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  1. Creating In-Services for your Activity Department and the Facility by M. Celeste Chase AC-BC, ACC, CDP ActivityDirector.org Learning opportunities through in-services not only sends an intrinsic message that staff is highly valued but will also boost employment retention and job satisfaction. Appropriately supported, in-services have an added benefit of preventing job burnout for those in the demanding healthcare industry and that is a win-win for everyone! Interpretive Guidelines Tag 679 – Identifies that “all staff” is accountable for assuring that meaningful activities are provided to ALL RESIDENTS regardless of resident limitations or lack of response. To this end, all staff members must fully understand not only the therapeutic value of engagement as it relates to quality of life, but must possess appropriate skills, techniques and strategies to deliver meaningful activities. The Activity Director is the key individual to take the lead in this training through facility in-services. A great place to find topics (“good bones”) for in-services can easily be found within the Interpretive Guidelines. Let’s take a look at three up and coming guidelines from: [Phase 3] - OBRA 87’ Interpretive Guidelines effective on: November 28, 2019 F940 §483.95 Training Requirements Facilities must develop, implement and maintain an effective training program that is based on the Facility Assessment. Training must be completed for new staff, existing staff, contracted individuals and volunteers (consistent with their roles). The amount and type of training required should be reflective of the services and patient acuity identified in the Facility Assessment. This guideline states that training topics must include, but are not limited to: Communication Resident’s Rights QAPI - Quality Assurance & Performance Improvement Infection Control Compliance and Ethics Behavioral Health F941 Communication Training Facilities must have mandatory training for direct care staff on effective communications. The importance of communication is emphasized, including communication across all shifts and information sharing between staff, residents and representatives. Direct care staff needs to understand their responsibilities for reporting change in condition and sharing information between team members for continuity in care provided that is based on individualized interventions. F942 Resident’s Rights Training Facilities must ensure that all staff members – not just direct care staff – receive appropriate education on resident’s rights and be knowledgeable in the facility’s responsibilities in providing care for its residents. Under F550 Resident’s Rights, residents have the right to be treated with dignity and respect, and all interventions with residents by staff must assist the residents in maintaining/enhancing their self-esteem and self-worth, show respect for each resident’s individuality and incorporate the resident’ goals, choices and preferences. NOTE: This training requirement is likely to already exist in most facilities, but facilities that do not have this topic included in its staff education requirements will need to do so by the [Phase 3] deadline mentioned above. You can easily see that OBRA 87’ Interpretive Guidelines makes training expectations abundantly clear and sets the bar for specific materials for learning opportunities. This will provide you with a strong arsenal of tools from which you can reference for new in-services to ensure that your facility complies with recommended standards. Be sure to compare these topics with your new staff member’s orientation training topics as well as your annual mandatory re-education plan. For a successful in-service experience, develop a strategy that supports team synergy and mutual respect to get other staff members excited and willing to be committed to your program. In-Service/ Foundation Plan: Listed below are the preliminary steps to develop your in-service program. Each component is a building block to the next and will get you well on your way to creating a strong and successful in-service that will enlighten your fellow staff associates in a way in which they will better understand and respect the complex nature of the work you do as a professional Activity Director. Component # 1 –Training Order The order of presenting in-service training sessions can start with the most urgent to least urgent or oldest information to newest information, or build upon the initial session to the next. The ladder works well if the attendees need to understand certain things before assimilating more advanced materials. Component # 2 - Ask How Your Attendees Learn Best Another effective time saving strategy is to incorporate learning styles that are well suited to in-service attendees. As you most likely know, many of us attain information better when given specific ways to learn. Some people learn the quickest through reading, while others prefer visuals and hands-on experience. Understanding the learning styles of your audience will make your time more effective and productive thus, getting the most value for the time spent. Component # 3 - Materials Distribution Before the In-Service Consider distributing informative materials such as manuals, or short “cheat sheets” or step-by-step introductions relating to the topic scheduled for the in-service before training session begins. This is a great way to build up in-service anticipation and interest. Distribution prior to the in-service will also decrease the customary introduction time at