The words, “state is here,” can evoke a myriad of thoughts and feelings to the staff in a long-term care facility. Some take this as an opportunity to show the great work and care being delivered to residents; others panic and hope the survey is over soon. To have someone inspect your work environment and the outcomes of your care delivery systems can be stressful, to say the least.
When adverse findings are reported in a state survey, the initial response is often “we must need to re-educate our staff.” Unfortunately, establishing an effective strategy for this re-education is often a missed step in the rush to respond. Miller’s Model of Clinical Competence serves as a framework to help determine what type of education intervention is best suited to produce the learning outcomes needed (Chappell & Koithan, 2012).
Infection Control standards are oft cited deficiencies in state surveys. An example of this citation includes the mishandling of linen. Linen that is not properly handled poses an infection risk to vulnerable residents. Before developing an in-service training related to the survey, it is important to identify the learning need at hand. Using Miller’s Model to evaluate the root cause of the problem, begin by asking, “Do the nursing assistants know the infection control principles related to handling laundry?” The Nursing Professional Development (NPD) practitioner may know this topic is covered in orientation and ongoing education courses and can review the education files to determine attendance and course completions. The next step to consider is, “Do the nurse aides know how to implement their knowledge of infection control?” For instance, do the aides know their uniform is considered dirty and that they must always hold linens away from their body and uniform? Determining the problem helps the NPD develop the education response (Hawkes, 2016). The final steps, show how and does, revolve around the nursing assistant’s ability to apply the knowledge and skills in a classroom/lab or on the nursing units and to display these skills effectively.
Responding to a survey with an appropriate educational intervention is critical in resolving concerns identified by the state surveyor. Miller’s Model is a framework that provides a clear path in determining which route to take in developing the educational content needed. Matching the right content to the identified need ultimately results in better resident care and services.
Chappell, K., & Koithan, M. (2012). Validating Clinical Competence. The Journal of Continuing Education in Nursing, 293-294.
Hawkes, B. (2016). Educational Content Development. Chicago: Association for Nursing Professional Development.