Annals of Long Term Care

Pressure ulcers are known to increase a patient’s risk of morbidity and mortality; thus, preventive care is paramount in ensuring optimal patient care and quality of life. Additionally, prevention of hospital-acquired conditions, including pressure ulcers, has become a national priority in light of the Centers for Medicare & Medicaid Services’ recent regulation change regarding nonpayment for
hospital-acquired conditions.¹ As such, staff education on preventive practice has become mandatory in many long-term care facilities; however, delivering informative, impactful, and enjoyable training can be challenging. Published studies and our own experiences demonstrate that making educational programming fun produces better outcomes in staff knowledge and overall quality of care. In this article, we share some creative ideas on how to make your training sessions more entertaining and memorable so that the goal of minimizing pressure ulcers is easier to achieve.

Researchers have examined the level of staff knowledge on pressure ulcer prevention in various clinical studies; however, these studies lack design consistency, limiting our ability to draw conclusions from them. In a 1993 study, Volgelpohl and Dougherty² reviewed textbooks from nursing schools and found that some nursing students may be exposed to as few as 200 lines of text related to pressure ulcers during their training. The authors noted that the information tended to be dispersed over three to seven chapters, was incomplete, and was sometimes inaccurate.

A review of the literature reveals several reports of success in decreasing nosocomial pressure ulcers after implementation of an educational program, when combined with other key changes.^3-5 Any educational program should extend to the patient and his or her family or caregiver. Other key strategies to prevent pressure ulcers include a heightened emphasis on risk assessment; proper use of skin care regimens; implementation of measures to control pressure, friction, shear, and moisture; and proper nutrition and hydration.³ Sinclair and colleagues⁵ conducted a quasi-experimental study to determine the efficacy of using a standardized, evidence-based educational workshop to educate registered nurses (RNs) and licensed practical nurses (LPNs) on pressure ulcer prevention. Participants’ level of knowledge was evaluated before and after the workshop using an adapted version of the Pressure Ulcer Knowledge Test, which consists of true/false questions. Immediately following the intervention and at a 3-month follow-up, the RNs’ and LPNs’ knowledge had significantly improved. This improvement is indicative of the effectiveness of education and suggests that ongoing staff training on pressure ulcer prevention and treatment is both necessary and important. More evaluative studies are needed to assess the impact of standardized, evidence-based education on nurses’ knowledge, and, ultimately, on how this impacts practice. 

Program Design: “Make it Fun or Don’t Bother” 

To make training more interesting and impactful, I (Ms. Oakley) adopted the “Make it fun or don’t bother” motto while working as a treatment nurse at a long-term care facility in New York. This is because I recognized that after a long day of giving care to residents, the staff needed something much more engaging and stimulating from my inservice to make the education meaningful. I recalled an important aphorism, which was first described by Ann Algier in her 1979 book Everything You Need to Know About Learning⁶: 

You remember approximately 10% of what you read.

You remember approximately 20% of what you hear.

You remember approximately 30% of what you see.

You remember approximately 50% of what you hear and see.

You remember approximately 90% of what you do.

With these facts in hand and a thorough knowledge of what needed to be taught, I designed a program that truly engaged the staff and made a difference in pressure ulcer prevention and treatment in my facility. The following describes each component in my plan to improve my staff’s knowledge of pressure ulcers and how to prevent and manage them.

Communication and Teamwork

To be an effective educator, I began by fostering open communication among team members. Giving staff the freedom to discuss their concerns and obstacles to providing quality care without fear of a punitive response is critical to determining how care can be improved. All levels of staff involved in patient care were invited to attend the sessions and were taught the importance of involving multiple disciplines in preventing and treating skin breakdown. For example, even the activities personnel played an important role in the care of patients with ischial pressure ulcers by making sure that these patients did not spend too much time in their wheelchairs. One way this was achieved was by having this staff bring these residents down to the activity room last for events (eg, Bingo) and bring them back to their rooms first following these events, enabling these residents to be helped back into bed more quickly as a measure to relieve pressure on their ischium.