This section includes suggested learning strategies, case studies, approaches to assessment, and resources that can be used to enhance student learning for each HCA course. A comprehensive list of recommended HCA program textbooks has been compiled and included in this section as well.

For each course in the HCA Curriculum Guide (2015), this section includes:

1. Suggested Learning Strategies
   • Examples of teaching/learning strategies are included to show how the course content might be used to further students’ abilities to:
     • Apply concepts of caring (with a strong focus on person-centred care).
     • Think critically, solve problems, and make decisions using knowledge, skills, and values inherent in the course content.
     • Maintain a professional approach to practice by assuring safety of self and others, functioning within the parameters of one’s role and functioning interdependently with others.
   • An unfolding case study called “Caring for Peter Schultz” has been integrated throughout program courses to emphasize concepts related to caring. Content for this case study has been adapted from the true story of a client who lived in B.C., as shared through the life writings of his wife in a personal anthology published for family and close friends. This material has been adapted with permission and all names have been changed. To build on their knowledge and to support completion of related learning activities, it is recommended that students develop a client portfolio that can be used throughout the program. To highlight this integrated, unfolding case study, it has been noted in bold red font where presented in each course.
2. Suggested Approaches to Assessment
   • Examples of assessment strategies are included that reflect how the learning outcomes might be appropriately assessed.
3. At the end of each course, there is a list of related online resources and ready-to-use online learning tools, which were selected based on input from stakeholders and their relevance to HCA education. While valid at the time of publication, the online links and resources included may be subject to change or the links may have changed. Before using, especially with learners in the classroom setting, educators will need to confirm that links are active and that online resources are appropriate and relevant to their teaching and learning context.

Textbooks listed could be used for specific HCA program courses or serve as overall program texts. Preference has been given to Canadian editions and those with online ancillary resources. In addition, a number of the textbooks listed are available online through BCcampus as open educational resources.

Adams, C., & Jones, P. H. (2010). Therapeutic communication for health professionals (3rd ed.) McGraw-Hill.

Adler R. B., Rosenfeld, L. B., Proctor, R. F., & Winder, C. (2012). Interplay: The process of interpersonal communication (3rd Canadian ed.). Oxford University Press.

Beebe, S. A., Beebe, S. J., Redmond, M. V., & Salem-Wiseman, L. (2017). Interpersonal communication: Relating to others (7th Canadian ed.). Pearson Canada.

Betts, J. G., Young, K. A., Wise, J. A., Johnson, E., Poe, B., Kruse, D. H., Korol, O., Johnson, J. E. Womble, M., & DeSaix, P. (2016). Anatomy and physiology. OpenStax. https://openstax.org/details/books/anatomy-and-physiology

Blackmore, T. (2020). Community palliative care and COVID-19: A handbook for clinicians who care for palliative patients with COVID-19 in community settings. Class Publishing.

Carr, E. & Mizock, L. (2021). Women with serious mental illness: Gender sensitive and recovery-oriented care. Oxford University Press.

Christie, J., (2020). Promoting resilience in dementia care: A person-centred framework for assessment and support planning. Jessica Kingsley Publishers.

Devereaux Ferguson, S., & Lennox Terrion, J. (2014). Communication in everyday life: Personal and professional contexts. Oxford University Press.

Donatelle, R., Chow, A., & Kolen-Thompson, A. (2017). Health: The basics ((7th Canadian ed.). Pearson Education, Inc.

Doyle, R. G., & McCutcheon, J. A. (2016). Clinical procedures for safer patient care. BCcampus. https://opentextbc.ca/clinicalskills/

Elsevier Inc. (2020). Job readiness for health professionals: Soft skills strategies for success (3rd ed.). Elsevier.

Jones, M. (2007). Gentlecare: Changing the experience of Alzheimer’s disease in a positive way (2nd ed.). Moyra Jones Resources Ltd.

Lidstone, R. & Camosun College. (2016). Line B: Employability skills competency B-3– Use interpersonal communication skills. ECampusOntario. https://openlibrary-repo.ecampusontario.ca/xmlui/handle/123456789/319

Lowey, S. E. (2015). Nursing care at the end of life [Open Textbook]. Open SUNY Textbooks. https://milnepublishing.geneseo.edu/nursingcare/

Melrose, S., Dusome, D., Simpson, J., Crocker, C., & Athens, E. (2015). Supporting individuals with intellectual disabilities and mental illness: What caregivers need to know. BCcampus. https://opentextbc.ca/caregivers/

Melrose, S., Park, C., & Perry, B. (2015). Creative clinical teaching in the health professions. Athabasca University. http://solr.bccampus.ca:8001/bcc/file/c6d0e9bd-ba6b-4548-82d6-afbd0f166b65/1/CREATIVE-CLINICAL-TEACHING-IN-THE-HEALTH-PROFESSIONS.pdf

Murray, K. (2014). Integrating a palliative approach: Essentials for personal support workers (2nd ed.). Life and Death Matters.To support B.C. HCA educators in adopting this textbook (and accompanying workbook), the author has prepared and published a resource map [http://lifeanddeathmatters.ca/for-educators-2/mapping-documents/] that outlines how a palliative approach could be integrated across the B.C. HCA Provincial Curriculum (2015).

Nightengale, D. J. (2020). The pocket guide to mouth and dental hygiene in dementia care: Guidance for maintaining good oral health. Jessica Kingsley Publishers.

Nouwen, H. (2011). A spirituality of caregiving. Upper Room Books.

Richards, C. (Ed.) (2020). Living well with dementia through music: A resource book for activities providers and care staff. Jessica Kingsley Publishers.

Schachter-Shalomi, Z. & Miller, R. (1997). From age-ing to sage-ing: A profound new vision of growing older. Warner Books.

Sorrentino, S. A., Remmert, L., & Wilk, M. J. (2021). Mosby’s Canadian textbook for the support worker (5th Canadian ed.). Elsevier.This textbook, as well as the accompanying workbook, are typically used as the core program resources in B.C. HCA Programs. The ancillary tools for this textbook are available for instructors and students at  https://evolve.elsevier.com/. The 5th edition was released in the fall of 2021, but some post-secondary institutions may continue  to use the 4th edition of this textbook.

Thelker, C. (2020). For this I am grateful: Living with dementia. Austin Macauley.

Wolgin, F., Smith, K., French, J., Butt, A., Patterson, D. (2017). The Canadian personal care provider. Pearson Canada, Inc.

Suggested Learning Strategies

Strategies that Focus on Caring

1. Caring and Caregiving Discussion

Invite students to work in small groups to discuss situations in which they have felt cared for or cared about and situations in which they did not feel cared about.

• Ask the groups to describe the characteristics of each experience. Also, ask them to identify the emotions experienced related to the differing situations. How did they feel about themselves in each situation? How did they feel about the other person?

2. Characteristics of Caring and Caregiving Discussion

Invite students to read the Values, Beliefs, and Principles section in the Introduction to the HCA Program Provincial Curriculum Guide 2015, with particular emphasis on the section about Caring and Caregiving. Encourage them to identify as many characteristics of caring as they can from their reading.

Now ask students if they can identify other characteristics of caring based on their own experience. Ask students to see if the characteristics of caring can be grouped (i.e., themes that come through).

Possible groupings might include:

• Knowing and understanding the other person.
• Respecting and trusting the other person.
• Respecting and trusting oneself.
• Recognizing the connectedness or similarities between ourselves and others.

3. Person-Centred Care

Invite students to work in small groups to examine two or more situations. For each situation, ask the group to consider: What is there about this situation that reflects person-centred care and what does not? Could the situation have been handled differently? If so, how? Refer to situations included on the STUDENT HANDOUT below.

4. Unfolding Case Study: Caring for Peter Schultz

As a homework assignment, have students read their textbook and other relevant course or online materials describing the five principles of compassionate, person-centred care (dignity, independence, preferences, privacy, and safety).

1. Whole Class Activity and Discussion
   • In class, briefly review the principles and list them on the whiteboard for reference throughout the activity.
2. Pairs Activity
   • Divide the class into pairs and ask each student to read the STUDENT HANDOUT below introducing the situation and providing a client profile for Peter Schultz. After reading the client profile, the pairs should complete a proposed schedule.
3. Whole Class Debrief
   • After students have completed the pairs activity, briefly come together as a class to share how the schedule they developed reflects the principles of compassionate care. Be sure to emphasize the importance of a flexible approach and easily adapted activities. As relevant, bring forward examples of how other client needs could be met or addressed at appropriate intervals (e.g., toileting before going out in the garden for a walk).

Note: Students could be instructed to add a copy of the client profile and schedule to their client portfolio for Peter Schultz.

Strategies that Focus on Critical Thinking, Problem-Solving, and Decision-Making

1. Problem-Solving Process

Since this course is the first time students will be presented with the concept of a systemic problem-solving process as it relates to the HCA role, it is important that they grasp how important it is that a careful analysis of the situation precedes decisions.

Ask students to work in small groups. Give them a fictitious problem that they can relate to. For example, “Imagine you have taken the first major exam in the HCA program and received a failing grade.”

In analyzing this problem students should ask:

• Why has this problem arisen?
• What caused it?
• Who is involved?
• What is my goal (i.e., how will I know when the problem is “solved”)?
• What feelings am I experiencing?

Once the problem has been analyzed, have students (again, in small groups) identify as many options or choices as possible. For each option, ask them to identify the positive and negative consequences of that particular action. For example:

Once the students have completed their analysis of the problem, have them decide on the “best” decision or solution. How did the analysis help them come to a decision?

Could a different decision be “better” for other people or situations?

Have students discuss how HCAs can best help others to analyze problems and look at possible options before jumping to a solution. Have them discuss the ways in which problem-solving can be a caring process.

Have students, individually, conduct the same analysis using a real problem from their own lives (see STUDENT HANDOUT below for use with this exercise). This process could be used as an assignment for this course.

2. Problem-Solving and Decision-Making in a Clinical Situation

The following steps for decision-making regarding care provision are used with permission of Island Health.Island Health Authority, the B.C. Health Education Foundation and the Ministry of Health Services are acknowledged for granting permission to adapt material from the Island Health Transitional Learning Continuum, Health Care Assistant in Acute Care Curriculum (2012). The “Six Steps” below provide a framework for decision-making by the HCA and could be used in a variety of situations. The case study on the STUDENT HANDOUT below outlines how these steps can be applied and could also be used in Healing 3: Personal Care and Assistance.

Six Steps

1. Confirm instructions
2. Gather information
3. Perform activity
4. Observe responses
5. Report
6. Record

3. Classroom Debate Activity

Invite students to engage in a debate about a topic discussed in this course. Divide the class into small groups of three to five students and assign two groups to each of the topics outlined; one group will take a pro position towards the topic and the other group will take a con position.

Ask each group to identify two to three reasons to support the position they have been assigned. Then, with the instructor acting as the moderator, the two groups will engage in a debate using the following structure:

• Each group provides a brief introduction to their position on the topic.
• In alternating format, the two groups present the two or three reasons identified to support their position.
• Each group provides a brief closing statement.

After the debate has concluded, briefly come together as a larger group and summarize the positions that were presented. Invite feedback from the students not involved in the debate and discuss further considerations. Alternate groups until each student has participated in a debate.

Debate topics for Health and Healing: Concepts for Practice:

1. Couples should receive priority to live together in care.
2. Clients are better supported by HCAs who share their culture, values and/or beliefs.
3. Clients are better supported by family and friends than by employed HCAs.
4. Working in a community setting requires HCAs to use critical thinking skills more often than working in a facility setting.
5. HCAs should support the use of medical marijuana as an alternative form of health care.
6. HCAs should allow their clients to live at risk (e.g., refuse to use a walker).

Strategies that Focus on Professional Approaches to Practice

Have students, in groups, use the STUDENT HANDOUT below to consider the case studies and how they are related to key course concepts.

Suggested Course Assessments

The course learning outcomes may be assessed by the following tasks:

1. One or more quizzes or examinations that pertain to knowledge of human needs, human development, and safety and protection (Learning Outcomes #1, #2, and #4).
2. An individual project that uses problem-solving and decision-making processes in a caregiving context. Students could be provided with a scenario from a practice environment and then directed to use a systematic problem-solving process to come to a decision (Learning Outcome #3).
3. An elder-awareness project. Each student will conduct an interview with an elder (i.e., someone who is over the age of 75), preferably someone who is also different from the student in gender, culture, ethnicity, and/or socio-economic level. Students will be invited to share their interviews with their student peers in small groups. Students will also be invited to discuss what these interviews tell them about generational differences, diversity, and changing family structures. Students will be expected to submit this exercise as a project paper (Learning Outcomes #1 and #5).
4. An occupational health and safety awareness project. WorkSafeBC accepts time-loss claims from about 50,000 injured workers each year. About 9,000 of those claims originate in health care and social services workplaces, more than any other sector in B.C. The workers at greatest risk of injury are those who provide direct care. HCAs are the most injured workers in the province, with about 3,000 claims accepted annually. The greatest hazards they face are from lifting and transferring, as well as exposure to violence and infectious disease, all of which are directly related to the people they are caring for.In order for students to get a better sense of the hazards facing them in the workplace, they could complete an assignment that requires them to go to the WorkSafeBC website health care section and research a topic to increase their awareness related to hazards and safety. Specific hazards to research (with most relevance to HCA safety) are: patient handling, slips and trips, violence prevention, and infectious disease. Students could be required to select and review a publication or watch a video related to one of the top health care hazards. They could describe the potential hazard, discuss possible ways to minimize the risk of injury, and recommend possible responses when facing that hazard. Additionally, they could describe how the hazard they face could also impact the person being cared for (Learning Outcome #4).

Resources for Health and Healing: Concepts for Practice

Online Resources

Anderson, J. (2016, March 21). 14 ways to help seniors avoid isolation. A Place for Mom. http://www.aplaceformom.com/blog/help-seniors-avoid-social-isolation-8-14-2014/

Baillie, L., Gallagher, A., & Wainwright, P. (2008). Defending dignity: Challenges and opportunities for nursing. Royal College of Nursing. https://www.dignityincare.org.uk/_assets/RCN_Digntiy_at_the_heart_of_everything_we_do.pdf

Battams, N. (2018). A Snapshot of Family Diversity in Canada. Vanier Institute of Canada. https://vanierinstitute.ca/a-snapshot-of-family-diversity-in-canada-february-2018/

B.C. Care Providers Association. (2020). Aging with pride. https://bccare.ca/aging-with pride/

Campion-Smith, B. (2012, Sept 20). Canadian families growing more diverse, Census data shows. Toronto Star. https://www.thestar.com/news/canada/2012/09/20/canadian_families_growing_more_diverse_census_data_shows.html

Canadian Human Rights Commission. (Nov, 2020) What is discrimination? https://www.chrc-ccdp.gc.ca/en/about-human-rights/what-discrimination

CBC Radio. (2014). Gay and grey: LGBT seniors fear care facilities, and Bridget Coll and Chris Morrisson’s story. [Radio special series]. CBC. https://www.cbc.ca/player/play/2441517900

Culo, S. (2011, October). Risk assessment and intervention for vulnerable older adults. BCMJ, 53, (8), October 2011, 421-425. http://www.bcmj.org/sites/default/files/BCMJ_53_Vol8_risk_assessment_0.pdf

Earle, L. (2011). Traditional Aboriginal diets and health. National Collaborating Centre for Aboriginal Health, University of Northern British Columbia. http://www.nccah-ccnsa.ca/docs/social%20determinates/1828_NCCAH_mini_diets_health_final.pdf

Eden Alternative. http://www.edenalt.org/

First Nations Health Authority. (n.d.). Creating a climate for change. https://www.fnha.ca/Documents/FNHA-Creating-a-Climate-For-Change-Cultural-Humility-Resource-Booklet.pdf

First Nations Health Authority. (2020). Cultural safety and humility. https://www.fnha.ca/wellness/cultural-humility

First Nations Health Authority. (2015). Declaration of commitment. https://www.fnha.ca/Documents/Declaration-of-Commitment-on-Cultural-Safety-and-Humility-in-Health-Services.pdf

First Nations Health Authority. (n.d.). Traditional healing. https://www.fnha.ca/what-we-do/traditional-healing

Government of British Columbia. About B.C.’s health care system. http://www2.gov.bc.ca/gov/content/health/about-bc-s-health-care-system

Government of British Columbia. Caring for seniors. http://www2.gov.bc.ca/gov/content/family-social-supports/seniors/caring-for-seniors

Government of British Columbia. Gender equity in B.C. https://www2.gov.bc.ca/gov/content/gender-equity?keyword=gender&keyword=diversity

Government of British Columbia. Self care. http://www2.gov.bc.ca/gov/content/family-social-supports/seniors/caring-for-seniors/caring-for-the-caregiver/self-care

Government of British Columbia (2015) Seniors. http://www2.gov.bc.ca/gov/content/family-social-supports/seniors

Government of British Columbia, Ministry of Health. (2015). The British Columbia patient-centered care framework. https://www.health.gov.bc.ca/library/publications/year/2015_a/pt-centred-care-framework.pdf

Government of British Columbia, Ministry of Health. (2011). Director of licensing standard of practice: Incident reporting of aggressive or unusual behaviour in adult residential care facilities. https://www2.gov.bc.ca/assets/gov/health/accessing-health-care/finding-assisted-living-residential-care-facilities/standard-practice-peportable-incidents.pdf

Government of British Columbia, Ministry of Health Services Policy Communique. (2011). Standardized hospital colour codes. https://www2.gov.bc.ca/assets/gov/health/keeping-bc-healthy-safe/health-emergency-response/standardized-hospital-colour-codes.pdf

Government of British Columbia, WelcomeBC. (2020). Multicultural B.C. https://www.welcomebc.ca/Choose-B-C/Explore-British-Columbia/Multicultural-B-C

Government of Canada. (2017). Indigenous peoples and communities. https://www.rcaanc-cirnac.gc.ca/eng/1100100013785/1529102490303

HealthCareCAN. (2016). Issue brief: The Truth and Reconciliation Commission of Canada: Health-related recommendations. https://www.healthcarecan.ca/wp-content/themes/camyno/assets/document/IssueBriefs/2016/EN/TRCC_EN.pdf

HealthLinkBC. http://www.healthlinkbc.ca

HealthLinkBC. (2019). Sexual orientation. https://www.healthlinkbc.ca/health-topics/abj9152

Island Health. (n.d.). Developing inclusive and affirming care for LGBTQ2+ seniors toolkit. https://bccare.ca/wp-content/uploads/2019/07/Inclusive-Care-Toolkit-Island-Health.pdf

Killermann, S. (2020). Breaking through the binary: Gender explained using continuums. https://www.itspronouncedmetrosexual.com/2011/11/breaking-through-the-binary-gender-explained-using-continuums/

Mas, S. (2015). Truth and Reconciliation offers 94 “calls to action. CBC News. https://www.cbc.ca/news/politics/truth-and-reconciliation-94-calls-to-action-1.3362258

McLeod, S. A. (2020, March 20). Maslow’s hierarchy of needs. Simply psychology. https://www.simplypsychology.org/maslow.html

Public Guardian and Trustee of British Columbia. http://www.trustee.bc.ca

Paul, R. & Eider, L. (2006). The miniature guide to critical thinking: Concepts and tools. The Foundation for Critical Thinking. https://www.criticalthinking.org/files/Concepts_Tools.pdf

Provincial Health Services Authority in B.C. (n.d.). San’yas Indigenous cultural safety training. http://www.sanyas.ca/

QMUNITY. (2018). Queer terminology from A to Q. https://qmunity.ca/wp-content/uploads/2019/06/Queer-Glossary_2019_02.pdf

QMUNITY. http://www.qmunity.ca/

Revera Inc. and International Federation on Ageing. (2014). Revera report on ageism. https://cdn.reveraliving.com/-/media/files/reports-on-aging/report_ageism.pdf?rev=8835002714be4f1da65588ad7d92a316&_ga=2.266237199.1252853060.1620072730-928366378.1620072730

SafeCareBC. http://safecarebc.ca/

SafeCareBC. Violence prevention. https://www.safecarebc.ca/initiatives/violenceprevention/

Simon Fraser University, Gerontology Research Centre. http://www.sfu.ca/grc/

Social Care Institute for Excellence. (2015, January). Promoting independence in care homes [Video and messages]. https://www.scie.org.uk/personalisation/practice/residential-care-homes/promoting-independence

Statistics Canada. (2020). Older adults and population aging statistics. https://www.statcan.gc.ca/eng/subjects-start/seniors_and_aging

Thompson, S. (2017, August 17). Cultural differences in body language to be aware of. Virtual Speech. https://virtualspeech.com/blog/cultural-differences-in-body-language

Truth and Reconciliation Commission of Canada. (2015). Truth and reconciliation commission of Canada: Calls to action. http://trc.ca/assets/pdf/Calls_to_Action_English2.pdf

University of Victoria, Equity and Human Rights. (2020). Unconscious biases. https://www.uvic.ca/equity/employment-equity/bias/index.php

U.S. National Library of Medicine. (n.d.) Medicine ways: Traditional healers and healing. In Native Voices: Native Peoples’ Concepts of Health and Illness [Online exhibition]. https://www.nlm.nih.gov/nativevoices/exhibition/healing-ways/medicine-ways/medicine-wheel.html

Ward, C., Branch, C., Fridkin, A. (2016). What is Indigenous cultural safety – and why should I care about it? Visions Journal, 11(4), 29. https://www.heretohelp.bc.ca/visions/indigenous-people-vol11/what-indigenous-cultural-safety-and-why-should-i-care-about-it

WorkSafeBC. (2006). Home and community health worker handbook. https://www.worksafebc.com/en/resources/health-safety/books-guides/home-and-community-health-worker-handbook?lang=en&direct

WorkSafeBC. What’s wrong with these photos (home care aide) [Photographs]. https://www.worksafebc.com/en/resources/health-safety/posters/home-care-worker-bathroom/full-booklet?lang=en&direct

Online Videos and Films

AgeismComs369. (2012, November 30). Representation of seniors in popular media [Video]. YouTube. https://www.youtube.com/watch?v=c94_eIYeBuI&feature=youtu.be

CBC News. (2017, June 1). How to talk about Indigenous people [Video]. YouTube. https://www.youtube.com/watch?v=XEzjA5RoLv0

CNN. (2013, July 30). CNN’s world’s untold stories: Dementia village [Video]. YouTube. https://www.youtube.com/watch?v=LwiOBlyWpko

Crashcourse. (2012, August 6). Digestive system: Crashcourse biology #58 [Video]. YouTube. https://www.youtube.com/watch?v=s06XzaKqELk&feature=youtu.be

Happiness.com. (2017, November 6). What is: Maslow’s pyramid – The hierarchy of needs [Video]. YouTube. https://www.youtube.com/watch?v=zLHiWjMFYUU

The Health Foundation. (2014, December 10).  Compassion, dignity and respect in health care [Video]. YouTube. https://www.youtube.com/watch?v=HVF0273iHus

The Health Foundation. (2015, February 2). Person-centred care made simple [Video]. YouTube. https://www.youtube.com/watch?v=6Dk3CV-Wt38

Knovva Academy. (2018, March). Me or we? Cultural difference between East and West [Video]. YouTube. https://www.youtube.com/watch?v=78haKZhEqcg

LanaLoutfy. (2013, February 3). Hierarchy of needs in Ratatouille [Video]. YouTube. https://www.youtube.com/watch?v=tzQ9vrvTAtk&t=1s

Learn My Test. (2019, May 24). Erik Erickson’s theory of psychological development [Video]. YouTube. https://www.youtube.com/watch?v=6XxFmXkD8M8

Media Partners. (2017, September 13). Unconscious bias [Video]. YouTube. https://www.youtube.com/watch?v=0veDFGo666s

National Association to Stop Guardian Abuse. (2008, August 23). A cry for help [Video]. YouTube. http://youtu.be/rjlMQD-S_YQ

Nucleus Medical Media. (2011, March 1). Pressure sores [Video]. YouTube. http://youtu.be/Eyuguc7KKC4

Phil Rice Productions (2018, February 28). The workplace safety news: Injury and hazard reporting [Video]. YouTube. https://www.youtube.com/watch?v=Q996gWGxZQ0

Psych Hub. (2020, January 28). Prevent caregiver burnout [Video]. YouTube. https://www.youtube.com/watch?v=EyeSbGBAmpI

Royal Liverpool Hospitals. (2018, April 12). Managing risks, Part 1 [Video]. YouTube. https://www.youtube.com/watch?v=GR8BZXC1vXI

Royal Liverpool Hospitals. (2018, April 12). Managing risks, Part 2 [Video]. YouTube. https://www.youtube.com/watch?v=nVadQGh-3Ec

Safety Memos. (2014, November 14). Caregiver safety – 30 second inspection –Safety training video [Video]. YouTube. https://www.youtube.com/watch?v=sB8qgt8eT5g

The School of Life. (2019, April 10). Why Maslow’s hierarchy of needs matter [Video]. YouTube. https://www.youtube.com/watch?v=L0PKWTta7lU&t=2

Sprouts. (2017, April 23). 8 stages of development by Erik Erikson [Video]. YouTube. https://www.youtube.com/watch?v=aYCBdZLCDBQ

Sprouts. (2018, August 1). Piaget’s theory of cognitive development [Video]. YouTube. https://www.youtube.com/watch?v=IhcgYgx7aAA

Ted-Ed. (2017, December 14). How the digestive system works – Emma Bryce [Video]. YouTube. https://www.youtube.com/watch?v=Og5xAdC8EUI

Tiffanyx93.2010, June 2)Up and the hierarchy of needs [Video]. YouTube. https://www.youtube.com/watch?v=Iucf76E-R2s

WorkSafeBC. (2012, June 2). Dialogue on dementia (5 parts) [Video]. YouTube. https://www.youtube.com/watch?v=E-PC-GtEetI&list=PLB54257BBCB1A9EB1

WorkSafeBC. (2008, May 23). Leave when it’s unsafe [Video]. YouTube. https://youtu.be/vnD2KgA2bIU

WorkSafeBC. (2018, July 17). Point-of-care risk assessments in long-term care [Video]. YouTube. https://www.youtube.com/watch?v=CLuI-QtyZEs

Wright, L. Mr. Nobody. National Film Board [Film]. https://www.nfb.ca/film/mr_nobody/

Online Learning Tools

The following materials are ready for use in the classroom. A brief description and estimated time to complete each activity is included for each.

Sagan, A. (2015, May 3). Canada’s version of Hogewey dementia village recreates “normal” life. CBC News. http://www.cbc.ca/news/health/canada-s-version-of-hogewey-

• A short article describing Hogewey dementia village and application of related principles at a care home in Ontario (15 minutes for review and discussion).

Social Care Institute for Excellence. (2014). Choice and control: Dignity in care [Video]. https://www.scie.org.uk/dignity/care/videos/social-inclusion

• A video and messages for practice to illustrate how offering choice and control supports a person-centred approach to care (20 minutes for review and discussion).

Social Care Institute for Excellence. ( 2014). Social inclusion: Dignity in care [Video]. http://www.scie.org.uk/socialcaretv/video-player.asp?v=social-inclusion

• A video and messages for practice to illustrate how social inclusion supports a person- centred approach to care (20–25 minutes for review and discussion).

