Category Archives: Training

Training the Trainer: A Beginner’s Guide Part 1

Setting the Scene
 
Derek’s boss has dumped a new role on his desk. The learning and Development budget has shrunk quicker than a scrotum in an ice bath and his organisation is now transferring it’s training provision from those pricey
freelance consultants to him. And Karen from Human Resources.
 
Of course he knows how myself and my trainer colleagues will react to that. We’ll make that sharp intake of breath noise like the hairdresser in the wake of a disastrous attempt at home makeover. “Tried
cutting your own fringe, love? Oh dear.” 
 
I’ve ranted about health and social care budgets elsewhere, but the slashing  and burning of this government’s administration has already made one thing very clear. More and more health trusts, local authorities and service providers are taking a DIY approach to training, and we in the professional training community need to be offering a helping hand to our less experienced colleagues. 
 
So here’s the first of two brief weekly ‘tasters’ taken from my company’s Train the Trainer programme
 
Come Dine with Me?
 
So what makes a good health and social care trainer? After fourteen years in the business and a long career in ‘shop-floor’ clinical work, I’ve seen lots of Dereks and lots of Karens. Derek is very enthusiastic and thinks he’ll make a great trainer because: a) he’s quite knowledgeable b) he can communicate with more than one person at a time and c) he knows how to do groovy fade effects on a Powerpoint slide.
 
And to demonstrate the sheer daftness of this assumption we’re going to use the analogy of a dinner party. Dinner party? Yes, really.
 
Being more of a pie and a pint sort of chap myself I can’t
profess great experience of ‘doing’ dinner parties, but I’ve seen enough ‘competitive entertaining’ to have half an idea how it works, or doesn’t work as the case may be. And the different approaches seem to me highly analogous to the training process.
 
Derek decides on a whim to have a few people round for
dinner. He has half an idea who to invite and texts a random selection of Facebook ‘friends’ the day before his ‘spectacular.’ He hops off down to Tesco. He hasn’t quite got around to deciding what to cook, so emerges with a few jars of Chicken Tonight, a packet of Uncle Bens and a carrier bag full of red wine. Just red? Well Derek likes red so if nobody else does, tough. In
the words of the song, ‘it’s my party and I’ll throw up if I want to.’  
 
Karen from Human Resources has a slightly different
approach. She thinks carefully about why she’s having the party, and who she’s going to invite. And she asks herself whether the answers to the why question match the answers to the who question. It’s going to be a birthday party for her best friend, and the evening is aimed at a ‘good food and fun’ sort of do.
 
She realises that most of the guests are vegetarians. Now Karen is a woman who likes her meat. In fact, she likes her steak so rare it’s practically walking around and mooing, but she decides on a rather nice Mushroom
Risotto from that nice Jamie Oliver book.
 
She has a shopping list. She prepares the ingredients carefully. She makes sure to sit her guests around
the table with people they know or who have something in common.
 
And the results? At Derek’s house half his invited guests don’t turn up, and those that do are the sort of people who don’t get out much and think World of Warcraft is a networking event. They shuffle around uncomfortably in the plastic chairs our hapless host turfed out of the garden shed at the last minute. Guests pick at poor Derek’s plateful of E-numbers wondering just how much they have to force down before turning radioactive, and Derek’s little dog is sleeping contentedly under the table
having suddenly become a much larger dog. And everyone leaves as early as is politely possible citing pressing engagements with unfed and imaginary pets.  
 
But at Karen’s they’ve licked the plates clean, are giving Tina Turner a run for her money on the Karaoke and have already invited themselves back for her next evening of fine dining. 
And while none of my own training courses to date have featured either Mushroom Risotto or Tina Turner, I hope the analogy is clear. Preparation and planning is all. Learning objectives are key. Structure is essential. A good course outline isn’t just something to be scribbled on the back of a fag packet, and the needs of your audience may be very different from your needs as a trainer. 
 
In the next instalment we’ll be looking at ‘setting the scene’ for training. Doing the ground work that goes into delivering course that helps colleagues do their job better and isn’t a dog’s dinner. 
 
See you again for Part Two.

Training the Trainer: A Beginner’s Guide Part 2

So if you’ve read Part One of this Train the Trainer double bill you’ll now be aware of a) how to take part in Come Dine with Me without looking a complete helmet, and b) the importance of REALLY GOOD PREPARATION in running a good health and social care training course. In fact, it’s so bloody important it’s in big capital letters and warrants a cheeky swear word.

