PUTTING THE PERT CURRICULUM TO USE: A CASE STUDY
Through the PERT Program classes and trainer workshops, the PERT Curriculum materials have been provided to health care professionals from dozens of nursing homes, hospices, and other facilities that provide long-term care in the Pacific Northwest. In 2005, the complete curriculum was made available on the Internet; to date, representatives from over 150 different health care organizations around the world have accessed it.
Many of the health care professionals with whom we've worked have praised the PERT materials as valuable teaching resources. However, some have encountered difficulties finding the time, resources, and opportunities to put the curriculum to use.
In an effort to highlight a facility where the PERT Curriculum has been successfully integrated into educational offerings, we spoke with Pam Ketzner, a Certified Hospice and Palliative Care Nurse employed by Franciscan Hospice in Tacoma, Washington. Pam was selected as the 2002 Certified Hospice and Palliative Care Nurse of the Year by the Hospice and Palliative Nurses Association (HPNA). Pam is the Unit Based Educator at Franciscan Hospice. She attended the PERT Trainer conference in October 2004, and has made the PERT Curriculum one of her most used educational materials.
Practical Uses
At Franciscan Hospice, Pam uses the PERT materials in the trainings she presents to the hospice staff. In addition, the hospice teams from Franciscan working at nursing homes use the materials when they provide trainings and in-services for the nursing home staff.
The hospice nursing assistants are required to complete 12 hours of continuing education per year to keep their accreditation, so Pam must provide a half-hour to hour-long training every month. For the trainings Pam provides to the nursing assistants and other staff, she cites her primary resources as the ELNEC (End-of-Life Nursing Education Consortium) materials and the PERT Curriculum. "It's amazing," she says, "When I go to plan an in-service, these two resources are the first place I look."
The hospice teams in nursing homes are tasked with providing training for both nursing home staff and families and caregivers. For nursing home staff, the hospice teams rely heavily on the PERT Hospice Care module. This module provides a basic understanding of how hospice interacts with nursing homes, and is often the starting point for the education the hospice teams provide. Other modules that are frequently used include An Overview of Pain Management and the Symptom Management modules that cover dyspnea and respiratory secretions.
"Both shortness of breath and respiratory secretions are part of our performance improvement efforts," explains Pam. Franciscan Hospice uses a survey for families developed by the National Hospice and Palliative Care Organization (NHPCO). On these surveys, one of the most common requests from families and caregivers is for better information about shortness of breath and respiratory secretions. To address this, one of the goals for performance improvement at Franciscan Hospice is enhancing the information they provide about signs and symptoms of difficult breathing and respiratory secretions. Pam has found that the PERT modules on these topics are valuable resources for meeting this goal. "The section on dyspnea is one used very often by our hospice teams in nursing homes," Pam states. "And I love the section on respiratory secretions — the images in that module are the best I've found for showing what actually happens in the body."
According to Pam, the best training materials are those developed from evidence-based practice. "When we can say, 'this is really why we do this,' people really appreciate it. It helps to put the science with the experiential."
Logistics
The PERT Curriculum materials are designed so that they can be customized to meet educational needs in a variety of health care settings. We asked Pam if she and her hospice teams modified the presentations to fit their specific circumstances.
"Definitely," she replies. "In fact, I really appreciate the sections that explain how to divide up the slides for shorter presentations." When presenting trainings for her hospice staff, Pam typically has 45 minutes to an hour and a large conference room. But when her hospice teams conduct in-services in nursing homes, the resources are often much more limited. "In nursing homes, you don't have a lot of time with staff," she explains. "A 15 minute in-service will be much better attended than an hour-long one."
Some participants in the PERT Trainer Workshops have expressed concerns about getting staff to attend their trainings. No one wants to throw a party where nobody shows up! We asked Pam about the typical attendance for nursing home trainings, and how to generate interest. "Humor helps!" she notes. It's also effective to have the trainings presented by people that the staff know and trust. "The nursing home staff know the hospice teams that work there, and they're the ones who provide the training."
Also critical is matching the subject matter to your audience. "Our hospice team at one of the King County nursing homes did an in-service about hospice that was open to both staff and families and caregivers, and nearly 40 people came — nurses, nursing assistants, and families!" To emphasize this point, Pam notes that, because of its popularity, the PERT Curriculum module on dyspnea has now been posted to her facility's intranet page. "Now anyone can look at it, which is great, because it's so beneficial to so many people!"
These types of creative efforts to make educational materials available to hospice and nursing home staff can be very successful. "For example," Pam offers, "at one nursing home, our hospice team has incorporated their training — using the PERT materials — into the new employee orientations. So now all the new employees attend!"
Pam finds the flexibility of the PERT Curriculum materials extremely useful in taking the trainings to the staff. The in-services provided by hospice teams in nursing homes are often conducted in the cafeteria, dining room, or any other space that's free. Computers, projectors, and other audio-visual resources often aren't available. Fortunately, the PERT materials are provided in PDF form for just such low-tech situations. "Our teams use transparencies on overhead projectors when they can, but for the most part, they give out the materials as hand-outs. We can supply a laptop and LCD projector if the nursing home would like PowerPoint®," Pam adds.
We asked Pam how well the PERT materials are received. "We usually have a very appreciative audience," she admits. "We don't do pre- and post- testing, because that can be a turn-off. But we do evaluations — just four quick questions about the quality of the training. Most people give us high marks."
In closing, we asked Pam what parts of the PERT Curriculum she found to be the most useful and most appreciated. "The pain assessment module, and the symptom management sections on shortness of breath and respiratory secretions," she replies. "Also, the Role of the Nursing Assistant section is really great." Pam also states that it is a goal of Franciscan Hospice to incorporate the spiritual, bereavement, and communication modules into the trainings they provide at nursing homes. "But the module we use the most," she notes, "is definitely the Introduction to Hospice section by Jan Williams. We call it our 'Hospice 101.'"