1. 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

2. 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

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

4. 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

5. 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

6. 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.

7. 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

8. 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

9. 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

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

11. 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

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

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

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Best Practice Approach
Method:
Focus Groups with CNA’s
Mentors
6 weeks after training for 4
sessions

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

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Focus Group Questions: 3 categories
1.Preparation for role
2. Workshop Suggestions
3. Implementation Needs

17. 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

18. 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

19. 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.

20. 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”

21. 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

22. 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

23. 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

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Organizational /Structural Problems
Time, Time, Time !

25. 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!

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

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CNA’s Suggestions:
Changing Care conference time
Changing Care conference day
Need to know when…develop calendar
Would like a say in structuring when

28. 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

29. 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

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Facilities Response
See it as an incentive for new hires
Integrated the role into orientation

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Responses to Program
From Families
Receiving information from the direct care giver:
details, details, details

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Responses to Program
From Residents
Attending Care Conference
Increase individualized care

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Recommendations for further study
Test for
Positive effect on MDS data:
Falls, behavior,pain, wt.
skin breakdown

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Evaluation
Family Outcomes:
decrease in complaints or
increase in satisfaction

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Evaluation
CNA’s/Staff
Decrease turnover
Increase job satisfaction

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Questions?
Contact Information:
Dr. Barbara Pieper:
Dr. Joan Dacher: