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Training challenges in care homes

Introduction                                          

The provision of quality education and training is vital in any health care setting. There is a requirement for three days training a year for care staff in care homes since the Care Standards Act 2000. Prior to this Act, there was no legal requirement for training. This article will explore the provision of training to care assistants and nurses within care homes.
Care homes provide home and care to vulnerable individuals and the quality of care provided is largely determined by the staff within the home - the majority of whom are care assistants. Different types of training are required within care homes. By 2005, 50% of all care assistants must possess NVQ 2 or the equivalent (Care Standards Act 2000 standard 28) and home managers must be in possession of NVQ4 or the equivalent. All staff must undertake three days training every year. There are mandatory topics including fire, moving and handling and health and safety but some staff must also undertake first aid so that one person on every shift is trained. This can be a huge but necessary expectation of 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. However, training is not only needed solely regarding clinical issues. There are also daily decisions to be made such as can Mr Box go out alone? Decisions are 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. Knowledge is needed by the staff of how and why to do tasks, more senior staff require knowledge of record keeping and leadership, for example. Some staff argue that they may learn on the job and have been doing the job for years, but nobody knows everything. There is always new information to be learned such as 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 (Reece and Walker 2001).

Training in practice

Many homes are concerned that they are unable to meet the requirements for training (Registered Homes and Services 1999). Concerns include the cost of training, who will provide it and staff 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 motivating staff.

As a nurse in a care home, the author offers informal training sessions whenever the opportunity arises, often in ‘quiet periods’ by commencing 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 can be a perfect opportunity to explore health and safety issues. A discussion may also focus upon specific residents’ care plans. This is particularly useful if a resident is quite a challenge to care for as his/her needs and caring approach needs to be clearly identified. It also assists those present to explore their own feelings towards that resident to increase self-awareness.
Also, individual policies of the home may be discussed to increase understanding and acceptance of them. Periods of reflection and evaluation may be undertaken with individual staff, this being particularly useful for newly qualified staff or adaptation nurses who may need support. It is possible also to undertake a shift evaluation. This involves gathering the staff who have been on shift together and exploring how the shift progressed as well as addressing any problems encountered. It 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 promote the enjoyment of training. More formal pre-arranged sessions may be held over a coffee and a bun, perhaps in a discussion format building upon 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 the staff. Indeed, some companies pay staff for attending training in their own time which does further motivate staff to attend and is worthwhile in the long run. However, some home owners will only pay for mandatory training such as moving/handling and fire safety.

Other forms of training, especially during the night, can include watching videos, TV programmes or reading policies. Another idea could be to hold a theme for the month. This involves 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 is therefore 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
Training is not only important regarding standards, it is essential to ensure that high quality care is delivered and also to motivate staff. However, there are always some staff members who are reluctant to participate. 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, however, it must always be remembered 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. Indeed, 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 therefore, 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, staff 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 be provided by specialist nurses (Harrison S 2004). However, there is a need for consultant nurses to promote training, development and research within care homes on all issues; not only clinical aspects. Such nurses must have a background of and experience in the care home sector. Often, clinical nurse specialists are district nurses.

Conclusion
As discussed, a wide range of specific issues arise within care homes and  training needs to be tailored appropriately.  As nurses we should not be frightened of training, it should be looked upon as part of our everyday work. Training should be an enjoyable, continuous activity and a challenge to be grasped with enthusiasm.

Reference

  1. Dimon C (1995)
    “Preparing care assistants for the qualified invasion”
    Elderly Care October/November v7n5 p35
  2. Harrison S (2004)
    Older people’s specialists needed in all care homes.
    Nursing Standard July 14 vol 18 n44 p8
  3. Reece I, Walker S (2000) Teaching Training and Learning. Sunderland: Business Education Publishers Ltd
  4. Registered Homes and Services June 1999
    v4 n2 p20
    “Providers prepare for consultation on nursing standards”



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