Create competency training for volunteers
Program adds quality, reduces staff stress
About five years ago, the Hospice of Northwest Ohio in Perrysburg, OH, had volunteers who said they'd like to do more hands-on work than what their duties typically allowed.
"Our staff said it would be lovely if these volunteers who come regularly could assist them," recalls Carol L. Nichols, MSW, a volunteer coordinator for the hospice.
The inpatient director, team leaders, nursing staff, volunteers, and Nichols talked about the idea and decided to move forward with a plan that would enable volunteers to provide hands-on care for patients in the inpatient facility, she says.
"Then we developed competency training, which is similar to home health aide training," Nichols says. "The tasks are not as comprehensive as home health aide tasks as we've limited the tasks volunteers do in assisting staff."
For example, volunteers assist but do not provide care without direct supervision of a nurse or home health aide, she says.
"The training is task-identified, broken down into different steps of how it's done," Nichols says. "It defines important issues, such as infection control, and it's taught by an RN and volunteer coordinator."
Volunteers are assessed with a competency skill demonstration checklist for each task they are trained to perform. (See sample volunteer competency checklist below.)
The Hospice of Northwest Ohio in Perrysburg, OH, has developed a set of skill demonstration checklists that are used to assess volunteer competency with various tasks volunteers perform at an inpatient hospice. With the hospice's permission, Hospice Management Advisor offers this example of one of the competency checklists: Skill demonstration checklist Bedpan Performance objective: Assist the patient with the use of the bedpan Performance Behavior Satisfactory/Unsatisfactory Comments 1. Washes hands prior to contact with patient 2. Explains procedure to the patient 3. Apply gloves 4. Provide privacy 5. Lower head of bed, roll patient onto side, apply bedpan correctly under patient's buttocks: standard bedpan — position bedpan so wider end of pan is aligned with client's buttocks'; fracture pan — position bedpan with handle toward foot of bed 6. Raise head of bed 7. If able to use tissues, leave within reach; leave call-light within reach 8. Lower head of bed before removing bedpan 9. Apply gloves 10. Roll patient onto side, remove bedpan and empty contents into toilet; measure urine if ordered making sure container is at eye level 11. Cleanse perineal area 12. Clean bedpan and return to storage 13. Remove gloves and offer washcloth to patient to wash hands 14. Wash hands 15. Place call light within reach Essential behaviors 1. Follows all rules of asepsis 2. Protects patient and self against physical harm 3. Takes action to prevent or minimize emotional stress to patient or significant others 4. Explains procedure to patient before initiating it 5. Reports abnormalities or changes |
Now that a number of volunteers have been trained, they provide an additional 120 hours of hands-on care per week, Nichols says.
"That's the equivalent of three full-time staff members," she says.
From a budget standpoint, the volunteers provide $6,000 to $7,000 in labor per month. While there are supervision and training costs, there still is a significant financial benefit to using volunteers to perform these types of tasks, Nichols says.
"The financial benefit would vary for each organization according to how much they used volunteers and how much supervision they felt the volunteers needed," Nichols says.
Here's how the training works:
- Identify tasks for volunteers: "We had a list of possible hospice tasks, and we went down the line and said, 'Yes, no, yes, no,'" Nichols says.
They decided that volunteers could assist with passing trays, feeding, and oral hygiene, but could not do catheter care, for example.
The training includes the list of personal care skills, as well as a review of infection control, isolation precautions, call light system, and phone system.
Here is a list of the personal care skills that are taught as part of the volunteer skills competency training:
- Assist with passing trays and set up;
- Assist with feeding;
- Assist with bag bath;
- Assist with oral hygiene;
- Assist with shaving;
- Assist with nail care;
- Assist with skin care;
- Assist with foot care;
- Assist with back rub;
- Assist with application of clothing;
- Assist with urinal;
- Assist with bedpan;
- Assist with brief application;
- Assist with H.S. care;
- Assist with ambulation;
- Assist with positioning;
- Assist with making occupied bed;
- Assist with making unoccupied bed;
- Assist with transfer techniques;
- Assist with post mortem care.
"They're doing tasks that a nonprofessional can appropriately handle given this competency training," Nichols says. "But that's it; it's not like going to nursing school, and this is only used in the inpatient setting."
The reason for the inpatient setting requirement is that volunteers will not perform the tasks on their own, and they'll always be under the supervision of a nurse, she explains.
"Certainly in the home care situations, caregivers are doing everything — all of these things," Nichols says. "But in a home care situation, we don't have volunteers doing those kinds of tasks."
The idea is not to replace staff, but to improve the quality of care for patients, Nichols notes.
"When you've got more people to help you and your team, your stress level goes down, and we think with more hands available to help there's going to be better patient care," she says.
- Assess volunteers' level of commitment: "You have to make sure the volunteers you're offering this training to are people who want to help in this way," Nichols says.
These volunteers must go through the original eight-week volunteer training, commit to volunteering in the inpatient unit, interact with staff and families and patients in a positive way, and know how to ask for help, she says.
Also, they must understand their role as volunteer, Nichols says.
"You hand-pick the people you offer this training to from the people who are interested," she adds.
Commitment is very important. The inpatient unit schedules volunteers from 8 a.m. to 8 p.m., Monday through Friday.
Volunteers who take on this new role are told that they can refuse to do any task that makes them uncomfortable, Nichols says.
"We tell our volunteers that even though they've been trained in some of these tasks, it doesn't mean they have to do them," Nichols says. "We have volunteers who are not comfortable with changing briefs, and they don't have to do this."
Also, while it's a good idea to have volunteers work consecutively, covering the 12 hour-period during the week, it rarely works out that efficiently, Nichols says.
Sometimes, two volunteers are available only on Monday mornings, and so that time slot is covered twice and another time slot may not have volunteer help, she says.
"Volunteers very frequently are not there because they go to Florida or visit their grandchildren," Nichols says.
- Use role playing during training: At Hospice of Northwest Ohio, the volunteer training is offered three or four times a year to six volunteers at a time. The training lasts three-to-four hours and takes place in an empty patient room or skills lab, where there is the necessary equipment of a bed, wheelchair, and supplies.
"In class we start with the volunteer coordinator playing the patient, and the nurse is teaching," Nichols says. "One of us is lying on the bed, getting fed, getting a brief changed, and we try to make it as real as possible for them."
Part of the training involves showing staff how to talk with volunteers and explain the various tasks each time they work together.
"The staff will say, 'We're going to be rolling Mrs. Smith this way,'" Nichols says. "They should always be talking with the volunteer and working together as a team."
The first tasks covered in training are feeding, passing trays, and setting up.
This task could take a couple of hours, but the nurse will be aware of what the volunteer is doing and will stay attuned even while doing other jobs, she says.
"Then we teach volunteers how to assist staff with bathing someone who can no longer get up and get out of bed," Nichols says. "They learn how to bathe someone and give them fresh linens."
Next, there is training in oral hygiene.
"We help someone brush their teeth or dentures, and that's generally done with the nurse in the room, doing something else," Nichols says. "Then there is the shampoo, nail care, and skin care, which involves lotion."
Volunteers will assist with dressing the patient, using the urinal and bedpan, and positioning the patient.
"We talk about the proper body mechanics and make sure they take care to protect their backs," Nichols says. "We talk about patient safety and working together as a team so the people who are helping the patient transfer from the bed to wheelchair can talk with each other."
Infection control is discussed, and volunteers are told to wash hands often and use gloves. They are told to answer call lights with a smile, saying, "Can I help you?"
"And if it's something they can help with, like 'I can't reach the remote control,' or something, they can do it for the patient," Nichols says. "At the very least they are smiling and responding immediately."
Survey for volunteer/staff satisfaction: The hospice surveyed volunteers and received a favorable response, Nichols says.
"Volunteers enjoy this role, and the staff enjoys having volunteers assist them," Nichols adds. "Some personalities work better with volunteers than others."
The hospice regularly receives positive feedback from volunteers, and patients have accepted the expanded volunteer role, as well.
"The staff is taught to ask patients if they're okay with a volunteer helping them," Nichols says. "They introduce the volunteer this way: 'This is Mary, and she's a very experienced volunteer who is here to help your with your bath this morning. Is it okay?'"
The goal of improving hospice care quality while expanding the volunteers' role has succeeded for the hospice, Nichols says.
"Volunteers assist with high-touch activities that allow the nurses to attend to high-tech activities," Nichols says. "We say that more people equal less running, less stress, and more smiles."
Need More Information?
- Carol L. Nichols, MSW, Volunteer Coordinator, Hospice of Northwest Ohio, 30000 East River Road, Perrysburg, OH 43551. Telephone: (419) 661-4001.
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