Alternatives to Traditional Classroom Education

March 1, 2003

Alternatives to Traditional Classroom Education

By Melba Rhodes, RN, BSN, CIC and Kathy Nugent, RN, CIC

OBJECTIVES:

1. Identify barriers to the efficacy of traditional education

2. Identify alternatives to traditional education.

With all the demands on our time, we have less time for education -- namely
traditional classroom education. There are three classifications of factors that
cause educational barriers: employee factors, presenter factors and content
factors. With the current staffing shortage, time is a barrier that affects both
the employee and the presenter. Instead of viewing this as a barrier, one must
view it as an opportunity to escape the concept of traditional classroom
education.

Some of the barriers to traditional classroom education fall upon the
employee as more and more is expected of them with less and less support.

"Sound infection control practices sometimes fall by the wayside as
healthcare workers work faster and harder than ever before."1
Educational deficits can increase the risk of transmission of infection.
Therefore, it is important to put forward educational efforts in fast
"bites" that are timely, relevant and in a format the employee will
remember. In short, RAP it: keep it Real (relevant), Active and Participatory.

As infection control and employee health professionals, we also have barriers
of our own, some of them self-made. We say, "You can't be a prophet in your
own land," "I don't have time," "We just have less time for
education," "I have more duties," "It's too little bang for
my buck" (we've all gone all out and had only one or two people show up to
an inservice), "It just doesn't matter" (apathy). However, as
educators we must realize the burden is on our shoulders to make education
memorable and to present the information in as many ways as possible.

Many alternatives to traditional classroom education involve relevant
activities or -- as we like to call it -- fun and games. However, we in general
are wrapped up in the seriousness of our work, saying, "The control of
infection is serious business. I've worked hard to be professional; people won't
take me seriously afterwards." Alternatively, we experience the fear of
failing in trying something new, all of which stymie our educational efforts.

But so what? We need to see the forest, not the trees. Education is one of
the most important aspects of our jobs. Whatever method the message is best
transmitted to the employee (and remembered by) is the "name of the
game." Moreover, education should include humor when appropriate. The focus
of humor is to create an atmosphere of interaction, amusement and association.
Avoid victimizing persons (focus on conditions, not persons), off-color jokes,
embarrassing remarks and disrupting the "show's" flow.

Use themes to dress up your learning activities. Coordinate memos, other
correspondence, refreshments, education and other activities around a central
theme to create a pleasant learning environment. For example, for a flu shot
booth, use "The flu doesn't bug me." Use bug graphics on your flu shot
flyers to catch the eye. Serve bug-shaped cookies and "bug juice"
during your flu shot booth. Use bug napkins and cups. Give each recipient a flu
shot packet with the current year's vaccine information sheet, post vaccine
information (i.e., ice pack for sore arm, fever/pain reducer of choice, etc.), a
sucker, post-vaccine survey for side effects and a plastic bug in a Ziploc bag
(which can serve as an icepack for arm soreness). Attach a bug sticker to each
participant to further "advertise" the flu shot. Fill a basket with
bug items (cup with bugs on it, wooden bug puzzle, plastic bugs, etc.) for a
door prize that all flu shot recipients are registered to win. Encourage return
of the post vaccine survey by registering each employee who returns the survey
for another door prize. Report flu vaccine rates and side effects to your
infection control committee. Since the optimum time for flu shots roughly
coincides with Infection Control Week, this makes an excellent Infection Control
Week activity.

Use safety faxes to deliver a quick and short message. The following are
examples; please customize to your facility's policies, procedures and data
where applicable.

A Safety Fax from Infection Control

Cleaning up a blood and body fluid spill

  • Put on proper PPE.
  • Remove as much fluid as possible with paper towels.
  • Discard in an infectious waste container.
  • Wipe area with approved germicide (discard towels).
  • Reapply a fresh layer of germicide and let stand.
  • Place wet floor sign.
  • Always use product as directed. Leave area wet for full "contact
    time" (usually 10 minutes).
  • When cleaning in clinical areas where patients (especially pediatrics) or
    the public has access to cleaning chemical storage, or where excess fluid
    could harm equipment, consider the use of Super Duper Wipe-e-cloths (a
    disposable wipe impregnated with a tuberculocidal germicidal).

A Safety Fax from Infection Control

Just say no to non-safety needles. Hepatitis B and C and HIV may be
transmitted through straight needlesticks. Don't let it happen to you -- pledge
to use all safety devices and follow safe work practices.

Three (two significant) sharps injuries reported in 2000 were preventable if
the proper device had been used ... straight needles will no longer be stocked
for general use.

Safety plastic cannula: IV access
Safety syringe: IM use
Safety blood draw: Blood draws

A Safety Fax from Employee Health

OSHA standards require PPE to protect the nose and mouth whenever exposure to
blood/body fluid or chemical splashes are likely. HIV, HBV and HCV may be spread
through blood/body fluid contact with mucous membranes, and may cost up to
$2,500 per exposure for follow-up/treatment.