Suggested Learning Strategies

Strategies that Focus on Caring

1. Qualities and Characteristics of Care Providers Discussion

Invite students to form small groups and discuss what qualities and characteristics they would want in a care provider for themselves or a family member.

Have them work to describe the “perfect” care provider in terms of:

• Personality
• Work habits
• Knowledge level
• Relationship with other health team members
• Relationship with family members
• Other characteristics that seem important

Which qualities/characteristics would be considered MOST important? What does this tell you about the qualities and characteristics of an effective care provider?

2. Caring for Clients Discussion

Questions that could be used to elicit discussion on caring:

• If we truly care about and for our clients, what sort of environment will we want them to live in (e.g., client-centred model of care)?
• In what ways does a team approach contribute to better care for a client?
• How are legal and ethical standards related to a philosophy of individual worth?
• How is striving for increased personal competence related to being a caring health care provider?
• How does maintaining professional boundaries by the health care provider show caring for the client?

3. Unfolding Case Study: Caring for Peter Schultz

As a homework assignment, have students read their textbook and other relevant course or online materials describing the role of the HCA in various health care settings, including community day programs, home care, and residential care. Ask the students to identify the positive aspects and challenges associated with working in each of these settings.

1. Whole Class Activity and Discussion
   • In class, briefly review the health care settings and list the positive aspects and challenges that may be experienced by the HCA working in these settings on the whiteboard. Following this, ask the students to consider positive aspects and challenges that might be experienced by clients and their families in these same settings and list them on the whiteboard.
2. Small Group Activity
   • Divide the class into small groups, assigning each group one of the following scenarios describing client and family experiences with various health care agencies and settings. After the students have read the scenario; they should work together to identify the positive aspects and challenges described in the scenario and be prepared to share their observations with the larger group. See STUDENT HANDOUT below.
3. Whole Class Activity Debrief
   • Come together as a class and have each group report back on the positive aspects and challenges that were identified. Work together to identify additional positive aspects and challenges that may be experienced by clients and families being supported in these care settings. For each setting, discuss how the HCA could provide support to address the challenges identified.

Note: Students could be instructed to add the scenario(s) and notes from this session to their client portfolio for Peter Schultz.

Strategies that Focus on Critical Thinking, Problem-Solving, and Decision-Making

1. Classroom Debate Activity

Invite students to engage in a debate about a topic discussed in this course. Divide the class into small groups of three to five students and assign two groups to each of the topics outlined; one group will take a pro position towards the topic and the other group will take a con position.

Ask each group to identify two to three reasons to support the position they have been assigned. Then, with the instructor acting as the moderator, the two groups will engage in a debate using the following structure:

1. Each group provides a brief introduction to their position on the topic.
2. In alternating format, the two groups present the two or three reasons identified to support their position.
3. Each group provides a brief closing statement.

After the debate has concluded, briefly come together as a larger group and summarize the positions that were presented. Invite feedback from the students not involved in the debate and discuss further considerations. Alternate groups until each student has participated in a debate.

Debate Topics for Health Care Assistant: Introduction to Practice.

1. HCAs can provide better care to clients in residential care settings (vs. community settings).
2. HCAs are better supported in residential care settings (vs. community settings).
3. Working in home support requires more critical thinking than working in facility settings.
4. HCAs should be able to provide formal care services to their own family members.
5. A HCA has the right to refuse to provide care to a client whose values or beliefs do not align with their own.
6. A female client has the right to refuse care provided by a male caregiver.
7. Diversity in the health care team (e.g., generational or educational differences) leads to challenges in the workplace.

2. Encouraging Reflective Practice

In order to develop HCA students’ ability to self-reflect and recognize and respond to their own self-development needs as care providers, consider introducing a model that can be used for reflective practice review, such as Gibbs’ Reflective Cycle (1988).Gibbs’ Reflective Cycle (1988). Retrieved from https://brightknowledge.org/medicine-and-healthcare/what-is-reflective-practice

• Description: What happened?
• Feelings: What did you think and feel about it?
• Evaluation: What were the positive and negative aspects?
• Analysis: What sense can you make of it?
• Conclusion: What else could you have done?
• Action Plan: What will you do next time?

Working together as a class, apply the Gibbs’ Reflective Cycle model to the following scenarios:

Today at your annual performance review, your supervisor tells you that she has received a report from another HCA that you were impatient with a client. The HCA stated that he had tried to approach you about the situation, but you would not discuss it. You remember that you had been feeling anxious that day about a personal matter and had felt bad for sighing loudly and saying, “I don’t have all day,” when your client, Mrs. Smith, was taking a longer time than usual to pick her outfit.

Today while you are assisting a client in the dining room, you overhear two of your co-workers recalling a story about another client and laughing loudly. Taken aback by the situation, you don’t approach your co-workers, but afterwards it bothers you and you are unsure of how to move forward.

As a recent HCA graduate, you are feeling excited about your new job at a residential care home. During the orientation session, you realize that the lift equipment being used is different from what you used during your clinical placement and despite the practice you receive during training, you still feel uncomfortable with using the equipment. You don’t want to leave a negative impression with your employer, so don’t speak up when the session leader asks if anyone has any questions or concerns.

You are an HCA who has recently been hired at a residential care home. Today you are assigned to work with Dorothy, an HCA who has been employed by the care home for 18 years. When you suggest that the two of you come up with a brief plan for how to schedule your morning, Dorothy insists that you follow her regular routine. Throughout the day, Dorothy makes all of the decisions and disregards any suggestions that you make, saying, “This is the way we do things here.” At the end of the day, you learn you will be working with Dorothy for the rest of the week.

3. Problem-Solving and Decision-Making Process

Have students, either alone or with colleagues, discuss an issue that presents itself to them. One that might be appropriate is the following:

As you move towards completion of the HCA program, you will have to decide within which health care context you’d like to find a job and/or whether you might want to continue your education.

The STUDENT HANDOUT below will help students analyze this problem and come to a decision that best “fits” for them at this point in time.

Strategies that Focus on Professional Approaches to Practice

1. Professional Practice Exercises

1. Invite students, as a whole class or in smaller groups, to discuss what is meant by “professional approach to practice.” Ask them to consider what sorts of behaviours reflect a “professional” approach. As the ideas are forthcoming, write them on a whiteboard or flip chart. Afterwards, encourage students to determine if there are any themes or major descriptors of professional approaches to practice. These may include:
   • Respect for the client
   • Respect for self as a health care practitioner
   • Providing safe, competent care and assistance
   • Being organized
   • Functioning within defined parameters of one’s role
   • Being dependable, reliable, and honest
   • Working collaboratively with other members of the health care team
   • Being ethical
   • Being a reflective practitioner, recognizing and seeking ways to improve competence
2. Introduce the Professional Behaviour Development Rubric and discuss how this type of tool could support students in their application of professionalism during the program.
3. To further extend the activity, invite students to identify what they will need to know and be able to do in order to function in a professional manner as an HCA in relation to the descriptors they have identified. Ask each small group to examine one of the major elements of professional practice and discuss the learning needs related to it. They may use a graph such as the one below.

2. Exploring Workplace Policies

1. Working in pairs, have students complete online research about the work-based policies of an employer or health authority in B.C. The policies could be related to professional image; social media, online communication, and texting; respectful workplace including cyber bullying; and confidentiality of personal information. Students should be prepared to report back to the larger group, describing the policy, why it is important, and how it relates to the professional practice of a Health Care Assistant.
   • The following resources may be helpful for this activity:
     • Fraser Health
     • Interior Health
     • Island Health
     • Northern Health
     • Vancouver Coastal Health
   • Note: Related information may also be found in workplace collective agreements available on union websites (See Online Resources at the end of this section for website information).
2. Case Scenarios
   • Invite students to form small discussion groups and discuss situations in which an HCA is confronted with a workplace dilemma. Ask them to discuss the situations on the STUDENT HANDOUT below and put forward suggestions for how each situation should be handled based on what they have learned in the course. Using the links above, have them consider if there is a program or workplace policy or collective agreement that they could refer to for guidance.

3. Interprofessional Teamwork

The following case study is used with permission of Island Health.Island Health. (2012). Transitional Learning Continuum, Health Care Assistant in Acute Care Curriculum.

Jane is an HCA who works on an inpatient orthopaedic unit and has worked on this unit as a casual for the past three months. Jane is participating in a morning huddle and hears about Gladys, a patient who was admitted two days ago with a fractured right hip that she sustained when she slipped on an icy patch outside her church.

Gladys lives alone in a two-level townhome, with a cat. She has one son who lives in town, who reports that his mom has lost a lot of weight since her husband passed away six months ago. The team leader reports that Gladys is one day post-op from a right hemiarthroplasty (partial hip replacement); she does not have hip precautions and is weight bearing as tolerated (WBAT). Gladys would like to be discharged home with supports in a week.

Discussion Questions:

1. Identify four members of the health care team who may be involved with Gladys’s care.
2. What unique contributions might Jane expect from the members of the interprofessional health care team that would support the goal of being discharged home?
3. What might Jane’s role be with Gladys’s care?
4. How might Jane demonstrate interprofessional communication with the team?

4. Understanding Workers’ Rights and Responsibilities Activity

This activity is designed to support students in better understanding HCA rights and responsibilities, the role of the supervisor and supervision, and the importance of workplace orientation and training. It is recognized that there may be some overlap with content covered in other courses but given the overall view to occupational health and safety, it is being included in this HCA Introduction to Practice course.

It is suggested that educators:

1. Invite students, as a whole class or in smaller groups, to identify the specific rights and responsibilities of workers. Elicit rights and responsibilities on the whiteboard or on a flip chart. See those listed below as a guide or provide the STUDENT HANDOUT below.
2. After the brainstorming session, work with students to consider workplace safety and how rights and responsibilities can be considered specifically within the role of the HCA, using the questions and answers on the DISCUSSION GUIDE, if helpful.

Suggested Course Assessments

The course learning outcomes may be assessed by the following tasks:

1. One or more quizzes or examinations that pertain to knowledge of the British Columbia health care system; workplace settings; roles and responsibilities of health team members; legal and ethical aspects of caregiver practice and human rights (Learning Outcomes #1, #2, and #3).
2. An assignment in which students analyze one or more scenarios taken from practice situations. Students discuss the role of the HCA, rights and responsibilities, legal and ethical implications, and appropriate caring (person-centred) approaches (Learning Outcomes #1 and #3).
3. A written assignment in which students describe the qualities and characteristics of an “ideal” care provider, with emphasis on how an “ideal” HCA works both independently and collaboratively. Each student will compare themselves to this ideal and use this comparison to delineate self-development needs (Learning Outcomes #1, #3, and #4).
4. A written assignment in which students develop a personal mission statement related to their work as HCAs, and career goals, both short and long term. The students should then use the internet to look up mission and value statements of various employers. Using this information and their knowledge of the challenges and rewards of various workplace settings (community, residential, acute care), the students will describe where they would like to work and why and how this fits with their own beliefs, values, goals, and interests (Learning Outcome #5). Refer to Section 5: Sample Evaluation Tools.

Resources for Health Care Assistant: Introduction to Practice

Online Resources

Access to Information Act, RSC 1985, c A-1. http://laws-lois.justice.gc.ca/eng/acts/a-1/

Adult Guardianship Act. RSBC 1996, c. 6. https://www.bclaws.gov.bc.ca/civix/document/id/complete/statreg/96006_01

B.C. Care Providers Association. http://bccare.ca/

B.C. Centre for Disease Control. (2020). Ethics. http://www.bccdc.ca/health-professionals/clinical-resources/covid-19-care/ethics

B.C. Government and Service Employees’ Union. http://www.bcgeu.ca/

B.C. Housing. (2016). Assisted living residences. http://www.bchousing.org/Options/Supportive_Housing/SSH/AL

Berta, W., Laporte, A., Deber, R., Baumann, A., & Gamble, B. (2013). The evolving role of health care aides in the long-term care and home and community care sectors in Canada. http://www.human-resources-health.com/content/11/1/25

Bright Knowledge from Brightside. (2017). What is reflective practice? https://brightknowledge.org/medicine-and-healthcare/what-is-reflective-practice

British Columbia College of Nurses and Midwives. (n.d.). Assigning and delegating to unregulated care providers. https://www.bccnm.ca/Documents/learning/RN_NP_Assigning_Delegating_UCP.pdf

British Columbia College of Nurses and Midwives. (2021). Licenced practice nurses-practice standards-working with health care assistants. https://www.bccnm.ca/LPN/PracticeStandards/Pages/WorkingwithHealthCareAssistants.aspx

Canadian Human Rights Act. RSC, 1983, c. H-6. https://laws-lois.justice.gc.ca/eng/acts/h-6/

Canadian Human Rights Commission. http://www.chrc-ccdp.ca

Canadian Interprofessional Health Collaborative. (2010). A national interprofessional competency framework. https://drive.google.com/file/d/1Des_mznc7Rr8stsEhHxl8XMjgiYWzRIn/view

Canadian Network for the Prevention of Elder Abuse. http://www.cnpea.ca/en/

Canadian Nurses Association. (2018). Interprofessional collaboration. https://www.cna-aiic.ca/en/nursing-practice/the-practice-of-nursing/health-human-resources/interprofessional-collaboration

Community Care and Assisted Living Act, SBC 2002 c. 75. http://www.bclaws.ca/Recon/document/ID/freeside/00_02075_01

Community Care and Assisted Living Act. Residential Care Regulation. [B.C. Reg. 96/2009.] https://www.bclaws.gov.bc.ca/civix/document/id/complete/statreg/96_2009

E-Health (Personal Health Information Access and Protection of Privacy) Act, BC 2008 c. 38. https://www.bclaws.gov.bc.ca/civix/document/id/complete/statreg/08038_01

Employment Standards Act, RSBC 1996 c. 113. https://www.bclaws.gov.bc.ca/civix/document/id/complete/statreg/00_96113_01

First Nations Health Authority. http://www.fnha.ca/

First Nations Health Authority. (2021). Cultural safety and humility. http://www.fnha.ca/wellness/cultural-humility

Fraser Health Authority. http://www.fraserhealth.ca

Government of British Columbia, (n.d.). About B.C.’s health care system. https://www2.gov.bc.ca/gov/content/health/about-bc-s-health-care-system

Government of British Columbia. (n.d.). Accessing health care. https://www2.gov.bc.ca/gov/content/health/accessing-health-care

Government of British Columbia. (n.d.). Assisted living in B.C. https://www2.gov.bc.ca/gov/content/health/assisted-living-in-bc

Government of British Columbia. (2014). B.C. health care assistants core competency profile. https://www.health.gov.bc.ca/library/publications/year/2014/HCA-Core-Competency-Profile_March2014.pdf

Government of British Columbia. Welcome to the B.C. Care Aide & Community Health Worker Registry. http://www.cachwr.bc.ca/Home.aspx

Government of British Columbia. (2016). Employment standards. http://www.labour.gov.bc.ca/esb/esaguide/guide.pdf

Government of British Columbia. (n.d.). Employment and workplace standards. https://www2.gov.bc.ca/gov/content/employment-business/employment-standards-advice

Government of British Columbia. (n.d.). Guide to good privacy practices. https://www2.gov.bc.ca/gov/content/governments/services-for-government/information-management-technology/privacy/good-privacy-practices

Government of British Columbia. (n.d.). Health authorities. https://www2.gov.bc.ca/gov/content/health/about-bc-s-health-care-system/partners/health-authorities

Government of British Columbia. (n.d.). Home and community care. https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care

Government of British Columbia. (n.d.). Human rights in British Columbia. What you need to know [Fact sheet]. https://www2.gov.bc.ca/assets/gov/law-crime-and-justice/human-rights/human-rights-protection/what-you-need-to-know.pdf

Government of British Columbia. (n.d.). Human rights protection. https://www2.gov.bc.ca/gov/content/justice/human-rights/human-rights-protection

Government of British Columbia. (n.d.). Long-term care services. https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/care-options-and-cost/long-term-care-services

Government of British Columbia. (2013, February). My voice. Expressing my wishes for future health care treatment. https://www.health.gov.bc.ca/library/publications/year/2013/MyVoice-AdvanceCarePlanningGuide.pdf

Government of British Columbia. (n.d.). Pharmacare for B.C. residents. https://www2.gov.bc.ca/gov/content/health/health-drug-coverage/pharmacare-for-bc-residents

Government of British Columbia. (n.d.). Policy and standards. https://www2.gov.bc.ca/gov/content/health/accessing-health-care/home-community-care/accountability/policy-and-standards

Government of British Columbia. (2015). Primary and community care in B.C.: A strategic policy framework. Cross-sector discussion policy paper. https://www.health.gov.bc.ca/library/publications/year/2015/primary-and-community-care-policy-paper.pdf

Government of British Columbia. (n.d.). Professional regulation. https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/professional-regulation

Government of British Columbia. (n.d.). Protecting personal information. https://www2.gov.bc.ca/gov/content/employment-business/business/managing-a-business/protect-personal-information

Government of British Columbia. (n.d.). Protection from elder abuse and neglect. https://www2.gov.bc.ca/gov/content/family-social-supports/seniors/health-safety/protection-from-elder-abuse-and-neglect

Government of British Columbia. (n.d.). Regional health authorities. https://www2.gov.bc.ca/gov/content/health/about-bc-s-health-care-system/partners/health-authorities/regional-health-authorities

Government of British Columbia. (n.d.). Residents’ bill of rights. https://www2.gov.bc.ca/assets/gov/health-safety/home-community-care/accountability/pdf/adultcare_bill_of_rights.pdf

Government of British Columbia. (n.d.). Respect in the workplace and health. https://www2.gov.bc.ca/gov/content/careers-myhr/all-employees/working-with-others/promote-respect/health

Government of British Columbia. (2013). Together to reduce elder abuse – B.C.’s strategy: Promoting well-being and security for older British Columbians. https://www2.gov.bc.ca/assets/gov/people/seniors/health-safety/pdf/trea_strategy.pdf

Government of Canada. (2016). Canada’s health care system. https://www.canada.ca/en/health-canada/services/canada-health-care-system.html

Government of Canada. (2021, January). Federal labour standards. https://www.canada.ca/en/services/jobs/workplace/federal-labour-standards.html

Government of Canada. (2012). It’s not right: What you can do when abuse or neglect is happening to an older adult in your life. https://www.canada.ca/content/dam/phac-aspc/documents/services/publications/health-risks-safety/what-you-can-do-elder-abuse/pub1-eng.pdf

Government of Canada, Department of Justice. (1982). The Canadian charter of rights and freedoms. https://www.justice.gc.ca/eng/csj-sjc/rfc-dlc/ccrf-ccdl/

Government of British Columbia. (n.d.). Medical Services Plan of B.C. https://www2.gov.bc.ca/gov/content/health/health-drug-coverage/msp

Government of British Columbia, Ministry of Health. http://www.gov.bc.ca/health/

Government of British Columbia, Ministry of Health. (n.d.). Assisted living registry. https://www2.gov.bc.ca/gov/content/health/assisted-living-in-bc/assisted-living-registry

Government of British Columbia, Ministry of Health Services. (2008). Personal assistance guidelines. http://www.health.gov.bc.ca/library/publications/year/2008/Personal_Assistance_Guidelines.pdf

Health Employers Association of B.C. (n.d.). Collective agreements. https://www.heabc.bc.ca/Page20.aspx#.YLEo5KhKjIV

Health Employers Association of B.C. (n.d.). Labour relations. https://www.heabc.bc.ca/page4480.aspx#.X2Uvw2hKg2x%20\

Health Professions Act, RSBC 1996 c 183. https://www.bclaws.gov.bc.ca/civix/document/id/complete/statreg/00_96183_01

Hospital Employees’ Union. http://www.heu.org/

Hospital Employees Union (n.d.). Facilities collective agreement. https://www.heu.org/collective-agreements/facilities

Hospital Employees Union (n.d.). Community health collective agreement. https://www.heu.org/collective-agreements/community-health

Hospital Employees Union (n.d.). Care aides. https://www.heu.org/taxonomy/term/454

Interior Health. http://www.interiorhealth.ca

Interior Health. (n.d.). Policies. https://www.interiorhealth.ca/AboutUs/Policies/Pages/default.aspx

InterRAI. http://www.interrai.org

Island Health. https://www.islandhealth.ca/

Island Health. (n.d.). Code of conduct and policies. https://www.islandhealth.ca/about-us/accountability/code-conduct-policies

MasterClass. (2021). How to recognize the five stages of group development. https://www.masterclass.com/articles/how-to-recognize-the-5-stages-of-group-development#what-is-tuckmans-model-of-group-development

National Healthcareer Association. (n.d.). Healthcare job interview questions (and how to answer them). https://info.nhanow.com/blog/healthcare-job-interview-questions-and-how-to-answer-them

Nidus Personal Planning Resource Centre and Registry.

Northern Health. http://www.northernhealth.ca

Northern Health (n.d.). Policies. https://www.northernhealth.ca/about-us/accountability/policies

Office of the British Columbia Ombudsperson. https://bcombudsperson.ca/

Office of the Seniors Advocate British Columbia. http://www.seniorsadvocatebc.ca/

Province of British Columbia. (2014). Elder abuse reduction curricular resource. BCcampus. http://solr.bccampus.ca:8001/bcc/items/8d5b3363-396e-4749-bf18-0590a75c9e6b/1/

Provincial Health Services Authority. http://www.phsa.ca/

Public Guardian and Trustee of British Columbia. (2014). Protecting adults from abuse, neglect, and self-neglect: Supporting self-determination for adults in British Columbia. https://www.trustee.bc.ca/Documents/adult-guardianship/Protecting%20Adults%20from%20Abuse,%20Neglect%20and%20Self%20Neglect.pdf

SafeCare BC (2020). Civility Matters. https://www.safecarebc.ca/civilitymatters/

Trentham, B., Andreoli, A., Boaro, N., Velji, K., & Fancott, C. (2010). SBAR: A shared structure for effective team communication: An implementation tool kit. (2nd ed.) http://www.uhn.ca/TorontoRehab/Education/SBAR/Documents/SBAR_Toolkit.pdf

Truth and Reconciliation Commission of Canada. (2015). Truth and Reconciliation Commission of Canada: Calls to action. http://trc.ca/assets/pdf/Calls_to_Action_English2.pdf

Vancouver Coastal Health. http://www.vch.ca

Vancouver Coastal Health. (n.d.). Policies. http://www.vch.ca/about-us/accountability/policies/

Workers Compensation Act, RSBC 2019 c. 1. https://www.bclaws.gov.bc.ca/civix/document/id/complete/statreg/19001_00

WorkSafeBC. (July, 2020). Back talk for workers. https://www.worksafebc.com/en/resources/health-safety/interactive-tools/back-talk-for-workers

WorkSafeBC. (n.d.). Bullying and harassment. https://www.worksafebc.com/en/health-safety/hazards-exposures/bullying-harassment

WorkSafeBC. (2012). Communicate patient information: Prevent violence-related injuries to health care and social services workers (for public bodies). https://www.worksafebc.com/en/resources/health-safety/information-sheets/communicate-patient-information-prevent-violencerelated-injuries-to-health-care-and-social-services-workers-for-public-bodies

WorkSafeBC. (2012, October). Communicate personal information: Prevent violence related injuries to health care and social services workers (for non-public bodies). https://www.worksafebc.com/en/resources/health-safety/information-sheets/communicate-personal-information-prevent-violencerelated-injuries-to-health-care-and-social-services-workers-for-nonpublic-bodies

WorkSafeBC. (2020). Industry claims analysis: Time-loss claims in B.C. https://public.tableau.com/app/profile/worksafebc/viz/IndustryclaimsanalysisTime-lossclaimsinB_C_/Didyouknow

WorkSafeBC. (2020). Occupational health and safety regulation. https://www.worksafebc.com/en/law-policy/occupational-health-safety/occupational-health-safety-regulation

WorkSafeBC. (July, 2018). Point-of-care risk assessments in long-term care [Videos].https://www.worksafebc.com/en/resources/health-safety/videos/point-of-care-risk-assessments-in-long-term-care/full-video

WorkSafeBC. (2013, December). Student WorkSafe Infosheet: Workplace rights and responsibilities. https://www.worksafebc.com/en/resources/health-safety/information-sheets/student-worksafe-infosheet-workplace-rights-and-responsibilities

WorkSafeBC. (2013, December). Toward a respectful workplace: A handbook on addressing and preventing workplace bullying and harassment. http://www.worksafebc.com/en/resources/health-safety/books-guides/a-handbook-on-preventing-and-addressing-workplace-bullying-and-harassment?lang=en

WorkSafeBC. (2016, November). Worker orientation checklist for healthcare. https://www.worksafebc.com/en/resources/health-safety/checklist/worker-orientation-checklist-health-care

World Health Organization. http://www.who.int/en/

Young, J. M. & Everett, B. (2018, July/August). When patients choose to live at risk: What is an ethical approach to intervention? BCMJ, 60(6), 314–318. https://bcmj.org/articles/when-patients-choose-live-risk-what-ethical-approach-intervention

Online Videos

Alberta Health Services. (2016, July 26). Patient and family centered care: Moments that make all the difference [Video]. YouTube. https://www.youtube.com/watch?v=Tej5g6w34BA&feature=youtu.be

Global News. (2014, April 3). Elder abuse victims speaks [Video]. YouTube. https://www.youtube.com/watch?v=3R5L_3Yu2wc

Indeed. (2020, January 7). How to write a cover letter [Video]. YouTube. https://youtube/hrZSfMly_Ck

Indeed. (2020, January 3). Top interview tips: Common questions, body language and more [Video]. YouTube. https://youtu.be/HG68Ymazo18

University of British Columbia. (2012, September 17). Resumes 101: Accomplishment statements [Video]. YouTube. https://www.youtube.com/watch?v=bOSKynkOgQE&t=2s

Online Learning Tools

Suggested Learning Strategies

Strategies that Focus on Caring

1. Discussion about Effective Interpersonal Communication

Invite students to form small groups to discuss the following:

Think of a time when you really felt comfortable with another person and you were both able to talk freely. What were some of the characteristics of that interaction? Have the groups share their responses with the whole class.

From these discussions, the class can develop a list of the characteristics of effective interpersonal communication which will likely include points such as:

• There is a feeling of trust between the people involved.
• There is a sense that the two people involved understand each other and what each is experiencing.
• Both individuals feel that the other likes or respects them.
• Often the two people have similar values, ideas, and experiences.

All effective interpersonal communications have one thing in common: each person involved feels valued, respected, and worthwhile.

Based on this understanding of effective interpersonal communication, ask students to discuss some examples of communication approaches they have experienced that they found to be particularly unpleasant, even dehumanizing. Some examples might include:

• Moralizing, judging, or blaming
• Threatening
• Ordering or commanding
• Shaming
• Stereotyping
• Ignoring

Invite students to think of times when they may have used these approaches and the outcomes of these responses. Why do we sometimes use dehumanizing communication?

Application to the workplace: Invite students to discuss how approaches to elderly clients might inadvertently be dehumanizing (ageism). What are some better choices?

