Resident Assistant Case Study

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LHU RA Training Case Study

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It notes the importance of logging shift-to-shift changes, and provides the Early Warning tool and the SBAR Situation, Background, Assessment, and Recommendation tool for the participants to get to know and use. This module is designed for presentation in two sessions. The first session introduces the importance of detecting change and describes how to detect change. The second session discusses the top 12 changes to watch for and describes how to use tools to document and get ready to communicate about the changes.

Have participants understand what it means to be in a safe work environment with open reporting and to buy into that as something they want to be part of at their nursing center. The module materials also can be used flexibly to fit a range of session lengths. Selecting materials to suit a minute single session, for instance, is quite possible. However, this module is designed to be a 2-hour session. Objectives are separated into knowledge and performance objectives. You can use these at the start of the session and even have them up on a flip chart or screen that stays on the side of the room during the session.

Alternatively, you can return to them at the end of the session to give participants a sense that they are following your road map. It is often best to select one, two, or three objectives and leave the others aside. In teaching material that you want participants to really take in and use in practice, "less is often more," so that participants can take in and integrate the new material in a usable way.

You can remove unwanted items on the slides or highlight the information on which you will focus. These training materials are meant to be used as a complete package. However, you may tailor them to the needs of participants and current practice at their nursing center. To determine needs, you may use a survey or talk to individuals familiar with the nursing center. Whether you choose to use all or some of the material in the Student Workbook, decide on a focused goal for teaching.

It is better for participants to learn and remember a few important pieces of new information than to feel overwhelmed by many new ideas. Consider the language level that will best suit your audience. If you use technical medical terms, be sure to insert the meaning of the term. If your audience uses English as a second language, speak clearly and not too quickly. Most instructors find that a combination of methods—lecture and interactive—works best.

Consider using a selection of these teaching methods:. Suggestions for ways to use these methods are in the " Recommended Teaching Methods " section of this module. Although this is a 2-hour module, you can teach it in two 1-hour blocks. You can also select material within the module to make a minute or a minute session or two minute sessions within a 1-hour time slot. This flexibility is important, as some nursing centers might not have adequate nursing coverage for a 2-hour session. The Student Workbook is not meant to be used as a prepared speech.

It assumes that you know the subject and offers material you may want to use. The suggested slides Appendix 1-A are meant to trigger your presentation. You will find it useful to practice speaking with them. This module aims to help participants improve the way they notice, report, and keep track of changes in a resident's condition. Adults take in new information more quickly and remember it better when it relates to their own experience. Structure your session to draw on what participants already know and what they want to learn.

Make sure everyone feels that they have something to contribute. Teaching methods such as interactive lecture, case discussion, and role play help lead adults to make changes on the job. A good way to get your group moving in this direction is by starting with a case for discussion. If the case reflects a situation that's familiar to participants, with a problem they want to solve, you will have a "teachable moment. With this method you present the material, using questions-and-answers Appendix 1-B and slides Appendix 1-A or other visual aids. The case tells a story. It involves situations similar to those faced by participants at work. You lead a discussion that brings in what they know and how they might handle the situation. You will want to be sure that different ideas are heard, and see if anyone changes his or her mind.

You'll find a sample case in the "Making the Presentation" section, below. It can help them see a situation from different points of view. It also helps them develop communications skills. With all these techniques, it's useful to note participants' ideas and questions—a flip chart works well. This helps keep participants thinking and engaged. You can keep a "parking lot" list of thoughts that may not be on point at the moment, but should be kept in mind when you're summing up the session. However, you should feel free to choose the parts you think are most relevant for your particular audience and their nursing center. The slides in Appendix 1-A may be reproduced and provided to participants.

Think ahead about the kind of setting that will be available and best allows your targeted group to participate in the training. You'll also want to consider work shifts, and how your session can fit with in-service training requirements or other options. It helps if your session meets some of the nursing center's requirements for staff training. It's also good to provide refreshments if you can—that tends to increase attendance. Post announcements ahead of time so that people know when and where your session is going to happen. You might have a leader introduce the session to show that it's important. These provide real-time feedback on how well the training session worked.

The pre-test sets a baseline of what participants knew about the topic before the session; this can be compared to the results of the post-test to answer the questions, "What changed from the beginning of the session to the end? Did participants learn what we wanted them to learn? You will need equipment that allows you to display slides and also record discussion points and questions from participants.

You may use:. For this module, a mix of teaching methods may be the best—some interactive lecture, some case discussion, and some role play. The "stand-up" lecture works well when it's about something participants care about, and when the speaker is engaging. It's best used when a large amount of information needs to be delivered to a silent audience. In an "interactive lecture" you still speak most of the time and control the subject being addressed, but the audience participates in different ways—asking or answering questions, giving examples from their experience, and expressing opinions.

Like a story, any lecture—regardless of length—has a beginning the introduction , a middle the body , and an end the summary. Each of these serves a different purpose. Introduction: establishes the purpose of the lecture, including overall goals and specific objectives. It should include an overview of the whole lecture. You are aiming to get participants interested and make them aware of expectations for the session. Body: includes the material needed to meet the objectives stated in the introduction. Your session will be most effective if you:. Summary: includes a recap of the material presented in the body of the lecture.

It may also include an opportunity for participants' questions and feedback. Most instructors prefer to use the case provided in this module. A clinically experienced instructor who is also a seasoned teacher may also invite participants to contribute relevant cases in which they have been involved. But a new instructor may prefer to keep the focus on a familiar case. A is a mentally intact year-old frail in a weakened condition woman who arrived at the Manor Nursing Center following a hip fracture suffered at home.

After a stay at an acute rehabilitation center, she is still not able to manage by herself. A walks with difficulty with a walker, and needs help with daily living activities. A also has several other medical problems, including high blood pressure, diabetes, and arthritis. She is also being treated for depression. Her family visits her regularly on weekends. She rarely participates in activities of the Manor Nursing Center; at mealtimes she tends to avoid conversation. Recently, she had diarrhea, was incontinent of liquid stool, was placed in adult briefs, and nursing assistants had to change her adult briefs once or twice per shift.

She began taking meals in her room. Stool tests showed that she had a bowel infection with Clostridium difficile. An antibiotic was started. Even with the antibiotic, her bowel movements continued to be liquid and frequent over the next week, and she was eating less. Yesterday she had a fever of How did Ms. A get so sick with only diarrhea? What changes might you have noticed about Ms. When might you have decided to do something about it? What could you have done? The case in the Student Workbook is the same. You may not need to use much or any of the clinical detail in your teaching; it is provided here in case it is relevant.

Once the case has been presented, pause and invite participants to comment. Questions to get discussion going and draw on prior knowledge might be of the "survey" type:. You might ask participants to brainstorm ideas about ways to communicate that would prevent this situation. Keep in mind that you are trying to get participants to think in terms of teamwork rather than blame.

Try to get them to talk with each other, not just to you. Have them discuss a topic in pairs or in groups of three. This method makes it easier for a shy person to be heard as the less shy member of the pair or team can speak up for both or all of them. If the number of participants is small, you could lead the case discussion with the whole group. Larger groups may be broken up into smaller ones, with each taking one or two questions and then reporting out to the whole group. Or, you could divide the participants into groups according to what they do i. This technique has participants take on roles in a clinical interaction. There is no written script, and the "actors" don't have to memorize anything.

Set-up: Ask participants about their previous experiences with role play. Explain the goals of this exercise and relate them to the key learning objectives. Make sure everyone is familiar with the overview of the case. Only the "actors," however, will know the details of their roles. It may be helpful to provide the description of the role play to those who are not participating as actors in the role play. Assign the roles: You may have actors play a role similar to the one they have in their real jobs, or you might encourage them to try out a new one. A licensed nurse, for example, could take the part of a resident, or a nursing assistant could act as a licensed nurse.

Involve as many people as possible in the role play. Because role play requires participants to be somewhat emotionally open, they may feel anxious or resist being an actor. Your own positive attitude and a light touch will help. Any participants who are not assigned to a role should be asked to be observers. Conduct the role play: Participants act out their roles in the "scenario" you provide example below , based on the case. Try not to interrupt the role play while it is running; just let the interactions flow naturally. Before the scenario, explain how much time it will take, and that it will be followed by discussion. It should take only minutes, followed by perhaps 5 minutes of discussion.

Don't let the role play go on for too long—most of the learning happens in the first few minutes. If actors seem too carried away by their roles, remind them to keep it simple. Scenario 1. Two roles: Mary and Marli. Mary is worried about how depressed Ms. A seems. She has tried unsuccessfully to get Ms. A to talk. Marli is concerned about there not being enough people on the floor to get all the work done, and thinks Mary is spending too much time with Ms. Marli has had the experience of bringing concerns to the RN and nothing being done. They talk about whether they should mention anything about Ms. A to anyone else. Tell the role players to simulate the interaction between the nursing assistant and the licensed nurse, making it clear when the interaction is happening and in what setting e.

Tell them their goals are to: 1 get all the information across, 2 communicate about the situation in a timely fashion, and 3 be able to push if the message does not seem to be getting across. You can also tell the role players that the purpose of this role play is to discuss barriers to communication and how to effectively overcome the barriers. Discuss the role play: Discuss the issues that came up in the role play. Everyone's input should be included. After each scenario is played out, ask the actors: What went well? What did not go well? What would they do differently next time? Ask observers for their opinions about what the desired outcome was in each situation and how they might have handled the situation differently.