Risky activities include:

  • Intubation
  • Extubation
  • Uncontrolled blood management (e.g., c-section, vaginal delivery, trauma
    code)
  • Transferring blood into a tube
  • ABGs, starting IVs, etc.
  • Suctioning
  • Fluid disposal

Send out a slide show presentation via e-mail. Attach a short post-test to
return for inservice credit. To encourage participation, place all participants'
names in a drawing for a door prize.

Use holiday cards to send an infection control or employee health message.
Consider writing a personal letter describing all the big happenings in
infection control over the past year (reminiscent of a holiday newsletter).
Alternatively, re-write the lyrics to a popular holiday tune: "Wash your
hands, wash your hands, wash them all the day" to the tune of "Jingle
Bells."

The calendar used to measure the temperature of refrigerators can be used to
deliver a brief message on handwashing, nail length, blood and body fluid
exposure, etc. We recommend using a graph to chart refrigerator temperatures.

Safety cards can be made using the postcard application of your word
processing program. Periodically pass out these cards while doing rounds, during
TB screening or flu vaccination or around holidays (safety trick or treat).
Attach appropriate graphics and candy to make the card memorable, such as:

"I'm a sucker for needle safety."
I pledge to use all available safety devices and abide by safe work
practices!
(Attach a safety sucker)

"Be smart! Practice needle safety."
I pledge to use all available safety devices and abide by safe work
practices!
(Attach Smarties candies)

"Chews safety sharp devices."
Ten sharps injuries in 2000 were preventable if the proper device had been
used ... Don't let it happen to you - "Chews" to use safety devices
and follow safe work practices!
(Attach gum)

"Wage war on sharps injuries"
"I pledge to advocate safety device use among my fellow workers!"
(Attach warhead)

Distribute an employee newsletter. Give it a catchy title, such as V.I.E.W.S.
(Valuable Infection control Employee health Wellness
Shorts). The objective of this newsletter is to provide accurate
information on seasonal issues or diseases related to the control of infection,
employee health and wellness and empower the employee to reduce modifiable risk
factors related to seasonal illness or injury and to aid the employee in making
necessary lifestyle changes. A list serv for persons who publish in-house
newsletters is available. Send a message to subscribeIcEhNewsletter@yahoogroups.com
to join. So don't re-invent the wheel; participate and share your ideas. There
is no charge to participate.

E-mail can also be utilized to communicate short messages on infection
control, employee health and wellness. An example for a catchy name is
IcEhBriefs. Again, have employees take and return a short post-test and return
to be registered for a surprise packet. The post-test also allows you to check
reader comprehension.

Post messages (laminated) in the restrooms. Keep them short and easy to read.
Again, develop a catchy title, such as "You're in here anyway; you may as
well be reading." Topics could include handwashing, nail length,
tuberculosis, etc.

Night shift and weekend-only workers present a dilemma. Some of the above
ideas will work -- but here are a few more:

  • Set up a demonstration hospital room and have the HCW record all that they
    find wrong in the room (e.g., Foley bag on floor, "bloody"
    (ketchup) dressing in regular trash, IV site not covered, etc.)
  • Videotapes with a message from the IC coordinator and a post-test.
  • Online education.

During your traditional classroom time, keep employees' ears open by
distributing BINGO cards to participants. Instead of numbers, use buzzwords such
as standard precautions, lice, handwashing, contact isolation, etc. During your
presentation, participants fill in the card when you say the buzzword (or when
the word shows on the screen). The first person to get all the words in a line
on his/her card wins a small door prize. Another inexpensive method is to
purchase a double roll of tickets and give one to each participant. Periodically
during the inservice, draw a number and give away a small door prize like hand
lotion, pen on a rope, etc.

Even if you must buy the door prize yourself, the return on your purchase is
worth the cost. The majority of persons enjoy walking away from an inservice
with a prize. And it helps them to remain alert during class and retain
information.

A few other alternatives to traditional education are:

