Supporting Direct Care Staff: You Know Your Residents, We Know the Research

“I feel very lucky to have attended and can’t wait to take what I’ve learned and apply it to my residents,” said Traci Bach, a certified nursing assistant (CNA) from Cuba City who works with people living with dementia.

Bach was referring to a free conference organized by the University of Wisconsin–Madison School of Nursing’s Center for Aging Research and Education (CARE) and held at Monroe Clinic in southern Wisconsin. It was CARE’s third annual conference for CNAs, personal care workers, resident assistants and other staff who work with older adults.

Direct care workers meet the daily needs of older adults in nursing homes, assisted living facilities and continuing care retirement communities, and greatly impact the care provided by hospitals and home health agencies. Yet most have limited access to educational opportunities. The CARE conference is changing that, sharing current research to help workers understand complex conditions and best care practices.

At the Monroe conference in June, more than 60 direct care workers from across Wisconsin heard from nurse researchers and experts about maintaining older adult mobility; understanding what’s normal and what’s not about vision changes with age; responding to dementia-related behavioral symptoms; and managing their own stress to avoid burnout.

The presenters acknowledged the important role that direct care workers play.

“It’s all about you guys. It’s all about what you do,” said Assistant Professor Barb King, PhD, RN.Barb King leads a hands-on simulation activity

King’s research focuses on older adults’ functional decline during hospitalization. She explained that older adults start losing muscle mass after only two days of bed rest. It can take a month to reverse those physiological changes.

King’s presentation inspired several conference attendees to take action.

One CNA who works in a nursing home said she hopes to use the information to develop more physical activity for her residents. A resident assistant said he plans to propose that the assisted living facility where he works begin offering walking aides to support residents.

Assistant nursing Professor Andrea Gilmore-Bykovskyi, PhD, RN explained how dementia-related behavioral symptoms—such as wandering, calling out, agitation or refusing care—are often attempts to communicate unmet needs.

People living with dementia may be less able to communicate their needs directly, especially as the disease progresses. To identify and address their needs, Gilmore-Bykovskyi described a simple approach. Caregivers examine a dementia-related behavior, and consider the conditions or actions prior to the behavior and the consequences. (See our spring 2016 issue for more information.)

“CNAs are by far the most important people” in figuring out the unmet needs of people living with dementia, Gilmore-Bykovskyi said.  “You have sufficient contact with the person to recognize patterns. You know what’s happening, how often, and what happens before or after that. In fact, CNAs are likely the only people to have all that information.”

One participant said the most useful thing she learned was how to “put myself in patients’ shoes, especially people with impairments and those living with dementia.” Another said she learned how to “be a voice for my residents that don’t have one.”

In addition to the presentations, attendees learned from hands-on exercises. During one, they put on low-vision goggles that simulate the effects of macular degeneration, glaucoma, cataracts and CNA with low-vision simulation gogglesother vision problems. They then tried to perform simple tasks. Another exercise used a simple kit to illustrate the sensory changes that accompany normal aging.

One hospital CNA held a piece of yellow cellophane up to her eyes to simulate changes in the aging lens. She found she could no longer distinguish the colors of small objects before her.

“Now imagine if I tell you to take the green pill when you get up in the morning,” King told her.

“Oh, no!” the CNA exclaimed.

The participants all said they would recommend the CARE conference to others.

As a health care provider, Monroe Clinic understands the importance of professional development for direct care staff.

“We were pleased to have the opportunity to host the conference,” said Tammie Evenstad, the clinic’s community outreach specialist. “Quality educational events like this benefit everyone in the communities we serve.”

–Diane Farsetta