Effective communication skills for nursing assistants are core to culture change of care. Nevertheless, proficiency in these abilities is not essentially instinctive. Valuable communication proficiencies must be trained in a manner that is comparable to the method other psychomotor abilities are trained. This is particularly important when “communicating with residents, awareness of the aging process and treating residents as people, not just bodies” (Inspector General Office, 2002, p. 4).
In addition, lacking of continuing education for nursing assistants has been well-documented in the literature (Inspector General Office, 2002). Findings from a 2002 Inspector General Report states that nurse assistant training has not kept pace with the needs of the nursing home industry. In addition, there is evidence to suggest that the method of delivery is extremely important. For example, studies consistently show that a lecture-type delivery is the least effective, and an interactive method is rated to be more effective among teaching methods. Enhancement of communication skills among nursing assistants can go a long way to improve service delivery to the community as well as interaction among peers.
Literature Review
According to Winchester (2003), those patients suffering from fatal illness are progressively being taken to nursing homes, and that while excellent soothing care calls for exceptional communication abilities, nursing helpers who have responsibilities of taking care of them are insufficiently skilled. The report further asserts that they “receive little education in communication during training programs or as in-services in the nursing home” (Lyons, Specht, Karlman & Maas, 2004, P. 5) acknowledges that
“effective communication and teamwork are essential for the delivery of high quality, safe patient care. Communication failures are an extremely common cause of inadvertent patient harm” (Rahman & Schnelle, 2008, p. 6).
The guiding principle to help in the process of culture change in nursing homes has been developed by Quality Partners of Rhode Island dubbed “Holistic Approach to Transformational Change (HATCH) model” (Quality Partners of Rhode Island, 2010, p. 7). These guidelines consist of six closely related domains that lead “to individual, organizational, community and systems changes” (Quality Partners of Rhode Island, 2010, p.8).
They include workforce, care practices, environment, leadership, family/community and regulatory/government.” HATCH model considers these six inter-related domains necessary for a transformation from institutional to individual care” (Kanter, 1993). Workplace Practice, Care Practice and Environment overlaps and surrounded by leadership and long term care unit are encircled by Family and Community and then by Regulatory/Government domains.
Among these six domains, the workforce domain is the ultimate purpose of the skill Lab enhancement. Workplace Practice (Workforce) refers to all of the activities, procedures and individuals whose labor and efforts impact on residents. This domain is critical because of the correlation between good jobs and good care. The domain of Workplace Practice offered these possible changes in establishing relationships as the number one organizational priority, supporting necessary changes and adjustments that will allow relationships to flourish personally, organizationally and environmentally; the inclusion of elders, caregivers, and families in developing avenues for relationship building; the use and promotion of learning circles; welcome and hospitality committees; Red carpet orientation programs; ways of welcoming new families, staff, and residents (Compas, Hopkins, Townsley, 2008).
Kanter’s Theory of Structural Power in Organizations provided the framework to assist the nursing assistant in their transformation or empowerment in changing the culture of care to patient-centered. Benner’s Novice to Expert Nursing Theory (9) provided the venue for peer mentoring. Kanter considers power as a structural determinant affecting organizational behaviors and attitudes. As stated, power is obtained from the ability to access and mobilize support, information, resources and opportunities from one’s position in the organization (Kanter, 1993).
Those with sufficient power are able to accomplish the tasks required to achieve organizational goals. These individuals have the ability to empower those around them through communication and thus create an effective work unit within the organization. On the other hand, individuals in positions that limit the ability to acquire power and opportunity perceive themselves to be powerless. Powerless individuals lack control over their practice and are dependent on those around them.
According to Kanter (1993), powerless individuals are more rigid, rules-minded and are less committed to the achievement of organizational goals. Kanter’s theoretical framework was the spark for developing the program called guided growth intervention to empower nursing assistants in the long-term care setting to effectively communicate with the residents. In the guided growth program, nursing assistants will be involved in the structured education in the Skill enhancement lab. The NA will watch a prepared video and identify ineffective communication styles. With the help of a facilitator, the nursing assistants will role-play the effective way of communication. Through role-playing, nursing assistants’ competency will be determined and mentored to enhance the skill.
Nature of the Problem
Communication within our Culture Change Committee and Council Leader Group meetings are critical at our hospital Community Living Center. Miscommunications sometimes do happen even when people have good intentions. Consequently, it is important to know how to show sincerity and warmth to our veterans, family members, and staff which is a core principle of Culture Change transformation. It is worth noting that miscommunications, Staff attitudes, and communication techniques directly affect resident care and the living and working environment of the Community Living Center (Hoffart &Woods, 1996).
