Healthcare Training Institute - Quality Education since 1979

Instructor’s Guide
for CD Inservice Training

Table of Contents | NCCAP/NCTRC CE Booklet

Introductory Commentary
Activity Director and Staff:

Wouldn’t it have been great if you could have purchased this Manual and CDs and have them act like a magic wand to gain support for your program from all staff in your facility?  I mean, seriously, just think for a minute.  Aren’t we all hoping for some magic that will instantly make our jobs easier regarding providing appropriate quality activities for each and every resident in our facilities?  Magic is great.  Let’s see.  How could it work?  You could merely ruffle through the pages of this Manual and a magic powder could be dispersed, which instantly permeates its way through every corridor in your facility, putting smiles on all staff members’ faces and making words like “Yes, I will do that” come out of their mouths.  Be honest with yourself.  When you purchased this course dealing with gaining staff support, at a certain, perhaps unconscious level, isn’t that what you were hoping for? 

Here’s the problem.  If in the back of your mind you have unrealistically high expectations for this material, that it will somehow magically resolve your support issues with little or no effort on your part, you may as well stop reading right now.  Why waste your time?  You can return the course for a full refund, so you are not out any money.  And most important of all, you are not out the time you would have wasted playing the CDs and reading this Manual.  So take about ten seconds and be honest with yourself.  Are you expecting magic?  Have you already decided this course belongs in the trash can?  Is it just another worthless piece of literature you have purchased that doesn’t know your residents in your facility, and certainly doesn’t know your staff and the kind of challenges you face in gaining support?  The ball is in your court. What do you plan to do?  Continue with your unrealistic, pie-in-the-sky expectations that will let you off the hook and put another “notch in your belt,” so to speak, to proclaim another unusable, impractical approach that “won’t work in my facility!”  Take ten seconds and think.

Did you take the ten seconds, or did you just read on?  Here’s my point.  Since I wrote the course, I happen to know this is probably the most concrete, practical material written to provide you with specific how-to’s regarding your getting support for your Activity Program.  In the pages of this Manual, and on the CDs, when you finish, you will have a whole truckload of very specific things to do regarding getting support.  However, unless you are Bill Gates and have a photographic memory, reading through this Manual once and working through the exercises once will be tantamount to, or the same as, hoping for magic fairy dust.

Here’s the way it works.  What you get here are a lot of really, really good ideas.  Why are they really, really good?  Not only because they work, regarding getting staff support, they are presented to you in enough specific detail and provide you with numerous quotes of scripts to use with staff.  In short, I not only tell you what to do, but I tell you exactly how to do it.  I try to make getting support in your facility as simple as I can, by providing you with as much specific, step by step information as I can. 

Here’s your challenge.  And if you are hoping for magic fairy dust, this is where your bubble will be burst.  These ideas are simple, but they may not be easy for you.  How long have you worked in your facility?  Two hours?  Two days?  Two weeks?  Two months?  Two years?  If you have been in your facility for two years, you have established a pattern of communication with other staff members over that two-year period of time.  Thus, these simple ideas may not be easy for you to implement, because you have built up a habit or pattern of interaction with certain unsupportive staff members.  Thus, prior to purchasing this course, since you were not sure how to gain their support, you ignored their actions, and thus have created a pattern of communication accepting their lack of support.  In the closing commentary I will talk about courage, because courage is exactly what it may take to break out of established ways of interacting with staff, which in the past has shown your acceptance of their lack of support.

By the end of this course, you will have the tools you need to gain staff and department head support.  However, it is up to you to add the courage it may take to interact with certain staff members differently than you have in the past.

Independent Training Tool:  The purpose of Part I is to facilitate your providing an Independent Inservice Training to Activity Staff. By “independent”, I mean the Reproducible Inservice Training Note Taking Booklet and CD are coordinated in such a way as to enable you to give the booklet and CD to an Activity Staff member for them to listen to and complete independently. 
1. You might assign them the listening to of one or two tracks per training session to accommodate their schedule. 
2. By their listening to the CD independently, you are not repeatedly taking your time for this training. 
3. The trainee is instructed to pause the CD frequently to allow time to write answers to the questions below, which appear in their Note Taking Booklet.
4. The content below contains the answers to the questions presented in this Reproducible Inservice Training Note Taking Booklet.
5. This Instructor’s Guide facilitates your discussion with Activity Staff following their listening to pre-assigned CD Tracks and completion of that portion of the Note Taking Booklet.

CD Track #1
Two Magic C’s to Get Your Administrator’s Support

What are three specific areas relating to support for your program?
1. Surveyors look for all staff to be involved in the provision of activities
2. Medication, shower, and therapy treatment schedules are to be scheduled in such a manner as to accommodate residents’ attendance at activities
3. Surveyor guidelines specifically reference the need for residents to be transported to and from activities

Who are the key individuals in your facility from whom you need support?
1.
2.
3.
4.
5.

Here are six quotes from the surveyor guidelines regarding activities that you can use to build your case.
1. "All staff are responsible for providing activities." 
2. "Activities can occur at any time and are not limited to formal activities being provided only by activities staff, and can include activities provided by other facility staff, volunteers, visitors, residents, and family members." 
3. "If not contraindicated, time the administration of medications, to the extent possible, to avoid interfering with the resident's ability to participate or to remain at a scheduled activity." 
4. "Transport for residents who need assistance to and from activities should be provided." 
5. "The facility may need to consider accommodations in schedules, supplies, and timing in order to optimize a resident's ability to participate in an activity of choice." 
6. "Altering a therapy or bath/shower schedule to make it possible for a resident to attend a desired activity that occurs at the same time as the therapy session or bath is recommended." 

