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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The Struggle With Choice

Resident choice is a cornerstone of culture change. As we transform our organizations, we are constantly asking ourselves, “How does this promote or honor the residents’ self-determination, preferences and daily pleasures?” This awareness, however, does not mean we don’t still struggle with how to balance these choices against other important concerns, such as resident safety. Continue reading “The Struggle With Choice”

Why We Do Learning Circles

whylc

The learning circle is the handy hammer of culture change – anyone can use it, it’s simple, it’s intuitive and it’s the tool you come back to, over and over, with each new piece of home life you build. For the Household Model to function at its potential, the organization must be reconfigured, doing away with traditional silos and hierarchy. The learning circle is the tool that can assist the organization in that work. Continue reading “Why We Do Learning Circles”

Changing Dining Atmosphere

Changing the atmosphere in the dining room is a great first step in an overall plan to creating a more enjoyable dining experience for elders. The folks at Bridgewater Retirement Community in Bridgewater, VA found a creative way to heighten awareness of the need for change in dining practices throughout the organization. Continue reading “Changing Dining Atmosphere”

Facilitating Organizational Change from Within

At Action Pact our philosophy of change focuses on developing leaders who inspire a vision, listen to others and step out of traditional roles and patterns. We specialize in creating learning organizations. In order to do this we help create—and help our clients learn to create—a climate for learning. An important element of that is utilizing different learning strengths. Some of us are visual learners, others are auditory learners and others are kinesthetic learners. Continue reading “Facilitating Organizational Change from Within”

An Environment Where Elders Living with Dementia Make Decisions

Megan Hannan, creator of PersonFirst®, addresses the need to create an environment where people living with dementia can make decisions and experience life like an adult.

When Communicating with Someone Who Lives with Dementia: Wait.

I love growing PersonFirst® teams. For many reasons, it is highly satisfying to collaborate with caring, willing people to really think through and then take action to empower those who live with dementia. And what I love most is how much I learn every time I engage with a new team. This year, one of the things I learned was from a CNA who is a Neighborhood Coordinator in a dementia specific neighborhood. It is the very simple and very powerful thing she says she teaches all of her staff: wait. Wait at least 90 seconds for someone who lives with dementia to answer or respond. Do not ask again, do not suggest, just patiently, wait.

This was such an easy thing to remember that is stuck with me. And I try to use it.

Photo by Alexander Raths

One morning recently, I was visiting a newly opened household. My mission was to find out how life and work was unfolding and to be able to offer any support or suggestions. To do this I talked with as many people living and working there as I could. The household I was in was nicely appointed, wide open spaces, the kitchen and dining area opening into the living area where here were comfy chairs, a table with chairs and a couch. At the table, Marge was sitting in her wheelchair. I introduced myself and asked her name. Then I explained my mission and asked, “What do you like about living here?” I then waited…30, 60, 90 seconds passed. I am not a patient person, usually. I am much better about it when serving those who live with dementia, but it is not my nature to be patient – but I waited.

After about two and a half minutes, Marge said, “It’s quiet here.”

“Oh,” I said, “What else do you like about living here?” And… I waited.

This time she answered in about 60 seconds, “The space.” Then she nodded her head and shut her eyes. I took that as a signal that she was, in fact, finished speaking with me.

I went on to talk with others who live and work in that house, moving around the space, until lunch time when I found myself back at the table in the living room with Marge who was still sitting there though now awake. I greeted her by name and sat down. Presently, the household leader came to remind Marge that is was lunchtime. She said, “May I take you over to the dining room?”

Marge replied, “No.” She then looked at me and asked, “Will you take me to the dining room?”

I was surprised, but mostly honored. What I think happened is that I waited…. and listened, and heard. Even people who feel in their hearts that they care deeply, at times do not recognize that interactions that may be slow, soft and quiet often grow a relationship. I did take Marge over to the dining room. We ate at the same table. She said little. I said little. Yet, we were together for that time.

Megan Hannan, MS, is an Executive Leader at Action Pact and has provided leadership in long-term care for over 25 years. Megan developed Action Pact’s signature train the trainer program, PersonFirst®. She serves on the Board of Directors of The Pioneer Network.