Alternatives to Traditional Classroom Education
By Melba Rhodes, RN, BSN, CIC and Kathy Nugent, RN, CIC
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:
- Uncontrolled blood management (e.g., c-section, vaginal delivery, trauma code)
- Transferring blood into a tube
- ABGs, starting IVs, etc.
- 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!
"Wage war on sharps injuries"
"I pledge to advocate safety device use among my fellow workers!"
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|
|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