 

Well let’s move on to look at what goes into REALLY GOOD PREPARATION long before we get anywhere near a gaggle of learners chewing nervously on custard creams and trying to figure out how the coffee machine works.

For the sake of authenticity we’re going to assume a real world situation. We’ve been asked to run a workshop on Dementia Awareness. Why Dementia Awareness? Well as I’m writing this it’s a topic very fresh in my experience (e.g this week) and in terms of bang for learning buck, its a subject that can yield significant results within a short period of time.

So let’s start off by asking ourselves these four fundamental questions:

1) How long have we got? 

With budgets getting squeezed to the Nth degree and every minute of every day carefully accounted for, we’ve been allocated three hours. Three hours!? This may seem a weeny bit harsh, but let’s look on the bright side. Sometimes a tight time window can lend much needed focus to course design, and we’re delivering a Dementia Awareness course and not a BSc degree programme. And haven’t we all attended courses stretched way beyond the time needed to achieve their objectives simply because the trainer has been booked by the day and not the hour?

2) Who are the learners, and what roles do they perform?  

We have a group of fifteen domiciliary care workers. They provide personal care and household tasks for older people in their own homes. Many of their clients experience a range of dementias of varying severity. The group are quite mixed in terms of experience, educational achievement, and command of English.

3) What are the group’s learning and job needs? 

Let’s all stop being cynical for a moment and assume that our domiciliary care provider has the funding, time and management nous to have conducted some form of learning needs analysis with our staff. Some have years of experience working with dementia while others simply can’t understand their client’s constant demands for that cup of tea they actually made five minutes ago, or how a simple request to make way for the vacuum cleaner becomes World War Three. Being able to understand and communicate better with dementia sufferers is a major learning and job need.

4) What are we trying to achieve in our allotted time? 

Well, with only three hours to play with (including the all important coffee break) let’s not be too ambitious. But we’re aware of a number of misconceptions held by staff about dementia. We’ve heard carers referring to clients as ‘a bit demented’ which roughly translated means ‘daft.’ Others get the terminologies of ‘Dementia’, ‘Dementias’ and ‘Alzheimer’s’ completely confused. Some of our colleagues seem to think all people with dementia have hearing problems AND SHOUT AT THEM ALL THE TIME. So if we’re looking for learning objectives (and if not, why not?) the busting of a few myths and improved communication skills may not be too much of a moving target.  

Some Do’s and Don’t s

So now we’re in the training room as our audience filters in. We feel great. Why? 

Because we have:

  • A very clear idea of our learning objectives and what we and our group want to achieve.
  • A fast-moving and varied programme which will prove interesting, challenging and thought-provoking. 
  • An atmosphere that encourages our learners to share experiences, discuss, debate, and ask questions without fear.
  • Well prepared training materials that are going to be useful for more than just doodling, origami or scribbling down phone numbers.

And hopefully we haven’t got:

  • Reams and reams of notes from which we’re going to stand. And read. And read. And… Zzzzzzzzzz
  • A 45-minute documentary downloaded from YouTube which allows the trainer to put their feet up and eat sweets, but does precious little in terms of meeting our learning objectives. 
  • A 76-slide Powerpoint file. Especially not a 76-slide Powerpoint file with a collection of different fonts, copious amounts of WordArt, teeny-weeny text and a dozen whizzy animations. A little Powerpoint (or one of its alternatives such as Prezi) can be very useful, but overuse is the highway to Snoozeville

So that’s our chopped-down to the bare basics minimalist guide to preparing a training session. Our next and final instalment will take a look at training delivery. Yes, the sexy bit. So if you don’t want to miss some valuable insights into getting ‘warmed up’, the use of visual aids and of course the joy of role-play then follow @connorkinsella on Twitter or subscribe to this blog. Or if you’re very old skool you could just write a note in your diary for next Friday 24 January. 

See you again next Friday. 

Physical Restraint: The Story Behind the Stats

As Mind publishes survey data and calls for a ban on face-down restraint, The Stuff of Social Care looks at the issue from the point of view of those doing the restraining

It’s been a long time since I last took part in physical restraint, but for many years I did work in environments where the need to prevent harm was part and parcel of a nurse’s working day.

For the most part we relied on the first resort. Talking, listening, reasoning, observing. Using a rapport that may have been built up over a period of time, and developing skills that were fundamental to working with highly distressed, agitated people. For most of my nursing career I was lucky enough to work in well-staffed forensic units where staff and patients knew each other well, and where the very thought of an agency or locum nurse was unimaginable.

But at times the last resort was unavoidable. Most of the trained, professional staff I worked with would much rather not use physical restraint. Like me, they would loathe the idea of holding down another human being to inject them with powerful drugs. But when all else has failed, or extreme harm was imminent, or where leaving a severely psychotic man or woman unmedicated would almost certainly leave them more terrified, confused and at risk than they already were, then I for one would not lose any sleep restraining that individual.

By the time I had qualified as a nurse, physical restraint had gone from the often chaotic bundle of arms legs and torsos of my student days toward a set of techniques called Control and Restraint (C&R), a Home Office approved means of managing physical aggression. I along with my colleagues attended regular training in C&R. We turned up at sports halls in trackies and trainers spending hours and days learning and practising the management of physical aggression.

A major (and rather unpopular) part of the training involved role-playing ‘the patient’ and being subjected to the procedures oneself. C&R was based on a 3-person team immobilising the patient. It used a certain amount of discomfort and even short bursts of pain to contain violent people, a fact which we as the role player would be only too well aware. Some of the techniques we learnt involved immobilising the patient face-down on a floor or bed. The reasons for this were that a) the person on their back can fight back much more effectively than if they are face down, and b) saliva and teeth make very potent weapons when they belong to a person who really, really doesn’t like being held down on a floor by several nurses. A key part of the 3-person team was the ‘head’ man or woman, whose job was to ensure minimum discomfort for the person on the floor and protect their airway.

But apart from the actual physical techniques, a fundamental of the training was that physical restraint was absolutely a last resort once every other strategy had failed, or where danger was imminent.

There are those who believe that physical restraint of the mentally ill is little more than state-sponsored thuggery, or who wonder whether restraint is necessary at all. Well, physical restraint is a necessary part of mental health care at times. That’s an undeniable fact, but it’s easy to see why and how restraint gets such a bad press, and why bodies such as Mind need to spend time, money and effort surveying it’s use.

We need go little further than Winterbourne View to acknowledge the presence of thugs masquerading as care professionals. From the very first emergence of the lunatic asylum, the opportunity to get paid for wielding power, authority and physical dominance over others has always proved attractive to a certain type of psychopath.

But there are much deeper and wide-ranging reasons why physical restraint may be over-used or abused. Mental health care certainly needs a sensible, contextualised and much broader discussion about physical restraint per se, and the reasons behind it’s use and misuse. The ‘face down’ issue is perhaps something of a narrow lens, and when 22% of staff report not having had face-to-face training in the last 12 months, we need to ask why that is.

I have a few observations. Questions about restraint are far from being a solely modern phenomenon, but for those whose 7.5 hour shift seems incomplete without a dose of adrenalin-pumping action and a ‘good decking’, current conditions have never been better.

Beds are disappearing. Only the very sickest of the sick have access to hospital treatment. The most distressed and disturbed are funnelled into smaller and smaller pockets of in-patient chaos, often provided by companies with shareholders and profit margins to maintain and gladly filling the gaps left by the running down of NHS in-patient psychiatry.

I would hope that such critical care would be delivered by the sort of skilled, well trained staff I described earlier. This all too often isn’t the case. Many of our most severely ill patients are being cared for by agency and locum staff with bare minimum training, a lack of experience and often poor communication skills. Many will barely know the names of the people in their temporary care.

This is where the ‘jump on, grab a limb and for f*** sake make sure they’re still breathing’ model of managing potential and actual aggression is practised today much as it was in the dungeons of Bedlam.

Right at this moment, someone, somewhere is in a psychiatric unit posing potential or actual danger to themselves or others. People with mental disorders can and do become violent, and staff are needed to contain the violence and minimise that risk. Hopefully they are with staff who can reassure, listen and diffuse aggression with empathy and skill. They are trained to use restraint safely and appropriately, and to be able to make decisions as to when and how it is used.

Mind’s survey results suggest this is all too often not the case.

Deaf, Daft and Demented: Improving Attitudes to Elderly Care

The woman on the radio sounded distraught. She was calling a phone-in show from the hospital where her frail, elderly Dad was being treated. Treated perhaps, but not being cared for. The caller described a ward full of elderly, infirm patients marooned in their beds trying to reach water jugs across the Grand Canyon of space between them and an impossibly far away bedside cabinet. Others pressed the call button repeatedly for commodes or help with moving up in the bed. Nobody came. 


The presenter Shelagh Fogarty suggested a shortage of staff. Apparently not. The caller described a large group of ward staff lolling around the Nurses Station chatting about Facebook. The phone-in took place on the back of a recent RCN report calling for minimum staff levels on elderly care wards. The RCN survey was itself a response to a catalogue of horror stories surrounding the care of older people. In the same week a Which? Magazine ‘secretshopper’ sting highlighted (yet again) serious failings in domiciliary care. It makes sad if not unfamiliar reading. Missed medication. Missed food and drink. Soiled beds. That sort of thing.

So what are the reasons for this constant torrent of bad news? There are plenty of ‘big picture’ factors involved, and others more eloquent than I have written about some of them elsewhere with the precision of front-line experience. But let’s look at one specific and rather uncomfortable area from my own perspective as a trainer.

It’s one of those elephants in the room that doesn’t get much of a public airing, and goes something like this. 

Care of the elderly is far and away the least popular of the health and social care specialities, and attracts the sort of staff who might just as well be earning a Gold Star for assembling Big Macs.

For as flawed as the bigger picture may be, it is still individual care staff leaving patients to dessicate or care home residents to sit in their own faeces. Whenever I hear one of these reports I imagine myself visited by The Ghost of Christmas Yet to Come, aged by forty years and placed in a nursing home by a family who have ignored my Living Will request to be shot at the merest suggestion of double incontinence. I have a memory span of thirty seconds, and I’m muttering to myself, probably because nobody else will listen. My Inco Pad fills with the end result of my soft diet lunch. A couple of care assistants haul me into a wheelchair and whisk me off to the nearest shower hose, deep in conversation over Kate Middleton’s choice in shoes. 

So in this Dickensian nightmare I’m quite literally at the arse end of the care sector, but back in the real world does it really follow that elderly care attracts the bottom of the pile in terms of it’s staff?

Speaking as a trainer working with hundreds of care staff over the years, most certainly not. But I do often see a demoralised workforce working long hours for poor pay and even poorer conditions. With the best will in the world it’s not hard to see how patients or clients eventually come to be seen not as valued individuals but as names on a job sheet spiralling ever downward  toward ever-increasing neediness and ultimate death.

So what do we do? Do we throw more centralised funding at our local authorities and privatised care providers?  Even if such fanciful thoughts had the slimmest of chances of becoming reality, I suspect this would achieve little in terms of progress beyond a healthier shareholding for their employers.

What about better training for care staff? For as long as I’ve been in the business training has been a luxury expense in an industry long governed by the bottom line of the profit/loss equation. ‘Stack it High, Sell it Cheap’ used to be the mission statement for Tesco but is now the essential business model for elderly care, where training is often seen as a costly irrelevance to short term profit. But could more and better quality training really improve the care and attitudes toward our vulnerable elderly? 
A few years ago I collaborated with some local colleagues on designing and facilitating a BTEC Short Course Award: Caring for the Older Person with Mental Health Problems. It was a fairly simple programme consisting of three classroom-based modules focussed on Dementia, Depression and Challenging Behaviour. We worked with a varied collection of staff from both nursing home, residential and domiciliary settings. Some of our candidates were managers, while most were front-line carers. Almost all were terrified at the prospect of taking a test at the end of each day although Exam Phobia faded quickly once our candidates realised how much they already knew and what they were capable of.

We looked at how depression, so endemically common among older people in care and yet so seldom tackled, can be quite easily identified by care staff using the sort of rapport and person skills that comes inevitably when helping a resident put on their socks every morning.  We looked at magnified images of protein plaques and discussed how these lead to memory loss. We looked at how awareness of the sensory and cognitive deficits of dementia can help us communicate much more effectively and reduce distress. Not only did our candidates earn a recognised qualification but challenged, examined and re-evaluated  how they worked with older people. Now let’s not pretend this was Dead Poets Society but the fact I’m talking about this award it in the past tense irks me more than Robin Williams. And that’s a lot of irk.

We were able to deliver the award only with the help of a generous funding pot from the now defunct Business Link Dorset. Once the funding dried up, so did the course, and we certainly didn’t have the resources to evaluate the shop-floor efficacy of the training. But on anecdotal evidence at least, investment in a reasonably cheap and effective project yielded greatly improved levels of care and support inspired by more positive attitudes and a greatly enhanced sense of self-worth among our groups. With potentially business-ruining CQC reports easily available online and a traditionally high turnover of staff, you don’t really need a degree in health economics to work it out. It’s just good business to have better trained staff.

