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Care Homes Education: what can we learn?

5 March 2021 | Sarah Armstrong
Dr Sarah Armstrong, GP and UCLPartners Education Fellow shares learning from her journey creating and delivering an education programme for care home staff.

Eighteen months ago, I started an education fellowship with UCLPartners and Medicus Health Partners. The project involved designing and implementing an education programme for carers in care homes. I was really looking forward to bringing together my background in general practice, my interest in frailty and my love of education. But although I had some experience in teaching, it had been largely confined to teaching medical students. How would I manage teaching such a diverse learner group, and, in addition, help to design the curriculum? So, whilst I was excited, I was also suitably terrified.

Preparation is key

Surround yourself with people smarter than yourself, said Henry Ford. This was fantastic advice in those early days. I was fortunate enough to have access to people with a wealth of experience in care homes education. I will remain extremely grateful to the end-of-life team at UCLPartners as well as Prof Mike Roberts and Prof Martin Marshall for all their advice and support. External to the organisation, Louise Keane (Education Nurse Specialist) and the Hertford hospital specialist nurses were also generous with their time. Asha Katwa shared her ‘Is my resident well’ resources, and these became an integral part of the teaching programme.

Feeling a little overwhelmed, I put together a project plan. This entailed trawling the literature, so that by the time I started the project I had a good idea of possible curriculum content and teaching approaches. I also attended a QI methodology course run by UCLPartners and would highly recommend this to anyone. I met with the care homes to find out what they wanted and needed, to ensure a collaborative approach. This was invaluable in ensuring a successful programme.

Creating engaging learning sessions

I got started, still anxious that the learners would sniff out the newbie teacher. But I needn’t have worried. No-one pelted apples at my head or put a whoopee cushion on my chair. The learners were engaged, friendly and genuinely interested. I ran teaching two or three times per week at four care homes, attempting to make the sessions fun and interactive. Games, discussions and quizzes – especially those with prizes – seemed to be popular with the carers, although I once had to adjudicate a full-blown row over a mug! We learned about (and ate!) snacks containing 100 calories as part of the nutrition module (bananas, five jelly babies, two Jaffa cakes and a slice of malt loaf, for anyone interested). We brushed false teeth for ‘mouthcare matters’ and we assigned patients with traffic-light colours based on their clinical signs and symptoms for the deterioration lesson. The sessions became fun, but it was the learners who really brought the sessions to life. Ensuring that the teaching involved lots of real-life cases and discussions allowed the carers to bring their own experiences to the table. The sessions became a good opportunity for the learners not only to learn, but also to discuss, offload and air. I think the fact that I was external to their organisations helped with this.

The learners were beginning to take ownership of their learning, with individualised learning records and by nominating a learning monitor. Then disaster struck in the form of COVID-19. The sessions stopped, just as the programme was getting into its stride. It was disappointing and I felt that I had let the carers down. It also seemed that, if there was ever the need for a ‘safe’ learning space, it was then. Attempts were made to move to remote learning, but this was hindered by lack of technology and time. Pre-recorded video teachings did not take off, probably because of the multiple calls on the learners’ time.

What have I learnt?

Of course, there are things that I would have done differently. Firstly, I could have been more proactive. I am reserved by nature and found it difficult at times to ‘inflict’ myself on the care homes, especially as they had so many other calls on their time. But being assertive and having lots of contact with the homes was important to keep the project in the fore. This became easier as our relationship developed.

Secondly, I realised part-way through that due to the nature of care work, regular attendance at teaching could not be assumed. Different people turned up each time. So, a key determinant of success was to integrate the core principles on deterioration-recognition in a slightly different way each session. This ensured dissemination, hopefully without boring everyone!

Thirdly, I really wish that the programme had been externally credited – more for the learners than me, who invested a lot of their time without a qualification to show for it.

I will always be grateful for having the opportunity to work on this project. And as much as I like to think I taught the carers something, the real value was what they taught me. Their dedication, commitment and zest for learning was inspirational, and it was a fantastic experience to work alongside them.

The only silver lining of the very dark cloud that is COVID-19 is that the spotlight has been shone on care homes, and how we can best support them in the future. In my new role as Clinical Lead for Deterioration for the UCLPartners Patient Safety Collaborative, I am involved in assisting with the implementation of tools to help carers recognise the early signs of deterioration. The education project has given me a good insight into the challenges involved in this. But more importantly, it has instilled in me a deep respect for carers and the work that they do, and a genuine desire to support this sector in any way that I can.

You can read a full write up of the education programme Sarah ran in BMJ Open Quality