Encouraging Best Practice in Residential Aged Care Program: Final Evaluation Report
5.1 - Improving staff knowledge and skills
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- Key Messages
- Executive Summary
- About This Report
1 - Introduction- 2 - Evidence, Changes in Practice and the EBPRAC Program
- 3 - Program Delivery/Implementation
- 4 - Program Impact
5 - Capacity Building- 6 - Generalisability
- 7 - Sustainability
- 8 - Dissemination
- 9 - Appropriateness
- 10 - Cost Implications for Government and Aged Care Providers
- 11 - Perceptions of High-Level Stakeholders
- 12 - Discussion and Conclusions
- 13 - Recommendations
- References
- Appendices 1 to 6
- Appendices 7 to 12
- Appendices 13 to 17
All projects focused on improving staff knowledge and skills, predominantly through the provision of formal education and training processes delivered either by project leads, local facilitators or external consultants/services. On the whole, educational materials were developed anew for each project, or existing materials were modified to meet the approach being undertaken.
Twelve projects delivered structured training programs, usually in small groups. These comprised face-to-face training in blocks of either hours or days, ranging from half an hour to up to two days duration, generally undertaken at a time suitable to the needs of participating facilities. One project used five-minute ‘micro training’ sessions, incorporated into the day-to-day work of facilities. The majority of training was provided face-to-face, although some projects provided e-learning opportunities to encourage a broader range of staff to access the learning materials. Two projects used an explicit one-to-one training approach (academic detailing/educational visiting). One of the palliative care projects facilitated learning opportunities through clinical placements. The numbers of staff trained, and how they were trained, are summarised in Table 18.
The education programs were delivered by a combination of project staff, ‘champions’ or ‘link’ staff and specialist consultants. The overall reach of the education programs depended on the approach of the individual project, with some reporting participation of staff in their hundreds, or significant percentages of a defined workforce. To support the education most projects included the development of resources, or a tool kit, which provided prompts, pathways, protocols and educational resources. For further information about the resources see Section 5.2.
Table 18 Numbers of staff trained
Project | Numbers of staff trained by type of training | Total | ||
|---|---|---|---|---|
Training workshops | Academic detailing | Other on-the-job training | ||
| 1 1 | 350 |  | 350 | 350 |
| 2 2 | | | | 0 |
| 3 | 364 | | 4 | 368 |
| 4 | 187 | | | 187 |
| 5 3 | | 675 | 60 | 735 |
| 6 4 | 641 | 94 | 47 | 782 |
| 7 | 473 | | 98 | 571 |
| 8 | 1534 | | | 1534 |
| 9 | 216 | 564 | | 780 |
| 10 | 525 | | 60 | 585 |
| 11 | 30 | | 350 | 380 |
| 12 | 180 | | 50 | 230 |
| 13 | 267 | | 100 | 367 |
| Total 5 | 4767 | 1333 | 1119 | 6869 |
- The staff trained in this project attended a training workshop and received on-the-job training i.e. the total number of staff trained was 350, not 700. The total number trained in all projects is therefore 350 less than it would otherwise have been if the total trained by each method were simply added together.
- Formal training was not part of this project’s methodology but 67 staff did attend action research meetings that formed the core of the approach to change management and would have developed skills as a result of their attendance.
- This project trained staff using three education modules. Of the total of 675 who attended at least one module approximately 450 were trained in all three.
- This project did not specifically use academic detailing but did report some 1:1 staff training in the section of the economic evaluation questionnaire which asked for information about academic detailing.
- The totals in the table are the best estimate of numbers of staff trained but contain some inaccuracies. For example, one person may have attended more than one workshop (and hence been counted twice), or attended a workshop and also received some on-the-job training.
One of the major challenges faced by the EBPRAC projects was tailoring education programs to the diverse level of knowledge and skills of facility staff:
The varying levels of education, experience and literacy among RACF staff was one of the greatest challenges for the project. (QUT wounds final report, p 26)
It is difficult to design education to meet the needs of both registered nurses and personal carers, for example. Six projects identified particular issues arising from low levels of literacy amongst facility staff, usually due to large numbers of staff from culturally and linguistically diverse backgrounds.
Some education facilitated the gradual development of knowledge and skills with a process of reflection and opportunities to ask questions, which seemed to work well:
You need to actually keep resurfacing the material that’s been taught and re-talking about it to make the cultural change. (F)
The way that you can get people to reflect on their practice and change their practice and then be available for them to come back at their own pace, that's the side that the participants have really enjoyed. (P)
When we had some of the training sessions that we were involved in, carers would come out and sit there and fold their arms like, “We have to sit through this training session.” They very quickly became interested when they realised the impact because the first session is about knowledge, it’s about the impact of oral health on general health and that started getting their interest. The second one was about practice, about workshopping activities, and then the third one was reflective practice. So very quickly their attitude changed. (P)
Training in facilitation skills was a key focus of some of the EBPRAC projects, and staff in facilities acquired a number of skills to enable them to take on these roles. The falls prevention project reported that its falls resource nurses gained skills in running education programs, project management, group facilitation and quality improvement cycles. As reported in Section 3.3.3 a total of 177 facility-based champions were trained as part of the EBPRAC program.
Similarly, the oral health project placed considerable emphasis on strategies to create a team amongst the project partners, including team building exercises with an organisational psychologist at the start of the project, and a workshop on presentation skills. The wound management project reported that its engagement with staff resulted in an improved learning culture within the organisation and improved communication between staff.
Facilitation was also supported by developing linkages between staff in facilities and other professionals. Several projects reported that links had been developed between facility staff and local (outside the facilities) experts.
Staff were introduced to research skills, particularly in those projects which used an action/participatory research approach (e.g. falls prevention, nutrition and hydration projects). In these cases, project staff worked closely with facility staff to identify problems, develop strategies and implement solutions:
I think it was good for some of the Div 2 staff to see what action research was all about, that gave a couple of them a really good understanding of action plans and how to evaluate and now all staff have a portfolio here and we do action plans but instead of me doing them all, I’ve noticed that a couple of girls on the project who actually write out an action plan for their portfolio so they’ve learnt that through the project and they’re good at it. I don’t think they would have known how to have done it without doing the project. But they do now. (F)
The same person, when asked how action research differed from quality improvement, responded as follows:
Action research is exactly the way I do any action plan and part of my continuous improvement plan here for the unit and it’s exactly the same.
The question arises with action research, as with other capacity building techniques, as to whether action research can be used on an ongoing basis to make improvements. Nothing was reported by the projects using action research that gives cause for a great deal of confidence in this regard, as indicated by this comment from someone who helped facilitate action research:
I think they would probably like to use that approach in other areas … they enjoyed being part of this process and they enjoyed the ability to make their voices heard and drive something, but being able to do that on their own without a project or external researchers coming in and helping them, it’s a bit of an ask for them I think. (P)
A key aspect underpinning the improvement of skills has been the provision of resources, both in terms of training/educational material as well as financial support e.g. for backfill so staff can attend training or participate in the project activities.
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