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What’s in it for Me? Developing Effective

Educational Programs Beyond the Traditional

In-Service Format

Josie Enriquez, MSN, RN-BC, CNL

• Explore the pitfalls to avoid in developing effective educational programs

• Utilize adult learning principles and evidence-based strategies in delivering continuing education

• Employ strategies to enhance the learning experience

• Understand the importance of ongoing evaluation of learning needs and being flexible in modifying the learning experience accordingly

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AreYOU

overwhelmed?

• Culture change

• Issues with staffing

• Inadequate staff development and education

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In the current long-term care environment, our team members are bombarded with a massive amounts of information and increasing demands to maintain competency in knowledge and skills to comply with regulatory changes and improve the quality of care. Most LTC facilities have limited

financial resources for staff development and education.

How effective are the educational programs we provide? Do you have the

appropriate resources for staff development and training?

Are you utilizing evidence-based strategies the delivery of educational programs?

HOW ARE YOU DOING?

• No clear purpose for the learning experience

“ The blind leading the blind”

• No training plan

“ Let’s just wing it”

• Trying to achieve too much in one session

“Death by In-service”

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• Turning sessions into Powerpoint shows

• No variety in instruction

Nonstop lecturing produces very little learning

• NOT establishing relevance

Trust Me approach to education DOES NOT work

“ You may not know why you need to know about this now but trust me in the future you will be thankful you did”

NOT able to connect present learning to the real world

• Skills NOT tested or enhanced

“ You went to nursing school so you should know this”

• Lack of follow-up

“ They’ve been educated on this, why do it again?”

• Lack of program evaluation

“ 100% attendance = great job!”

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• Disrespecting the learner

Making sarcastic remarks in class about their skills, intelligence, and work ethics.

Disparage their questions or their responses to your questions.

Give the impression that you are in front of them because it’s your job, not because you like the subject and enjoy teaching it.

Coming to the session unprepared, run overtime, and cancel

Cold calling participants

Turning the session into a scolding session

Embarrassing the learner

Going back to the BASICS

Understanding how we learn

• Adult learners bring experiences and self-awareness to learning that younger learners do not.

• Understanding learning domains, learning styles, and how and why adults learn.

• Applying adult learning theories in delivering effective educational programs: Knowles Adult Learning Theory and Transformational learning

Adults need to know why they are learning something

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• Adults want to know WHY they should learn- Adults are motivated to put time and energy into learning if they know the

benefits of learning and the costs of not learning

• Adults need to take responsibility- Adult learners want to be in charge of their own lives, their own decisions, and

their learning. They want to seen and treated as being capable of taking responsibility

• Adults are task-oriented- Problem-centric

• Adults bring experience to learning- Experience is background for learning, can be both a plus and minus- As an adult, experience is the source of “self-identity”

• Adults are ready to learn when the need arises- They perceive employer-provided training as employer-required training- Careful use of the term “mandatory”- They learn when they choose to commit to learn- SUBJECT needs to be of IMMEDIATE USE

• Set a cooperative climate for learning in the classroom;

• Assess the learner’s specific needs and interests;

• Develop learning objectives based on the learner’s needs, interests, and skill levels;

• Promote collaborative learning – “How do they best learn?”

• Provide a variety of instruction to meet different learning styles

• Evaluate the quality of the learning experience and make adjustments, as needed, while assessing needs for further learning

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Adults want to be co-creators of the learning process

They don’t want to be perceived as “blank slates” but as individuals with knowledge and skills to contribute

• Learning that changes the way individuals think about themselves and their world, and that involves a shift of consciousness.

• Create a climate that supports transformative learning.

• Know your students and the types of learning activities that most appeal to them.

• Develop and use learning activities that explore and expose different points of view.

•

•QSEN competencies

•NLN‐CNEA

•

•QSEN competencies

•NLN‐CNEA

•3 Domains

•Active Learning

•Strategies

•Methods

•3 Domains

•Active Learning

•Strategies

•Methods

•Respect, Excellence, Service, Diversity, Integrity, Lifelong Learning

•10 Caritas Processes

•Creating a caring environment

•Being present and authentic 

Watson’s Human Caring Theory

Mission, Values, Philosophy

Professional Standards

Outcomes, Economic, Legal, & Ethical Factors

Person‐centered Learning

Education

CommunityOrganization

Figure 1. Conceptual Educational Framework Model on Person-centered Learning

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• The traditional in-service format is the primary method of delivering mandatory in-services

• Pre-planned, with defined objectives

• Handouts are given regarding the content

• Lecture is the main teaching instruction

• Attendance is checked then kept in the binder

• Most cost-effective way of delivering education

Why do I need all this information?

How is this going to improve the quality of my job?

WHAT’S IN IT FOR ME?

What are the alternatives?

How can I make use of this in a practical way on the job?

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• Establishing the NEEDS and GOALS of the community

- Topic content should be driven by outcomes and data (e.g. high hospital readmission rate, nosocomial infections, acquired pressure ulcers, high incidence of falls)

- Make use of satisfaction and engagement surveys, quality assurance reports

- Evaluate your current situation when developing a plan for education and training by soliciting feedback from residents and team members

- Focusing on person-centered care – emphasize the importance of building relationships and creating a sense of belongingness

• Identify learner needs

- Who is the learner? (e.g. Nurse, CNA, Housekeeping team, Maintenance)- NOT everyone learns the same way and at the same pace

- Mind the educational levels of the team when teaching- Ask the team members themselves what their needs are

- Avoid letting a few vocal or assertive team members dictate the education content

- Identify preferred type of learning method

- Anticipate future learning needs (e.g. new organizational initiatives, upcoming regulatory changes)

Learning Need Topic 1

(Must know)

2 3 4 5

(nice to know)

1.

2.

3.

4.

Place an X next to your preferred

learning method(s):

______ Lecture and discussion

______ Case studies

______ Posters/ Displays

______ Self-learning modules

______ Journal article review

(journal club)

______ Audiovisuals (video, slides)

______ Written materials

(pamphlets, books)

______ Games and simulations

______ Computer-assisted

instruction

______ Other (describe)

______________________________

______

Sample Needs Assessment (Please list your top 10 learning needs and rank them from 1 to 5)

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• Develop an Education Plan- Set a time period for the plan

- Share it!

- In addition to listing in-service and CE topics arranged by month, identify possible resources, such as individuals who could serve as presenters, and a variety of traditional

and nontraditional teaching strategies

- Examine your web-based curriculum and avoid duplication

- Plan should be flexible and allow for new learning needs (e.g. new equipment, change in policy

• Celebrate Diversity- Identify language barriers

- Build teamwork by encouraging team members with similar backgrounds to help each other

- Use graphics or pictures to help new team members understand EMR documentation

• Importance of testing

- They may not have used certain skill sets for a long time

- They may have never performed specific tasks

- Policies and procedures may have changed

- Inaccurate or unsafe ways of performing tasks will need to be identified and corrected

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• A combination of in-service education, bedside instruction, competency-based education modules, and orientation were used as part of an integrated educational approach.

• A one-day CE program or skills fair for complex topics (e.g. Physical assessment) may be needed to allow sufficient time to retain information and evaluate understanding. You will be surprised at what you will discover.

• Utilize a variety of teaching strategies –• Lecture and discussion• Case presentations• Posters and bulletin boards• Education fairs• Clinical unit and clinical simulations• Self-learning packets and modules• Journal article review (journal club)• Audiovisuals (video, MicrosoftR PowerPointR, slides, overhead transparencies)• Written materials (pamphlets, books)• Games and simulations• Computer-assisted instruction, CD-ROMs, Internet

Observe and Learn

Adjust your pace and approach

Ask for Feedback

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• Storytelling- Remember how adults bring a lot of theirpersonal experience to their learning

- Story must be related to the goals of the classe.g. describing how it feels providing end-of-life care

• Video presentation- Pay attention to length and appropriateness to audience- Have a post-test, game or discussion after- Make your own video (e.g. fire safety video) – fun, lightens up the learning

experience, increases engagement

• Discussion- “When planning to integrate a discussion into a classroom activity, it is important to

first determine the “overarching purpose and expectations for the discussion” (Davis, 2013)

- Provide guidelines and have a specific format

• Role-playing- Effective for responding to situational events (e.g. a patient is unresponsive, how do

you activate EMS?, using the SBAR process with nurse-physician communication)

- Some may not be comfortable, start the process

• Post-up- Gather ideas from large groups

- Participants are given slips of paper (or Post-it notes) and asked to write down ideas which are discussed or evaluated

- A question or problem is read to the group (e.g., “How do we?” or “What would it take to?”). Ideas are written down and posted on a wall or flip-chart.

• Asking Probing questions- Asking the right questions invites participation

E.g. fact-finding, feeling-finding, tell me more, best/least, third party, magic wand (2015, Regents of the University of Minnesota)

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• Research also demonstrates that, while individual skill training provided by e-learning may comply with auditor needs, it alone will not result in benefits of quality of care or reduced turnover

• Establishing a feedback culture emphasizes communication. For example, training clinical nurses to provide feedback to nursing aides thus seems to be as important as the intervention itself

• Skills training must go beyond a single dose AND should be followed by refresher or periodic “booster” sessions to assist staff with continuing to implement new skills

• Evaluating Learning

- Accountability is key reason to evaluation

- Post tests allow you to review every question and answer with the team, provide time for discussion and sharing of answers, and how the answers relate to the learning objectives.

- Evaluation is an ongoing process

- Be sure to monitor for changes in quality indicators collected and monitored (e.g. sources: patient and staff satisfaction surveys, quality assurance outcomes, competency testing , and employee performance appraisals)

• Don’t be afraid to ask the difficult questions- Did they like the learning program?

- What would they have added to the learning experience?

- What did they like best? What did they like least?

- What are your takeaways?

- Was the learning environment comfortable?

• Consider using shorter evaluation forms that ask simple yes-or-no questions or questions with rating scales

- You should be able to measure outcomes

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Is your in-service a disservice?