Conclude the role play: Encourage a round of applause as the participants transition "out of role. Consider with the group how to apply the role play to real life clinical situations. Emphasize what was learned during the role play. Thank your participants for attending. Let them know that you enjoyed being with them. Hand out the post-tests. Emphasize how important it is to complete the post-tests because they can get feedback on what they've learned based on their answers to the pre- and post-tests. Tell participants that you will provide the correct answers and rationales for the tests after they are done. It is often hard to get what is taught in a classroom or in-service learning session translated into action as part of resident care.

Even if the teaching has gone well and the learning was taken in and appreciated, it can be hard to put the new learning into practice. There are many possible barriers. For instance, the system of care may not accommodate the new practice, or the culture of care may not accept the change, or the leadership may not be aware of the new learning and so may not make room for it.

Following up after a teaching session with a quality improvement project in which the new learning is put into practice by the whole team can help a lot. Quality improvement projects use a step-by-step approach to improving care by taking a long, hard look at what needs to be done; starting out with a small change, watching it, adding to it, and continuing in this fashion until the job is done.

There is a method at work here, and the method is described in the next section, "Quality Improvement. Quality improvement methods often include a teaching step. This module can be the teaching material for that step. If the quality improvement project is to improve the way nursing assistants and licensed nurses detect and communicate changes in a resident's condition, then this module is perfect for the teaching portion of the project. The three main components are to:. QI is a team approach that involves everyone in thinking about innovation and recognizing that the key to improvement is the people who care for patients.

It is not about individual rewards and punishments, but rather QI relies on measurement to improve the center's performance as a whole. In this example we focus on detection of changes in a resident's condition. Most likely, a process to get to this point is already in place at the center. Still, it is helpful when starting the project to make sure everyone believes in its importance. Collect data to support your assumption that there is a problem and establish a baseline for measuring improvement. Leadership teams must include one or a few people with enough institutional authority to help get the resources that the project team needs. The ideal team size is five to nine members.

Additional temporary members with special areas of expertise can be invited to particular meetings as needed. For a "detection of changes" improvement project, the following project team members are one example of a good team. The aim should include a "stretch" goal that may be hard to reach but is achievable—for example: Decrease the rate of resident falls by 50 percent in 12 months. Examples of measurement data include a "process measure" like compliance rates for use of the Early Warning Tool or SBAR, or documented nursing notes in a resident's chart on reports of change. To show improvement, you should be able to plot the variable being measured on a run chart a graph that displays observed data in a time sequence.

Tools that you can use to collect and analyze data include process flow charts, brainstorming, cause and effect diagrams, and consumer focus groups. New South Wales Department of Health. Get team consensus on priorities and changes most likely to result in improvement and then decide on an intervention. Many interventions focus on what is done—for instance, changing or adding a protocol. These are good, but they often don't work as well as they could unless they go along with changing the culture to appreciate the importance of the new protocol.

The best interventions tend to address culture with team meetings and other educational or inspirational materials at the same time that the new protocol is added. Usually, culture change includes implementing and disseminating some core teaching. The cycle begins with a plan and ends with an action based on learning gained. It should specify who, what, when, and where. The end of one cycle leads directly to the start of the next one. The way you document observations may be simple, such as counting and recording on a tally sheet, or it may be more complex, such as using sophisticated tools for data analysis. If the data do not support the intervention, they may not be appropriate. Look at the data for clues about what to change, and run another PDSA cycle.

When you have finally arrived at a sustained change of the kind you intended, that final version of the intervention may be implemented on a larger scale. This means making it a permanent part of normal business throughout the unit or setting. It may mean applying the intervention throughout the nursing center, for instance. In this case, it would probably mean ensuring that all nurses and nursing assistants take the online teaching and demonstrate their familiarity with SBAR and Early Warning Tool.

Relevant support processes have to be implemented at the same time. For instance, the rollout of education will need to be supported with suitable in-service learning time. To provide evidence that the intervention resulted in improvement in all places where it was implemented, you will need to collect, analyze, and display the data. For example, you might create an annotated run chart showing changes in reported use rates for SBAR, unit by unit in the whole nursing center, after nursing assistants started using a new form to document changes in a resident's condition. You will be able to choose your measure from the experience you gained in the Intervention Phase as described previously. The QI step that fails most often is sustaining the improvement.

In nursing it is important to be empathetic. The nurse ensure that they are being empathic towards the client and not sympathetic. A smile alone cannot get the job done, but a positive outlook and a pleasant disposition, combined with fundamentals such as work ethic and discipline, make for a well-rounded employee. Flexibility and enthusiasm are also components of possessing a good attitude. A good employee must have good communication skills. These are essential for a.

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There now is someone in her life that is known for her beautiful piano playing. My communication skills are paramount in this environment, speaking with patients and staff members was a large part of the experience. This learning process helped me develop my tact and patience, and appreciate that the care of the patients is the first priority of the nurses. I have also carried out work placement in a hospital that offers palliative care. I relish this opportunity as I learnt that nurses see very challenging patients and need to be not only compassionate and thorough but also comfortable with ambiguity and careful advocates for their. Her ability to have the kindness and be that loving astonishes me.

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