2. Discussion about Caring

Questions that could be used to elicit discussion about caring:

• How are self-caring and self-esteem interrelated? Why is it so difficult to care for oneself? In what ways might a person with healthy self-esteem be a more effective care provider?
• What is the difference between task-oriented touching and caring touch in a health care environment? In your caregiving role, what are some ways you might appropriately show caring through touch? What are some other non-verbal behaviours you might use to exhibit caring?
• Consider the following statement: When we make an effort to truly understand the other person, we are exhibiting caring. Do you agree with this statement? How is this related to the interpersonal communications skills you have learned in this course?
• What are some potential challenges to caring communication in an acute care setting or an acute situation? For example:
  • Not being in the client’s usual home situation may create more barriers, such as unfamiliar sights and sounds.
  • An acute illness may cause fear and increased need for empathetic communications skills.
  • Increased urgency of caregiver tasks may interfere with active listening.
  • A changing client condition requiring immediate action may make caring communication more of a challenge in the moment.
• Why is assertiveness on the part of the caregiver important to the care of the client? Why is it important and caring for an HCA to say “no” sometimes? How is self-respect related to one’s ability to act assertively? For example, an HCA may be asked to work outside of their role, possibly putting themselves and/or the client at risk. Saying “no” does not have to be absolute. Rather, it could be phrased in the following manner: “I am not comfortable with this and would like to seek further information,” or “I have not been trained to do this task (or do the task in this way).”

3. Unfolding Case Study: Caring for Peter Schulz

1. Whole Class Review
   • In class, review the characteristics of effective communication and verbal and non-verbal communication. Also consider how cultural and generational differences may impact communication.
2. Small Group Activity
   • Divide the class into small groups and have the students read the following conversation between Peter and his wife, Eve. Ask the groups to make a list of the communication techniques that Eve uses to connect with Peter during the conversation and be prepared to share their findings with the larger group. See STUDENT HANDOUT below.
3. Whole Class Debrief
   • Come back together as a class and have each group report on the communication techniques that were used, highlighting any that were not identified. Ask the students to consider how and why this conversation may have been difficult for Eve and discuss how the strategies she used led to positive outcomes. Discuss the role of the HCA in ensuring effective communication with clients.
   • Note: Students could be instructed to add the scenario or notes to the client profile.

Strategies that Focus on Critical Thinking, Problem-Solving, and Decision-Making

1. Classroom Debate Activity

Invite students to engage in a debate about a topic discussed in this course. Divide the class into small groups of three to five students and assign two groups to each of the topics outlined; one group will take a pro position towards the topic and the other group will take a con position.

Ask each group to identify two to three reasons to support the position they have been assigned. Then, with the instructor acting as the moderator, the two groups will engage in a debate using the following structure:

1. Each group provides a brief introduction to their position on the topic.
2. In alternating format, the two groups present the two or three reasons identified to support their position.
3. Each group provides a brief closing statement.

After the debate has concluded, briefly come together as a larger group and summarize the positions that were presented. Invite feedback from the students not involved in the debate and discuss further considerations. Alternate groups until each student has participated in a debate.

Debate topics for Health 1: Interpersonal Communication.

1. Verbal communication is more important than non-verbal communication.
2. Cell phones should not be used in the workplace.
3. It is ok to talk about your clinical experience on social media.
4. It is beneficial for people to talk about their feelings.
5. Talking to people who are upset is not the job of the HCA.
6. Disagreement leads to conflict in the workplace.

2. Problem-Solving Exercise

When students are learning about conflict resolution, it might be helpful for them to grasp how a problem-solving process might be applied even (and possibly especially) in situations of heightened emotions.

Using one or more scenarios taken either from clinical practice or personal experience, invite students to work in small groups to analyze the problem, suggest alternative choices, determine the best outcome, and suggest how it will be evaluated.

The STUDENT HANDOUT below could be used to direct this discussion.

3. Case Study: Interprofessional Communication

The following case study is used with permission of Island HealthIsland Health (2012).

Barbara is an HCA who has been working on the general medicine unit for the past year. Today she is being asked to mentor David, a newly hired HCA. David has been working as a casual in residential care and will be working as a casual HCA on Barbara’s medical unit, as well. Today is David’s first mentorship time with Barbara.

Just as Barbara and David are about to get Mr. Roberts out of bed, Barbara is called by the LPN to offer assistance to Mrs. Jones in the next room. When she returns to Mr. Roberts’ room, she sees David struggling to get Mr. Roberts out of bed. David identifies that the physiotherapy assistant who just popped in the room a few moments ago stated that Mr. Roberts can get out of bed on his own.

Mr. Roberts is an ALC patient and has been on the medical unit for the past 30 days and is well-known to Barbara. A second patient on this unit, also a Mr. Roberts, had been admitted for pneumonia several days ago and is awaiting his discharge.

Discussion Questions:

1. How might Barbara approach David about his decision to get Mr. Roberts out of bed?
2. What recommendations should Barbara suggest to David about his future decision-making processes related to patient care?
3. What other team members should be made aware of this situation?
4. Identify two ways that interprofessional communication could be improved in this scenario.

Strategies that Focus on Professional Approaches to Practice

A professional approach to practice presupposes an ability to “tune in” and respond appropriately to clients in a variety of situations.

1. Provincial Violence Prevention Curriculum – E-Learning Module Completion

Recognized HCA Program educators are asked to build specific learning opportunities into their programs and confirm students complete the Provincial Violence Prevention e-modules prior to the start of their practice education placements. The curriculum was developed to fill a need for effective, recommended, and provincially recognized violence prevention training. After completing this curriculum, HCA students will have received education and tools to prevent, defuse, and/or deal with potentially violent situations. Given the provincial commitment to health and safety of workers and reducing the risk of violence, an active partnership with health program educators is essential.

The Provincial Violence Prevention curriculum is available online at LearningHub.

A quiz is embedded at the end of each module and students are then able to print their results to provide proof of completion.

The curriculum consists of eight e-learning modules and takes approximately 3.5 to 4 hours to complete. Modules include:

• Module 1: Introduction to Violence Prevention
• Module 2: Recognize Risks and Behaviours
• Module 3: Assess and Plan Part 1 – Complete Point-of-Care Risk Assessments
• Module 4: Assess and Plan Part 2 – Develop Behavioural Care Plans
• Module 5: Respond to the Risk Part 1 – Perform De-escalation – Communication
• Module 6: Respond to the Risk Part 2 – Perform De-escalation Strategies
• Module 7: Respond to the Risk Part 3 – Determine When and How to Get Help
• Module 8: Report and Communicate Post-Incident

2. Communication Skills Practise

Good communication skills are invaluable to the effective HCA and these skills need to be practised. Below are several approaches that are aimed at giving students opportunities to practise effective communication.

Practising non-verbal listening skills

Invite students to select partners to practise non-verbal listening skills. While one partner assumes the role of speaker, the other is the listener. The speaker can talk about anything, but a topic that elicits opinions or feelings is best. While the speaker is talking, the listener will practise excellent listening. For example:

• Face the speaker.
• Make eye contact whenever possible.
• Lean slightly toward the speaker.
• Maintain a relaxed, open posture.
• Maintain a facial expression appropriate to the content.
• Nod the head or use other non-verbal ways to indicate that the speaker is being heard.

After 5 or 10 minutes, the interaction stops and the partners change roles. Once both participants have had a chance at both roles, discussion should take place guided by the following:

• What was it like for you to be a non-verbal listener?
• Was it easy to listen to this intensely?
• Was it hard to keep your mind from wandering?
• What did you learn about the speaker’s opinions, feelings, and ideas?
• What did you learn about yourself as a listener?
• What was it like for you to be the speaker?
• Did you feel that the other person was truly listening to you?
• Was it helpful for you to clarify your own thoughts, opinions, or feelings?

Practising paraphrasing

Invite students to get into groups of three for a short discussion period. Each member of the group will take on one of these roles:

• Listener
• Speaker
• Observer

The speaker can talk about anything, but may be helped by some suggested topics such as those below:

• I think that the worst part about being a student is…
• I think that the best part about coming back to school is…
• What I enjoy most about my work is…
• The reason I decided to take the HCA program is because…
• The things that I am most concerned about in becoming an HCA is…

The process for each group will be as follows:

1. The speaker makes a comment related to the chosen topic.
2. The listener must paraphrase what the speaker has said in their own words and must do it to the speaker’s satisfaction. Once the speaker is satisfied that the listener has understood the meaning, then the listener is allowed to take on the speaker role and make a comment.
3. The observer serves to make sure that the rules are being followed (i.e., the listener may not become the speaker until they have paraphrased the content of the communication to the satisfaction of the speaker).
4. Take turns in each role.

Following this practice, invite the groups to discuss the difficulties they experienced trying to understand the other person and trying to be understood. Students should identify what they learned from this exercise about speaking and listening.

Practising empathic responding

Invite students to practise empathic responding in two real-life situations. Ask them to pick one person they don’t know well (e.g., a sales person in a store, a new client in the practice setting) and one person they do know well (e.g., a close friend or relative). Instruct the student to initiate a conversation with each person and attempt to tune in to what the other person is saying and what they seem to be feeling. Ask the student to attempt to respond empathically.

At the next class, discuss the following questions:

• Was it difficult for you to really tune in to the other person? If so, why?
• Did you find your mind wandering as the other person was speaking?
• Did you feel ill at ease with the active listening and empathic responding? If yes, why do you think this felt uncomfortable for you? What might make it more comfortable?
• How did the other person respond?
• Reviewing what you said, how might you improve your responses in future interactions?
• Did you feel that you had a better understanding of the other person when the conversation was over?
• What did you learn about yourself as a result of this exercise?

Practising assertive communication

Ask students to work with a partner and use the scenarios on the STUDENT HANDOUT below to practise assertive communication skills.

3. Role Play Activity: Practising Effective Communication Skills

Students will apply effective communication strategies using the scenarios provided below. If available, students may enjoy completing this activity in the lab, with measures taken to simulate a real-life setting. The role play should be used towards the end of the course, as a consolidation activity.

1. Activity Set Up
   • The instructor could first elicit or list effective communication strategies (e.g., non-verbal listening skills, paraphrasing, responding empathetically, etc.) on the whiteboard and have these displayed for student reference throughout the activity. To increase student engagement and comfort, the instructor could also model the activity (with two students) before tasking the students to work together.
2. Role Play
   • Have students work in groups of three, with one student taking the role of the HCA, the second student taking the role of the client or co-worker, and the third student acting as an observer/recorder.
   • All three students should read the scenario provided on the STUDENT HANDOUT below. Following this, the student taking the role of the HCA should identify three communication skills that they will apply to the scenario. The students should then act out the scenario, with the student in the role of the HCA applying the communication skills they selected. The student acting as the observer should make notes about the perceived effectiveness of the communication skills that were used during the interaction.
3. Small Group Discussion after Role Play
   • After each role play is complete, the group should discuss the following:
     • What important information was provided about the client and situation?
     • What three communications skills were applied and why were they chosen for this client and situation?
     • What did the observer/recorder notice about the communication strategies that were used?
     • What worked or didn’t work with the approach that was taken?
     • Were there any other approaches that could have been used?
4. Whole Class Activity Debrief
   • Come together as a class to discuss the different communication strategies used for each scenario.

Suggested Course Assessments

The course learning outcomes may be assessed by the following tasks:

1. One or more quizzes or examinations that pertain to knowledge of the concepts and principles underlying effective interpersonal communication (Learning Outcome #1).
2. An assignment in which students analyze one or more scenarios in which communication was ineffective. They will be asked to identify the barriers to effective communication displayed in the scenario and suggest alternative approaches that might have been more effective (Learning Outcomes #1 and #3).
3. A written assignment in which students describe a situation in which they used communication skills they learned in this course. Students will describe what they did or said and analyze the outcome, with particular focus on self-reflection and self-appraisal (Learning Outcomes #2, #3 and #4).
4. A written assignment in which students analyze a video-recorded interaction with a simulated client (other student or actor). Students will identify where they used specific communications skills (paraphrasing, empathic responses, perception checking, etc.) and/or where they could have used these skills to improve the interaction (Learning Outcomes #3 and #4).
5. An assessment – or series of assessments – of students’ abilities to use the skills learned in the course. This may take place in the classroom where students conduct guided role-playing or it may be assessed as part of the lab or clinical experiences (Learning Outcome #3).

Resources for Health 1: Interpersonal Communications

Online Resources

Amareson, S. (2021, June). 27 conflict resolution skills to use with your team and your customers. Hubspot. https://blog.hubspot.com/service/conflict-resolution-skills

Benjamin, K. (2021, July 6). 6 Steps to conflict resolution in the workplace [Blog post] HR Daily Advisor. https://hrdailyadvisor.blr.com/2013/06/24/6-steps-to-conflict-resolution-in-the-workplace/

British Columbia College of Nurses and Midwives. (n.d.). Taking pictures of clients: Is it ever OK? https://www.bccnm.ca/LPN/learning/confidentiality/Pages/photos_clients.aspx

Pappas, C. (2015, June 6). 10 netiquette tips for online discussions. eLearning Industry. https://elearningindustry.com/10-netiquette-tips-online-discussions

Online Videos

Arnold, R. (2015, February 23). A world of gestures. Culture and nonverbal communication [Video]. YouTube. https://www.youtube.com/watch?v=GRo0gLWqKxI

Academic Skills, The University of Melbourne. (2017, April 5). Giving and receiving effective feedback [Video]. YouTube. https://www.youtube.com/watch?v=zSEGZaI3fIY

Academy of Social Competency. (2018, April 10). Communication skills: Empathetic listening [Video]. YouTube. https://www.youtube.com/watch?v=t685WM5R6aM

Ballerz Mixtape. (2020, January 10). Non-verbal communication – the documentary [Video]. YouTube. https://www.youtube.com/watch?v=Ym081ObRtPcClassic

Conversation Sparks. (2017, September 12). How to be a better listener: Paraphrasing [Video]. YouTube. https://www.youtube.com/watch?v=BjUCF_Z146c

Cuddy, A. (2012, June). Your body language may shape who you are [Video]. TED Global. https://www.ted.com/talks/amy_cuddy_your_body_language_may_shape_who_you_are/up-next?language=en

The Distilled Man. (2018, April 15). How to be more assertive: 7 tips [Video]. YouTube. https://www.youtube.com/watch?v=NBkvWCmz2W4

EIRMC (Eastern Idaho Regional Medical Center). (2013, November 25). Say this, not that: Patient experience video [Video]. YouTube. https://www.youtube.com/watch?v=r842Ylpa-nQ&t=267s

Fact and Figures. (2017, January 25). How to show respect in a conversation [Video]. YouTube. https://www.youtube.com/watch?v=1wVw4D5KvVM

GavProVideo. (2013, September 9). Communicate! – Paraphrasing with Denise Besson-Silva [Video]. YouTube. https://www.youtube.com/watch?v=5JL2iizK2c0

Happify. (2016, January 19). How mindfulness empowers us: An animation narrated by Sharon Salzberg [Video]. YouTube. https://www.youtube.com/watch?v=vzKryaN44ss

Headly, J. (2013, May 22). It’s not about the nail [Video]. YouTube. https://www.youtube.com/watch?v=-4EDhdAHrOg

Health Chronicle. (2017, November 8). How laughter affects our health (and why it’s the best medicine) [Video]. YouTube. https://www.youtube.com/watch?v=DB_cSy0IIOg

Izzo, J. (2014). 5 words that will improve your ability to receive feedback [Video]. YouTube. https://www.youtube.com/watch?v=4BpPtjKpJZM

Kiawans, K. (2013, December 12).The importance of non-verbal cues as told by “Friends.” [Video]. YouTube. https://www.youtube.com/watch?v=OvEci5Bjgd4

Kurtzberg, T. (2016, May 26). The unintended consequences of electronic communication [Video]. YouTube. https://www.youtube.com/watch?v=rH6dMhf_P-w

Lyon, A. (2019, June 11). Communicate with empathy [Video]. YouTube. https://www.youtube.com/watch?v=8tyFJTtzYtY

McAdam, E. (2017, November 2). Empathetic listening: “The hairy eyebrow” and other essential communication skills [Video]. YouTube. https://www.youtube.com/watch?v=MGdgUP8XLwc

MindToolsVideos. (2014, August 19). The Johari window [Video]. YouTube. https://www.youtube.com/watch?v=skKBI8wcMaA&feature=emb_logo

Richards, L. (2016, October 29). Conflict resolution techniques. A brief overview [Video]. YouTube. Teamworks. https://www.youtube.com/watch?v=NJH0XV9jGIE

RSA. (2013, December 10). Brené Brown on empathy [Video]. YouTube. https://www.youtube.com/watch?v=1Evwgu369Jw&list=PLoLnm0ZhSqhCsQmLI6U4zzDQBleEeyH0t

Santilli, B. (2016, November 6). 5 ways to improve nonverbal communication/body language skills [Video]. YouTube. https://www.youtube.com/watch?v=oQh7t4WRHOk

Sesame Street. (2007, April 20). Ernie and Bert can’t communicate [Video]. YouTube. http://www.youtube.com/watch?v=kjF4rKCR81o&feature=related

Sesame Street. (2007, September 29). Ernie and Bert “very important note” [Video]. YouTube. http://www.youtube.com/watch?v=RLgJtxCzDmM&feature=related

TEDx Talks. (2015, May 7). Interpersonal communication in the future world with Celine Fitzgerald [Video]. YouTube. https://www.youtube.com/watch?v=KlI2qDO0J6s

TEDx. Talks. (2015). Sheila Heen: How to use others’ feedback to learn and grow [Video]. YouTube. https://www.youtube.com/watch?v=FQNbaKkYk_Q

Van Edwards, V. (2020, January 14). Self-worth: 20 ideas to build your self-esteem [Video]. YouTube. https://www.youtube.com/watch?v=iDqik1-U3is

Winch, G. (2014, November). Why we all need to practice emotional first aid [Video]. TEDxLinnaeusUniversity. https://www.ted.com/talks/guy_winch_why_we_all_need_to_practice_emotional_first_aid/up-next

Online Learning Tools

The following materials are ready for use in the classroom. A brief description and estimated time to complete each activity is included for each.

LearningHub. Provincial Violence Prevention Curriculum [E-learning modules]. https://learninghub.phsa.ca/Courses/7558/provincial-violence-prevention-for-medium-and-high-risk-departments-8-modules

• Students complete independently and print out a module quiz at the end to demonstrate successful completion. Eight e-learning modules (approximately 30 minutes per module.

Social Care Institute for Excellence. (2014). Dignity in care: Communication [Video]. http://www.scie.org.uk/socialcaretv/video-player.asp?v=communication

• A video and messages for practice that illustrate how effective communication with clients and the health care team supports a person-centred approach to care (15–20 minutes for review and discussion).

Suggested Learning Strategies

Strategies that Focus on Caring

1. Caring and Caregiving Discussion

Invite students, as a whole class or in small groups, to discuss the following questions:

• How is caring about your own health related to being an effective care provider? How do your lifestyle choices reflect your caring for yourself?
• If we truly care for and respect our physical bodies, how will this be reflected in our lifestyle choices?
• How is psychological and emotional health related to the ability to express caring for others?
• How does social connectedness relate to physical and emotional health? What does this tell you in terms of social needs of clients with whom you’ll be working?
• How does cognitive ability relate to overall health? Why is this important for you to understand as you work as a care provider with cognitively challenged individuals?
• In what ways is caring in all its dimensions related to spiritual health?

2. Building a Health Wheel

Caring always presupposes a person-centred approach to all caregiving practice. In order to fully understand the uniqueness of each client, students need to grasp how changes in one dimension of health affect and are affected by all the other dimensions. The following exercise helps to portray this interaction:

Begin by drawing a health wheel which identifies the five components or dimensions of health. Encourage students to suggest indicators or signs of health in each of the five components. See diagram below with some suggestions for indicators of health. Another resource is the First Nations Health Authority’s Health Wheel.

The Health Wheel: Indicators of Health

Physical

• Healthy body weight
• Sensory acuity
• Strength and endurance
• Flexibility
• Coordination
• Energy
• Recuperative ability

Emotional

• Ability to cope effectively with the demands of life
• Ability to express emotions appropriately
• Ability to control emotions when necessary
• Possessing feelings of self-worth, self-confidence, and self-esteem

Cognitive

• Ability to process and act on information, clarify values and make sound decisions
• Ability to take in new information and understand new ideas
• Ability to learn from experience
• Ability to solve problems effectively

Spiritual

• Having a sense of unity with one’s environment
• Possessing a guiding sense of meaning and value in life
• Ability to experience love, joy, wonder, and contentment
• Having a sense of purpose and direction in life

Social

• Ability to initiate and maintain satisfying relationships with others
• Knowing how to behave in a variety of social situations
• Having a group of friends and family who care and provide support
• Ability to provide understanding and support to others

3. Exploring the Implications of the Health Wheel

In order to assist students to see the intimate interconnectedness of the five components or dimensions of health, guide the students through the following exercise:

1. Identify symptoms or indicators of challenges to health
   • Draw a circle around the health wheel and label it “symptoms.” Encourage students to identify symptoms or challenges to health in each of the five dimensions.
   • Your question might be: What are physical symptoms or indicators that something is wrong? What are emotional symptoms or indicators? Cognitive? Social? Spiritual? As the students identify these, write them in the circle (see Understanding Holistic Nature of Health below for examples).
2. Identify causes of health challenges
   • Draw another circle and label it “causes.” Encourage the students to give suggestions for possible causes of health challenges in each dimension.
   • Your question might be: What are some physical causes of ill-health? Emotional causes? Cognitive? Social? Spiritual? As the students identify these, write them in the circle (see Understanding Holistic Nature of Health below for examples ).
   • NOTE: The causes do not need to match the symptoms.
3. Identify behaviours that contribute to health
   • Draw a third circle and label it “approaches to health.” Encourage students to give suggestions of behaviours or choices that contribute to health in each dimension.
   • Your question might be: What are some behaviours or choices in the physical dimension that contribute to health? In the emotional dimension? Cognitive? Social? Spiritual? As students identify the behaviours, write them in the circle (see below for examples ).
   • NOTE: The approaches to health do not need to correspond with the already listed causes or symptoms.
4. Examine the interconnectedness of the dimensions
   • Choose a student from the group and ask that person to secretly select one of the symptoms and write it down, another to secretly select a cause, a third to secretly select an approach to health and a fourth to secretly select a sign of health. Encourage these students to select from any of the health dimensions.
   • Invite the students to reveal their selection by using the following script:
     Here’s a situation in which a person is experiencing          (symptom), caused by          (cause). The approach to health that will be undertaken is          (approach to health), and the result, hopefully, will be          (sign of health).
   • Experiment with this exercise two or three times. Since each dimension of health represents a part of a whole, no combination will ever be too far-fetched.
5. Invite students to discuss what this exercise has displayed with respect to:
   • The degree to which one dimension of health affects every other dimension.
   • The degree to which choices or approaches to health in one dimension affect the other dimensions and what this suggests for creative thinking when individuals are searching for remedies or treatments.
   • In Canadian society we tend to be more comfortable with the physical dimension of health and most often seek physical treatments for physical symptoms. Is this adequate? Could we be more creative and discover more options?
   • How might traditional medicines or alternative treatments contribute to holistic health?

4. Unfolding Case Study: Caring for Peter Schultz

As a homework assignment, have students review their client portfolio for Peter Schultz and the Health Wheel: Indicators of Health. They could also use the First Nations Health Authority’s Health Wheel for this assignment.

1. Whole Class Activity and Discussion
   • In class, draw a health wheel on the white board, labelling the components (e.g., emotional) and their indicators (e.g., ability to cope effectively with the demands of life), where applicable. Leave the health wheel on the white board for reference throughout the activity.
2. Small Group Activity
   • Divide the class into small groups, assigning half of the groups to develop a health wheel for Peter and the other half to develop a health wheel for Peter’s wife, Eve.
   • Students should use their knowledge about person-centred care, family care providers, and health to identify two to three challenges that may be experienced for each component of health (e.g., for emotional health, caregiver stress is a potential challenge for Eve).
   • The students should then identify one or two positive behaviours that could be used to address the challenges identified (e.g., to address caregiver stress, Eve may benefit from attending a support group). If time allows, students could also be directed to identify a resource available online or in the community as support (e.g., Alzheimer Society of B.C. Caregiver Support Group).
3. Whole Class Activity Debrief
   • Come together as a class and review the health wheels that have been developed. Work together to identify additional challenges and behaviours to support health.
   • Note: Students could be instructed to add the completed health wheel to their client portfolio for Peter Schultz.

Understanding Holistic Nature of Health

Strategies that Focus on Critical Thinking, Problem-Solving, and Decision-Making

1. Classroom Debate Activity

Invite students to engage in a debate about a topic discussed in this course. Divide the class into small groups of three to five students and assign two groups to each of the topics outlined; one group will take a pro position towards the topic and the other group will take a con position.

Ask each group to identify two to three reasons to support the position they have been assigned. Then, with the instructor acting as the moderator, the two groups will engage in a debate using the following structure:

1. Each group provides a brief introduction to their position on the topic.
2. In alternating format, the two groups present the two or three reasons identified to support their position.
3. Each group provides a brief closing statement.

After the debate has concluded, briefly come together as a larger group and summarize the positions that were presented. Invite feedback from the students not involved in the debate and discuss further considerations. Alternate groups until each student has participated in a debate.

Debate topics for Health 2: Lifestyle and Choices:

1. Health care professionals should not smoke.
2. HCAs should be required to have vaccinations.
3. HCAs who understand health care from a global perspective are able to provide better care for their clients.

2. Determinants of Health – Critical Thinking Exercise

3. Evaluating Online Health Information

Health literacy is described by the Canadian Public Health Association as “the ability to access, understand, evaluate, and communicate information as a way to
promote, maintain, and improve health in a variety of settings across the life-course.”Canadian Public Health Association. (2017). A Vision for a Health Literate Canada: Report of the Expert Panel of Health Literacy. p. 11. https://www.cpha.ca/vision-health-literate-canada-report-expert-panel-health-literacy

1. To support students in accessing reliable health information, ask them to work in pairs to research a health-related topic (e.g., determinants of health, components of health).
2. Using the STUDENT HANDOUT below, have the students visit a website related to their topic and complete an evaluation of the information provided.
3. After students have completed the exercise, briefly come together as a group to review the online health resources that were evaluated, discussing why it is important for health consumers, HCAs, and students to carefully evaluate health information found online.
4. Ask students what other criteria are important to consider when evaluating information online.

This activity could be completed as part of a related assignment, such as the Lifestyle Change Project (Learning Strategy 4) below.

4. Lifestyle Change Project

Invite students to undertake a Lifestyle Change Project, which may be a marked assignment for the course. This assignment will encourage students to actively use an informed problem-solving process to make positive changes in their lives. If possible, have students carry out the change for a period of three to four weeks. This allows time for them to understand the difficulty in sustaining the change, especially during the time of other changes in their lives (e.g., being a student). Students may enjoy using technology to monitor their progress. See Online Learning Tools and Apps at the end of this chapter.