the beginning of the in-service and help you jump right into the material to be presented. Component # 4 - Create a Training Schedule When in-service trainings are conducted during “on-duty” hours it is wise to set a predictable schedule. This allows attendees to plan for floor coverage and seek necessary supervisory approval in advanced. Be cognizant and adaptable to staff availability to ensure optimum participation. Mindful scheduling during on-duty hours to reduce staff “off the floor time” will also be looked upon favorably by your administration. HINT: In-services held after regular work hours should also be respectfully scheduled so that it doesn't infringe upon the staff’s anticipated leisure time. Once again your consideration and sensitivity in this area will more likely create eager participation. Component # 5 – Incorporate Session Breaks It’s a given that long in-service training may not be permissible particularly when staff’s “off the floor” coverage proves to be challenging. That said, take a moment to break away even for s short bathroom visit. It may be all you need to keep your attendees focused and refreshed thus, moving the in-service in a positive direction throughout the session. Component # 6 – Serve Light Refreshments As a very common and familiar adage goes, If you feed them - they will come! Providing food at a business event can promote attendance and provide a welcoming atmosphere which in turn, will get your in-service off to a great start. Keep it simple – consider dietary restrictions. What you serve will depend on the time of day that you schedule your in-service. Morning events tend to focus on coffee, tea, fruits, pastries, etc. Afternoon events are more likely to be about soda, cookies, pretzels, etc. Bottled water is always appropriate no matter what time of the in-service and decaffeinated options should always be offered. Creating and organizing interdisciplinary facility in-services for staff will set you apart from the rest and help you develop a reputation as a knowledgeable and credible professional in your field. Fellow staff members and associates will quickly recognize the complexity of your position and will readily get on board to ensure that every staff member provides “quality of life” opportunities for all the residents within your facility. “Opportunities for learning - present an extraordinary prospect to expand our knowledge base and growth both in personal confidence and competency skills that ultimately will benefit the residents we serve.” Have a topic request or question for Celeste? Send them over to CelesteChase @ activitydirector.org ENROLL Now Activity Directors Network was founded in 1996 on the idea that we could help create elderly care that dramatically improved the lives of those we all serve. Activity Directors are the key to creating environments that we ourselves would be excited to live in. We envision facilities that feel like homes, not institutions. Facilities that celebrate our resident’s individuality and allows them to live with dignity, purpose and joy. We believe providing the best education available, with the most talented teachers we can find, is the way to make an impact. Each and every single one of you are the revolution that is changing everything. Thanks for being a part of The Network. Copyright © 2019 Activity Directors Network, LLC All rights reserved. Our mailing address is: 2010 US HWY 190 W Ste 120 Livingston, Texas 77351
  2. Resolving Resident Conflict – Combative Behavior [Part I] Residents in long-term care may experience chronic cognitive impairment or confusion which may manifest into combative behavior. It is imperative to recognize that a resident’s combativeness could be the residents’ effort to communicate need for care. Healthcare professionals must always be mindful that the behavior is not personal in nature; as in emotional feelings of dislike or misplaced, unwarranted fear. Communication issues can occur when a resident has limited (receptive) abilities that fail to translate to a normal dialog appropriately. Reduced information processing speed and capacity can be attributed to problems with comprehension. Even simplified sentences can put a strain on residents’ brain processing resources to assimilate more information than he/she is capable of understanding. Aging adults may also be (expressively) compromised with less ability to form comprehensible sentence structures, largely due to declining working memory capacity. The healthcare professionals’ ability to assess, understand and take action to prevent combative behavior “before it occurs” will significantly reduce communication breakdowns and help the resident to be more fully accepting of his/her personal care. What is Combative Behavior? Any physically aggressive act that causes or is intended to cause hurt or damage to another person or object and even to self may be an indicator of combative behavior. Some types typically encountered in long-term care may include: Physical acts- punches, fighting, kicks to endanger others Resisting care- aggressively hampering efforts to accomplish ADL’s (bathing or dressing) Verbal aggression- arguing, cursing, threatening or accusing Catastrophic reaction- sudden mood swings, outbursts, or lack of self-control What may cause combative behavior? Psycho-social: Resident feels threatened by life changes and frustrated at a perceived loss of control. Unable to communicate adequately, a resident may misinterpret efforts to provide care or may be unable to control his/her feelings, or may withdraw from interaction due to