By Kelly M. Pyrek
One of the most critical roles of the infection preventionist is instructing healthcare workers about the proper principles and practices relating to infection prevention and control -- especially as an increasing number of healthcare institutions and accreditation agencies are examining more closely the competencies of healthcare professionals. Experts Marguerite M. Jackson, RN, MS and Patricia Lynch, RN, BSN, in a 1986 paper in AJIC, asserted that although infection control practitioners are expected to be capable and effective educators, few individuals have had formal training in preparing, presenting and evaluating education programs for healthcare personnel from different disciplines, educational backgrounds and comprehension levels.
Ann Marie Pettis, RN, BSN, CIC, director of infection prevention at the University of Rochester Medical Center in Rochester, N.Y., points to the anonymous quotation that "Teaching can occur without learning and learning can occur without teaching," and emphasizes that as the content expert, infection preventionists must capture and hold the attention of adult learners -- no small task in the busy, demanding, chaotic healthcare environment.
Pettis explains that a crucial part of infection preventionists' role is to develop, facilitate and evaluate teaching and learning at the institutional level while simultaneously creating an environment for participation and interaction and stimulating reflective and critical thinking to promote good practice. This task is known as "andragogy," the science of lifelong learning for adults. Andragogy is used to describe the scholarly approach to what is more commonly known as the practice of adult education; in other words, teachers facilitating and supporting the active learning process of adults.
What may be helpful is a quick review of the basics of learning and teaching theory. Pettis explains that the basic theory of learning boils down to the learner receiving a stimulus, which may either be the act of experiencing (concrete) or thinking (abstract). Then, the learner must process the information gained through experimentation (active) or reflection (passive). As for teaching styles, they can be Authoritarian (traditional); Socratic (using questions to elicit answers); Heuristic (relies on the student's curiosity level; and Counseling (concentrates on the emotional impact of the lesson). When it comes to learning styles, there are Activists (those who enjoy hands-on learning or role playing/games) Reflectors (those who enjoy watching audio/visual presentations or engaging in discussion); Theorists (those who enjoy complex problem-solving); and Pragmatists (those who enjoy exploring practical situations with the formulation of goals as the end result).
It may also be helpful to remember the various adult learning styles, which include Visual, Auditory and Kinesthetic, which all require different approaches to presenting information so that maximum retention is achieved. Pettis explains that retention varies by learning method and that individuals retain:
- 10 percent of what they read
- 20 percent of what they hear
- 30 percent of what they see
- 50 percent of what they see and hear
- 70 percent of what they say
- 90 percent of what they teach someone else
A good example of this is illustrated by the ancient Native American saying, "Tell me and I'll forget, show me and I may not remember, involve me and I'll understand." And because so much of adult learning tends to be problem-centered, encouraging healthcare professionals to be actively engaged during the learning process, is critical to retention and to ensuring that they disseminate the proper protocols and techniques to their colleagues.
"In order for participants to retain the information taught, they must see a meaning or purpose for that information," says Christian Oliver, a product manager at HealthStream, a healthcare learning solutions company. "They must be able to interpret and apply the information, including the ability to assign the correct degree of importance to the material. Training plans need to provide a blend of instructional strategies to meet these needs." Oliver continues, "Three days after a training session, we only retain about 50 percent of what we see and hear, on average, and even less of what we only see, or only hear. We tend to retain a lot more – over 80 percent -- of what we say as we do something. So, if we explain what we are doing to a partner while we do it, our chances of retaining it are a lot higher. Creating opportunities where this can happen – through small group discussions or practice sessions with a partner, for example – is a good way to increase retention."
Pettis says infection preventionists face a number of barriers to effective education in the healthcare setting including rapid change (encompassing everything from an evolving regulatory landscape to fast-moving innovation in medical technology); the challenge of information overload in a 24/7 society; constant healthcare worker turnover; and the complexity of the educational message that must be delivered and then monitored for translation into practice. There are basics, such as hand hygiene, that require constant education and reminders -- these perennial issues dictate messages that may sometimes become so frequently heard and seen that healthcare workers tune them out. Critical information becomes tedious and healthcare workers' practices become rote, thus exacerbating lack of compliance with principles and practices that drive good patient care and ensure patient safety.
There are a number of topics that bear repeating, according to Bill Anderson, director of training solutions for DuPont Sustainable Solutions. They include basic infection control precautions, such as hand hygiene, environmental cleaning, instrument decontamination and safe injection practices, as well as how and when to use standard precautions, transmission-based precautions and personal protective equipment (PPE). Anderson adds, "There is a need to provide a deeper understanding on how infection spreads, the sources of infection, and modes of transmission."
There is a fine line between what bears repeating and what healthcare workers tune out; some in-service topics that are simply run into the ground and become less effective over time. "I think that self-learning packets have been over-used and although they are quick and easy, many staff either skim the information or quickly take the test and not read the information," says Linda R. Greene, RN, MPS, CIC, director of infection prevention and control at Rochester General Health System in Rochester, N.Y.