• Assessment: They will be invited to assess their present health status in light of what they have learned in the course.
• Goals: They will set achievable goals related to their assessment.
• Planning: They will be guided to plan carefully for their change project.
• Evaluation: They will be guided to evaluate the effectiveness of their project and reflect on the process.

Students may be invited to form small groups to share their change projects and what was learned.

See the STUDENT HANDOUT to guide this Lifestyle Change Project.

For an alternate assignment, you could use the Planning Your Journey to Wellness: A Road Map from the First Nations Health Authority.

Strategies that Focus on Professional Approaches to Practice

1. Scenarios

Invite students, working in small groups, to review the following scenarios and determine to what degree the HCA is behaving in a professional manner. Have students discuss how self-care relates to professional practice.

Sharon Sandhu is an experienced HCA working for a home support agency. Sharon has struggled with her weight for many years, knowing that the extra 30 pounds she carries could be increasing her chances for high blood pressure, diabetes, and cancer.

One of her elderly clients, Mable Chung, is an outspoken, sometimes brutally honest, 90-year-old who regularly advises Sharon that “there is no excuse for being fat.” One day, after hearing Mable’s comments many times, Sharon responds sharply, “Oh, for goodness sake Mable, get off it. I’m sick of hearing your nagging.”

Marg Thompson is an HCA who works in a special care unit with clients who have dementia. She loves her work but often feels tired and lacking in energy. She knows she would feel better if she could cut back on her smoking and exercise more. She tells herself that she will start exercising next month, or when the weather improves, but somehow she never actually gets started. She also promises to stop smoking every New Year’s but so far, she hasn’t. One day Marg’s supervisor mentions to her that he has noticed her lack of energy, which can seem like apathy. He has also noticed that Marg has had more illness (mainly colds) in the past year than anyone else on the unit. He wonders if she is unhappy with her job and, possibly, should consider working elsewhere.

James Ahmed is an HCA on a surgical unit in an acute care hospital. He works steady afternoon (1500–2300) shifts. This works well for him, as his wife works day shifts, so he can take his children to school and they only need a couple of hours of after-school child care per day. They are saving to buy a house and every penny counts!

This evening, one of the clients who had surgery today is very confused and agitated. The nurse assigns James to do 1:1 observation with the client. James keeps the client safe and reports his observations to the nurse. At the end of the shift, the nurse asks James if he can “do a double” (work until 0700) as the night HCA who was booked for 1:1 phoned in sick. James really needs the money, so decides to accept the shift, even though he only slept a few hours the night before and this is the third double shift he has done this month. James leaves the hospital at 0710 to drive home – a 35-minute drive. He really has trouble keeping his eyes open on the way home.

Suggested Course Assessment

The course learning outcomes may be assessed by the following tasks:

1. One or more quizzes or examinations that pertain to knowledge of effective approaches and lifestyle choices that support health (Learning Outcome #2).
2. An assignment in which students analyze their personal nutrition level and/or physical activity routines. Invite students to discuss how their choices in nutrition and/or exercise affect all other dimensions of their health (Learning Outcomes #1 and #2).
3. A written assignment in which students report on a personal health and lifestyle change process (Learning Outcomes #1, #2, and #3). Students may enjoy tracking their progress using an online tool or app (See Online Learning Tools and Apps for a list of tools).

Resources for Health 2: Lifestyle and Choices

Online Resources

Bergland, C. (2014, March 12). Eight habits that improve cognitive function. Psychology Today. https://www.psychologytoday.com/ca/blog/the-athletes-way/201403/eight-habits-improve-cognitive-function

Brown University, Health and Wellness. (2015). Alcohol and your body. https://www.brown.edu/campus-life/health/services/promotion/alcohol-other-drugs-alcohol/alcohol-and-your-body

Canadian Institute for Substance Use Research. (2013). Understanding substance use: A health promotion perspective. Here to Help. https://www.heretohelp.bc.ca/infosheet/understanding-substance-use-a-health-promotion-perspective

Care for Caregivers. (n.d.). Healthcare worker resources. https://www.careforcaregivers.ca/

Emerald Works Mind Tools. (n.d.). Stress management: Manage stress. Be happy and effective at work. https://www.mindtools.com/pages/main/newMN_TCS.htm

First Nations Health Authority (n.d.) First Nations perspective on health and wellness. https://www.fnha.ca/wellness/wellness-for-first-nations/first-nations-perspective-on-health-and-wellness

First Nations Health Authority (n.d.) Wellness streams. https://www.fnha.ca/wellness/wellness-for-first-nations/wellness-streams

First Nations Health Authority (n.d.) Wellness roadmap. https://www.fnha.ca/Documents/FNHA-wellness-roadmap.pdf

Government of British Columbia. (2014). Elder abuse reduction curricular resource. BCcampus. http://solr.bccampus.ca:8001/bcc/items/8d5b3363-396e-4749-bf18-0590a75c9e6b/1/

Government of British Columbia, Ministry of Health. (2005). Healthy aging through healthy living: Towards a comprehensive policy and planning framework for seniors in B.C. http://www.health.gov.bc.ca/library/publications/year/2005/healthy_aging.pdf

Government of Canada, Health Canada. (2016). Eating well with Canada’s food guide. http://www.hc-sc.gc.ca/fn-an/food-guide-aliment/index_e.html

Government of Canada, Health Canada. (2012). Environmental and workplace health. http://www.hc-sc.gc.ca/ewh-semt/index-eng.php

Government of Canada, Health Canada. (2015). Food and nutrition. http://www.hc-sc.gc.ca/fn-an/index-eng.php

Government of Canada, Public Health Agency of Canada. (n.d.). Social determinants of health and health inequalities. https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health.html

HealthLinkBC. (2015). Making a change that matters. https://www.healthlinkbc.ca/health-topics/abp2710

HealthLinkBC. (2015). Spirituality and your health. https://www.healthlinkbc.ca/health-topics/abq0372

HealthLinkBC. (2019). Stress management. https://www.healthlinkbc.ca/health-topics/rlxsk#hw153409

Lewis, C. (2019). Why is the wellness wheel important? [Blog post]. https://www.1and1life.com/blog/wellness-wheel/

National Institute of Diabetes and Digestive and Kidney Diseases. (n.d.). Changing your habits for better health. https://www.niddk.nih.gov/health-information/diet-nutrition/changing-habits-better-health

New York State Department of Health Bureau of Injury Prevention. (2009). Check for safety: A home fall prevention checklist for older adults [Brochure]. https://www.health.ny.gov/publications/0641.pdf

Proactive Mindfulness. (n.d.). Proactive stress management. https://www.proactivemindfulness.com/category/stress/

Simon Fraser University (2014). The 7 dimensions of wellness. http://www.sfu.ca/students/health/resources/wellness/wheel.html

World Health Organization. (n.d.). Health topics. https://www.who.int/health-topics/

WorkSafeBC. (2014, December). Back talk: An owner’s manual for backs. https://www.worksafebc.com/en/resources/health-safety/books-guides/back-talk-an-owners-manual-for-backs

Online Videos

AsapScience. (2014, December 14). Are you sitting too much? [Video]. YouTube. https://youtu.be/uiKg6JfS658

Alcohol and Drug Foundation. (2014, October 26). Alcohol and your body [Video]. YouTube. https://www.youtube.com/watch?v=I_OoW_w-uM8

Australian Lions Drug Awareness Foundation, Inc. (2010, August 26). Alcohol and your brain [Video]. YouTube.https://youtu.be/zXjANz9r5F0

Boroson, M. (2011, March 2). One-moment meditation: “How to meditate in a moment” [Video]. YouTube. https://youtu.be/F6eFFCi12v8

Braive. (2017, December 10) Stress bucket [Video]. YouTube. https://youtu.be/1KYC5SsJjx8

Braive. (2016, March 31). The fight flight freeze response [Video]. YouTube. https://youtu.be/jEHwB1PG_-Q

Buettner, D. (2009, September). How to live to be 100+ [Video]. TEDxTC. https://www.ted.com/talks/dan_buettner_how_to_live_to_be_100/up-next?language=en

Government of British Columbia. (n.d.). Move for life DVD [Videos]. https://www2.gov.bc.ca/gov/content/family-social-supports/seniors/health-safety/active-aging/move-for-life-dvd

Maudsley Learning. (2016, July 1). What is mental health? [Video]. YouTube. https://youtu.be/G0zJGDokyWQ

McGonigal, K. (2013, June 13). How to make stress your friend [Video]. TEDGlobal. https://www.ted.com/talks/kelly_mcgonigal_how_to_make_stress_your_friend/up-next

MHLiteracy. (2020, May 1). Stress (le stress) [Video]. YouTube. https://youtu.be/jHjkEfwfECo

Motivation Thrive. (2021, January 19). I can’t say no! – Don’t be emotionally triggered: Dr.Gabor Maté [Video]. YouTube. https://youtu.be/JKbZbiXzvDg

PE Buddy. (2020, May 10). Learn the 5 dimensions of health! PE Buddy [Video]. https://www.youtube.com/watch?v=ijpvLaArBBI&t=11s

PsycheTruth. (2011, August 8). Self-esteem, confidence, how to love yourself, human needs and humanistic psychology [Video]. YouTube. https://youtu.be/hplaY196ARw

TED. (2020, September 2). A walk through the stages of sleep: Sleeping with science, a TED series [Video]. YouTube. https://youtu.be/eM2VWspRpfk

Youngster. (2019, November 6). Top 3 benefits of physical activity: Dr. Greg Wells [Video]. YouTube. https://youtu.be/5-SgF18bCHQ

Online Learning Tools

The following materials are ready for use in the classroom. A brief description and estimated time to complete each activity is included for each.

DocMikeEvans. (2011, December 2). 23 and 1/2 hours. What is the single best thing we can do for our health? https://www.youtube.com/watch?v=aUaInS6HIGo&list=PL4TcyUrQ3YhJ4X5kajWc

• A video discussing the benefits of daily walking to improve our overall health (15 minutes for viewing and discussion).

Government of Manitoba. (n.d.). Physical education/health education. Module B: Fitness management, lesson 2: Changing physical activity behaviour. https://www.edu.gov.mb.ca/k12/cur/physhlth/frame_found_gr11/rm/module_b_lesson_2.pdf

• A lesson outline which applies the Stages of Change model to physical activity. Learning tools and activity suggestions are included (20–30 minutes).

Here to Help. (2016). Wellness modules. http://www.heretohelp.bc.ca/wellness-modules

• A series of 11 modules that address health from a holistic perspective. Modules include discussions of a topic area, self-assessments, and tips for achieving wellness (10–20 minutes per module).

Online Learning Tools and Apps

Anxiety Canada. (n.d.). MindShift CBT [Mobile app]. https://www.anxietycanada.com/resources/mindshift-cbt/

• An app that can be used to identify and apply strategies for dealing with anxiety.

Canadian Mental Health Association. (n.d.). Mental health meter [Mobile app]. http://www.cmha.ca/mental_health/mental-health-meter/

• A mental health self-assessment tool (5–10 minutes).

Healthwise. (2015). Interactive tools. https://www.healthlinkbc.ca/health-topics/tu6657

• A list of tools that can be used to assess health, fitness, and lifestyle (5–10 minutes).

Optimity. (2016). My optimity [Mobile app]. https://www.myoptimity.com/

• An app that can be downloaded to obtain rewards points for improving health-related knowledge (5–10 minutes).

Suggested Learning Strategies

Strategies that Focus on Caring

1. Contributing to a Broadened Understanding of Common Health Challenges

Using the health wheel from Health 2: Lifestyle and Choices as a guide, invite students, working in small groups, to discuss how common health challenges might affect all areas of health and healing.

Each group may be assigned a specific health challenge and given the task of identifying the primary components of the health challenge (e.g., pain, loss of function, immobility, fatigue, confusion, stress, etc.).

With this information, the group will identify how these changes might affect all other aspects of the person’s health (e.g., how fatigue might affect social, cognitive, emotional, and spiritual health).

The group will then discuss how changes in each dimension of health might positively contribute to healing. Each group will report back to the whole class.

2. Contributing to Person-Centred Care

The above process could be undertaken using scenarios of real or fictitious individuals who are struggling with one or more of the common health challenges studied in this course. Students, in small groups, will discuss how the changes in health brought about by the health challenge(s) are affecting all dimensions of the person’s health and healing and how each level of needs (as described by Maslow) is affected. The group will then discuss how changes in each dimension of health might positively contribute to healing. Each group will report back to the whole class.

3. Unfolding Case Study: Caring for Peter Schultz

As a homework assignment, ask students to review relevant textbook, online or other course materials describing cerebral vascular accidents (CVAs).

1. Whole Class Review and Discussion
   • In class, review the risk factors, signs, and symptoms of CVAs. List them on the whiteboard for reference. Following this, have students read the account describing the CVA experienced by Peter Schultz. See STUDENT HANDOUT.
2. Small Group Discussion
   • Working in small groups, students should apply their knowledge about CVAs to the scenario below by responding to the following discussion questions:
     • What signs and symptoms of CVA did Peter experience?
     • What were the immediate and long-term results of the CVA experienced by Peter?
3. Whole Class Debrief
   • Come back together as a class and summarize the findings of each group. Highlight any signs, symptoms, and results of CVA that were not identified.

Note: Students could be instructed to add the scenario and session materials to their client portfolio for Peter Schultz.

4. Case Study: Creating a Caring Environment for a Patient Who is Dying

The following case study is used with permission of Island Health.Island Health (2012).

A 61-year-old male is being admitted to the unit by stretcher from Emergency. He was receiving palliative end-of-life care at home, but has been admitted due to a pain crisis. You enter the room with the RN from your unit, and under the direction of the RN, you assist in moving the patient from stretcher to bed. With a gentle touch and a caring smile, you introduce yourself.

As the RN gets the report, you continue to help position the patient. You go for more pillows to help with positioning, get a warm blanket, and retrieve other care items. You ask the RN how you can help (for example, find an IV pole, collect mouth wash supplies, or get ice water.)

Once the patient is settled, you turn your attention to the family. You consider how many chairs they will need in the room and ask if you can get them something to drink. You also show them where the washroom, ice machine, and public telephone are located.

Remember to consider the family in planning the care of your patient. The death of a loved one is an experience that stays with most people forever. It is our job to be supportive during this time. The RN will need to pay attention to eliminating the pain crisis and attend to the other needs while you help to create a caring environment.

Questions for Discussion:

• Have you ever visited someone who was dying in the hospital?
• What did staff do to help make your loved one feel better?
• What could have been done differently that would have helped your loved one?
• How did staff help you during this time?
• Empathy – what does it mean to you? How could you demonstrate empathy with the patient?

Strategies that Focus on Critical Thinking, Problem-Solving, and Decision-Making

1. Classroom Debate Activity

Invite students to engage in a debate about a topic discussed in this course. Divide the class into small groups of three to five students and assign two groups to each of the topics outlined; one group will take a pro position towards the topic and the other group will take a con position.

Ask each group to identify two to three reasons to support the position they have been assigned. Then, with the instructor acting as the moderator, the two groups will engage in a debate using the following structure:

1. Each group provides a brief introduction to their position on the topic.
2. In alternating format, the two groups present the two or three reasons identified to support their position.
3. Each group provides a brief closing statement.

After the debate has concluded, briefly come together as a larger group and summarize the positions that were presented. Invite feedback from the students not involved in the debate and discuss further considerations. Alternate groups until each student has participated in a debate.

Debate topics for Healing 1: Caring for Individuals Experiencing Common Health Challenges.

1. HCAs should respect the rights of a client, who has lung cancer, to smoke.
2. The family of a client with a developmental disability should be informed of the client’s involvement in a romantic relationship.
3. HCAs should support the rights of a client to access medical assistance in dying.

2. Developing a Best Practices Tool to Support a Client Who is Dying

Invite students, working alone or in small groups, to develop a tool (for example, a checklist of best practices) that would aid them when they are supporting a client who is dying.

Based on what they have learned about end-of-life care, what regular observations should be made:

• In respect to physical changes and comfort needs of the client?
• In respect to mental or emotional changes in the client?

After developing the tool, students will discuss how the information will influence choices they will make about caregiving practice and how they will evaluate the care they provide.

3. Common Patterns of Dying Learning ActivityCopyright © 2017, Life and Death Matters. This material is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License (CC BY-SA 4.0)

1. As a class, watch the Unprecedented – Common Patterns of Dying instructional video available on the Life and Death Matters website.
   Before watching the video, you may wish to use the STUDENT HANDOUT below to assign video review questions to focus viewing. You may elicit answers and other observations from viewing afterwards.
2. Following this, have students read the case scenario describing the pattern of stuttering decline (“Stuttering Decline – The Roller Coaster”) on the Student Handout below. Students should then form small groups to discuss their responses to the questions provided.
3. Afterwards, come together as a class and briefly elicit responses from the small group discussion. Next, identify common health challenges reviewed in the course that may result in a prolonged pattern of dying and further consider implications for the provision of care.

4. Critical Thinking Activity: Responding to Clients with Common Health Challenges

Students will use knowledge about communication, common health challenges, and observing and reporting to identify and respond to a variety of health-related situations.

Scenarios are provided below. Included for each scenario are a HCA Role Card, a Client Role Card, and a Client Profile. The Client Profile should be used to inform client care; alternately, it could be used to populate preferred templates in use by the program (e.g., bedside care plan or assignment sheets). The material provided for this activity has been formatted in a way that will facilitate its direct use in the educational setting.

Students may enjoy practising this activity in the lab, with measures taken to simulate a real-life setting. This critical thinking activity could also be adapted for use during the Healing 3: Personal Care and Assistance course.

Depending on program sequencing, scenarios and client profiles could be further adapted to increase the complexity of this activity. This could be accomplished by incorporating additional props and/or equipment or by adding information to the client profile (e.g., medication information).

While not directly indicated, the health-related situations are listed below for instructor reference. Students in the HCA role should be able to identify these situations (using observation and reporting) through the role play and when documenting. The instructor will highlight these during the debrief.

• Role Play 1: Responding to a client showing signs of hypoglycemia
• Role Play 2: Responding to a client showing signs of orthostatic hypotension
• Role Play 3: Responding to a client indicating she is hungry
• Role Play 4: Responding to a client showing signs of pneumonia
• Role Play 5: Responding to a client showing signs of a urinary tract infection
• Role Play 6: Responding to a client showing signs of constipation

Setting Up the Activity

A. Role Play

5. Case Study: Decision-Making Regarding Reporting Changing Client Condition

The following case study is used with permission of Island Health.

It is not unusual for client status to change quickly in acute care settings; HCAs need to be aware of how to most effectively communicate changes in client conditions in order to ensure their safety and well-being.

For the past few months, Greg, an HCA, has been working full time on a surgical unit. He is getting to know the team members and enjoys the opportunity to work in partnership with the health care team.

For the past few shifts, Greg has been supporting care for Mr. Stark. Mr. Stark is 67 years old and is a retired teacher. He had surgery six days ago to remove a tumour in his small intestine and now has a colostomy bag. He has been progressing well after the surgery and is looking forward to returning home to his wife. Mr. Stark plans to independently manage his colostomy care with assistance from community based nursing as required.

Greg is stopped by Mr. Stark while doing his hourly care rounds. Mr. Stark indicates that he is feeling like he is going to vomit and needs help. Mr. Stark’s RN, Jane, is currently in a family meeting with another patient.

Ask students to consider the “who, what, when, where, why and how” for this situation.

Who to communicate with. It is important to get the assistance of nursing staff with this as there may be a variety of factors contributing to the nausea. If unable to interrupt Jane, contact the RN covering for Jane, or the team leader.

What to communicate. Tell the RN what you saw (observations), when you saw it and what Mr. Stark reported to you regarding his nausea. Determine if the RN wants you to record this on any special forms. Be prepared to answer some questions from the RN.

When. This nausea is a change for Mr. Stark. Because of this, it is important that you verbally communicate this information immediately.

Where. It may be that you are asked to record this information on a special form or chart. Depending on the outcome, this may be a topic that is addressed in a team huddle as well. Collaborate with the RN to determine who will report this information and where. Ensure patient confidentiality and privacy is respected during verbal communication.

Why. It is critical that this information is shared in a timely way as Mr. Stark will require the assessment of his condition and possible treatment. Timely communication will also reassure Mr. Stark that his care needs are being addressed.

How. You may be able to use the nurse call bell system, pager, or voice-activated devices to alert team members that you require assistance.

Consider what forms and meetings you can use to share information once immediate needs are addressed.

Strategies that Focus on Professional Approaches to Practice

1. The Dance: Maintaining Professional Boundaries

Maintaining professional boundaries when caring for a dying person can sometimes be particularly challenging. Elizabeth Causton, in her writings on the “The Dance” (See STUDENT HANDOUT), provides caregivers with a metaphor that may be helpful as they work closely with clients and families.

Have students read the description of “The Dance” and ask them to discuss the following:

• Does the metaphor of the dance make sense in relation to professional practice when caring for dying individuals?
• What does the author mean by “hooks” in this context? Can you think of any hooks that might affect you in an end-of-life context?
• Have you seen or could you envision caregiver behaviours, such as those described, that reflect lack of perspective? How would a caregiver behave who is kind, compassionate, and caring yet maintains professional boundaries – who is able to “feel deeply and to act wisely”?
• How might the ideas in this reading apply to other caregiving contexts (e.g., with clients who are vulnerable but not necessarily dying)?

Suggested Course Assessments

The course learning outcomes may be assessed by the following tasks:

1. One or more quizzes or examinations that pertain to knowledge of human anatomy and physiology, normal changes of aging, nutrition in healing, and common challenges to health and healing (Learning Outcomes #1, #2, and #3).
2. An assignment in which students, working in small groups, research a common health challenge and present their findings to the class. Each group should be prepared to discuss the physical, social, emotional, and cognitive changes that a person dealing with a particular health challenge might face. Each group should also identify community resources and discuss the HCA role in caring for and supporting individuals experiencing the health challenge (Learning Outcomes #2 and #4).
3. A written assignment in which each student identifies what they would want in a care provider for themselves or a close family member who is dying. Each student will discuss this fictitious “perfect” caregiver in terms of the person’s:
   • Comfort with the death and the dying process.
   • Knowledge of and ability to provide palliative care.
   • Ability to communicate with the dying individual.
   • Relationship with other health team members.
   • Relationship with family members.
   • Ability to communicate with family members during the dying process and immediately after the death of the client.
   • Ability to adapt to cultural, religious, or other person-centred care requirements.

Each student should reflect on their strengths as a caregiver as these relate to end-of-life care and identify areas of personal or professional development that would assist them to become more effective or confident in providing end-of-life care (Learning Outcomes #4 and #5).

Resources for Healing 1: Caring for Individuals Experiencing Common Health Challenges

Online Resources

ALS Canada. https://www.als.ca/

American Psychological Association. (2019). Culturally diverse communities and palliative and end-of-life care [Fact sheet]. https://www.apa.org/pi/aging/programs/eol/end-of-life-diversity.pdf

Arthritis Canada. https://arthritis.ca/

Association of Canadian Community Colleges and Canadian Association of Continuing Care Educators. (2012, June 28). Canadian educational standards for personal care providers. https://www.collegesinstitutes.ca/wp-content/uploads/2014/05/Reference-Guide_Canadian-Educational-Standards-for-Personal-Care-Providers_ACCC.pdf

British Columbia Hospice Palliative Care Association. https://bchpca.org/

Canadian Cancer Society. https://www.cancer.ca/

Canadian Hospice Palliative Care Association. https://www.chpca.ca/

Canadian Liver Foundation. https://www.liver.ca/

Canadian Lung Association. https://www.lung.ca/

Challacombe, L. (2021). The epidemiology of HIV in Canada [Fact sheet]. CATIE. https://www.catie.ca/en/fact-sheets/epidemiology/epidemiology-hiv-canada

Diabetes Canada. https://www.diabetes.ca/

Diabetes Canada. (2021). Basic meal planning [Blog post]. http://www.diabetes.ca/diabetes-and-you/healthy-living-resources/diet-nutrition/basic-meal-planning

Dodd, K. (2020). End of life nutrition [Blog post]. The Geriatric Dietitian. https://www.thegeriatricdietitian.com/embracing-hospice-end-of-life-nutrition/

Dying with Dignity Canada. https://www.dyingwithdignity.ca/

Elsevier. (2015). Body spectrum [Illustrations]. Elsevier, Inc. http://sites.elseviermultimedia.us/common/HP/bodyspectrum/

Emedicinehealth. (2017). HIV and AIDS quiz: HIV testing and symptoms [Online quiz]. http://www.emedicinehealth.com/hiv-aids_quiz_iq/quiz.htm

Government of British Columbia. (n.d.). Advance care planning. https://www2.gov.bc.ca/gov/content/family-social-supports/seniors/health-safety/advance-care-planning

Government of Canada. (2016). End of life care. https://www.canada.ca/en/health-canada/topics/end-life-care.html

HealthLinkBC. https:k//www.healthlinkbc.ca/

HealthLinkBC. (n.d.). Seniors’ health. https://www.healthlinkbc.ca/health-topics/common-health-concerns/seniors

Heart and Stroke Foundation. https://www.heartandstroke.ca/

Interior Health Authority. (2021). Palliative and end of life care to relieve suffering and improve quality of life. https://www.interiorhealth.ca/YourCare/PalliativeCare/Pages/default.aspx

Kidney Foundation of Canada. https://kidney.ca/

Mayo Clinic. (2017). Diseases and conditions [Index]. https://www.mayoclinic.org/diseases-conditions/index?letter=A

Medical News Today. (2017). What causes difficulty swallowing (dysphagia)? http://www.medicalnewstoday.com/articles/177473.php

MS Society. https://mssociety.ca/

Muscular Dystrophy Association. https://www.mda.org/

Osteoporosis Canada. https://osteoporosis.ca/

Pacific AIDS Network. https://pacificaidsnetwork.org/

Pain B.C. https://www.painbc.ca/

Parkinson Society British Columbia. https://www.parkinson.bc.ca/

Quizlet Inc. [Mobile app]. https://quizlet.com/

Victoria Hospice. https://victoriahospice.org/

WebMD. (2019). What is constipation? http://www.webmd.com/digestive-disorders/digestive-diseases-constipation

WebMD. (2016). What is edema? http://www.webmd.com/heart-disease/heart-failure/edema-overview

Wedro, B. (2021). Blood clots (in the leg). MedicineNet. https://www.medicinenet.com/blood_clots/article.htm

Online Videos

9News. (2016, July 3). Storytellers: The ALS death ride [Video]. YouTube. https://www.youtube.com/watch?v=2TkXt_hRfY0

Alilia Medical Media. (2018, November 5). The endocrine system, overview, animation [Video]. YouTube. https://www.youtube.com/watch?v=vLdNX5Te1Xo

Alilia Medical Media. (2018, November 20). The lymphatic system, overview, animation [Video]. YouTube. https://youtu.be/cCPyWFK0IKs

Alilia Medical Media. (2019, September 3). Overview of the nervous system, animation [Video]. YouTube. https://youtu.be/R1_B5_ytWSc

American Foundation for the Blind. (2008, October 16). Visual simulations [Video]. YouTube. https://www.youtube.com/watch?v=DwtH1mO4eE0