Sample CMS Guidelines to Present
to your Administrator and Director of Nursing

Even though they are aware of these, you are in a more knowledgeable position to make Culture Change requests when you have the printed word of CMS substantiating the validity of your request.  Search Google for updates.

F248 INTENT: 483.15(f)(1) Activities
“Non-traditional Approaches to Activities
Surveyors need to be aware that some facilities may take a non-traditional approach to activities.  In neighborhoods/households, all staff may be trained as nurse aides and are responsible to provide activities, and activities may resemble those of a private home.  Residents, staff, and families may interact in ways that reflect daily life, instead of in formal activities programs.”
   -“Activities can occur at any time, are not limited to formal activities being provided only by activities staff, and can include activities provided by other facility staff, volunteers, visitors, residents, and family members.  All relevant departments should collaborate to develop and implement an individualized activities program for each resident.”

   -“Some medications, such as diuretics, or conditions such as pain, incontinence, etc. may affect the resident’s participation in activities.  Therefore, additional steps may be needed to facilitate the resident’s participation in activities, such as:
   -“If not contraindicated, timing the administration of medications, to the extent possible, to avoid interfering with the resident’s ability to participate or to remain at a scheduled activity; or
   -“If not contraindicated, modifying the administration time of pain medication to allow the medication to take effect prior to an activity the resident enjoys.”
   -“Transporting residents who need assistance to and from activities (including indoor, outdoor, and outings).”
   -“For the resident with varying sleep patterns, activities are available during awake time.  Some facilities use a variety of options when activities staff are not available for a particular resident: nursing staff reads a newspaper with resident; dietary staff makes finger foods available; CNA works puzzle with the resident; maintenance staff takes the resident on night rounds; and/or early morning delivery of coffee/juice to residents.”

CD Track #2
Developing Clout with Nursing

Why should you meet with your administrator before scheduling a meeting with your DON?
Meet with your administrator so that you can indicate his or her support when you tell the DON the specifics of what you need to have happen in order for your department to be in compliance with federal guidelines.

Rate on a scale of 1-10 how likely it would be to get the following response from your DON if you have not met with your administrator first.  1 indicates highly unlikely, 10 indicates highly likely.
"Well, you know we were short-handed yesterday.  So that's why Mary Sue the CNA on A-Wing just didn't have time to transport Esther.  And you know, those shower schedules are set and we just have to take the residents when it's their time for a shower.  We're so short-handed!  How can my CNA's be expected to have time to give yarn winding to a resident?!"

1          2          3          4          5          6          7          8          9          10

What four points should you include in a brief document regarding Culture Change guidelines to hand to your DON during your initial meeting?
1. Transporting residents
2. CNAs doing activities with residents
3. Shower, medication, and therapy schedules coordinating with residents’ attendance at activities
4. Any other guidelines which you feel require the support of nursing

CD Track #3
Conquering your Conflict Avoidance

What kind of relationship do you have with your administrator?  Your DON?

Who is a staff member who you are uncomfortable around?

Do you feel fearful when there might be a potential for conflict with this person?

Envision your administrator.  Let's give your administrator the name Mr. Smith.  If your administrator is a female, you might transpose this in your mind to Ms. Smith, and change my pronouns from he's and him's to she's and her's.   Envision where this meeting will take place, perhaps with your Mr. Smith sitting behind his desk, and you in a chair across from him.  You have been smart enough, as mentioned on the previous track, to of course schedule an appointment with your Mr. Smith.  Next, imagine how you are feeling before you start this conversation.  Envision this scene seated across from your administrator, ready to discuss activity department compliance with federal guidelines. 

How did you feel before you started this conversation regarding activity department compliance with your administrator?  Nervous?  Anxious?  Afraid?  Even nauseous?  Or happy, relaxed, and at ease? 

The Two-Screen Technique
Think back to a time when you had a conflict with the first people in your life whom you viewed as authority figures.  Describe this incident:

Envision one scene of conflict from your past on the left side of your TV screen, perhaps with a thin line dividing the left and the right half.  Then on the right side of the screen, envision at whatever angle you would like, your future meeting with your administrator.  Now, envision your television screen. 

Create a statement based on reality using the word “not”:

Create a statement of reality, in other words facts about the present:

Envision the split screen with your photo of a past conflict on the left, and perhaps a live videocam shot of your future meeting with your administrator on the right.  State the "not statement" that the person on the left, using his or her name, is not your administrator.  Then, create a reality statement.  Repeat this until you are comfortable.

CD Track #4
Priorities & Strategies for Your Wish List

What are the three steps in attainting staff support that have been covered so far?
1. Meet with your administrator to clarify his or her ideas concerning Culture Change compliance
2. Acquire a hard copy of CMS Guidelines
3. Meet with your DON and provide him or her with a copy of the CMS guidelines

What are three criteria you might use to set priorities for your wish list?
1. The resident who is the most in need
2. The easiest victory first
3. The least supportive staff member first

What are your priority goals?
1.
2.
3.

Sample Format for a Listing of Residents to be Transported

How might you acquire the names of the charge nurses?

Record the names of the charge nurses below: