Daughters of Sarah Nursing Center CNA Care Planning Initiative Excellence through Engagement! CNAs joining the IDT! Barbara B. Pieper, Ph.D., R.N. Project Director Joan E. Dacher, PhD, RN, GNP Joan Healey, MS, RN Administrator Daughters of Sarah Nursing Center Albany, NY

Excellence through Engagement! CNAs joining the IDT! Assumptions guiding the Project Built on knowledge from prior DOH Dementia grant CNA knowledge re residents is vast & valuable We want to utilize & acknowledge their contribution in a formal way

Excellence through Engagement! CNAs joining the IDT! GOALS of Project Integration of the CNA into the care planning process Enhance resident care Empowering CNA

Excellence through Engagement! CNAs joining the IDT! Goals of Project Working with 6 consortium agencies Develop and test a best practice training program Develop & disseminate training materials

Excellence through Engagement! CNAs joining the IDT! The Who DOS as lead agency for 6 Consortium Members Adirondack Tri-County Nursing & Rehabilitation Center St Peter’s Nursing & Rehab. Center Nathan Littauer Hospital & Nursing Center Schuyler Ridge Residential HC Facility, Seton Health Ellis Residential & Rehabilitation Center

Excellence through Engagement! CNAs joining the IDT! Yr 1 Develop and test the CNA Observation Sheet Workshops for CNA’s Workshops for the Coaches/Mentors Information sessions for ID Team, families Follow-up: observation, focus groups for support & feedback (x4) post 6 mos.

Excellence through Engagement! CNAs joining the IDT! Focus groups with CNA’s & mentors TT program for agency sustainability Test training materials by trainers Year 2 Focus Groups with Trainers Develop training materials: print & film Dissemination

Excellence through Engagement! CNAs joining the IDT! CNA Training Outline Role of IDT & Care Planning Their role vis-a vis the nurse Use of Observation Sheet Confidentiality Communication with families

Excellence through Engagement! CNAs joining the IDT! CNA Resident Observation Sheet Based on MDS categories Provides structure Records contribution Integrate into each facilities’ QI Process

Excellence through Engagement! CNAs joining the IDT! Training 6 FACILITIES: 118 CNA’S (including 3-11& 11-7)

Excellence through Engagement! CNAs joining the IDT! Role of Mentors Assist in role transition Provide feedback on performance…not evaluate! Provide “back-up” Key players in process implementation Change nature and content of communication with CNA

Excellence through Engagement! CNAs joining the IDT! Training for Mentors Education on being a Mentor Complementary nursing roles Work on developing an implementation strategy

Excellence through Engagement! CNAs joining the IDT! Training at 6 sites 28 mentors trained

Excellence through Engagement! CNAs joining the IDT! Best Practice Approach Method: Focus Groups with CNA’s Mentors 6 weeks after training for 4 sessions

Excellence through Engagement! CNAs joining the IDT! Method: Focus Groups Total CNA’s: 87 Total Mentor’s: 24

Excellence through Engagement! CNAs joining the IDT! Focus Group Questions: 3 categories 1.Preparation for role 2. Workshop Suggestions 3. Implementation Needs

Excellence through Engagement! CNAs joining the IDT! CNA Responses Felt prepared for the role “ …although felt funny at first” Eager for the role Felt they where making a contribution Felt welcomed and supported by team

Excellence through Engagement! CNAs joining the IDT! Develop a deeper understanding of the resident “ I didn’t realize how old they were” “ I finally understand why they want me to do something” It’s another opportunity to talk with family and learn about the resident

Excellence through Engagement! CNAs joining the IDT! Downside: it’s not for everyone! For some CNA’s, they don’t like being there; they’d rather be “doing” at the bedside.

Excellence through Engagement! CNAs joining the IDT! CNA Empowerment “now maybe we CNAs can get something done!” “it’s nice to hear thank you directly from the family” “it gets into the communication chain”

Excellence through Engagement! CNAs joining the IDT! Examples of Contribution: Alerting team to eating difficulty: swallowing evaluation, and diet change Settling a dignity issue for resident with family about a toileting protocol Requesting new clothes Learning habits of new residents

Excellence through Engagement! CNAs joining the IDT! MDS Data: antecdotal Changing care plan from independent to 2 assist with transfer Describing behavior changes with time of day

Excellence through Engagement! CNAs joining the IDT! Mentor’s Response: On units with high turn over, time is an issue Some CNA’ s need assistance with writing Not sure of the value Overall, positive They control the time…keep it on time…clocks, family appointments

Excellence through Engagement! CNAs joining the IDT! Organizational /Structural Problems Time, Time, Time !

Excellence through Engagement! CNAs joining the IDT! CNA’s are looking to the organization and mentors/NM to make their participation happen!!! They want to be there!

Excellence through Engagement! CNAs joining the IDT! Site Coordinators: key role in connecting organization with project solutions

Excellence through Engagement! CNAs joining the IDT! CNA’s Suggestions: Changing Care conference time Changing Care conference day Need to know when…develop calendar Would like a say in structuring when

Excellence through Engagement! CNAs joining the IDT! Facilities Response: Inventing Solutions Structural change – changing care conference time Creating energy about change…raffels Recognition…honoring participants On-going support from strong NM

Excellence through Engagement! CNAs joining the IDT! Facilities Response: Inventing Solutions 4. CNA participation is not an option 5. Developing teams for coverage 6. Using $$ to support change …replacements

Excellence through Engagement! CNAs joining the IDT! Facilities Response See it as an incentive for new hires Integrated the role into orientation

Excellence through Engagement! CNAs joining the IDT! Responses to Program From Families Receiving information from the direct care giver: details, details, details

Excellence through Engagement! CNAs joining the IDT! Responses to Program From Residents Attending Care Conference Increase individualized care

Excellence through Engagement! CNAs joining the IDT! Recommendations for further study Test for Positive effect on MDS data: Falls, behavior,pain, wt. skin breakdown

Excellence through Engagement! CNAs joining the IDT! Evaluation Family Outcomes: decrease in complaints or increase in satisfaction

Excellence through Engagement! CNAs joining the IDT! Evaluation CNA’s/Staff Decrease turnover Increase job satisfaction

Excellence through Engagement! CNAs joining the IDT! Questions? Contact Information: Dr. Barbara Pieper: piepeb@sage.edu Dr. Joan Dacher: dachej@sage.edu