  • Self-learning packets: Assemble self-learning packets that go into detail
    on subjects such as West Nile virus. Include a pre- and post-test so
    learners can measure what they have learned.
  • Floating storyboards: On a science project board, develop a simple,
    easy-to-read message just as you would for a bulletin board. Move the
    storyboard to another unit after about a week. A good topic for a storyboard
    would be samples of all safety devices available in the hospital and how to
    order the items or particulate respirators and how to seal check. Use
    storyboards as your open houses and info and education booths.
  • Info and education booths: Put together information booths where the
    employee can pick and choose seasonal information. Stick to three themes
    with your information and storyboards. For example, a fall booth could
    include flu and cold prevention, RSV, Halloween safety, lice control, etc. A
    summer booth could focus on dangers of sunning and skin cancers, swimming
    safety tips, summer food safety, etc. A winter booth could focus on stress,
    holiday food safety (buying, cooking and storing turkeys) and holiday safety
    (safe decoration, food safety). Another time for a booth is during National
    Housekeeping Week in September. Give away snacks with a job duty from
    housekeeping and ask the employee to thank a housekeeper for performing that
    task during this week.
  • Lunch box theater: Invite employees to bring their lunches; you provide
    dessert and beverages to a lunchtime inservice. Limit activity to a short
    tape or talk that can be delivered in 20 minutes.
  • Infection Control Week: Host an e-mail contest for all e-mail holders.
    Encourage staff to print out and distribute to employees who don't have
    e-mail. Send a daily question focused on ones a JCAHO surveyor might ask,
    like "Who is in charge of infection control?" "What type of
    precautions do you use routinely?" etc. Offer a daily small door prize
    daily and a bigger one for the whole week (enter all names from the whole
    week). Ask your sales rep to give you hand lotion or alcohol gel to
    "Make suds, not germs." Give away small bottles of bubbles with a
    handwashing message on it. Use your storyboard to detail when and how to
    wash.
  • Offer small "bites" of information by putting TB factoids along
    with a piece of candy in an Easter egg or spider pack (spider ring and fake
    web) for TB screening. Use information such as the TB rate (at 8.2 per
    100,000 population, the Louisiana case rate of TB has exceeded the average
    national rate of 6.8 for more than 5 years) or atypical TB (True or False?
    Atypical TB is not commonly transmitted by the airborne route. Atypicals
    (like MAC) are most often acquired through environmental exposure (drinking
    raw cow's milk, aerosolized dust, saltwater injuries, etc.). The symptoms of
    an atypical mycobacterial pulmonary infection are the same as for pulmonary
    TB. The only way to tell the difference is by culture.).
  • Pocket cards: Use for material like types of isolation, Standard
    Precautions or other information for which quick access is needed. Use card
    stock, print two on each page (which can be double-sided) then cut apart and
    tri-fold.
  • Magnets: Place a business card on a magnetic backing. Place one on each
    refrigerator with a food safety message: remove leftovers after three days;
    keep the refrigerator at around 40 degrees Fahrenheit.
  • Badge cards: Develop badge cards for Standard Precautions, isolation or
    any information to which the employee may need to have quick access.
  • Disaster drill: Use disaster drill time to access PPE knowledge among
    staff. Remember many staff members are called to an area with which they are
    unfamiliar. Teach employees to locate and don PPE in the time between
    arriving at their stations and the "patients" actually arriving.
  • Birthday postcards: If you have access to employee birthdays, send them a
    specialized message to remind them to stay healthy and well.

In conclusion, there are many ways to provide education that is both accurate
and fun. In addition, the use of humor and novel ways of providing education may
boost retention of knowledge.

Melba Rhodes served as infection control coordinator at Huey P. Long
Medical Center from 1989 to 2002 and is now an independent consultant. She is a
founding member of the Central Louisiana Infection Control Coordinators (CLIPS),
an organization dedicated to networking between infection control, employee
health and central supply coordinators in Central Louisiana. Kathy Nugent has
worked in infection control and employee health at Huey P. Long Medical Center
since 1992. They co-publish a quarterly newsletter on infection control and have
devoted much of their careers to targeting behavioral changes through active
learning and experience.

TEST QUESTIONS: TRUE OR FALSE
  T F
1. Traditional educational methods are the best way to inform HCWs about
infection control.
   
2. The three types of educational barriers are related to employees,
presenters and content.
   
3. Educational efforts should provide as much information as possible,
rather than in limited "bites."
   
4. Education falls solely on the shoulders of the healthcare workers
themselves.
   
5. As more is required of healthcare workers, educators must make an
extra effort to engage the healthcare worker's attention.
   
6. The only way to make HCWs understand the importance of infection
control is by taking the subject seriously.
   
7. The use of humor makes education more memorable.    
8. Using themes can tie education efforts together.    
9. A newsletter on infection control is a waste of time and will just be
thrown away.
   
1 0. E-mailing infection control information is pointless, since not all
employees have access to e-mail.
   

Resources for the "goodies" mentioned in this
article:

US Toys 1.800.448.7830 http://www.ustoy.com/novelty/default.asp

Oriental Trading Company 1.800.875.8480 http://www.oriental.com/home.html

MediBadge 1.800.228.0040 http://www.medibadge.com/

Insect Lore 1.800.LIVEBUG. Includes 5 cutters: Butterfly, Ladybug, Bee,
Dragonfly, and Grasshopper http://www.insectlore.com/bugcookcut.html

Bug Cookie Cutters http://www.cookiecutter.com/default.asp
(search for "bugs")

Bug Sugar cookies. & Personalized Buggy Tins http://www.selectshoppinglinks.com/generic67.html

Bug Party Ideas http://www.birthdaypartyideas.com/html/bug_parties_20.html

"Jitterbug Cookies" recipe http://maryland-info.com/bugcookies.htm

ANSWERS

1. F
2. T
3. F
4. F
5. T
6. F
7. T
8. T
9. F
10. F