BioDigital, Inc. (2008, October 14). 3D medical animation – What is cancer? [Video]. YouTube. http://youtu.be/LEpTTolebqo

Brown, G. (2009, July 15). Jenny’s Huntington’s story [Video]. YouTube. https://www.youtube.com/watch?v=rleVDQ-4MsY

CTE Skills.com. (2015, November 31). The urinary system in 7 minutes [Video]. YouTube. https://www.youtube.com/watch?v=CkGqp5tr-Qk

Diabetes UK. (2013, September 3). Diabetes and the body: Diabetes UK [Video]. YouTube. https://youtu.be/X9ivR4y03DE

Diseases Simplified. (2020, January 16). Must know causes of edema/swelling [Video]. YouTube. https://www.youtube.com/watch?v=jyoaxSbwFTM

DocMikeEvans. (2014, March 13). Failing kidneys and different treatment options [Video]. YouTube. https://youtu.be/mi34xCfmLhw

DrDrewLCTV. (2011, October 31). What alcohol can do to your liver [Video]. YouTube. https://www.youtube.com/watch?v=l-SBR7p7K-M

End of Life Project. (2012, November 29). Completing the circle: End of life care with Aboriginal families [Video]. YouTube. https://www.youtube.com/watch?v=XbUGMIKId0c

FilmSpawn. (2012, June 12). World elder abuse awareness day [Video]. YouTube. https://www.youtube.com/watch?v=mSFnDe6A2Ww

Geriatric Dietitian. (2019, July 20). Embracing hospice end of life nutrition [Video]. YouTube. https://www.youtube.com/watch?v=suj_EXYHhGI

Gilbert, D. (2014, February 18). Loss of independence within the elderly [Video]. YouTube. https://www.youtube.com/watch?v=up7rGG0ytoE

Halton Healthcare. (2020, February 20). Pressure injury prevention 2020 [Video]. YouTube. https://www.youtube.com/watch?v=qcyhJuNhPG4

Healthguru. (2008, February 8). Understanding epilepsy. (Epilepsy #1) [Video]. YouTube. https://www.youtube.com/watch?v=MNQlq004FkE

Heat Inc., Health Education and Training. (2017, September 11). The nursing assistant: pressure ulcer prevention [Video]. YouTube. https://www.youtube.com/watch?v=6OGSkxlr9-c

HeistheStud. (2014, December 14). Emphysema & bronchitis [Video]. YouTube. https://www.youtube.com/watch?v=S-tryBgTBBk

Human Biology Explained. (2014, March 8). Anatomical terms – drawn and defined (updated) [Video]. YouTube. https://www.youtube.com/watch?v=kvHWnJwBkmo&app=desktop

Innovative Hearing Solutions, Inc. (2015, July 14). Inserting and removing RIC’s, CIC’s and BTE’s hearing aids [Video]. YouTube. https://www.youtube.com/watch?v=K4BK-ohwhoI

Janux. (2015, January 10). Human physiology – Introduction to the immune system [Video]. YouTube. https://youtu.be/CG931UYMbN0

Los Angeles Times. (2013, July 3). The singing nurse at Valencia hospital soothes the suffering [Video]. YouTube. https://www.youtube.com/watch?v=ODok6eNtA9c

Lee Health. (2012, January 6). Recognizing lymphedema [Video]. YouTube. https://www.youtube.com/watch?v=ruDdySPgt4k

Life and Death Matters. (2015, March 21). My tribute to PSWs [Video]. YouTube. https://www.youtube.com/watch?v=7nvHOawDX8M

Life Before Death. (2013, December 7). Life before death – Roger’s story [Video]. YouTube. https://www.youtube.com/watch?v=eQRHrgCiEzI

LivingHealthyChicago. (2016, March 7). Living with arthritis [Video]. YouTube. https://www.youtube.com/watch?v=D6HtMELddcg

Magic Spangle Studios. (2012, July 11). 3D medical animation – central nervous system [Video]. YouTube. https://youtu.be/-s8yEhRZgvw

Markivmedcom. (2009, July 15). Acute myocardial infarction – heart attack [Video]. YouTube. http://youtu.be/zeS-0au8ij4

Marwaha, S. (2016, October 28). Wash your hands. It just makes sense [Video]. YouTube. https://youtu.be/BJStsvWPz7k

Miller, B. (2015, March). What really matters at the end of life [Video]. TED2015. https://www.ted.com/talks/bj_miller_what_really_matters_at_the_end_of_life

MooMooMath and Science. (2017, May 18). Types of human body tissues [Video]. YouTube. https://www.youtube.com/watch?v=O0ZvbPak4ck

Moovly. (2014, September 22). What is ALS? [Video]. YouTube. https://www.youtube.com/watch?v=Q2Xt4noBVws

NPT Reports. (2013, September 13). End of life. Aging matters NPT reports. [Video]. YouTube. https://www.youtube.com/watch?v=uzfcvptgJ2c

PBS Digital Studios. (2013, March 25). You are mainly microbe! [Video]. YouTube. https://youtu.be/4BZME8H7-KU

Seet, J. (2006, April 12). UTI [Video]. YouTube. https://www.youtube.com/watch?v=I9fJHLSw4Og

St. Michael’s Hospital. (2018, August 2). What is hypoglycemia? – DiaBiteSize [Video]. YouTube. https://www.youtube.com/watch?v=e0XN_hjfQiA&feature=youtu.be

Sunnybrook Hospital. (2018, March 13). Quality dying – Let’s talk about it [Video]. YouTube. https://www.youtube.com/watch?v=9CYl12mBluA

TED-Ed. (2014, November 10). How a wound heals itself – Sarthak Sinha [Video]. YouTube. https://www.youtube.com/watch?v=TLVwELDMDWs

TED-Ed. (2014, November 24). How do lungs work? – Emma Bryce [Video]. YouTube. https://youtu.be/8NUxvJS-_0k

TED-Ed. (2017, December 14). How your digestive system works – Emma Bryce [Video]. YouTube. https://www.youtube.com/watch?v=Og5xAdC8EUI

TED-Ed. (2018, March 12). The science of skin – Emma Bryce [Video]. YouTube. https://youtu.be/OxPlCkTKhzY

Teepa Snow’s Positive Approach to Care. (2017, December 21). How dementia affects language skills [Video]. YouTube. https://www.youtube.com/watch?v=0BlZF_4EKp4

ThePenguinProf. (2011, July 29). Medical terminology [Video]. YouTube. https://www.youtube.com/watch?v=3fiEszFPRE8

University of Bristol. (2010, March 3). How the human brain works [Video]. YouTube. https://www.youtube.com/watch?v=9UukcdU258A

USMLE pass. (2019, November 18). Sounds of breathing patterns (Cheyne-Stokes, Kussmauls, Biots) [Video]. YouTube. https://www.youtube.com/watch?v=ViGjOiPE2mY

WebMD. (2019). The basics: Diarrhea [Video]. http://www.webmd.com/digestive-disorders/digestive-diseases-diarrhea

Whitford, B. and Paskievich, J. (Directors). (2005). The gift of diabetes [Film]. National Film Board. https://www.nfb.ca/film/gift_of_diabetes/

YourRenalCare. (2011, December 15). Kidney stones [Video]. YouTube. https://www.youtube.com/watch?v=LngbrHJkXoE

Online Learning Tools

The following materials are ready for use in the classroom. A brief description and estimated time to complete each activity is included for each.

SuperTeacherTools: https://www.superteachertools.us/#.

• Instructors can use this site to create customized games for classroom use. Styles include Jeopardy, Who Wants to be a Millionaire, and Speed Match.

Canadian Virtual Hospice. (2016). Livingmyculture.ca. http://livingmyculture.ca/culture/

• A series of online videos discussing quality palliative care for people from the following cultures: First Nations, Inuit, Métis, Chinese, Ethiopian, Filipino, Indian, Iranian, Italian, Pakistani, Somali. Videos range from 2 to 25 minutes.

Joyce, S. & Grainger, J. (2021). NHA-CL-Palliative care awareness. LearningHub. https://learninghub.phsa.ca/Courses/7491/nha-cl-palliative-care-awareness

• An e-learning course that takes 1 hour 30 minutes to complete.

Life and Death Matters. (2015). Boundaries and self-care in hospice palliative care. https://www.youtube.com/watch?v=wSb_O6_E7_A&feature=em-share_video_user

• Author Elizabeth Causton discusses the importance of boundaries and self-care for those working in palliative care (25 minutes for review and discussion).

Course Guideline

The main focus of this course (at least 70%) should be on:

• Learning Outcome #1 – Describe ways to organize, administer, and evaluate person-centred care and assistance for clients experiencing cognitive health challenges (dementia).
  and
• Learning Outcome #3 – Demonstrate an understanding of effective approaches to disruptive or abusive behaviours.

A maximum of 30% of course hours should be dedicated to:

• Learning Outcome #2 – Describe ways to organize, administer, and evaluate person-centred care and assistance for clients experiencing mental health challenges (other than dementia).

Suggested Learning Strategies

Strategies that Focus on Caring

1. Contributing to a Broadened Understanding of Cognitive Health Challenges

Invite students to imagine what it is like to suffer from a cognitive health challenge, particularly dementia. Have students sit comfortably, close their eyes, and take several deep breaths.

Speaking softly, lead them through the following scenario:

Imagine yourself walking alone through a forest. It’s a lovely warm spring day. The sights and sounds and smells of the forest are refreshing and you are enjoying your walk.

As the afternoon progresses, you realize you aren’t sure which direction you should take to get back to your friends and family. As you look around, you realize that you are lost.

As you realize your situation, you experience a twinge of fear.

You decide to keep walking in hopes of seeing something familiar, but find that the further you go, the more lost you become. Time passes and your fear is verging on panic. As evening draws closer, you realize that you may have to spend the night alone in the forest.

Invite students at this point to open their eyes and discuss their bodily experiences, feelings, and thoughts. Invite them to discuss how this is similar to what some cognitively challenged individuals might experience.

The client with cognitive changes may constantly feel lost. No matter what they do or where they go, they can find nothing that is familiar.

What feelings, therefore, would this person be likely to have? How is this related to some of the behaviours we might see in a cognitively challenged person?

Invite students to close their eyes once again and visualize themselves back in the forest. Continue the scenario as follows:

You are back in the forest, still feeling lost and fearful. As dusk begins to settle, you notice that there is a strange man who seems to be following or observing you.

Can you see him? He is about 30 feet away. When you attempt to speak to him, he answers in a language you don’t understand.

Invite students to open their eyes and describe their responses to the stranger. What feelings were stimulated? How does this relate to how a cognitively challenged individual might experience the people in their environment (even family members)? How might this help us understand some of the responses of clients?

2. Contributing to Person-Centred Care

Using the health wheel from Health 2: Lifestyle and Choices as a guide, invite students to work in small groups to discuss how cognitive health challenges might affect all areas of health and healing (physical, cognitive, emotional, social, and spiritual). Then ask the groups to discuss how changes in each dimension of health might positively contribute to improved quality of life for the affected individual. Invite each group to report back to the whole class.

The above process could be undertaken using scenarios of real or fictitious individuals who are experiencing a cognitive health challenge. Invite students, in small groups, to discuss how the changes in cognitive ability and perceptions affect all dimensions of the person’s health and lifestyle. Ask the groups to discuss how changes in each dimension of health might positively contribute to healing. Discussion should also focus on how this understanding might influence caregiver practice. Invite each group to report back to the whole class.

An alternative to the above could involve using scenarios of a real or fictitious individual who is supporting a family member experiencing a cognitive health challenge. The focus should be on a family member (wife, husband, daughter, son, etc.) and how the cognitive health challenge of a family member is impacting them. Invite students, in small groups, to discuss how the cognitive and perceptual changes in a family member affect other members of the family. Students should consider all dimensions of the health wheel. Discussion should also focus on how this understanding might influence caregiver practice. Invite each group to report back to the whole class.

3. Unfolding Case Study: Caring for Peter Schultz

As a homework assignment, ask students to review relevant textbook, online course, or other course material related to communicating with clients with dementia.The following resource could also be referenced: Alzheimer Society of B.C. (n.d.). Communicating with people living with dementia. http://www.alzheimer.ca/en/bc/Living-with-dementia/Ways-to-communicate

Whole Class or Small Group Activity

In class, briefly review the challenges to communication experienced by clients with dementia. Following this, create a table with three columns on the whiteboard (or use the STUDENT HANDOUT) below.

• First column: To provide a meaningful context for this activity, the communication challenges experienced by the unfolding case study client, Peter Schultz, can be listed.
• Second column: For each challenge listed, ask the students to consider the potential impact on the client (and his family) and list them.
• Third column: List communication strategies that could be used by the HCA to address the challenge and reduce the potential impact. The instructor may wish to complete a few full examples through each of the columns and then ask the students to complete the remaining items in a small group.

Throughout the activity and/or during the debrief, highlight further communications challenges and strategies that were not listed.

4. Ambiguous Loss and Grief Discussion ActivityCopyright © 2017, Alzheimer Society of B.C. This is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License (CC BY-SA 4.0)

Using the document, Ambiguous Loss and Grief: A resource for health-care providers as reference, introduce the concept of ambiguous loss and grief to the class.

Explain that this document is intended to help health care providers, Alzheimer Society staff, and volunteers gain a better understanding of how loss and grief affect people with dementia and their family caregivers. It provides useful strategies to assist families with their multiple losses and grief and to help caregivers stay connected with the person with dementia, while building strength and resilience as the disease progresses.

Using the DISCUSSION GUIDE below, explore the following questions with the students:

• What is ambiguous loss and grief?
• Why is ambiguous loss and grief different from other types of grief?
• How can HCAs provide support to individuals and families experiencing ambiguous loss and grief?

Invite students to share their response to the questions listed above. As ideas are forthcoming, write them on the whiteboard or flip chart. Use the discussion guide to highlight any items that were not considered.

Note: To promote discussion, you may wish to prepare a few copies of the document to share with the class. Students could also be asked to review the document as a homework assignment prior to the class discussion. To support a professional approach to practice, students could be provided with a link to the document for reference during their clinical placement and after completion of the program.

Strategies that Focus on Critical Thinking, Problem-Solving, and Decision-Making

1. Classroom Debate Activity

Invite students to engage in a debate about a topic discussed in this course. Divide the class into small groups of three to five students and assign two groups to each of the topics outlined; one group will take a pro position towards the topic and the other group will take a con position.

Ask each group to identify two to three reasons to support the position they have been assigned. Then, with the instructor acting as the moderator, the two groups will engage in a debate using the following structure:

1. Each group provides a brief introduction to their position on the topic.
2. In alternating format, the two groups present the two or three reasons identified to support their position.
3. Each group provides a brief closing statement.

After the debate has concluded, briefly come together as a larger group and summarize the positions that were presented. Invite feedback from the students not involved in the debate and discuss further considerations. Alternate groups until each student has participated in a debate.

Debate topics for Healing 2: Caring for Individuals Experiencing Cognitive or Mental Health Challenges.

1. For clients with dementia, reality orientation is more effective than validation therapy.
2. A client demonstrating responsive behaviours should be moved from a communal setting to a quiet room.

2. Supporting Clients with Dementia

As a homework assignment, have students read relevant course or online materials describing challenges that may be experienced by people with dementia and their families and the role of the HCA in responding with appropriate care and support.

1. Whole Class Reading and Discussion
   • Using the STUDENT HANDOUT below, read one of the following scenarios and use it as an example. Then have the students identify key information and observations from the scenario and list it in the first column. Following this, have students identify important considerations that could provide context for the situation and list them in the second column. Lead the students in a discussion about how they, as HCAs, would respond to the situation (A DISCUSSION GUIDE on supporting clients with dementia has been provided below).
2. Small Group Activity
   • Divide the class into small groups, assigning each group one of the remaining scenarios. Using the handout provided below, the students should identify key information and considerations. The students should then identify how they, as HCAs, could respond to the same situation.
3. Whole Class Activity Debrief
   • Come back together as a class and have each group report on the key information, considerations, and potential responses identified. Use the Discussion Guide to highlight any that were not identified.

3. Person-Centred Care in PracticeCopyright © 2017, Alzheimer Society of B.C. This material is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License (CC BY-SA 4.0).

Using the document, Guidelines for Care: Person-centred care of people with dementia living in care homes framework as reference, explore the role of the HCA in providing person-centred care to clients with dementia.

1. Whole Class Review and Discussion
   • Ask the students to respond to one or more of the following questions:
     • What is person-centred care?
     • How can health care staff provide person-centred care for clients with dementia?
     • What does it mean to understand the reality of someone with dementia?
     • Is it possible to provide person-centred care if you don’t know anything about dementia and how it progresses?
     • How can you involve family?
     • How can you provide choices to the person who appears unable to choose, and why is this important?
     • How would you respond to the following statement: “Come on, sweetie. Let me help you get dressed”?
   • As ideas are forthcoming, write them on the whiteboard or flip chart. Use the DISCUSSION GUIDE below on person-centred care in practice to highlight any items that were not considered. Discuss terms commonly used to address clients (e.g., love, dearie, etc.) and discuss why they are not appropriate. Ask students to identify appropriate ways to address clients (e.g., according to preference, culture, formality, etc.).
2. Small Group Activity
   • Divide the class into small groups. Ask the students to read the scenario on the STUDENT HANDOUT below and respond to the discussion questions provided. To support completion of the small group activity, ensure that students are able to link to the reference document or provide printed copies.
3. Whole Class Activity Debrief
   • Briefly come back together as a group and have each group report on their responses. Use the DISCUSSION GUIDE below to highlight any considerations that were not identified.

Strategies that Focus on Professional Approaches to Practice

1. Discussion on Mental Illness

Invite students, individually, to reflect on the following questions:

• What are your concerns or fears in relation to people experiencing mental illness? What has caused you to have these concerns?
• Do you have any friends or family members who have had experience with mental illness? If so, how has this influenced your feelings about mental health?
• Do you think you would enjoy working with individuals with mental illness? On what do you base your response to this question?

Invite students to form small discussion groups to discuss how the caregiver role, whether in the community or a facility, would be different when the client is experiencing a mental health disorder as opposed to a physical health challenge.

What personal and professional caregiver characteristics would be most valuable when working with individuals with mental illness? Encourage them to consider characteristics related to:

• Personality/temperament
• Knowledge about mental health
• Perceptions of people with mental health disorders
• Ability to form relationships with clients
• Need for control
• Ability to work with other health team members
• Ability to interact with family members
• Other characteristics that seem important

What legal and ethical issues would be particularly important to be aware of when working with clients experiencing mental illness?

2. Addressing Myths and Stigmas: Promoting Person-Centred Language

As a homework assignment, have students review relevant textbook, online material,Alzheimer Society of Canada (2017). Person-centred language guidelines. https://alzheimer.ca/sites/default/files/documents/culture_exec_summary_e.pdfHeretohelp (2014). Stigma and discrimination around mental health and substance use problems. http://www.heretohelp.bc.ca/factsheet/stigma-and-discrimination-around-mental-health-and-substance-use- problems or other course information describing myth and stigma associated with dementia and mental health.

1. In class, discuss language and terms that contribute to myth and stigma.
2. Using the STUDENT HANDOUT below, have students work in partners or small groups and consider the following questions for each scenario:
   1. How does the language and/or actions presented in the scenario contribute to myth and stigma associated with dementia or mental health disorders?
   2. What do you think your immediate reaction to this situation would be?
   3. How could you use assertive communication to respond to the situation?
3. After coming back together as a class, discuss possible responses to each situation, such as checking the behaviour immediately, paraphrasing back using person-centred language, gently explaining why the language is not appropriate, providing an alternative communication strategy, etc.

Suggested Course Assessments

The course learning outcomes may be assessed by the following tasks:

1. One or more quizzes or examinations that pertain to knowledge of common cognitive or mental health challenges and principles of crisis intervention (Learning Outcomes #1, #2, and #3).
2. A written assignment, that students will complete individually, based on interactions with a client with cognitive changes (see STUDENT HANDOUT below) (Learning Outcome #1).
3. Supporting Clients with Dementia or a Mental Health Disorder: Best Practices for HCAs – Group Presentation. Students can research and complete this project in small groups. They should be expected to put together visual material (e.g., a poster or a PowerPoint) and a short written handout to give to the class. The focus should be on how to best communicate with and care for clients with dementia or mental health disorders. The online resources provided for this course will be particularly useful in preparing for this assignment (Learning Outcome #1 and #2). Refer to Section 5: Sample Evaluation Tools.
4. An assignment where students, working in small groups, research a mental health disorder and present their findings to the class. Each group should be prepared to discuss the physical, social, emotional, and cognitive changes that a person dealing with the particular mental health disorder might face. Each group should also identify community resources and be prepared to discuss the HCA role in supporting individuals experiencing mental health disorders (Learning Outcome #2).

Resources for Healing 2: Caring for Individuals Experiencing Cognitive and Mental Health Challenges

Online Resources

Alzheimer’s Association. (2021). Aggression and anger. https://www.alz.org/help-support/caregiving/stages-behaviors/agression-anger

Alzheimer’s Association. (2021). How the brain works: A tour of how the mind works. https://www.alz.org/alzheimers-dementia/what-is-alzheimers/brain_tour

Alzheimer Society. (2019). Ambiguous loss and grief in dementia: A resource for individuals and families. https://alzheimer.ca/sites/default/files/documents/ambiguous-loss-and-grief_for-individuals-and-families.pdf

Alzheimer Society. (n.d.). Communicating with people living with dementia. https://alzheimer.ca/en/help-support/i-have-friend-or-family-member-who-lives-dementia/communicating-people-living-dementia

Alzheimer Society. (n.d.) Communication challenges and helpful strategies. https://alzheimer.ca/en/help-support/im-living-dementia/managing-changes-your-abilities/communication-challenges-helpful

Alzheimer Society. (2011). Guidelines for care: Person-centred care of people living with dementia in care homes. https://alzheimer.ca/sites/default/files/files/national/culture-change/culture_change_framework_e.pdf

Alzheimer Society. (2017). Person-centred language guidelines. https://alzheimer.ca/sites/default/files/documents/Person-centred-language-guidelines_Alzheimer-Society.pdf

Alzheimer Society. (2017). Providing person-centred care. https://alzheimer.ca/en/help-support/im-healthcare-provider/providing-person-centred-care

Alzheimer’s Society. (n.d.). Restlessness or “sundowning.” http://www.alzheimer.ca/en/bc/Living-with-dementia/Caring-for-someone/Understanding-symptoms/Sundowning

Alzheimer Society. (2019). Supporting clients through ambiguous loss and grief. Strategies for healthcare providers. https://alzheimer.ca/sites/default/files/documents/Ambiguous%20Loss%20Health%20Provider%20En-20-FINAL-MD_1.pdf

Alzheimer Society. (2018). Understanding genetics and Alzheimer’s disease. https://alzheimer.ca/sites/default/files/documents/research_understanding-genetics-and-alzheimers-disease.pdf

Alzheimer Society. (2017). Using person-centred language. https://alzheimer.ca/en/take-action/become-dementia-friendly/using-person-centred-language

Alzheimer Society British Columbia. https://alzheimer.ca/bc/en

Alzheimer Society Canada. https://alzheimer.ca/en

B.C. Mental Health and Substance Use Services. (2020). Trauma-informed practice. http://www.bcmhsus.ca/health-professionals/clinical-professional-resources/trauma-informed-practice

B.C. Provincial Mental Health and Substance Use Planning Council. (2013, May). Trauma-informed practice guide. https://bccewh.bc.ca/wp-content/uploads/2012/05/2013_TIP-Guide.pdf

B.C. Schizophrenia Society. https://www.bcss.org/

Beattle, E. (2015). BCcampus leads the collaborative development of new and open elder abuse prevention, detection and response resources. https://bccampus.ca/2015/10/20/bccampus-leads-the-collaborative-development-of-new-and-open-elder-abuse-resources/

Canadian Alliance on Mental Illness and Mental Health. https://www.camimh.ca/

Canadian Association for Suicide Prevention. http://suicideprevention.ca/

Canadian Coalition for Senior’s Mental Health. https://ccsmh.ca/

Canadian Mental Health Association. http://www.cmha.ca/

Canadian Mental Health Association: Here to help. (2014). Learn about Alzheimer’s disease [Information sheet]. https://www.heretohelp.bc.ca/sites/default/files/alzheimers-disease.pdf

Canadian Mental Health Association. (2016). Myths about mental illness. http://www.cmha.ca/mental_health/myths-about-mental-illness/

Carreiro, D. (2013, October 15). Suicide rates climb among elderly in Canada. CBC News. https://www.cbc.ca/news/canada/manitoba/suicide-rates-climb-among-elderly-in-canada-1.2054402

Centre for Addiction and Mental Health. (2020). Trauma. https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/trauma

Chan, P. (2011). Clarifying the confusion about confusion: Current practices in managing geriatric delirium. BCMJ, 53(8). https://bcmj.org/articles/clarifying-confusion-about-confusion-current-practices-managing-geriatric-delirium

Dementia.org. (2016). Dementia grief – Part 3: The three stages. https://www.dementia.org/dementia-grief-3-stages

Government of British Columbia. (n.d.). Protection from elder abuse and neglect. http://www2.gov.bc.ca/gov/content/family-social-supports/seniors/health-safety/protection-from-elder-abuse-and-neglect

Government of British Columbia, Ministry of Health. (2012, October 25). Best practice guideline for accommodating and managing behavioural and psychological symptoms of dementia in residential care. A person-centered interdisciplinary approach. https://www.health.gov.bc.ca/library/publications/year/2012/bpsd-guideline.pdf

HealthLinkBC. (2019). Dementia, British Columbia specific information. https://www.healthlinkbc.ca/health-topics/uf4984

HealthLinkBC. (2019). Dementia: Helping a person avoid confusion. http://www.healthlinkbc.ca/healthtopics/content.asp?hwid=hw135788

HealthLinkBC. (2019). Elder abuse, British Columbia specific information. http://www.healthlinkbc.ca/healthtopics/content.asp?hwid=aa60933spec

HealthLinkBC. (2018). Preventing abuse and neglect of older adults. https://www.healthlinkbc.ca/healthlinkbc-files/prevent-abuse-older-adults

Here to Help. (2019). Resource library. http://www.heretohelp.bc.ca/self-help-resources

Island Health. (2021). Mental health and substance use resources and education. https://www.islandhealth.ca/learn-about-health/mental-health/mental-health-substance-use-resources-education

Lidhran, G. (2016). OP-ED: Exploring dementia villages and other care models in Canada. SafeCare B.C. http://safecarebc.ca/op-ed-exploring-dementia-villages-and-other-care-models-in-canada

MedicineNet. (2016). What are phobias? Agoraphobia, social anxiety disorder, other fears. https://www.medicinenet.com/phobias_picture_slideshow/article.htm

Mental Health ., RSBC 1996, c 288. http://www.bclaws.ca/civix/document/id/complete/statreg/96288_01

Mental Health Commission of Canada. http://www.mentalhealthcommission.ca/

Mood Disorders Society of Canada. https://mdsc.ca/

National Institute on Aging. (2019). Assessing risk for Alzheimer’s disease. https://www.nia.nih.gov/health/assessing-risk-alzheimers-disease

Office of the Seniors Advocate British Columbia. (2016, June). Resident to resident aggression in B.C. care homes. https://www.seniorsadvocatebc.ca/app/uploads/sites/4/2016/06/SA-ResidentToResidentAggressionReview-2016.pdf

PIECES. (n.d.). PIECES. Learning and development model. http://www.piecescanada.com/index.php?option=com_content&view=article&id=1&Itemid=3

Schizophrenia Society of Canada. http://www.schizophrenia.ca

Seniors First B.C. http://seniorsfirstbc.ca/
(Formerly the B.C. Centre for Elder Advocacy & Support)

Simon Fraser University, Centre for Applied Research in Mental Health and Addiction. http://www.sfu.ca/content/sfu/carmha.html

Smith, M. (2020). Caregiver stress and burnout. HelpGuide. https://www.helpguide.org/articles/stress/caregiver-stress-and-burnout.htm

STA Health Care Communications. (n.d.). Canadian Review of Alzheimer’s Disease and Other Dementias. http://www.stacommunications.com/adreview.html

University of Waterloo, Murray Alzheimer Research and Education Program. https://uwaterloo.ca/murray-alzheimer-research-and-education-program/

Vancouver Coastal Health. (2020). First Nations ReAct. http://www.vch.ca/Pages/First-Nations-ReAct0131-6129.aspx?res_id=1238

Validation Training Institute Inc. (n.d.). Getting started: Validation to suit your needs. https://vfvalidation.org/get-started/validation-to-suit-your-needs/#ui00c2e24|tab2

Wincer. P. (2020, November 26). What caring for my mum taught me about caring for my son. BBC News. https://www.bbc.com/news/stories-55057440

Wong, S., Gilmour, H. & Ramage-Morin, P. L. (2016). Alzheimer’s disease and other dementias in Canada. Health Reports, 27(5), 11–16. Statistics Canada. http://www.statcan.gc.ca/pub/82-003-x/2016005/article/14613-eng.pdf

WorkSafeBC. (2010). Dementia: Understanding risks and preventing violence. https://www.worksafebc.com/en/resources/health-safety/books-guides/dementia-understanding-risks-and-preventing-violence?lang=en

WorkSafeBC. (n.d.) Working with people with dementia. https://www.worksafebc.com/en/health-safety/industries/health-care-social-services/topics/working-with-people-with-dementia

Online Videos

AboutAlzOrg. (2010, October 26). What is Alzheimer’s disease [Video]. YouTube. https://www.youtube.com/watch?v=7_kO6c2NfmE

Alila Medical Media. (2014, September 10). Neuroscience basics: Human brain anatomy and lateralization of brain function, 3D animation [Video]. YouTube. https://youtu.be/owFnH01SD-s

Alzheimer’s Australia VIC. (2015, June 1). Purposeful activities for dementia: Alzheimer’s Australia VIC [Video]. YouTube. https://www.youtube.com/watch?v=9Y6LCpL8HUU

Animated Alzheimer’s Patient. (2021, January 27). Understanding Alzheimer’s disease [Video]. YouTube. https://www.youtube.com/watch?v=lFBTlHfV8Iw

Applewhite, A. (2017, April).Let’s end ageism [Video]. TED2017. https://www.ted.com/talks/ashton_applewhite_let_s_end_ageism

Bartlet, S. & LeRose, M. (2007). Beyond memory: A documentary about dementia [Film]. National Film Board of Canada. https://www.nfb.ca/film/beyond-memory-a-documentary-about-dementia/

Caregiver Stress. (2013, May 17). Family caregiver stress relief [Video]. YouTube. https://www.youtube.com/watch?v=XaonoH1XqNI

CBC News: The National. (2015, October 11). Home recreates past for dementia patients [Video]. YouTube. https://www.youtube.com/watch?v=9rOYmxIWzJI

CBC News: The National. (2015, August 4). Seniors home brings young and old together [Video]. YouTube. https://www.youtube.com/watch?v=3LGSfgOi9UU

CNN. (2014, June 9). Anderson Cooper tries a schizophrenic simulator [Video]. YouTube. https://www.youtube.com/watch?v=yL9UJVtgPZY

Creative Connections. (2016, May 17). Delirium awareness video [Video]. YouTube. https://www.youtube.com/watch?v=BPfZgBmcQB8

Crime Beat TV. (2012, August 23). 16×9. The real truth: Senior’s home abuse caught on camera [Video]. YouTube. https://www.youtube.com/watch?v=qIAiMylHT-k

Crime Beat TV. (2014, April 28). Full story: Dementia – The unspooling mind [Video]. YouTube. https://www.youtube.com/watch?v=kkvIZaSfUxc

Dementia Careblazers. (2018, February 4). 5 surprising facts about dementia you may not know [Video]. YouTube. https://www.youtube.com/watch?v=qwtMU5mwGJ4

Dementia Careblazers. (2018, January 28). What are the different stages of dementia? The 3 stage and the 7 stage models explained [Video]. YouTube. https://youtu.be/sGjuX8WHJLk

Education for Rural and Underserved Communities. (2016, April 8). Persons with dementia: Skills for addressing challenging behaviors [Video]. YouTube. https://www.youtube.com/watch?v=hgVMKEnkvHo

havethattalk. (2017, May 3). Reducing stigma [Video]. YouTube. https://www.youtube.com/watch?v=eio-I8PbdDk

Kujath, J. (2017, November 16). Understanding cycles of abuse [Video]. YouTube. https://youtu.be/0Q0-Eps1ThE

Martin, G. (2015, June 22). How to approach residents with behaviors [Video]. YouTube. https://www.youtube.com/watch?v=xylQt7TxDwo

Memorybridge. (2009, May 26). Gladys Wilson and Naomi Feil [Video]. YouTube. https://www.youtube.com/watch?v=CrZXz10FcVM

Mental Health at Work. (2016, July 1). What is mental health? [Video]. YouTube. https://www.youtube.com/watch?v=G0zJGDokyWQ4

Miller, B. (2015, March). What really matters at the end of life [Video]. TED2015. https://www.ted.com/talks/bj_miller_what_really_matters_at_the_end_of_life

Mmlearn. (2018, September 28). How to talk to someone with dementia: Diane Waugh [Video]. YouTube. https://www.youtube.com/watch?v=ilickabmjww

Music and Memory. (2011, November 18). Man in nursing home reacts to music from his era [Video]. YouTube. https://youtu.be/fyZQf0p73QM

My Alzheimer’s Story. (2015, August 15). 10 ways to de-escalate a crisis with Teepa Snow [Video]. YouTube. https://www.youtube.com/watch?v=xNznZ2MnV3I

Programs for Elderly. (n.d.). Documentary library [Documentary films available as videos]. http://www.programsforelderly.com/index-documentaries-subpage.php

SafeCare B.C. (2019, February 5). Dementia care teams: Families and continuing care providers working together [Video]. YouTube. https://www.youtube.com/watch?app=desktop&v=VxDopCVswmg

Saks, E. (2012, June). A tale of mental illness from the inside [Video]. TEDGlobal2012. https://www.ted.com/talks/elyn_saks_seeing_mental_illness

Senior Helper National. (2013, July 23). Teepa Snow discusses the ten early signs of dementia [Video]. YouTube. https://www.youtube.com/watch?v=pqmqC-702Yg

Seniors First B.C. (n.d.). Finding a future for Ellen [Video]. http://seniorsfirstbc.ca/resources/video/finding-a-future-for-ellen/

Social Care Institute for Excellence (SCIE). (2011, May 13). Dementia: End of life care [Video]. YouTube. https://www.youtube.com/watch?v=bQXtC3HdCIc

TED. (2017, May 19). What can you do to prevent Alzheimer’s disease: Lisa Genova [Video]. YouTube. https://www.youtube.com/watch?v=twG4mr6Jov0

TED-Ed. (2016, June 9). Why do our bodies age? Monica Menesini [Video]. YouTube. https://www.youtube.com/watch?v=GASaqPv0t0g

TEDx Talks. (2012, October 9). The power of addiction and the addiction of power: Gabor Maté at TEDxRio=20 [Video]. YouTube. https://www.youtube.com/watch?v=66cYcSak6nE

TEDx Talks. (2017, March 27). I am not a monster: Schizophrenia – Cecilia McGough. TEDxPSU [Video]. YouTube. https://www.youtube.com/watch?v=xbagFzcyNiM

Teepa Snow’s Positive Approach to Care. (2017, April 29). Challenging behavior [Video]. YouTube. https://www.youtube.com/watch?v=ZpXeefZ2jAM

Teepa Snow’s Positive Approach to Care. (2019, May 15). Dementia dare – How to redirect hallucinations with Teepa Snow of Positive Approach to Care [Video]. YouTube. https://www.youtube.com/watch?v=3s0ktYUIn0Y

Therapist Aid. (2014, September 19). How to do deep breathing [Video]. YouTube. https://youtu.be/EYQsRBNYdPk

University of Derby Online Learning. (2015, July 10). Creating a culture of compassion for dementia patients in our society [Video]. YouTube. https://www.youtube.com/watch?v=QIYY4nNHkXo

Validation Theory Institute. (2017, March 13). What is validation – Interview by Naomi Feil [Video]. YouTube. https://www.youtube.com/watch?v=ejVqVKWnDOE

Online Learning Tools

The following materials are ready for use in the classroom. A brief description and estimated time to complete each activity is included for each.

Alzheimer’s Society. (n.d.). Video resources. https://alzheimer.ca/en/help-support/dementia-resources/video-resources#The_Alzheimer_Journey

• A series of 12 video resources.

Canadian Mental Health Association. (n.d.). Myths about mental illness. http://www.cmha.ca/mental_health/myths-about-mental-illness/

• A list of 10 common myths and facts about mental illness, along with a brief discussion about what we can do to challenge attitudes and behaviours related to mental illness (15–20 minutes).

Canadian Virtual Hospice. (n.d.). My grief.ca: Because losing someone is hard…. https://www.mygrief.ca/

• Nine modules about grief, loss, caring for yourself, and where to find help.

Home Instead Senior Care. (2017). Alzheimer’s disease or other dementias CARE: Changing aging through research and education. http://www.helpforalzheimersfamilies.com/alzheimers-dementia-education/

• A series of online modules that can be used to understand dementia. Each session can be completed within 5–15 minutes.

Island Health. (n.d.). Dementia video series: Practical advice from caregivers, for caregivers. https://www.islandhealth.ca/learn-about-health/seniors/dementia-video-series

• A variety of videos and resources about dementia and caregiving (approximately 10 minutes per video).

Province of British Columbia. (2015). Elder abuse reduction curricular resource. BCcampus. http://solr.bccampus.ca:8001/bcc/items/8d5b3363-396e-4749-bf18-0590a75c9e6b/1/

• An instructor’s guide and a presentation for teaching core competencies in elder abuse prevention, detection, and response in British Columbia. Within the guide, there are activities, assignments, online video links, readings and evaluation questions, as well as references to additional resources for some topic areas.

PsychHub. (2021). Videos. https://psychhub.com/videos/

• A series of over 100 videos about mental health.

Rossato-Bennett, M., McDougald, A., Scully, R. K., Cohen, D., Sacks, O., McFerrin, B., Shur, I. (2014). Alive inside: A story of music and memory. MVD Visual (Film). Available on Netflix.

• This film can be used as part of a larger discussion on the important of person-centred care, dementia, and music (77 minutes).

Web Services. (2012). Delirium Videos [Videos]. https://www.bing.com/videos/search?q=delirium&&view=detail&mid=26A860D4F26C551495B226A860D4F26C551495B2&FORM=VRDGAR

• A series of videos about delirium.

WorkSafeBC. (2013). Two-person care needs a planned approach [Video]. https://www.worksafebc.com/en/resources/health-safety/videos/two-person-care-needs-a-planned-approach

• A video and discussion guide about how planning two-person care can reduce risk (10–15 minutes).

WorkSafeBC. (2009). Working with dementia: Safe work practices for caregivers [Videos]. https://www.worksafebc.com/en/resources/health-safety/videos/working-with-dementia-safe-work-practices-for-caregivers/introduction?lang=en

• A series of six videos and a discussion guide describing how to care for people with dementia (10–15 minutes per video).

Course Guideline

A minimum of 65% of this course should consist of the supervised application of hands-on skills to ensure students are deemed safe and competent in performing personal care.

Suggested Learning Strategies

Strategies that Focus on Caring

1. Personal Care Discussion

Use the following questions and statements to elicit discussion about caring:

• Discuss this statement: Careful and consistent handwashing is one of the most caring things you can do for yourself and your client. (Consider: Diseases like norovirus may have short-term effects for workers, but be fatal to clients).
• How is being concerned about safety related to caring? (Consider: Your safety and the safety of your client are linked. If you are hurt physically or psychologically, the care that you provide will be affected. If you are injured, you won’t be there to provide care at all).
• What are some ways an HCA can show caring while assisting a client with hygiene and grooming? With moving and ambulation?
• In what ways can an HCA show caring while assisting a client with elimination?
• How is being concerned about accuracy in measuring vital signs related to caring? How is being meticulous when assisting with medications, or when carrying out a delegated task, related to caring?

2. Scenarios from Clinical Situations

Use scenarios from clinical situations to help students contextualize the caregiving practices they are learning in this course. With only preliminary information about the client who is the recipient of care, ask students to consider the following:

• What further information should be collected prior to commencing care for a client? Where and from whom should information be gathered?
• What should be included in a quick assessment of the client prior to providing care or assistance? Why?

Once the student has collected information and assessed the (simulated) client, they will progress with the provision of care or assistance. During this process, the student should be observed to assure that:

• Adequate communication with the client takes place (and family, if appropriate).
• The client’s comfort and independence are appropriately maintained.
• The client’s privacy and dignity are maintained.
• The client’s preferences are honoured as much as possible.
• The care or assistance provided is consistently safe for both the client and the student.
• The care or assistance is provided in an organized manner.

Following the provision of care or assistance, the student will be invited to reflect on the process using the points above and to discuss their experience with those who observed the process.

3. Unfolding Case Study: Caring for Peter Schultz

As a homework assignment, have students review their client portfolio for Peter Schultz.

1. Whole Class Review
   • In class, ask students to summarize what they have learned about Peter, highlighting details related to his personal history and family, health care services accessed in community and residential care, and his health status.
2. Small Group Discussion
   • Divide the class into small groups. Have the students read the following scenario describing changes to Peter’s health status and response to care. Students will then use the STUDENT HANDOUT below to objectively record the observations that have been made. For each observation, the students should list possible responses that fall within the parameters of the HCA role.
3. Whole Class Activity
   • Come back together as a class and ask the groups to share the observations and responses that were identified, highlighting what should be reported to the team leader. Following this, lead the students in a discussion about possible interventions or adaptations to the plan of care that may be made by a health care professional, based on the observations that have been reported by the HCA. Emphasize how observations shared by HCAs advocate for the client, support a collaborative team approach, and lead to safe and effective client care. If time allows, the instructor may decide to develop or update a care plan for this client as a classroom activity.

Strategies that Focus on Critical Thinking, Problem-Solving, and Decision-Making

1. Classroom Debate Activity

Invite students to engage in a debate about a topic discussed in this course. Divide the class into small groups of three to five students and assign two groups to each of the topics outlined; one group will take a pro position towards the topic and the other group will take a con position.

Ask each group to identify two to three reasons to support the position they have been assigned. Then, with the instructor acting as the moderator, the two groups will engage in a debate using the following structure:

1. Each group provides a brief introduction to their position on the topic.
2. In alternating format, the two groups present the two or three reasons identified to support their position.
3. Each group provides a brief closing statement.

After the debate has concluded, briefly come together as a larger group and summarize the positions that were presented. Invite feedback from the students not involved in the debate and discuss further considerations. Alternate groups until each student has participated in a debate.

Debate topics for Healing 3: Personal Care and Assistance.

1. Past experiences with a client should influence future care provided to that client.
2. Restraints should not be used in residential care settings.

2. Critical Thinking Exercises

After students have learned about body mechanics and asepsis, and have mastered basic transfer, bathing, and toileting techniques, present them with scenarios that simulate various practice environments, such as community (homelike) settings and acute care. Working in small groups of two or three, students should use critical thinking, problem-solving, and decision-making skills to consider how they will apply the skills in settings that are different from the standard lab setting or in changing situations.

Situations may include:

• Home settings, such as one that would be found in an apartment: very small bathrooms, low beds, low and soft chairs. Encourage students to identify situations in which safety is NOT possible without changes in the environment or the assistance of another health care worker or a mechanical lift.
• Acute care settings where clients may have wound dressings, IVs, or other tubes.
• Less medically stable clients (e.g., client has pain while being repositioned in bed or becomes dizzy and weak while being transferred to a chair). Ask students what actions they will take (reporting immediately, recording).
• A witnessed cardiac arrest while providing care (e.g., summoning help, commencing CPR if trained and per employer policies, being available to assist the team as directed).

3. Case Study: Putting Safety into Practice

The following case study is used with permission of Island HealthIsland Health. (2012). Changes have been made to the case scenarios and learning activities contained within the original source document (p. 87): Health Care Assistant Program Provincial Curriculum (2015) Supplement by the B.C. Ministry Of Advanced Education, licensed under a Creative Commons Attribution-ShareAlike 3.0 Unported License (CC BY-SA 3.0).

The case study, provided as a STUDENT HANDOUT below, could be used as a “pen and paper” exercise, either individually or with the students in small groups, or it could be set up as a practice scenario. There is also a DISCUSSION GUIDE below on putting safety into practice.

Note the use of the four-step process to help ensure patient safety:

• Prevent
  • Actions and measures put in place to minimize the chances of a safety event occurring.
• Check
  • Prepare yourself, the environment and others before proceeding with the task.
• Respond
  • Actions taken to eliminate or minimize an identified safety risk.
• Report
  • Let others know about safety concerns or incidents.

Strategies that Focus on Professional Approaches to Practice

1. Handling Challenging Situations

Invite students, working in small groups, to discuss scenarios in which, as HCAs, they are faced with being asked to undertake questionable activities. For each one, have them identify an appropriate response and explain their response. Suggest that they refer to the Assigned/Delegated Task Decision Tree for support during this activity.

Here are some examples:

As an HCA, you are providing care and service for an elderly gentleman, Mr. Syms, who requires help with his meals and his bath. One day, when you arrive at Mr. Syms’ house, you find that a doctor is visiting him. Apparently, Mr. Syms’ daughter, who lives across town, called the doctor when her father complained of chest pain. The doctor says to you, “Well, he seems to be fine now. Maybe it was only indigestion.” As he is leaving, he says to you, “Mr. Syms was telling me that his back is bothering him. I’ve left some Tylenol with codeine. Give him two of those whenever he needs them.”

How might you handle this situation?

As an HCA, you have been visiting Mr. and Mrs. Sihota for several months. Mrs. Sihota is a woman of 78 years who is physically frail and experiencing some cognitive decline. Two days ago, she had day surgery to correct a cataract in her left eye. Mr. Sihota is almost 10 years older than his wife and suffers from arthritis and heart problems.

When you come to their house, Mr. Sihota greets you at the door saying, “Thank goodness you are here. Now you can give my wife her eye drops. I’m no good at that sort of thing and she’ll be happier to have you do it.”

How might you handle this situation?

You are working on an acute care orthopaedic ward. When you walk into the room of a client you have not met before, he says, “Oh, there you are, nurse. Can you please hand me the magazine that’s on the chair?”

What will you say?

Student Self-Assessment Video Scenarios

The following video scenarios have been developed for students to self-assess their learning prior to their practice experience. Instructors should provide the links for these videos to their students near the end of the Healing 3: Personal Care and Assistance course so students can complete each scenario and be better prepared for their practice experiences. Instructors should review these videos before assigning them to students.

Instructors can request or require that students submit a reflective journal for each video scenario. Another option is to have a class or small group discussion after all students have completed the video(s). A Self-Assessment Video Reflective Journal Sheet [PDF] sample is available.

Video Scenarios

• Roles and Responsibilities of the HCA
• Communicating with the Health Care Team
• Isolation Precautions
• Lifts and Transfers
• Morning Care

Suggestions for Follow-Up Discussion

There are also some practices and procedures that are worthy of follow-up discussion. For example:

• Roles and Responsibilities of the HCA. In this video, the nurse is wearing a bracelet and an activity tracker on her wrist while administering cream on the client’s back. Wearing a bracelet would normally not be acceptable; however, the bracelet is actually a medical alert bracelet, and she wears the activity tracker to monitor her heart rate. Students could be asked to consider this situation and comment on alternative practices that could be used, such as wearing the bracelet and activity tracker on the non-dominant arm or covering them with a glove.
• Communicating with the Health Care Team. In this video, Mrs. Simon jumps from the past to the present tense when she talks about her wife. Trevor does not correct Mrs. Simon on these details, but instead redirects and engages her in a meaningful activity by asking her about the pictures, etc. Students could be asked to reflect on Mrs. Simon’s actions and words and determine if they truly reflect those of a client with Alzheimer’s disease.
• Isolation Precautions. Institutions may use isolation signs that differ from the ones used in this video. Students could be directed to comment on the use of various isolation signs and discuss what is acceptable and not acceptable.
• Lifts and Transfers. Practices for lifts and transfers may vary from facility to facility. The students could be asked to comment on the practices outlined in this video. For example, students can discuss whether a gait belt should be used for Mrs. Barclay, and if so how they would go about getting this added to the client’s care plan.
• Morning Care. Bathing a client can be done in a variety of ways as long as principles are maintained. Students could comment on whether Edgar proceeded in a manner that followed principles of hygiene. They could discuss what could have been done differently.

Suggested Course Assessments

The course learning outcomes may be assessed by the following tasks:

1. One or more quizzes or examinations that pertain to principles, legal/defined parameters of practice, and safety in relation to the implementation of personal care and assistance skills (Learning Outcomes #1, #3, and #4).
2. Demonstrations of ability in performing personal care and assistance skills that maintain the comfort and safety of the client and the safety of self and other members of the health care team. Students should be checked on their competency in performing specific skills by their instructors. Peer review and using skills checklists may also be useful for formative assessment as students seek to develop their proficiency (Learning Outcomes #1, #2, #3, and #4). Refer to Section 5: Sample Evaluation Tools.
3. Prior to the first clinical experience, demonstration of skills performance through an integrated skills practice examination (scenario-based lab skills assessment). Students should demonstrate their ability to:
   • Perform personal care and assistance skills competently.
   • Maintain the comfort and dignity of the client.
   • Maintain the safety of the client, self, and other members of the health care team.
   • Perform in an organized manner.
   • Maintain medical asepsis.
   • Utilize proper body mechanics.
   • Communicate with the client and other health care team members where appropriate.

   Testing can be accomplished through performance of a scenario simulating the practice environment and may include an opportunity for problem-solving. The specific skills tested and expected level of competency may vary, depending upon when the first clinical experience occurs within the program. At a minimum, students should perform safely prior to entering the clinical setting. Students should be evaluated using clear and consistent criteria; an evaluation rubric may be used (Learning Outcomes #1, #2, #3, and #4). Refer to Section 5: Sample Evaluation Tools.

4. Completion of a safety assessment in a home environment. Preferably, students would conduct this assessment as part of their community care (home support) practice experience (See STUDENT HANDOUT Home Safety Assessment Guide below.) The questions included in this assessment are not definitive; the program may adapt this tool, as necessary. Based on the assessment, the student should discuss the safety issues that they have identified and make suggestions for ways that the environment could be made safer for the client/family and members of the health care team (Learning Outcomes #2 and #4).
5. Completion of a reflective journal assignment to confirm students have viewed the self-assessment videos in preparation for clinical (Learning Outcomes #1, #2, #3, and #4).

Resources for Healing 3: Personal Care and Assistance

Online Resources

B.C. Centre for Disease Control. http://www.bccdc.ca/

B.C. Centre for Disease Control. (2017). Harm reduction guidelines. http://www.bccdc.ca/health-professionals/clinical-resources/harm-reduction

B.C. Centre for Disease Control & Government of British Columbia, Ministry of Health. (2020, August 31). Infection prevention and control requirements for COVID-19 in long-term care and seniors’ assisted living. http://www.bccdc.ca/Health-Info-Site/Documents/COVID19_LongTermCareAssistedLiving.pdf

B.C. Public Service Agency and B.C. Government & Services Employees Union (2007). Guide to Prevention and Control of Infectious Diseases in the Workplace. https://www2.gov.bc.ca/assets/gov/careers/managers-supervisors/managing-occupational-health-safety/infectious_disease_guide.pdf

Doyle, G. R. & McCutCheon, J. A. (n.d.). Ostomy care. In Clinical procedures for safer clinical care. BCcampus. https://opentextbc.ca/clinicalskills/chapter/10-6-ostomies/

Fortis B.C. (2017). Gas leaks and odours. https://www.fortisbc.com/safety-outages/natural-gas-safety/gas-leaks-and-odour

Government of British Columbia. (n.d.). Safety at home. https://www2.gov.bc.ca/gov/content/family-social-supports/seniors/health-safety/safety-at-home

Government of British Columbia, Ministry of Health Services. (2008). Personal assistance guidelines. https://www.health.gov.bc.ca/library/publications/year/2008/Personal_Assistance_Guidelines.pdf

Interior Health. (2017). Safe patient handling videos. https://www.interiorhealth.ca/sites/Partners/WHSresources/Pages/SafePatientHandling.Aspx

Provincial Infection Control Network of British Columbia. https://www.picnet.ca/

Provincial Residential Care Musculoskeletal Injury Prevention Team (2011). Provincial safe resident handling standards for musculoskeletal injury prevention in British Columbia. https://www.safecarebc.ca/wp-content/uploads/2020/10/Provincial-Safe-Resident-Handling-Standard-2011.pdf

SafeCareBC. (n.d.). Point of care risk assessment. http://safecarebc.ca/wp-content/uploads/Point-of-Care-Risk-Assessment-SCBC-Version1.pdf

Tiner, S. (2020, April 1). Your new super power: Hand-washing. Mayo Clinic. https://discoverysedge.mayo.edu/2020/04/01/your-new-super-power-hand-washing/?_ga=2.139963571.1440117354.1590880017-2090357955.1590880017

WorkSafeBC. (2014). Back talk: An owner’s manual for backs. https://www.worksafebc.com/en/resources/health-safety/books-guides/back-talk-an-owners-manual-for-backs?lang=en

WorkSafeBC. (2009). Controlling exposure: Protecting workers from infectious disease. https://www.worksafebc.com/en/resources/health-safety/books-guides/controlling-exposure-protecting-workers-from-infectious-disease?lang=en

WorkSafeBC. (n.d.). Health care and social services. https://www.worksafebc.com/en/health-safety/industries/health-care-social-services

WorkSafeBC. (2006). Home and community health worker handbook. https://www.worksafebc.com/en/resources/health-safety/books-guides/home-and-community-health-worker-handbook

WorkSafeBC. (2020). Patient handling: Overhead lifts vs floor lifts – what’s the difference? https://www.worksafebc.com/en/resources/health-safety/hazard-alerts/patient-handling-overhead-lifts-vs-floor-lifts?lang=en

WorkSafeBC. (2014). Patient handling. https://www.worksafebc.com/en/health-safety/industries/health-care-social-services/topics/patient-handling

WorkSafeBC. (2020). Patient handling: Soaker pads. https://www.worksafebc.com/en/resources/health-safety/hazard-alerts/patient-handling-soaker-pads?lang=en

WorkSafeBC. (2013). WorkSafeBC occupational health and safety regulations.