conflicting thought processing. Environmental: Room lighting that is either too bright or too dim, blaring radios, television, intrusive central facility intercom announcements, clutter or constant staff traffic distractions, unanticipated room changes or routine changes, lack of consideration for how the resident likes his/her belongings arranged or reorganizing without resident involvement. Other areas that should be respected include the halls, nursing stations, dining rooms and any and all locations residents can easily navigate as part of their daily living. Dementia: A declining brain disorder affecting both personality and thought processing. It is an organic brain disease caused by a number of illnesses (including Alzheimer’s) that is considered progressive in which the afflicted individual begins to lose touch with reality and is unable to understand the world they have found themselves surrounded by. Unskilled care-giving: Staff unknowingly contribute to behavior issues when they take a position of authority, display gestures that startle or frighten, administer care roughly or in hurried fashion, display impatience, or speak in loud or demeaning conversation. Multi-faceted underlying illness: A comprehensive assessment must be done to determine the probability of other underlying medical illnesses that further contributing to aggressive behavior; and may include non-organic external elements such as alcohol or drugs abuse, medication interactions and lack of sleep. Interventions – The 'Never List' for Resident Agitation 101 NEVER enter a residents’ room in numbers of two or more staff members as it may put the resident in defensive mode. If safety is a concern, ask a supporting staff member to wait outside the room NEVER wear a stethoscope, hanging earrings or shiny jewelry around your neck. NEVER ask the resident to do more than two or more tasks at once; keep your instructions to one-step at a time. NEVER approach a resident quietly by surprise. Allow him/her to see you coming. NEVER forget to introduce yourself every time with a smile; even when your resident knows you. NEVER display your emotions through body posture; emotions are easily expressed non-verbally in body language. NEVER speak to your resident while competing with multiple stimulus such as a radio, television or music. NEVER take action to do something before explaining what you are about to do it in simple terms; ascertain that he/she understands. NEVER approach a wheelchair bound resident face on for your own safety. NEVER underestimate that the resident may also be just as confused and surprised by his/her own behavior as you are. NEVER correct or point out word usage errors expressed by your resident; use visual cues at this time Never, never instruct or state limits when dealing with an agitated resident. Be particularly mindful of certain command statements in the heat of the moment as they only tend to escalate the level of resident transgression: NO – STOP THAT DON’T DO THIS DON’T DO THAT PUT IT DOWN NOW LEAVE IT ALONE STOP GETTING UP While it is impossible to anticipate how one resident may interact with another resident and or staff member, each facility must be prepared to handle difficult interpersonal or behavioral issues. The goal is to prevent escalation from resulting into physical altercations. Behavior modification techniques and strategies must be a standard in-service education for all staff members to develop expertise in dealing with conflict and/ or other related issues involving safety and well being. When aggressive behavior is mismanaged, it affects families, staff and disrupts other residents. But when handled in a respectful, positive way, conflict can be quickly dissipated and restore peaceful harmony within the community. QUIZ 1. TRUE or FALSE A resident’s combative behavior is often a sign that he or she does not like you or is afraid of you. 2. TRUE or FALSE Resisting care, verbal aggression, fighting and catastrophic reactions are common forms of combative behavior. 3. TRUE or FALSE Dementia, the type seen in organic brain diseases such as Alzheimer’s, is the only true medical cause of combative behavior. 4. TRUE or FALSE Combative behavior often occurs when a resident is unable to communicate adequately, misinterprets efforts to provide care or is unable to control feelings. 5. TRUE or FALSE Loud television, speakers or people coming and going, and very bright light do not really trigger combative behavior. 6. TRUE or FALSE Unanticipated room or routine changes can trigger combative behavior. (ANSWERS: T, F, T, F, T, F) Next Week: Part II – Discover Patterns That Lead to Outbursts Have a topic request or question for Celeste? Send them over to celestechase@activitydirector.org Join the Activity Consultants Help Desk or Share the Link with a Friend.. BUY Now Activity Directors Network was founded in 1996 on the idea that we could help create elderly care that dramatically improved the lives of those we all serve. We envision facilities that feel like homes and that celebrate our resident’s individuality and allows them to live with dignity, purpose and joy. We believe the exchange of education and wisdom between the most talented teachers and passionate students is the way to make an impact. Each and every single one of you are the revolution that is changing everything. Thanks for being a part of The Network. Copyright © 2019 Activity Directors Network, LLC All rights reserved. Our mailing address is: 2010 US HWY 190 W Ste 120 Livingston, Texas 77351
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