In care homes, training and education of both care assistants and nurses is vital. It is essential that high quality care is delivered, standards are maintained and that staff are motivated.
There are always some staff members who are reluctant to participate in training. As nurses we should not be frightened of training but it should be looked upon as part of our everyday work.
Care homes provide treatment to vulnerable individuals and the quality of care provided is largely determined by the staff within the service - many of whom are care assistants.
The Care Standards Act 2000 (standard 28)requires three days annual training for care home staff.
The act called for half of all care assistants to hold a national vocational qualification (NVQ) 2 or equivalent, by 2005. Additionally, all care home managers were to have an NVQ 4.
Care home staff need a range of training. Annual mandatory training courses must include fire safety, moving and handling, and health and safety.
There is also an expectation that every shift is covered by at least one person who has been trained in first aid. This can be a huge but necessary expectation of both the staff and the home.
The purpose of training
Some individuals fail to recognise why training is required for working in a care home (Dimon 1995). Residents have multiple needs ranging from the prevention of pressure ulcers to the provision and maintenance of tube feeds.
But training is not only needed on clinical issues. There are also daily decisions to be made, such as whether or not it is safe to allow Mr Box to leave the home unaccompanied.
Decisions are also needed regarding the prioritising of actions to be taken. For example, time is needed to complete care plans but also to talk to Mrs Smith.
Staff need to know why they are doing certain tasks, as well as how to do them. For example, senior staff require knowledge of record-keeping and leadership.
Some may argue that they can learn on-the-job as they have been doing it for years. But nobody knows everything. There is always new information to be learned, like how to prevent the spread of MRSA.
It is also important to reflect upon practice and consider how something is being done. There are always improvements to be made. Staff need to be creative and flexible, and education can promote this.
Training in practice
Many homes are concerned that they are unable to meet the requirements for training. Concerns may include the cost of training, who will be providing it, as well as people?s motivation to attend.
It may be easier for larger companies to employ training officers and commence rolling programmes, but all registered nurses and senior care assistants can provide some form of training, thus reducing cost and increasing the motivation of staff.
As a nurse in a care home, I offer informal training sessions whenever the opportunity arises, often by starting a discussion with bemused care assistants.
Any situation may be regarded as a training session. For instance, a discussion about the resident who fell out of bed could be a perfect opportunity to explore health and safety issues.
A discussion may also focus on specific residents? care plans. This is particularly useful if a resident is a challenge to care for and requires his needs to be clearly identified. This approach may help people explore their feelings towards that resident and increase their self-awareness.
Another approach is to discuss individual policies of the home to increase understanding and acceptance of them. Periods of reflection and evaluation may be undertaken with individual staff. This could be particularly useful for newly qualified staff who may need extra support.
It is possible also to undertake a shift evaluation. This involves gathering the staff who have been on shift together and exploring how it progressed, as well as addressing any problems encountered.
This is also a great time for motivating staff by offering them encouragement and praise. Such incentives are essential in order to promote staff participation.
It is important to encourage the enjoyment of training. Formal pre-arranged sessions may be held over a coffee and a bun, perhaps in a discussion format, building on existing staff knowledge.
Topics addressed could include pressure area care, abuse, infection and communication. Any relevant issues within the home may also be discussed.
Planned sessions need to be delivered at a time most convenient to staff. Indeed, some companies pay staff for attending training in their own time, which does further motivate them to attend and is worthwhile in the long run. But many home-owners will only pay for mandatory training.
Other forms of training, especially during the night shift, can include watching training videos, TV programmes or reading policies.
Another idea could be to hold a theme for the month. This might involve identifying a subject such as ‘eating and drinking and considering relevant issues during quiet periods.
The benefit of this is that staff are unaware of this as training and actually identify many problems and solutions themselves.
It would be possible to select a topic that does require addressing as a theme, with a good chance of the required action being taken. By formally recording the training that was undertaken (and its duration) the home can prove that the standard of three days training per year has been met.
The right approach
Important decisions to consider when providing training include:
- Who is the training for?
- What topic is to be addressed?
- What facilities are available?
- Who will provide the training?
- Is it possible for all staff to be involved in the provision of training?
Some care assistants may instigate discussion, but please remember that staff who provide training need support and encouragement.
Training may be undertaken in many forms (Reece and Walker 2001). It does not solely refer to a ‘formal? training session. Training requires adaptability and creativity as all individuals have different needs.
Some may learn better by a more formal session, others by discussion. Many staff in care homes have a lot of experience and it is important to consider their knowledge and expertise.
Providing training in care homes requires a specific approach - not the authoritarian, lecture type delivery. Staff do not want to be told that what they are doing is wrong.
By discussion and examination of case studies, people can often work it out for themselves and feel so much better for it.
Whilst training can be provided by a nurse or senior care assistant in a care home when on shift, even just for ten minutes, it may also be provided by specialist nurses.
There is a need for consultant nurses to promote training, development and research within care homes on all issues; not only clinical aspects. These nurses must have a background and experience of the care home sector. Often, clinical nurse specialists are district nurses.
A wide range of specific issues arise within care homes and training needs to be tailored appropriately. Training should be an enjoyable, continuous activity and a challenge to be grasped with enthusiasm.
Carol Dimon BSc(Hons) MMedSci PGCE
Dimon, C (1995)
? Preparing care assistants for the qualified invasion? Elderly Care October/November vol 7n5 p35
Harrison, S (2004)
?Older people?s specialists needed in all care homes.? Nursing Standard July 14 vol 18 n44 p8
Reece I, Walker S (2000) - Teaching Training and Learning?Sunderland: Business Education Publishers Ltd
Registered Homes and Services June 1999 V4 n2 p20
?Providers prepare for consultation on nursing standards?