Ergonomics (MSI) requirements. https://www.worksafebc.com/en/law-policy/occupational-health-safety/searchable-ohs-regulation/ohs-regulation/part-04-general-conditions

Biological agents. https://www.worksafebc.com/en/law-policy/occupational-health-safety/searchable-ohs-regulation/ohs-regulation/part-06-substance-specific-requirements

WorkSafeBC. (2013). Two person care needs a planned approach. https://www.worksafebc.com/en/resources/health-safety/videos/two person-care-needs-a-planned-approach?lang=en

WorkSafeBC. (2019). WHMIS (Workplace hazardous materials information system). https://www.worksafebc.com/en/health-safety/hazards-exposures/whmis

Online Videos

Align Home Health. (2015, November 17). Glove removal [Video]. YouTube. https://youtu.be/wZO9O9iGlKs

All N One Home Health. (2015, November 12). How to help someone who uses a wheelchair including walkers, crutches and canes [Video]. YouTube. https://www.youtube.com/watch?v=EZestPFcvP0

American College of Surgeons. (2015, September 8). Feeding tube skills: What is an enteral feeding tube? [Video]. YouTube. https://www.youtube.com/watch?v=1Gd_LSR9VIA

Coughsafevideos. (2012, March 7). Why don’t we do it in our sleeves [Video]. YouTube. https://www.youtube.com/watch?v=CtnEwvUWDo0

Dynamis. (n.d.). Bathing without a battle [Video]. Vimeo. https://vimeo.com/121147508

Eaton, C. (2014, August 29). Bed bath and occupied bed making video part 1 [Video]. YouTube. https://www.youtube.com/watch?v=75O-MWF8K6w

Eaton, C. (2014, August 29). Bed bath and occupied bed making video part 2 [Video]. YouTube. https://www.youtube.com/watch?v=zjPu4EbbGNE

FunctionFocusedCare. (2013, June 26). Function focused care for assisted living residents: Dressing [Video]. YouTube. https://www.youtube.com/watch?v=4qTVkBn2i-A

FunctionFocusedCare. (2013, June 26). Function focused care for assisted living residents: Toileting [Video]. YouTube. https://www.youtube.com/watch?v=tNDGfuUtcFo

Globalhygienecouncil. (2012, September 20). Bacteria on your hands [Video]. YouTube. https://www.youtube.com/watch?v=YfzgWpG4H5c

Handicare. (n.d.). Handicare band sling [Video]. Vimeo. https://vimeo.com/269759430

Handicare. (n.d.). Handicare positioning sling [Video]. Vimeo. https://vimeo.com/274733472

Handicare. (n.d.). Handicare TriTurner sling [Video]. Vimeo. https://vimeo.com/269767001

Handicare. (n.d.). Handicare universal sling [Video]. Vimeo. https://vimeo.com/274735676

Handicare North America. (2018, June 29). Handicare slings: ComfortCare [Video]. YouTube. https://youtu.be/NxpHCFBGNuE

Handicare North America. (2018, June 29). Handicare slings: Deluxe hammock [Video]. YouTube. https://www.youtube.com/watch?v=qrcl6TzSM4o

Healthy Canadians. (2020, June 2). COVID-19: How to wear a non-medical mask or face covering properly [Video]. YouTube. https://youtu.be/gvLA–hGU70

Kozak, J. (2012, May 20). How may I help you? – A guide to assisting the visually impaired [Video]. YouTube. https://youtu.be/YS8aaPmZeUI

Lippincott, Williams and Wilkins. (2013, March 25). Positioning and lifting patients and residents [Video]. YouTube. https://www.youtube.com/watch?v=H68Sa04s_1s

Lortie, C. & Fontaine, N. (2022). AM Skills Care [Video]. Selkirk College and College of the Rockies. https://video.bccampus.ca/playlist/dedicated/26132/0_gmt3777b/0_1m7lxqfz

Marwaha, S. (2011, September 30). Wash your hands – it just makes sense [Video]. YouTube. https://www.youtube.com/watch?app=desktop&v=M8AKTACyiB0

Ostomystory. (2012, February 11). How to change your ostomy bag [Video]. YouTube. https://www.youtube.com/watch?v=l9PYMfqNGm0

Provincial Health Services Authority. (n.d.). Patient handling videos [Videos]. http://learn.phsa.ca/phsa/patienthandling/

World Health Organization. (2014, July 2). WHO: SAVE LIVES – Clean your hands – No action today; no cure tomorrow [Video]. YouTube. https://youtu.be/kOKeFv5VvY4

Online Learning Tools

The following materials are ready for use in the classroom. A brief description and estimated time to complete each activity is included for each.

Provincial Infection Control Network of B.C. (2017). Infection prevention and control practices modules. https://www.picnet.ca/education/education-modules/infection-control-module/

• This online module covers the basics of infection control and hand hygiene in the health care system (60 minutes).

Social Care Institute for Excellence. (2014). Personal hygiene: Dignity in care [Video]. http://www.scie.org.uk/socialcaretv/video-player.asp?v=personal-hygiene

• A video with examples to illustrate how personal hygiene can be provided to clients using a person-centred approach to care (15 minutes).

WorkSafeBC. (2008). Assess every time [Video]. https://www.worksafebc.com/en/resources/health-safety/videos/assess-every-time?lang=en

• A video and discussion guide about the importance of assessment. (10–15 minutes).

WorkSafeBC. (2013). Ceiling lifts. Why aren’t they being used? [Video]. https://www.worksafebc.com/en/resources/health-safety/videos/ceiling-lifts

• A video and discussion guide about the use of ceiling lifts to reduce injuries (15 minutes)

WorkSafeBC. Home care visits. Find the hazards in this staged photo [Photo collection].

• A series of photos illustrating hazards that may be faced by health care assistants working in the home setting (30–60 minutes for review and discussion). Students can work together to identify what is wrong in each photo. Answers on reverse.
  • (2015). Home care visits (outside the home). Closest to the home. https://www.worksafebc.com/en/resources/health-safety/posters/wwwtp-home-care-visits-outside-the-home/closest-to-home
  • (2015). In the car [Photo]. https://www.worksafebc.com/en/resources/health-safety/posters/wwwtp-home-care-visits-outside-the-home/in-the-car
  • (2015). Near the home. https://www.worksafebc.com/en/resources/health-safety/posters/wwwtp-home-care-visits-outside-the-home/near-the-home
  • (2011). Slips and trips. https://www.worksafebc.com/en/resources/health-safety/posters/wwwtp-home-care-visits-inside-the-home/slips-and-trips?
  • (2011). Soft tissue injuries. https://www.worksafebc.com/en/resources/health-safety/posters/wwwtp-home-care-visits-inside-the-home/soft-tissue-injuries?lang=en
  • (2011). Violence, choking. https://www.worksafebc.com/en/resources/health-safety/posters/wwwtp-home-care-visits-inside-the-home/violence-choking

WorkSafeBC. (2008). Leave when it’s unsafe [Video]. https://www.worksafebc.com/en/resources/health-safety/videos/leave-when-its-unsafe

• A video and discussion guide describing what to do if you feel threatened or unsafe while working in the community setting (10–15 minutes for review and discussion).

WorkSafeBC. (2014). Make your home safer for care workers [Information sheet]. www.worksafebc.com/en/resources/health-safety/books-guides/make-your-home-safer-for-care-workers?lang=en

• An information sheet and checklist that can be used to discuss the safety of HCAs working in the home setting (10–15 minutes for review and discussion).

WorkSafeBC. (2009). Working with dementia: Safe work practices for caregivers [Videos]. https://www.worksafebc.com/en/forms-resources#q=Working%20with%20Dementia&sort=relevancy&f:content-type-facet=[Videos%20%26%20slide%20shows]&f:language-facet=[English]

• A series of six videos about working with dementia.

Suggested Learning Strategies

The following learning strategies can be applied within a variety of contexts, depending on the parameters of the clinical placement and the preferences of the instructor.

Strategies that Focus on Caring

1. Gathering Information About a Client

Early in the clinical placement, ask students to gather information about a client for whom they are providing care. Potential sources of information include the client, family, friends, staff, the chart, and other client-specific documents. Ask students to describe what they learned about the client and how the information has influenced how they provide care to them (Learning Outcomes #1, #2, #3, #4, #6, and #7).

2. Person-Centred Goals

Have the students write person-centred goals for the care of their client(s). This will help them become more focused on the client(s), ensuring their best care, rather than placing focus on other areas (e.g., their time schedule).

Strategies that Focus on Critical Thinking, Problem-Solving, and Decision-Making

1. Pre- and/or Post-Conference Sessions

Have students gather with the clinical instructor topics and issues to discuss related to their clinical placement.

Topics to support pre- or post-conference discussions or journal writing are outlined below.

• Describe a situation when you provided person-centred care to one of your clients.
• Describe a situation where you applied a holistic approach to client care.
• Reflect on your cultural competence and whether you feel prepared to provide adequate care.
• Describe a communication challenge that you experienced this week and how you responded. Discuss an alternative approach you could have taken to effectively address the situation.
• Has there been a time during this placement that you felt out of your depth or overwhelmed? How did you manage it? What did you learn from it?
• Describe a communication challenge that you experienced with a staff member. How did you handle it?
• Describe how you organize your day and prioritize care.
• Describe a situation where your organization and time management went well.
• Describe how you are using resources (e.g., textbook, nurse, instructor) to inform your practice.
• Describe a situation where you used creativity when you did not have the supplies you required.
• Use Gibbs’ Reflective CycleGibbs’ Reflective Cycle. (1988). Retrieved from https://www.brightknowledge.org/knowledge-bank/medicine- and-healthcare/spotlight-on-medicine/what-is-reflective-practice to analyze a situation that you encountered during clinical:
  • Description: What happened?
  • Feelings: What did you think and feel about it?
  • Evaluation: What were the positive and negative aspects?
  • Analysis: What sense can you make of it?
  • Conclusion: What else could you have done?
  • Action Plan: What will you do next time?

2. Communication Challenges

Ask students to identify a scenario where they faced a challenge related to communication with a client, family member, or staff member. Have the students use the problem-solving/decision-making process to analyze the problem, identify what they learned through the situation, and describe how it has impacted their approach to future communication in this context (Learning Outcomes #2, #6, and #8).

3. Observation in Person-Centred Care

Invite students to use their clinical practice to learn the importance of observation to person-centred care. Students, working individually or in small groups, will choose a client experiencing cognitive challenges and observe this individual closely for at least two days, being particularly aware of the person’s behaviours and what aspects of the environment and of the client’s needs seem to be related to the behaviours. Students are also encouraged to talk with other members of the health care team who know this client and, if possible, research the client’s background.

Students will review the information and discuss what environmental factors seem to be contributing to the client’s behaviours, both positively and negatively. This should include the social environment as well (e.g., the actions of staff and other residents). Students should also observe for unmet needs of the client which may be causing responsive behaviours.

This information can be brought back to post-conference for wider discussion of possible causes of responsive behaviours and determination of how the information might help to guide caregiving practices.

Strategies that Focus on Professional Approaches to Practice

1. Orientation Activities

Provide orientation activities where students become familiarized with the clinical setting and routines, staff, and the clients. As an orientation activity, invite students to engage in a “search and find activity” for important items and information at the clinical site. Include a list of staff members for students to meet and introduce themselves to.

2. Learning from Other Professionals

Invite members of the team at the clinical site to talk with students about their role or profession. As part of these sessions, have the team member and students identify how the role of the HCA interacts with the specific discipline and how the two parties can work most effectively together (Learning Outcomes #5 and #9).

3. Synthesizing Learning

Provide reflective learning activities where students record observations, challenges, and other information. This will help students to synthesize their learning.

4. Additional Skills Assessment

Assist students to obtain the HCA job description for their practice education site and to assess what, if any, additional skills they would need to acquire to be employable in that setting (Learning Outcome #8).

Suggested Course Assessments

The course learning outcomes may be assessed by the following tasks:

1. A skills checklist, completed by instructors when observing skills practised by the student for the first time in the clinical setting, will be useful for verifying the proficiency and safety of students to perform these skills without direct supervision (Learning Outcome #7). Refer to Section 5: Sample Evaluation Tools.
2. A mid-term evaluation, completed by the instructor and the student, will be helpful to evaluate a student’s progress towards meeting the program learning outcomes, as well as identifying areas for improvement prior to the final evaluation (Learning Outcomes #1 to #9).
3. A final evaluation assessing whether students have met (or not met) the program learning outcomes will assist the instructor to determine whether or not students have the required skills to progress to the next practice education experience (Learning Outcomes #1 to #9). Refer to Section 5: Sample Evaluation Tools.
4. A reflective journal will help students to process information from their clinical experience and relate it to the program learning outcomes. Students should complete entries on a regular schedule throughout the placement. Thought-provoking questions can be provided to help students (e.g., asking students to reflect on professionalism – their own and what they have observed in others, their “aha” moments, etc.).
5. For a self-evaluation tool, ask students to consider the learning outcomes for the practice education placement and whether they have met (or not met) them or are still progressing to meet them. Have them record situations to illustrate how they met each outcome and put forward ideas on how they could meet any that have not yet been met. The self-evaluation tool can be reviewed and discussed with students at the mid-term and final evaluation as a method of ensuring all learning outcomes have been or will be demonstrated by the end of the practice education placement period (Learning Outcomes #1 to #9).
6. A professional behaviour development rubric can be completed by the course instructor to assess the student’s ability to behave in a manner that supports their success in the workplace (Learning Outcomes #1, #2, #5, #6, #8, and #9). Refer to Section 5: Sample Evaluation Tools.

Resources for Practice Experience

Online Resources

B.C. Academic Health Council. (n.d.). B.C. preceptor development initiative: Supporting health preceptors in practice, modules 1–8. http://www.practiceeducation.ca/modules.html

B.C. Care Aide and Community Health Worker Registry. (2014). B.C. health care assistants core competency profile. https://www.cachwr.bc.ca/getattachment/About-the-Registry/Resources/HCA-Core-Competency-Profile_March2014-(2).pdf.aspx

Gibbs, G. (2013). Learning by doing: A guide to teaching and learning methods. Oxford Brooks University. https://thoughtsmostlyaboutlearning.files.wordpress.com/2015/12/learning-by-doing-graham-gibbs.pdf

Hampe, Narelle. (2013). Reflective practice and writing: A guide to getting started. Australian Library and Information Association. https://www.betterevaluation.org/en/resources/guide/reflective_practice_and_writing

Melrose, S. Park, C. & Perry, B. (2015). Creative clinical teaching in the health professions. Athabasca University. http://solr.bccampus.ca:8001/bcc/file/c6d0e9bd-ba6b-4548-82d6-afbd0f166b65/1/CREATIVE-CLINICAL-TEACHING-IN-THE-HEALTH-PROFESSIONS.pdf

Phaneuf, M. (n.d.). Learning and teaching in clinical settings. http://www.prendresoin.org/wp-content/uploads/2014/05/LEARNING-AND-TEACHING-IN-CLINICAL-SETTINGS.pdf

Practice Education Guidelines for B.C. (2021). https://hspcanada.net/pegs/

Suggested Learning Strategies

Strategies that Focus on Caring

1. Overcoming a Challenge

Have the student identify a challenge they faced in providing personal care and assistance to a client with complex health needs. Ask the student to describe the assistance provided, how they adapted the care to accommodate the challenge, and the action(s) they took following the encounter (Learning Outcomes #1, #2, #3, #5, and #7).

2. Person-Centred Goals

Have the students write person-centred goals for the care of their client(s). This is particularly important in community settings, where students should be encouraged to consider ways to promote and further client independence, with an orientation to “help with,” rather than to “do for.”

Strategies that Focus on Critical Thinking, Problem-Solving, and Decision-Making

1. Meetings about Community Placement

Set up meetings with the site supervisor/mentor and/or course instructor to give students the opportunity to discuss topics and issues related to their community placement.

2. Home Safety Assessment

Ask students to complete a home safety assessment of the residence for one of the clients they are working with in their community placement (see instructions in the DISCUSSION GUIDE: Putting Safety into Practice). Have the student report their findings to the site team and/or supervisor at a daily meeting. If possible, the student could compare their assessment to the one completed by the employer and discuss the effectiveness of the strategies used to enhance safety in that setting (Learning Outcomes #2, #7 and #8).

3. Debrief

If this is the final placement, bring students together back at the college for a final debrief. This could provide rich learning opportunities for students to share what they have learned, gain insight from the learning of others, and consider further areas for their continued professional growth and development.

Strategies that Focus on Professional Approaches to Practice

1. Synthesizing Learning

Reflective learning activities where students record observations, challenges, and other information can be used to synthesize their learning.

2. Identifying Opportunities for Learning

In the community setting, students will likely practise as part of the team, under the supervision of site staff. During the first week of placement, ask students to identify a minimum of two areas where they would like to enhance their own learning. They should discuss these areas with their site supervisor and/or course instructor and identify potential opportunities for learning. Ask the student to record the conversation outcome and report to the instructor at the end of the community placement (Learning Outcomes #5 and #8).

Suggested Course Assessments

The course learning outcomes may be assessed by the following tasks:

1. A reflective journal will help students to synthesize information from their practice experience and relate it to the program learning outcomes. Throughout the practice experience, ask students to record examples of how they met each of the program learning outcomes. The instructor could review the journal at the mid-term to ensure students are progressing satisfactorily and to review and discuss as part of the student’s overall final evaluation (Learning Outcomes #1 to #9).
2. A final evaluation completed by the site supervisor and/or course instructor will assesses whether students have met (or not met) the required skills outlined in the program learning outcomes (Learning Outcomes #1 to #9). Refer to Section 5: Sample Evaluation Tools.
3. A professional behaviour development rubric can be completed by the site supervisor and/or course instructor to assess the student’s ability to behave in a manner that supports their success in the workplace (Learning Outcomes #1, #2, #5, #6, #8, and #9). Refer to Section 5: Sample Evaluation Tools.

Resources for Practice Experience

Refer to Resources for Practice Experience in Practice Experience in Multi-Level and/or Complex Care.

Computer Skills Self-Assessment

Student Name:                                 Date:                     

Computer Knowledge

Word Processing

Electronic Communication

Note: This tool has been adapted from the “Generic topic outlines, computer studies: fundamental level, adult basic education: A guide to upgrading in British Columbia’s public post-secondary institutions” (2014), produced by the Post-Secondary Programs Branch, Ministry of Advanced Education, Province of British Columbia.

Download Computer Skills Self-Assessment [PDF].

Computer Resources List

If you answered No/Not Sure to one or more of the questions in the Computer Skills Self-Assessment, you can use the following strategies to help you to complete computer-related assignments throughout the HCA program.

Basic Computer Skills

Ask a friend or family member to demonstrate the basic skills of using a computer, including identifying its main parts, turning it on/off, starting and shutting down a computer program, and using a printer.

Microsoft Word Training

• Training for Microsoft 365, Word 2021,  Word 2019 , and Word 2016, and Office.com:
  • Microsoft Word. (2021). Word for Windows Training. https://support.microsoft.com/en-us/office/word-for-windows-training-7bcd85e6-2c3d-4c3c-a2a5-5ed8847eae73?wt.mc_id=otc_home
• Training for Word 2013:
  • Microsoft Word. (2013). Word 2013 training videos. https://support.microsoft.com/en-us/office/create-your-first-word-2013-document-abfe7d91-98e5-422f-9033-6df5f5998b0a

Internet Searches

• For assignments using the internet, work with another student who understands how to complete an internet search.
• Access the following Google search tips:
  • How to search on Google

Email

If you do not have an email account, you can set one up by accessing one of the following:

• Google
• Microsoft
• Yahoo

*Basic tasks and functions of your email, including attaching files, will depend on your account.

References

Government of British Columbia, Ministry of Advanced Education. (2014). Adult basic education in British Columbia’s public post-secondary institutions: An articulation handbook.

Government of British Columbia, Ministry of Health. (2014). B.C. health care assistants core competency profile. https://www.health.gov.bc.ca/library/publications/year/2014/HCA-Core-Competency-Profile_March2014.pdf

Human Resources and Skills Development Canada. Literacy and essential skills, skills definitions and complexity. http://www.esdc.gc.ca/eng/jobs/les/definitions/inde.g.,shtml

Health Care Assistants in Acute Care

The addition of acute care content in the current Health Care Assistant Program Curriculum Guide (2015) is at the level of introducing students to the acute care context only, and only in theory and lab courses. Practice experiences in acute care are not part of the 2015 Guide.

With a goal of minimizing disruption to the 2008 curriculum (to not require a change in hours or a shift in existing content from one course to another), the following table indicates where acute care content could fit into existing courses with associated outcomes/content and align with the HCA Program Curriculum Guide (2015). Time estimates for the added content are also given.

The acute care content provided in this section is based on materials developed by Island HealthIsland Health Authority, the B.C. Health Education Foundation and the Ministry of Health Services are acknowledged for granting permission to adapt material from the Island Health Transitional Learning Continuum, Health Care Assistant in Acute Care Curriculum (2012). (formerly Vancouver Island Health Authority, VIHA). Instructors are encouraged to adapt and integrate this content into their instructional activities (e.g., PowerPoint slide, student handouts, course manuals, etc.).

Acute Care Content in HCA Courses

1. The supervision structures in acute care that support HCA practice

Course: Health Care Assistant Introduction to Practice

Estimated additional time: 30 minutes

Examples of content based upon Island Health materials

• Every health authority and unit has an organizational structure. This organizational structure outlines the supervision structure by identifying who reports to whom.
• Within a unit structure, there are members of the health care team that will guide the role of the HCA. This includes the team members who the HCA will report to when supporting client care and/or unit operations. These team members may include, but are not limited to, Registered Nurses (RNs), Licensed Practical Nurses (LPNs), Registered Psychiatric Nurses (RPNs), Clinical Nurse Leads (CNLs) and Unit Managers.
• Supervisors can help determine which team members HCAs will regularly work with.
• Depending on who assigns and delegates the tasks, different team members need to establish supervision plans for the activities that HCAs will support.
• Communication is essential when reporting to and collaborating with other members of the health care team.
• As an HCA, there will be times where different types of questions and concerns should be brought to different members of the health care team. HCAs can also talk to their unit supervisors/leaders for guidance.

2. Similarities and differences between clients in acute care settings and clients in residential or community settings

Course: Healing 1: Caring for Individuals Experiencing Common Health Challenges, specifically within Learning Outcome #4: Ways to organize, administer and evaluate person-centred care. The content could be addressed with case studies or other activities already being delivered in teaching the course by basing some of these in acute care to emphasize differences.

Estimated additional time: 1 hour 30 minutes

Examples of content based on Island Health materials

• In most instances, acute care settings will be very different from residential and home or community care settings. The pace of activities and the variety of sights, sounds, and smells can be overwhelming for someone new. However, in much the same way as we view a beehive, all of this activity is purposeful and coordinated. All interprofessional team members work collaboratively in a variety of different ways in order to meet many diverse client and family care needs every day.
• As HCAs become acquainted with the acute care setting, they will start to notice that in many instances acute care and residential care settings will share the same clients along their health and wellness journey. Many of these clients will be elderly clients who have been admitted into acute care units for some type of medical intervention, such as surgery, or to deal with a chronic condition that requires symptom control or readjustment. The care needs of these types of clients will be very familiar to HCAs who have practised in other settings. It is within these instances that HCAs can offer significant support to these clients, families, and other members of the health care team.
• There are some important considerations to keep in mind when HCAs are working in an acute care setting. The first is that HCAs will never be working independently. Instead, HCAs will draw upon the knowledge, skills, and resources of a variety of interprofessional care team members that will work collaboratively with them in caring for each client. Secondly, as a member of the interprofessional care team, HCAs also bring with them a wealth of knowledge and skills in caring for elderly clients. These skills and knowledge in caring for the elderly add strength to the interprofessional team and can contribute to the care planning process.
• Acute care is a complex working environment. HCAs have many skills that contribute to providing quality care in this setting, but may not be familiar with some of the unique aspects of the acute care environment.
• As part of a process of exploring how skills translate from residential or community settings, we will look at what might be the same and what might be different about working in acute care.
• It is important to note that the role of the HCA may vary from site to site and from health authority to health authority.
• Residential and community-based clients may be admitted to acute care in the following circumstances. If the client:
  • Is frail, elderly, and has a fractured hip
  • Has had a stroke or a heart attack
  • Has acute congestive heart failure
  • Has uncontrolled pain
  • Requires surgical intervention
  • Has a crisis in their caregiving supports
• Most clients in acute care will have different medical needs than those in residential or community settings. For example, they may:
  • Have had recent surgery
  • Have lines and tubes
  • Have new incisions, wounds, or dressings
  • Be experiencing acute mental health issues
  • Be admitted for alcohol and drug detoxification
  • Be acutely palliative

3. Specific elements of the acute care environment

Course: Healing 1: Caring for Individuals Experiencing Common Health Challenges; applied aspects in Healing 3: Personal Care and Assistance

Estimated additional time: covered in #2 and #5

Examples of content

Examples of environmental aspects more often encountered in the acute care setting may include:

• Additional forms of documentation, or documentation the HCA will access more often than they might in other settings
• Increased technology, such as various pumps, monitors, etc.
• Positive/negative pressure rooms for isolation
• Call bell systems

4. How the role of the HCA may change in the acute care setting, depending on client acuity and intensity

Course: Healing 1: Caring for Individual Experiencing Common Health Challenges; may be addressed through specific examples while teaching about specific health challenges. Acute care information should also be added to Learning Outcome #1: “Display an understanding of the roles…” in the Introduction to Practice course

Estimated additional time: 1 hour in Common Health Challenges, 15 minutes in Introduction to Practice, and 30 minutes in Concepts for Practice (recording/reporting)

Examples of content based on Island Health materials

• HCAs can help care for clients in the acute care setting by helping with:
  • Bathing and washing
  • Toileting
  • Meal assistance
  • Basic treatments (as identified by site-specific role and responsibilities)
  • Ambulation, mobilization, and transfer of stable clients
• The health care professional (Registered Nurse, Social Worker, Speech Language Pathologist, etc.) considers such factors as client stability and impact/probability of an adverse event prior to assigning tasks. HCAs are generally assigned tasks where the impact/probability of an adverse event is lower. The health care professional will modify their supervision plan depending on these factors.
• Introduce the concepts of acuity and intensity.
  • High acuity clients are those who experience an event that is characterized by sharpness or severity, having a sudden onset, sharp rise and short course and lasting a short time. Examples of clients with high acuity needs are those with:
    • Respiratory distress (using high flow oxygen)
    • Active gastrointestinal bleeding
    • Unstable vital signs
  • Low acuity clients are those who have become more stable in their health concerns, the prescribed medical treatment is working, and they are demonstrating improvements in their health status. Examples of clients with low acuity care needs are those:
    • Who are progressing as expected, three days after an operation
    • With pneumonia, requiring IV antibiotics
    • With influenza (the flu)
    • With C. difficile
  • Intensity refers to the volume of work that may be required from the health care team to meet the care needs of a particular client. Examples of clients with high intensity/complex care needs are those who require:
    • Complete ADL support — total care client
    • Care of more than one health care team member (e.g., mechanical lifts, bariatric clients, etc.)
    • Complex wound management (e.g., VAC dressings, ulcers, infected surgical wounds, etc.)
    • Support to manage complex family dynamics
  • Examples of clients with low intensity/complex care needs are those who require:
    • Minimal ADL support required for client care
    • Basic meal tray set up (clients who are able to feed themselves)
    • Limited support as they are stable and waiting to be discharged or transferred
• Complexity refers to the range of variables, such as multiple medical diagnosis or challenging family dynamics, which may influence the care needs of a particular client.

