Encouraging Best Practice in Residential Aged Care Program: Final Evaluation Report

4.4 - Impact on staff

Up to Publications

prev page| TOC |next page

Table 15 summarises the processes of education and training used by the projects and the outcomes achieved, as identified in the project-level evaluations.

Table 15 Processes of education and training, and staff outcomes

Project title	Processes of education and training	Staff outcomes
NARI pain	Education tailored to the needs of individual facilities. Clinical nurse educator appointed in each facility to support staff, including pain champions in each facility.	Staff have enhanced knowledge and skills and a more positive attitude to pain assessments and interventions.
UN nutrition	Participatory action research approach, involving regular ‘nutrition meetings’. Some education undertaken at the nutrition meetings. Other education was informal and opportunistic, in response to the needs of facilities.	Increased staff awareness of nutrition issues, and evidence of the application of specific tools to both monitor nutrition and respond when nutrition status is of concern.
NARI falls	A participatory action research method was used, in which ‘champions’ (falls resource nurses) were identified in each facility and received training. The falls resource nurses were supported to work with staff to identify strategies and resources particular to their facility, and to organise interactive falls prevention expos and/or training sessions.	Slight improvement in knowledge of falls risk factors and prevention interventions following training of falls resource nurses. Falls resource nurses reported improved skills in public speaking, leadership, organisation skills and running a training program.
SA dental	‘Oral health’ champions established in each facility and participated in education program on oral health assessments and oral health care. Three training modules on oral health assessment, oral health care planning and daily oral hygiene were developed. Champions supported in their delivery of training to staff.	Improved knowledge and insight about oral health by nursing and care staff, and improved oral health practices. Registered nurses did 60% of the oral health assessments.
DATIS meds	The original funding submission includes reference to ‘train the trainer’ education but this did not occur. Training was provided by people employed for that purpose. The majority of staff trained were personal care workers (250-300 per module) compared to nursing staff (approx 135-150 per module).	The final project report notes that there was increased confidence, competency and knowledge of staff, but there is insufficient data to identify the extent to which these changes occurred. Staff demonstrated improved medication management techniques, indicated by medication chart audits of residents conducted prior to and following the project.
QUT wounds	Local ‘wound champions’ provided with training which was also delivered to staff individually and in groups. A self-directed learning package was established, and resources developed to support the training.	Improved staff knowledge and skills regarding wound care. Improved learning culture and communication between staff.
PW inf control	Use of the Collaborative Methodology for quality improvement resulted in 102 PDSA cycles undertaken across seven facilities. Estimated that 70% of staff involved in education program that included various topics: hand hygiene, management of infections and issues around waste management, especially sharps.	Improvements in knowledge not directly measured. The project final report notes it had not been possible ‘to directly assess to what extent staff members generally understood the idea of a Collaborative methodology, remembered it and were capable of applying it in their workplaces, and/or were capable of teaching it to others’ (p 22).
MGPN pall care	The project facilitated access to existing education and training opportunities and built on existing infrastructure and resources. Additional training provided to introduce end-of-life care pathways and palliative care minimum data set. Staff responsible for providing day to day care participated more readily in training, whereas decision-makers (registered nurses and general practitioners) were less responsive.	Some evidence of improved confidence and skills of staff in discussing and implementing end-of-life care.
NEVDGP pall care	Academic detailing was used to deliver the two education modules for the project.	The education sessions increased staff knowledge, skills and confidence about end-of-life care and medication administration.
UQ pall care	Link nurses and champions established in each facility and provided with education and training to support the implementation of the palliative care pathway. The champions were supported to flexibly deliver training to staff within their facility. Resources were developed to support the implementation of the pathway.	The project reported enhanced knowledge and skills of staff in providing a palliative approach. There was also improved access to evidence in palliative care, including through the Caresearch website.
UTS behav	Local champions identified in each facility and provided with a training program which combined person-centred care and needs driven behaviours models. The champions were supported in their introduction of the action research method within facilities.	Mixed outcomes for staff. Three of the six facilities demonstrated an increase in knowledge and attitudes regarding behaviours of concern. Improvements in the way staff interacted with residents, according to observations of project staff, management and residents’ families.
HC behav	Three mentors delivered training and support to implement person-centred care and manage behaviours of concern. 80% of staff working with identified residents participated in a two-day training program. Staff provided with more informal learning opportunities through the provision of support from mentors, and participation in mentoring sessions to identify strategies to reduce behaviours of concern.	Staff demonstrated increased knowledge, skills and confidence in identifying, and responding to behaviours of concern. Many staff reported a reduction in stress and an increase in calmness and objectivity when faced with behaviours of concern.
MU behav	Best practice champions were established in each facility. The champions were supported to promote the e-learning package developed by the project which was made more generally available to facility staff. The champions were supported to facilitate ‘micro’ training in day-to-day practice.	Mixed outcomes for staff, dependent primarily on level of engagement and support of facility management. In those facilities where management was supportive, there were changes in staff behaviour which reflected person-centred care being implemented.

The main focus of activity for EBPRAC projects was improving the knowledge and skills of staff working in residential aged care. On the whole, projects developed their own materials to use with staff, basing them on existing evidence or clinical guidelines but adapted to suit the perceived needs of the audience. A small number used existing educational resources and/or infrastructure. The general approach of the majority of projects was the need to work closely with the facilities, and provide learning opportunities in a style and format that was flexible and responsive to the needs and circumstances of the facility, staff and resident profile, and the context within which care was being delivered. To that end, a number of strategies were used, including:

• Various collaborative approaches including action research and Plan-Do-Study-Act cycles.
• Structured training programs delivered in a group format.
• Self-directed learning modules.
• Academic detailing.
• Informal, opportunistic learning.

For further details about what was done to improve staff knowledge and skills see Section 5.1.

Outcomes for staff were mixed, but on the whole, included:

• Improved knowledge, skills and attitudes in the clinical area or approach to care.
• Improved access to and use of evidence-based resources and tools.
• Greater collaboration between nursing and care staff, as well as with health and allied health in the planning and provision of care.
• Increased confidence of staff.
• Reduction in stress.

Education is typically central to any program for promoting evidence-based practice, either alone or in combination with other strategies. Education that is more interactive seem to be more effective in changing practices than didactic education, although the effect tends to be small (Forsetlund, Bjorndal et al. 2009), and education outreach has a small to modest effect (O'Brien, Rogers et al. 2007). There has been little work on the effectiveness of inter-professional collaboration and education (Reeves, Zwarenstein et al. 2008). A recent review of the literature on the role of education and training for residential aged care staff concluded that education is a necessary but not sufficient for change and that the outcomes of such education ‘are equivocal and that benefits for residents are variable, neither always detectable or statistically significant, nor persistent. Nonetheless, the literature describes a formidable range of positive outcomes for residents’ (Nolan, Davies et al. 2008, p 418). From a human resource management perspective it is interesting to note that research into the effectiveness of training has generally focused on outcomes for individuals who attend the training, rather than the organisations they work for (Tharenou, Saks et al. 2007).
Top of page

prev page| TOC |next page