As your nurse aides provide personal care and assist with ADLs, it’s vital that they also pay attention to their clients’ mental health status.  If you are looking for additional mental health resources, don’t forget In the Know inservices.  We offer the following related topics:

• Understanding Depression
• Working with the Mentally Ill
• Understanding Schizophrenia
• Understanding Common Phobias
• Understanding Suicide

Because your CNAs spend so much time with your clients, they are in a good position to notice changes in mental health.  So, be sure to arm your nursing assistants with the knowledge they need to make (and report) appropriate observations about their clients’ mental health.

It’s a fact: adult learners enjoy lively continuing education sessions.  But, coming up with ways to spice up your CNA inservice meetings can be challenging.  Here are six tips that may help:

1.  Every month, insert a crisp new $1.00 bill in a couple of the inservice handout packets.  If you conduct your inservices in a group setting, ask the lucky recipients to read part of the inservice out loud or to “volunteer” for the participatory activities.
2.  To promote participation during the inservice, pick a “secret word” or “secret phrase” prior to the inservice.  It should be a word or phrase that is likely to be said by a participant during the learning session.  Write it down on a piece of paper and seal it in an envelope.  When someone says the secret word or phrase, make a big fuss and give that person a prize.  You can even have two or three secret words prepared to keep the group alert and active throughout the entire inservice.
3.  During an inservice–especially one that’s on a serious topic–take a few minutes to get rid of stress.  Pass out some “stress-reducers” such as squeeze balls, bubble gum or rubber bands.  Make paper airplanes and race them.  Or inflate balloons and let them loose.
4.  Reward participation during inservice meetings.  using “Monopoly money”, give out a bill for each contribution to the topic at hand.  Allow your CNAs to redeem the play money for little prizes (candy, magazines, pretty pens, etc.) that “cost” a certain amount of play money each.
5.  Put a disposable tablecloth on the table during your inservices.  Let your nurse aides draw or write on it (before and after the inservice and during a two minute break in the middle of the meeting).
6.  To encourage group discussion or to make it easier to break into teams, copy each inservice onto two or more different colors of pastel paper.  Group the participants together based on the color of their inservice.  Or, ask for a member of each group to comment on a discussion question.

Using one or more of these simple strategies is bound to enliven your educational sessions and enhance learning…so, happy teaching!

Your CNAs make observations about their clients all day long.  Therefore, it’s incredibly important that each of your CNAs know what, when and how to report what they see.  Not only should your nurse aides know the procedure for reporting and documenting client care, they should also be aware of what observations are considered abnormal.  After completing our new inservice topic, “Recognizing and Reporting Abnormal Observations”, your nurse aides will be able to:

• Distinguish between normal and abnormal observations in their clients.
• Identify the specific course of action to take with each abnormal observation they may encounter.
• List at least three abnormal observations they might make in regards to:  vital signs, mental status, nutrition and pain.
• Distinguish between objective and subjective observations.
• Demonstrate the ability to recognize and properly report abnormal observations in their daily work.

Would you like to see a sample page from the inservice? Click here to view the PDF file.

Interested in ordering this topic? Click here to visit our website.  If you would prefer to order over the phone, call us toll-free at 877.809.5515 and one of our helpful associates will be happy to assist you!

It’s part of life. As we age, we are forced to deal with a greater number of serious emotional losses.  Most elderly people must face a variety of different losses.  Do your CNAs know how to help their elderly clients deal with those losses?  At your next CNA inservice meeting, consider using the following scenario as a way to open a discussion about loss among the elderly.

Emotional Losses of the Elderly

“In youth, we run into difficulties.  In old age, difficulties run into us.”

~Josh Billings

There’s no way around it. Losses are painful and often sad. They represent an end to something—and this ending creates an emotional wound. This is especially true for the elderly who must endure a number of different emotional losses. For example:

• At age 65, Sarah Smith retires from her job. Even though this gives her more free time, she misses the daily contact with her former coworkers. A year later, Sarah’s husband dies. His sudden death leaves her devastated…and in some financial trouble.

• During that same time, Sarah is diagnosed with both diabetes and hypertension. She also develops chronic back pain.

• On her 67th birthday, Sarah receives word that her sister has passed away. Three months later, Sarah’s best friend dies from cancer.

• Six months later, her son decides that she should no longer live alone. He helps Sarah sell her house and moves her into an assisted living facility.

• To the staff at the facility, Sarah seems like a grumpy, forgetful woman who keeps to herself and seems impossible to please. No one is very fond of her. But look at things from Sarah’s point of view. Within two short years, she has lost her work, her friends, her health, her husband and her home. Is it any wonder that she tends to be grumpy and withdrawn?

Just like physical injuries need time to heal…so do emotional wounds. People who spend time grieving are doing what they need to heal their emotional wounds. The only “cure” for grief is to go through the grieving process. People must do this in their own way and at their own pace.

Grieving is hard work and can leave people physically and emotionally exhausted. In the end, the process of grieving encourages people to take charge of their own lives and to move forward.

Would Your Nursing Assistants Like to Know More?

If you’d like to give your CNAs more information about emotional losses, consider presenting an inservice that includes information on:

• The three stages of grief.
• The physical and emotional symptoms of grief.
• The loss of youth.
• The loss of family and friends.
• The loss of work.
• The loss of a spouse.
• The loss of health.
• The loss of independence.
• What your CNAs can do to help clients through these losses.

Don’t have time to put together your own inservice?  Then, please check out our inservice called Emotional Losses in the Elderly.  It covers all of the above information…and more.

Happy Teaching!