Training on communication techniques would enable the nursing assistants to recognize the importance of effective communication skills and stellar attitudes in the delivery of healthcare services within the Community Living Center. Workplace relationships are largely influenced by effective communication. A structured educative program that entails interactive methods is required to educate and empower frontline nursing assistants. The Skill Enhancement Lab will help to determine competency and advancement in communication and relationships (MIT, 2006).
Purpose of the Internship
The purpose of the internship is to utilize Benner’s classification of novice to experts to match nursing assistants with mentors.
Methods and Procedures
This internship will take place at a hospital in Palm Beach and will interact with adults and veterans.
Goal & Objectives
The goal is to enhance nurses’ ability to access and mobilize support, information, resources and opportunities from one’s position in the organization to achieve empowerment (Kanter, 1993). Under support, the mentor will be available to meet nursing assistants’ educational needs. This program also provided teaching opportunities. Other support also comes in from other disciplines and staff like the librarian. Resources included financial support for conferences and poster presentations. Information is provided through classes, group projects as a direct application of communication skills acquired. Opportunity encompasses participation in actual role-playing and other skill enhancement opportunities.
Methods
The theory of Benner’s (1984) From Novice to Expert described how nurses perceived their clinical expertise or skill, through five stages: novice, advanced beginner, competent, proficient, and expert. These classifications are modified to describe the growth of the individual nurse in their journey to expertise in communication (Benner, 1984). The stages are as follows with corresponding structured intervention and outcome measure:
- Novice: No background knowledge to critically analyze cases.
- Advanced beginner: Begins to grasp situations with assistance from mentor/preceptors,
- Competent: analyze the situation and able to change approach to care based on the situation and needs of the resident
- Proficient: Sees total picture, has background and understanding, the needs of the residents. Able to understand nonverbal cues
- Expert: Has enormous background and vast experiences, zeroes in on problem, takes action by changing or supporting practice.
Skill Enhancement Lab
Design and implementation is based on a timeline that is being deployed in phases. During the first phase, a doctoral student preceptor the Nurse Researcher was identified as the architect for designing a Skills Lab for all LTC staff with emphasis on relationship management. Also, during this phase, of the Innovative Skills Lab is branded as “Nursing Assistant Culture Change Skill Enhancement Lab (NACCC-SEL)” (Misiorski, 2004, p. 3)
Strength, Weakness, Opportunity, and Threats (SWOT) Analysis
- Strength – begun the culture change, established N-NACCC, all staff had prior orientation and education about culture change
- Weaknesses – no objective way to measure nursing staff competency in carrying out culture change
- Opportunities – to intern with the chief of Long term care unit in the process of creating, monitoring and evaluating a culture change skill lab in establishing the competency of the nursing staff.
- Threats to the institution – required to carry out mandate of the central office, and improve score in the artifact of change
Schedule of Activities
References
Bergman-Evans, B. (2004). Beyond the basics: Effects Of the Eden Alternative Model on Quality of Life Issues. Journal of Gerontological Nursing, 30(6), 27-34.
Benner P. (1984). From Novice to Expert: Excellence and Power in Clinical Nursing Practice. Menlo Park, CA: Addison-Wesley.
Compas, C., Hopkins, K.A. & Townsley, E. (2008). Best practices in implementing and sustaining quality of care. Research in Gerontological Nursing, 1(3), 209-216.
Dellefield, M.E. (2000). The relationship between nurse staffing on nursing homes and quality indicators. Journal of Gerontological Nursing, 26(6): 14-28.
Hoffart, N. & Woods, C.Q. (1996). Elements of a nursing professional practice Model. Journal of Professional Nursing, 12, 354-364.
Inspector General Office. (2002). Nursing Aide Training Report. Geneva, Switzerland: Moran William.
Kanter, R. (1993). Men and Woman of the Corporation. New York, NY: Basic Books.
Misiorski, S. (2004). Getting Started: A Pioneering Approach to Culture Change in Long-term Care Organizations. Rochester, New York: Pioneer Network.
MIT. (2006). MIT Training Delivery Methods Survey Report. Geneva, Switzerland: Gerzon Jeannette.
Quality Partners of Rhode Island. (2010). HATCh Model – Individualized. New York, NY: Gail Patry.
Rahman, A. N., & Schnelle, J. F. (2008). The nursing home culture-change movement: Recent past, present, and future directions for research. The Gerontologist, 48(2), 142-148.
Winchester, T. A. (2003). Teaching Communication Skills to Nursing Home Certified Nursing Assistants. Geriatric Nursing, 24(3), 178-81.