In the meantime we’ll continue to hear an unending tide of bad news stories and radio phone-ins about staff who have become demoralised and dispirited when they could, with a little time and effort, be taking a fresh look at the work they do as something which is as skilled and satisfying as any of the ‘sexier’ areas of the care and support industry.  

It could certainly beat flipping a burger.

Coffee. Biscuits. Powerpoint: Does Social Care Training really do the business?

This article first appeared on The Guardian’s Social Care Network




With social care budgets trimmed to the bone, how do we make sure the little money still  available for staff training gives maximum ‘bang for buck’ and becomes more than just a tick-box exercise?


Dear Reader

If you’re reading this then there’s a reasonable chance you work in health and social care and that you’re a veteran of the training room. And by training I don’t mean a Degree or Diploma, nor the Fire Lecture or the Food Hygiene course that taught you how to boil an egg. I mean the sort of workshop type training typically delivered over a day or two, focussing on a particular subject or skill with the intention of making you better at your job and better able to deliver services to vulnerable people. 

I hope the course left you inspired and invigorated, filled with new skills and knowledge. But there’s also another significant possibility. That it was little more than a chance to catch up with a few bods you haven’t seen the last Clinical Supervision workshop. Not to mention of course the free coffee and a chocolate bourbon.

The course may have been terrible/boring/poorly facilitated/ inappropriate. Tick any which applies. Or it may have been thoroughly enjoyable and a great means of meeting new people and networking. 

But (and it’s rather a big ‘but’) answer this question; ‘Did that course actually change the way you do your job?’ If the answer is usually ‘Yes, and in a good way’ then great. But if it’s ‘No, it was rubbish’ or even ‘No. But it was quite interesting’ then perhaps we need to be thinking about ways and means of delivering training that is both value for money, and effective.

Ask any group of health and social care staff how to resolve a particular issue and the probability is that ’more training’ will loom very large in the responses, as they often do following independent inquiries. ‘More training’ so often seems to be the panacea to all the ills of health and social care work, but is there an evidence base to suggest throwing a few workshops at failures in adult protection is the path to practice redemption? No. At least not according to a PhD student Lindsey Pike.

Lindsey’s doctoral thesis asks the same sort of question I’ve asked you here. It explores the remarkably under-researched question of how training actually impacts practice at the front-line of care and support, specifically focussing on safeguarding adults training in one particular county. Her findings are telling.

To summarise, Lindsey’sw  work shows that lots of resources, effort and administration are being ploughed into costly training which doesn’t, at the end of the day, result in improvements in safeguarding skills on the shop-floor- unless training is embedded within a positive training culture and transfer climate. Transfer climate refers to “those situations and consequences in organisations that either inhibit or facilitate the use of what has been learned in training back on the job” (Burke & Hutchins, 2007, :282). A positive transfer climate would be one where delegates attend relevant, timely training, with a clear idea of what they need to gain from it, and support and opportunity to use their learning in practice.

I know that both myself and others from both the UK and further afield are starting to think about a move on from the ‘Coffee Biscuits Powerpoint’ model, which ticks the box on a manager’s To Do list but achieves little else in terms of making us better at our jobs or providing better services. So what’s the answer? I suggest that traditional classroom-based training can be worth so much more when combined with three key features. 

Firstly, tightly-knit integration of the one or two-day course with an organisation’s own policies and procedures, client groups and focus of attention.
Secondly, training could and should be followed up by some form of one-to-one or small group meeting to allow participants to ‘nail down’ whether the course made an impact on their practice. And who should be doing this follow-up? Well, preferably the trainer who delivered the course. But what if the trainer is now hundreds of miles away? Well there is of course Skype or one of the many e-learning packages out there. But there is an even better solution. 
Localised training delivered by local practitioners who’ve been ‘skilled-up’ by a competent, focussed ‘Train the Trainer’ package is, I think, a genuine and realistic alternative to the ‘expert from afar’ model. Delivering good training is a considerable skill, but not so much a considerable skill it can’t be learnt, especially when training skills are backed up by the sort of expertise and experience in health and social care so valued by course participants.

Connor Kinsella is an author and training consultant at JCK Training: www.jcktraining.co.uk

Connor would like to acknowledge the contribution of Lindsey Pike to this article. Lindsey is currently working with Research in Practice for Adults: www.ripfa.org.uk