Innovative course puts aides in patients' shoes
It's human nature for aides sometimes to rush sick, elderly patients who have trouble completing their daily activities or learning to do simple tasks. But in this case, human nature should change. Aides may lose patience with their frail, elderly clients who likely have multiple disabilities. Aides don't understand how difficult it can be for such patients to complete even the simplest tasks. This attitude could hurt the patient/aide relationship and lower the agency's client satisfaction scores. So it's in your best interest to teach aides to understand and empathize with patients.
One way to do this is for an education manager to hold an inservice that includes role-playing, so aides can see how it feels to be elderly and sick. Home Health Care Providers of Oklahoma in Broken Arrow, OK, held such an inservice, called "Understanding the Elderly," and found it made a huge impression on the agency's home health aides, says Betty Wolfe, RN, director of education for the freestanding, full-service agency that serves Northeastern Oklahoma.
Wolfe came up with the idea after reading some articles on role-playing and about how patients have a strong need to be understood by the home care or health care professionals who help them.
One article in Newsweek magazine was written by an 84-year-old woman, who spent her last years in a nursing home.1 The woman described how she lost so much of her privacy and dignity because the staff would walk into her room without knocking and usually spoke to her in baby talk.
Teaching aides how it might feel to be an elderly patient is one way to prevent them from treating patients in an impatient or patronizing way. Wolfe designed a one-hour inservice that gives aides the opportunity to see exactly how they interact with patients from the patient's perspective. After the inservice, they were given a 15-question quiz. (See "Real Patient" quiz, p. 135.)
Wolfe gives these tips on how you can create a similar inservice:
1. Write your goals.
Wolfe wrote these objectives for the inservice:
· to provide knowledge of the developmental changes that occur with aging;
· to enable students to experience some of the sensory/motor changes that occur with aging so they can understand the impact these changes may have on the patients;
· to recognize the importance of a positive attitude and patience when caring for elders;
· to be aware that sensory changes can be a major source of morbidity in old age;
· to promote an awareness of their own feelings and attitudes toward older people before undertaking a home care assignment;
· to understand that accidents are the sixth leading cause of death in those 75 and older.
Also, Wolfe gives aides this brief speech:
"These aging changes certainly do not occur overnight. One of the objectives of this class is to expose each of you to a simulated experience and to give you greater compassion when you encounter patients in the same situations at home.
As you experience some of the aging changes yourselves, you will be sensitive to the elderly patients' changes and adapt the home environment for them. You will experience what it is like to have basic needs furnished - but sometimes not the way you would like them to be done.
Many times, we do not give elderly people time to chew their foods. We hurry them along; we rob them of their independence because we're pushing them to hurry. We want everyone to experience the sensation of 'I woke up this morning, and I've really aged.'"
2. Prepare for role-playing.
Select a few aides to portray patients and others to portray the aides who assist them. Home Health Care Providers of Oklahoma had four aides act as patients and four be their aides. Those playing patients met with the education manager at least 15 minutes before the inservice to get dressed for the part, Wolfe says. The props and costumes she used included:
· simulating poor vision by smearing cheap sunglasses smeared with Vaseline;
· immobilizing legs and knees by wrapping rolls of newspaper around knees and covering legs with long pants;
· simulating incontinence by filling quart-sized refrigerator bags with two cans of dog food, placing them in a blue pad on a chair, and having the pretend patients sit on them;
· reducing sensitivity and agility in the hands through the use of splints and gloves;
· putting a half cup of unpopped popcorn in their shoes to give them the sensation of bone spurs in their feet.
Wolfe says rice could be used in place of popcorn, but she feared rice would fall out more easily and get stuck in the carpeting.
3. Let the play begin.
Wolfe videotaped the role-playing exercises for use at later inservices. The scenarios were as follows:
· Aides helped the pretend patients walk to chairs, which had the blue bags and dog food on them. "The look on their faces when they sat on the squishy stuff was really interesting," she says.
The patients sat facing the audience, and they were told to not get up without help from their aides. Beside them were television trays holding food and drinks. Also, the aides had cold washcloths ready to wash the patients' faces.
· The trays had baby food on plates, buttered bread sandwiches cut in thirds, and cups of water. Aides handed patients washcloths and told them to wash their hands and faces before breakfast. Some patients were told to eat with their hands in gloves and some of their fingers in splints. In other cases, aides fed them.
· As the patients ate, the aides tried to rush them by saying, "I do wish you would try to hurry. Don't take so long. Don't be so poky."
· After breakfast, the patients were told to put on a button-up shirt. With their hands immobilized, they found the tasks quite difficult, Wolfe says.
· After dressing, patients had to read the labels of their fake pill bottles, while they were wearing the Vaseline-covered glasses. They were told to decide how many pills they needed to take. The patients also had to open child-proof pill bottles, which were filled with candies, and take the "pills" with water.
· The patients also were told to read the newspaper, which proved difficult, Wolfe says. "We also gave them some coins, mostly dimes, pennies, and nickels, and they had to try to figure out what coin they were actually giving or getting when they had to pay for something."
· Finally, patient instruction began. Elderly people often are distracted by background noises, so Wolfe used three radios, each tuned to a different station, to simulate noise distractions. "We tried different noise levels and placed them strategically around the room. We tried to have the aides instruct patients on medicine with this noise in the background."
These experiences proved instructive, she says. "We had a lot of laughter, but the aides who were actually experiencing how it felt to be a patient said they had never dreamed it would be anything like this, and it made a real big impact on them."
Reference
1. Seaver, Anna Mae Halgrim. Newsweek. 1994: June 27.
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