Grow A Culture of Critical Thinking to Calm Survey Angst

This article was written by Action Pact writer Keith Schaeffer for the Pioneer Network, and published on their blog on June 12, 2018

Anxiety over the new Mega Rule survey process that examines caregivers’ critical thinking skills may have some long-term-care providers on edge, but not at Garden Spot Village in New Holland, PA.

“Our focus on critical thinking and empowering staff over the years in working with Action Pact has put us in better position,” says Steve Lindsey, CEO. “Getting everyone involved, not just assigning tasks but helping them understand the big picture, the issues, and how to make decisions has created a high level of critical thinking throughout the organization.”

How to achieve all that is the subject of Action Pact’s intensive session, Navigating the Mega Rule; Building a Highly Involved Culture of Critical Thinkers, at the Pioneer Network’s 2018 Annual Conference in August.  Presenters include LaVrene Norton, MSW, Megan Hannan, MS, Gloria Blackmon, RN, Glenn Blacklock, MS, and Linda Bump, MPH, RD, NHA.

Their purpose isn’t to tell attendees how to develop critical thinking among their staff, says Hannan, but to give them the information and understanding needed to chart their own course.

“We really appreciate that Action Pact’s is not a cookie cutter, pre-formulated approach,” says Lindsey. “It’s a journey of learning together and shaping something that is different for each organization’s culture.”

Garden Spot Village operates six skilled nursing households, each with its own culture shaped by those working and living there. Staff’s critical thinking abilities enable them to weigh carefully what they want to do while understanding it within the context of the regulatory environment and the lives of the people they serve, says Lindsey.

But most care homes leave critical thinking to the leadership,middle management, and nurses, says Norton. CNAs and others are simply told what to do, often without understanding the importance or context of their tasks within a person-centered, resident-directed culture.

But now, CMS expects hands-on caregivers to be critical thinkers, as well. Brains

All staff must know about the new survey requirements and their organization, residents, and services provided, and how to use that knowledge to better serve the residents. Do they know what to do when an incident occurs … that pudding should not be offered to Vivian because she is allergic to eggs … or that serving George dinner in his favorite nook outside the usual dining areas still requires proper hand hygiene and food safety practices?

Nurses develop critical thinking in college and in clinical training while going through a process of study, discussion, practice, feedback, reflection, further study, and more discussion. CNAs and other hands-on caregivers rarely get the opportunity.

“If we really expect them to think things through, know how to collaborate as a self-led team, and make decisions, then let’s give them the time, information, and education to develop critical thinking,” says Norton.

Person-centered environments with permanently-assigned, cross-trained staff working in teams to serve small groups of residents naturally enable caregivers to know the elder’s needs and desires well.

But staff’s capacity to contribute becomes much higher when they also are taught critical thinking skills … how to analyze, develop good judgement, and make decisions, says Norton.

For instance, CNAs know to inform the nurse when something doesn’t seem right. But what if the nurse fails to follow up after being told?

Rather than letting the matter drop or complaining to peers that “I told the nurse but nothing was done,”a CNA trained in critical thinking understands it’s important to follow up to ensure the nurse got the message.

“A sense of responsibility grows along with a more integrated understanding about how to serve the resident, and thoughts and actions toward her become more accurate,” says Norton.

As information is shared, the whole work team gains a deeper understanding and capability. They think through challenges as they arise, day or night, “determining whether to take the initiative and deal with it in the moment, or knowing when they shouldn’t take the initiative and call in resources from outside their team,” says Norton.

“It bubbles up in different ways in how life is lived and the sense of empowerment that residents and staff have … to live life on their own terms,” says Lindsey.  That and a CMS Five-Star rating has come from growing critical thinking skills at Garden Spot Village, he concludes.

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Ahead of its Time: Action Pact’s PersonFirst® Methods Bolstered by U.K. Study

A study(1) in 69 care homes in the United Kingdom affirms principles that Action Pact’s PersonFirst® train-the-trainer program has advanced for 20 years – that person-centered care with meaningful social interaction as simple as daily chats can improve quality of life for people living with dementia and enhance their relationships with caregivers.

Published Feb. 6, 2018 in PLOS Medicine, the study found improvements in agitation, pain, and neuropsychiatric symptoms(2) along with a nearly 20 percent increase in positive care interactions with staff. Continue reading “Ahead of its Time: Action Pact’s PersonFirst® Methods Bolstered by U.K. Study”

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Every month, hundreds of nursing home residents across California board shuttle buses on their way to their local homeless shelters. They arrive with pans full of meals they’ve prepared themselves, and enough food to feed crowds that often exceed 100 hungry neighbors.

Heart to Serve logo

In 2016, Rockport Healthcare Services became the first organization to involve every nursing home and assisted living community they serve in fulfilling community service through its A Heart to Serve program . This community service-centered program presents service opportunities to every resident, including those who have physical and cognitive challenges, such as dementia, stroke, MS, Parkinson’s disease, or vision impairment, so that they can experience the transformative power of purpose through service. Continue reading “Nursing Home Residents Find Purpose Through Service and Community Commitment”

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The wall is lined with photos of staff members who have worked five years or longer at the Life Plan Community (LPC) in Midland, TX. With turnover plummeting from 44 to 30 percent for all employees over the past four years, more photos are sure to be added as more staff reach the five-year threshold. Continue reading “Manor Park Sees Greater Staff Retention with New Households”

Fostering Kittens Brings Joy and Purpose to Seniors Needing Care

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Four Ways to Build the Culture You Want to See in Your Senior Community

I had a conversation with a leadership team recently that was incredibly frustrated by the initiative being taken by aides in the building. The complaint was that they were sitting around at the nurse’s station when they weren’t busy with cares. Leadership wanted them to be engaging with residents. But in most traditional nursing homes, this is not what CNA’s understand as their job. To get to this place we have to create a culture where engaging with residents is everyone’s job. Continue reading “Four Ways to Build the Culture You Want to See in Your Senior Community”

Secret Santa Makes Their Day

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Garden Spot Village opened its doors in September of 2001 and from the beginning we have always enjoyed the holiday activities planned by staff. When we built our new households in 2006 and renovated our original building into households, we started to think about how we could have a more meaningful experience for residents, staff and families. We brainstormed with the team and came up with a day that could be enjoyed by all. Continue reading “Secret Santa Makes Their Day”