5. Key considerations for providing holistic, person-centred care for acute care clients with IV lines, tubes, wounds, and surgical incisions

Course: Healing 3: Personal Care and Assistance

Estimated additional time: 2 hours theory/lab

Examples of content based on Island Health materials

• Examples of lines and tubes in acute care are:
  • Intravenous lines
  • Oxygen tubing
  • Surgical drains
  • Chest tubes
  • NG tubes
  • Catheters
• How do these lines and tubes affect the care of acute care clients?
  • Considerations for giving daily care, such as removing or putting on new gowns.
  • Asking the RN if there is anything special that they need to know or do related to this client’s tubing.
  • Receive instructions from the RN/LPN about any special approaches or care plan interventions.

Emphasize: When providing care, be sure to look at the client and to look at the site of the surgical or medical line. Seek assistance if there are any concerns or questions before proceeding with care and care-related activities.

IV lines

Ask: “What is an IV?”

Answer: An intravenous catheter is a small plastic cannula that is inserted in the vein with the use of a needle. After the plastic cannula is secure within the vein, the needle is removed. They are most commonly inserted in the hand or forearm but can be located in other areas such as the foot. Intravenous catheters are used to supply a client with additional fluids or medications.

Ask: “What does an HCA need to do when providing care to a client with an IV?”

Answer: When providing care to a client with an IV, the HCA should:

• Never remove the IV bag from the pole it is situated on.
• Never disconnect a tube or unplug equipment from the wall without having permission from the RN to do so.
• Notify an RN if:
  • They observe blood in the IV tubing or the IV site is leaking.
  • They accidentally dislodge the IV during care.
  • The client is complaining about pain in the area.
• Avoid getting the dressing or insertion site wet during care.
• If available, use an IV gown to dress the client (IV gowns will have snaps on the sleeves of the gown).
• Check with the RN or team leader about specific client information or instructions before mobilizing a client. Clients who are allowed to be up and walking and have an IV can generally be mobilized.
• There are a few exceptions.

Oxygen tubing

Ask: “What does an HCA need to know about providing care to a client with oxygen tubing?”

Explain: Clients may require oxygen therapy as either a short-term intervention (clients with pneumonia, for example) or for long-term use (such as COPD clients). How much oxygen therapy is required and what method of delivery is used will depend on the client’s condition and may change as the client improves or deteriorates. Chronic conditions, such as COPD, will require consistent oxygen therapy at all times.

Describe: Different methods of delivering oxygen, such as nasal prongs or facial masks.

Ask: “What does an HCA need to do when providing care to a client on oxygen?”

Answer: When providing care to a client on oxygen, the HCA should:

• Never adjust the flow rate of the oxygen.
• Check with the RN or team leader about whether the client requires oxygen before and during mobilization.
• Check with the RN or LPN If you find oxygen tubing laying on the floor in rooms where there is more than one client, to ensure that the nasal prongs are replaced before being reapplied to the correct client.
• Reapply nasal prongs to a client if the prongs become dislodged during care.
• Check with the RN or team leader about specific client information before mobilizing a client.
• Clients who are ambulatory and on oxygen generally can be mobilized.
• There are a few exceptions.

Surgical drains

Ask: “What is a surgical drain?”

Answer: Surgical drains are:

• External drainage systems that are used to collect and drain internal fluids after a surgical procedure.
• There are many different types of surgical drains, and HCAs must always confirm instructions with the health care team prior to providing care for  clients with surgical drains.
• Often pinned to gowns to prevent them from accidentally becoming dislodged.
• Often covered by dressings.

Ask: “What does an HCA need to do when providing care to a client with a surgical drain?”

Answer: When providing care to a client with a surgical drain, the HCA should:

• Use caution when removing a client’s gown, as some drains may be pinned to the gown.
• Safely remove safety pins from the old gown and secure them to the new gown when care is complete.
• Never remove a dressing that may be oozing. HCAs may place a gauze over the site and must report it to the RN or team leader immediately.
• Avoid getting the dressing around the drain wet during care. Wash and dry around the dressing site.
• Report any pain or discomfort a client may experience during care and care-related activities.
• Read the client’s care plan/talk to their RN or your team leader to determine if the client is allowed to sit/get up and walk if they have a surgical drain. HCAs should also have the RN or team leader check the client prior to getting out of bed to ensure the drainage system is secure.

Chest tubes

Ask: “What does an HCA need to know about providing care to a client with a chest tube?”

Answer: HCAs need to know that:

• Chest tubes are used when a client’s lung cannot inflate and deflate on its own. This may be the result of an external trauma such as an accident, or as a result of a fluid buildup in the lung that has caused it to collapse.
• Chest tubes are secured with a lot of tape.

Ask: “What does an HCA need to do when providing care to a client with a chest tube?”

Answer: When providing care to a client with a chest tube, the HCA should:

• Avoid getting too much moisture around the chest tube dressing. Wash around the tape with a moist washcloth.
• Report any drainage that may be observed during care to the RN or team leader.
• Report any pain or discomfort a client may experience during care and care-related activities.
• Always check with the RN prior to mobilizing a client with a chest tube. Accidently dislodging or withdrawing the chest tube may cause the client to go into respiratory distress and requires immediate medical intervention.

Catheters

Ask: “What does an HCA need to know about providing care to a client with a catheter?”

Answer: HCAs need to know that:

• Catheters in acute care settings are inserted as a short-term medical intervention. This may include surgical clients both pre-operatively and post-operatively to facilitate bladder drainage during surgery. Unless otherwise indicated, catheters in acute care settings should only be used for short periods of time.
• Although clients who are allowed to be up and walking and have catheters can generally be mobilized, there are a few exceptions. HCAs must check with the RN or team leader about specific client information.

Ask: “What does an HCA need to do when providing care to a client with a catheter?”

Answer: When providing care to a client with a catheter, the HCA should:

• Confirm instructions and gather information regarding anything that may be different in providing care for a specific client with a catheter.
• Report any pain or discomfort a client may experience during care or care-related activities.

Surgical incisions

Ask: “What types of surgical incisions would you expect to see in acute care?”

Answer: In acute care, you may encounter a wide variety of incisions. Incisions are generally covered with a dressing/bandage.

Common surgical incisions include:

• Abdominal incisions
• Hip or knee incisions
• Other

Ask: “What does an HCA need to do when providing care to a client with a surgical incision?”

Answer: When providing care to a client with a surgical incision, the HCA should:

• Confirm instructions with the RN/LPN.
• Gather information and supplies for care.
• Seek permission from the client to look at the bandage over the incision and to perform care.
• Notify an RN immediately if there is a large amount of drainage on the bandage over the incision.
• Never remove a dressing that may be oozing. HCAs may place a gauze over the site and must report it to the RN or team leader immediately.
• Avoid getting a dressing wet during care. Wash and dry around the dressing site.
• Report any pain or discomfort a client may experience during care and care-related activities.

6. Strategies for prioritizing tasks, demonstrating flexibility in work assignments, and problem-solving and decision-making regarding care provision

Course: Health and Healing: Concepts for Practice; Healing 1: Caring for Individuals Experiencing Common Health Challenges; applied aspects in Healing 3: Personal Care and Assistance

Estimated additional time: 1 hour for theory/lab

Examples of content based on Island Health materials

Ask: “What does an HCA need to know to prioritize tasks when providing care in acute care settings?”

Answer: When providing care in acute settings, HCAs need to know that:

• Acute care environments and client assignments can change rapidly due to:
  • Client admissions and discharges
  • Moving clients from one room to another
  • Transferring clients from one unit to another
  • Changing acuity of clients
  • Clients developing infections that require special precautions

The health care team needs to respond to these changes by managing their priorities.

Ask: “What does an HCA need to do to prioritize tasks when providing care in acute care settings?”

Answer: When providing care in acute care settings, HCAs need to:

• Attend huddles/shift reports or seek information from the other members of the health care team about changing priorities throughout the day.
• Seek guidance and direction from the RN or LPN related to their responsibilities.
• Communicate clearly with the health care team to identify what tasks have or have not yet been completed.
• Anticipate that they will need to be flexible in their client care assignment based on the clients’ needs. Although they may have been given assignments, they may be reassigned during their work days due to unforeseen circumstances.

Emphasize that although HCAs may not be assigned to specific client assignments or teams, they may be required to support specific aspects of daily care under the direction of another health care team member. This will require a level of flexibility and adaptability of the HCA to meet the client care needs in the rapidly changing environment in acute care.

Problem-solving and decision-making regarding care provision

Case studies or lab scenarios could be used to give students an opportunity to apply critical thinking and problem-solving skills to acute care settings, or to compare and contrast acute care and other settings.

7. Interprofessional collaborative practice in acute care settings

Course: Health Care Assistant Introduction to Practice

Estimated additional time: not applicable, as already covered in program

Interprofessional collaborative practice is important because it meets the following needs in providing client care:

• Improving client outcomes, care, and services
• Reducing medical error
• Ensuring knowledge transfer and communication between, and to, relevant professionals
• Informing government policy and leadership at all levels
• Addressing health and human resource shortages

Describe: When teams work interprofessionally:

• Decision-making is shared
• Leadership is shared
• The role of each health care provider is understood and the client and family are included in the process
• Team communication  is efficient, open, respectful, and client-centred and the client and family are integrated into the care process

Highlight: The outcomes of interprofessional collaboration.

Clients and families have:

• Expressed more satisfaction and identified a more positive experience
• Enhanced self-care and health condition knowledge and skills
• Improved health outcomes
• More timely referrals to other team members
• More comprehensive care

Health care providers:

• Are more satisfied and have a more positive experience
• Develop enhanced knowledge and skills
• Experience improved communication between providers

The health care system:

• Can offer a broader range of services and more efficient use of resources
• Provides improved access to services and shorter wait times
• Improves coordination of care

Reference: Barrett, J., Curran, V., Glynn, L., & Godwin, M. (2007). CHSRF synthesis: interprofessional collaboration and quality primary healthcare. Canadian Health Services Research Foundation.

8. The importance of knowing when and how often to communicate with the client and health care team

Course: Healing 1: Caring for Individual Experiencing Common Health Challenges; applied aspects in Healing 3: Personal Care and Assistance. This also relates to supervision in Introduction to Practice. Specific examples related to acute care could be included in Healing 1 and Healing 3

Estimated additional time: 30 minutes

Examples of content based on Island Health materials

Communication principles in acute care for HCAs:

• Who to communicate with: know the interprofessional team that is involved in client care
• What to communicate: the methods of gathering, reporting, and recording information
• When to communicate: the urgency and frequency of communication required
• Where to communicate: whiteboards, client charts, huddles, meetings
• Why communication is important
• How to communicate: unit processes and technology
  • Communication processes within acute care settings require the full and active participation of all interprofessional team members.
  • In acute care, it is important to consider the urgency for information (how quickly something is needed) as well as the frequency required of communication (how regularly information is needed). Critical decisions regarding such factors as hospital admissions and discharges, client care routines, diagnostic assessments, medical treatments, and access to supplies depend on clear and timely communication between team members.

There are several YouTube videos that reinforce the concept of communication

Therapeutic communication for nurses (from a client’s perspective)

Classic Sesame Street – Ernie and Bert can’t communicate

Sesame Street – Ernie and Bert “Very Important Note”

Poor communication (health care assessment – context of care)

“See Me, Nurse” – video clips to the poem about nursing

Pink Glove Dance: The Sequel

9. The role of the HCA in responding to emergency codes

Course: Coverage recommended in the Health and Healing: Concepts for Practice course. A lab scenario could also be added into the Healing 3: Personal Care and Assistance course

Estimated additional time: 30 minutes

Review the role of the HCA in assisting with emergencies

The following lists are examples of what may be expected of HCAs for the three top codes at one particular site:

Code Blue:

• Activate help (this may simply involve notifying the unit clerk, LPN, or RN nearest to the phone system, or emergency call button).
• Remove all obstructions from the client’s bedside and room (bedside table, chairs, etc.).
• Close the privacy drapes of any clients in the same room.
• Stand in the hallway and direct emergency personnel to the correct room.
• Be available to retrieve supplies and equipment that the code response team may require.
• Comfort any clients who may be located in the same room.
• Clean and tidy the area after the event.

Explain the site policy and protocol for both witnessed and unwitnessed cardiac arrests.

Code White:

A call for help due to a potentially violent situation, or a violent or escalating incident.

• Call for help (this may simply involve notifying co-workers, the unit clerk, LPN, or RN nearest to the phone system or emergency call button). 911 may have to be called.
• Maintain personal safety at all times, removing yourself and any clients who may be at risk.
• Be available to provide support to those responding to the code white.
• Seek first aid if you were injured.
• Participate in any review of the incident.
• Provide support to those who may have been affected by the incident. Be aware of your own internal responses to the event and seek help if you are experiencing unhealthy reactions.
• Recognizing that a member of the interprofessional care team may not be available as a resource for HCA practice during the time they are responding to an event, identify the next appropriate care provider who will provide guidance and direction.

Question: What are the differences between a code white response in a hospital, residential care home, and in a community setting?

Code Yellow:

• Activate help (this may involve notifying the unit clerk, LPN or RN nearest to the phone system).
• Seek direction from the interprofessional care team.
• Join unit team members in the systematic search of the unit.
• Be specific and thorough in your search processes.
• Report back to the RN or team leader as soon as your area has been searched to receive further direction.

Standardized codes in B.C.

The following codes have been standardized for B.C. Not all codes will be used by all health regions or all sites.

Refer to the following document for further information:

Ministry of Health Services Policy Communiqué: Standardized Hospital Codes

10. Other acute care content revisions

Course: Healing 2: Caring for Individuals Experiencing Cognitive or Mental Challenges

Estimated additional time: 15 minutes

Examples of content based on Island Health materials

Explain: There are specific criteria and processes for people who are admitted involuntarily into acute care.

An involuntary admission is guided by criteria that are outlined in the Mental Health Act of British Columbia.Mental Health Act [RSBC 1998] Chapter 288, Section 22. http://www.bclaws.ca/civix/document/id/complete/statreg/96288_01#section22 Generally, the client has been examined by a physician who is of the opinion and provides reporting supporting the opinion that the client:

a. Has a mental health disorder.

b. Requires treatment in or through a designated facility.

a. Requires care, supervision, and control in or through a designated facility to prevent the person’s or patient’s substantial mental or physical deterioration or for the protection of the person or patient or the protection of others.

b. Cannot suitably be admitted as a voluntary patient.

Reinforce that depending on specific client care needs, there may be unique forms that are being used by the health care team. An example of client needs is substance withdrawal – CIWA protocol.

Image descriptions

British Columbia Hospitals Emergency Colour Codes

• Code red: fire
• Code blue: cardiac arrest
• Code orange: disaster or mass casualties
• Code green: evacuation
• Code yellow: missing patient
• Code amber: missing or abducted infant or child
• Code black: bomb threat
• Code white: aggression
• Code brown: hazardous spill
• Code grey: system failure
• Code pink: pediatric emergency and/or obstetrical emergency

[Return to image]

The Clinical Instructor Orientation supports clinical instructors in Health Care Assistant programs. It includes information on the role and expectations for both instructors and students; suggestions for instruction, reflection, and assessment; information on how to set students up for success; tips on giving and receiving feedback; and resources for more information. It also includes several sample evaluation tools.

The Clinical Instructor Orientation is available as a downloadable Word or PDF file for instructors. You can modify the file to reflect the specific background and requirements of the Health Care Assistant program at your institution.

The Preceptor Orientation provides information to support Health Care Assistant preceptors who are working with students completing the course Practice Experience in Multi-Level and/or Complex Care. The orientation guide includes information on the role and expectations for both preceptors and students, tips on giving and receiving feedback, and resources for more information. It also includes a preceptor checklist, a student information form, and a practice education evaluation.

The Preceptor Orientation is available as a downloadable Word or PDF file. You can modify the file to reflect the specific background and requirements of the Health Care Assistant program at your institution.

Assignment Outline

The purpose of this assignment is for students to explore workplace settings that are compatible with your values, beliefs, interests, and career goals as a Health Care Assistant (HCA).

Using the internet, students will research potential employers and settings of employment in their communities. After completing the research, students will prepare a written report of 500–750 words that addresses the follow components:

• Identify and describe a workplace setting (e.g., residential, community, or acute care) that interests you. Discuss why you would like to work there and outline a minimum of two challenges and two rewards of working in that setting.
• Describe the mission and value statement of the prospective employer. Discuss how it aligns or does not align with your beliefs and values. Print and submit a copy of the employer’s mission statement along with your assignment and use APA referencing style to indicate your source(s).*
• Develop a personal mission statement that describes your beliefs, values, interests, and career goals (short- and long-term) as an HCA.

You will be marked using the following criteria:

• Your ability to thoroughly address the required components of the assignment (Total possible marks: 10/10)
• The depth of your reflection regarding how your own beliefs, values, goals, and interests align with that of the prospective employer (Total possible marks: 5/5)
• Your ability to prepare a report that is well written and presented in an organized manner (Total possible marks: 5/5)

APA Citation Referencing Style

• Purdue University. (2019). APA citation basics. Purdue Online Writing Lab. https://owl.purdue.edu/owl/research_and_citation/apa_style/apa_formatting_and_style_guide/in_text_citations_the_basics.html
• Simon Fraser University & Dymarz, A. (2021, September 10). General notes: APA (7th ed., 2020) citation guide. http://www.lib.sfu.ca/help/cite-write/citation-style-guides/apa

Rubric: HCA Workplace Settings Assignment

Download Rubric: HCA Workplace Settings Assignment [PDF].

Note: This tool has been adapted from the Reflection Evaluation Criteria (the rubric). Retrieved on August 26, 2016.

Note: This sample tool has been included to align with Suggested Course Assessment 4 for the Health Care Assistant Introduction to Practice course.

Assignment Outline

The purpose of this assignment is to explore best practices for communicating with clients with dementia or mental health disorders.

Working in small groups, students will research a cognitive or mental health disorder of their choice. After completing the research, the groups will prepare an 8–10 minute presentation, with visual materials (e.g., a PowerPoint presentation or poster) and a short written handout to give to the class, addressing the following components:

• Briefly describe the type of dementia or mental health disorder (causes, signs, and symptoms).
• Describe how communication between a client with this diagnosis and an HCA may be impacted. Consider the elements of interpersonal communication (sender, receiver, message, feedback).
• Demonstrate and/or describe a minimum of three communication strategies/techniques (verbal and non-verbal) that can be used by the HCA to enhance communication while providing care to the client.

You will be marked using the following criteria:

• The ability of the team to thoroughly address the required components of the assignment (Total possible marks: 15/15).
• The ability of the team to present the information in a thorough and engaging presentation (Total possible marks: 10/10). *Each group member will receive an individual mark based on delivery of a portion of the presentation.
• The ability of the team to develop visual and written materials to support the presentation (Total possible marks: 5/5).

Online Resources

• Alzheimer Society of B.C.
• Canadian Mental Health Association, B.C. Division
• HealthLinkBC
• Heretohelp

Rubric: Supporting Clients with Dementia or a Mental Health Disorder

Note: This sample tool has been included to align with Suggested Course Assessment 3 for the Healing 2: Caring for Individuals Experiencing Cognitive or Mental Challenges.

Download Rubric: Supporting Clients with Dementia or a Mental Health Disorder [PDF].

To support program consistency, recognized B.C. HCA programs are expected to use case scenario testing to confirm that students are safe and competent before they go into the clinical setting.

As noted in the suggested course assessment for the Personal Care and Assistance course, skills testing could be accomplished through performance of a scenario simulating the practice environment and may include an opportunity for problem-solving. The specific skills tested and expected level of competency may vary depending upon when the first clinical experience occurs within the program. To support student success, it may be helpful to implement a mid-course assessment and/or pre-testing practice session.

For scenario-based or case study type assessment, it is typical to have at least four client scenarios for skills testing that students could receive in advance for preparation purposes. On testing day, a scenario will be randomly chosen for each student to perform. The student will have a set amount of time (e.g., 45 minutes per student) to complete the scenario. Students will work in pairs with one acting as the client and the other being the HCA.The program may choose to have an instructor or a standardized patient (actor) in the role of the client. It is important that the student acting as the client play the role seriously. Prompting or cueing by the client is not allowed. With some scenarios, it may be necessary for the HCA to obtain a partner who will be designated the “helper.” Some components of care may be provided on a mannequin or using simulation aids (e.g., torso with a penis or torso with a vulva).

A care plan is often provided for each scenario for the purpose of student testing.

Assessment Criteria

HCA programs may already have skills testing assessment criteria in place. At a minimum, students should demonstrate their ability to:

• Maintain the comfort and dignity of the client.
• Maintain the safety of the client, self, and other members of the health care team.
• Perform in an organized manner.
• Maintain medical asepsis.
• Use proper body mechanics.
• Communicate with the client and other health care team members, where appropriate.
• Demonstrate competency of the personal care and assistance skills being tested in the scenario.

Evaluation is typically conducted on a satisfactory/unsatisfactory or a pass/fail basis. Programs implementing a mid-course skills assessment may add a “needs improvement” designation, which, if assigned, is followed up with a learning contract.

To ensure fair and reliable student practical skills assessment, there should be established criteria regarding what would constitute unsatisfactory performance. This could include the designation and number of minor infractions that may result in a cumulative fail, or major infractions that may result in an immediate fail.

Elements that may be considered include:

• Skill testing takes longer than established time allotted for testing.
• Student leaves client on the side of the bed or leaves client unattended with side rails down.
• Student rolls client onto the edge of the bed without raising side rails.
• Student performs a lift transfer incorrectly or no safety check.
• Student makes offensive or inappropriate comments to the client.
• Student leaves the client unattended in bed in the high position.
• Student does not apply brakes to wheelchair, bed, or equipment in an appropriate manner.
• Student repeatedly (more than once and/or after prompt or without self-correcting):
  • Forgets a portion of the skill.
  • Dresses client haphazardly/with inappropriate assistance from the client (e.g., clothes, TEDS, shoes).
  • Poorly positioning or moving of the client in bed.
  • Does not collect all supplies pre-scenario.
  • Provides care in a way that does not flow smoothly or is disorganized.
  • Does not use the appropriate number of side rails.
  • Performs morning care or perineal care in the incorrect order.
  • Contaminates objects by failing to wash hands, change gloves, touching clean objects with dirty gloves or dropping items on the floor.
  • Does not use proper body mechanics.
  • Forgets to give client an aid (e.g., glasses or hearing aid).
  • Fails to provide a thorough report of the client’s condition.

There should also be details set out in regards to requirements for retesting.

See sample case scenarios and rubrics below.

Rubric 1: Scenario-Based Lab Skills

You are an HCA working in a residential care home. Today you are assigned to provide morning care for Edith Blaise, a 92-year-old woman who has recently fractured her left foot. This morning when you enter Ms. Blaise’s room, she asks you to assist her with a bedpan. Following this, you will assist Ms. Blaise with a partial bed bath, assist her with dressing, and transfer her to her wheelchair using a full mechanical lift.

Depending on the case scenario, each required skill could be evaluated as follows:

Download Rubric 1: Scenario-Based Lab Skills Assessment [PDF]

Note: This sample tool has been included to align with Suggested Course Assessment 3 in the Healing 3: Personal Care and Assistance Course.

Rubric 2: Scenario-Based Lab Skills

You are an HCA working in a residential care home. Today you are assigned to provide morning care for Edith Blaise, a 92-year-old woman who has recently fractured her left foot. This morning when you enter Ms. Blaise’s room, she asks you to assist her with a bedpan. Following this, you will assist Ms. Blaise with a partial bed bath, assist her with dressing and transfer her to her wheelchair using a full mechanical lift.

Depending on the scenario, and the using following criteria (NI = Needs improvement [may be used for mid-point testing], NS = Not Satisfactory, S = Satisfactory) the rubric could be used as follows:

Instructor Name                               Instructor Signature                                Date                                 

Student Name                                 Student Signature                                 Date                                

Download Rubric 2: Scenario-Based Lab Skills Assessment [PDF].

Note: This sample tool has been included to align with Suggested Course Assessment 3 included in the Healing 3: Personal Care and Assistance Course.

The following summary list could be used as an organizational tool to identify learning needs and record practise of HCA skills in the lab and clinical settings. It is not intended to replace scenario-based lab skills testing or assessment of meeting program learning outcomes for practice education placements.

This is a summary list only. It is expected that additional procedure criteria for each skill would be provided by the program in a lab skills manual. The program may wish to indicate skills with additional safety-related considerations (e.g., instructor is present for the first time demonstration of a skill in the clinical setting, two person mechanical lift policy, etc.).

Completion Criteria

Student Name:                                                        has demonstrated completion of the following personal care and assistance skills.

• A check mark indicates that the skill was completed in a safe and efficient manner in accordance with established procedures and criterion.
• Reviewed by identifier – Full name to be provided for first instances along with initials may be used thereafter for repeat reviewer.

Instructor Name                                  Instructor Signature                                 Date                                

Student Name                                 Student Signature                                 Date                                

Note: This sample tool has been included to align with Suggested Course Assessment 2 included in the Healing 3: Personal Care and Assistance course and Suggested Course Assessment 1 included in the Practice Experience in Multi-Level and/or Complex Care course.

Download HCA Skills Summary Checklist [PDF].

This form confirms that the student identified below has completed the required practice education placements and placement hours for the HCA Practice Education program segment and has been deemed by their instructor as having met the required program learning outcomes outlined in the HCA Program Provincial Curriculum Guide 2015, p. 18.

Student Name: (please print)                                              

Multi-level/complex care placement site name(s):                                              

Date(s):                                               Number of hours completed:                                              

Name of instructor(s):                                              

Assisted living/home support/group home placement site name(s):                                               

Date(s):                                               Number of hours completed:                                              

Name of instructor(s):                                              

Directions: Please indicate whether or not the student has met (been able to demonstrate) the following learning outcomes in the clinical setting and sign and date the bottom of the form.

Instructor Name                                  Instructor Signature                                 Date                                

Instructor Name                                  Instructor Signature                                 Date                                

Student Name                                 Student Signature                                 Date                                

Download Health Care Assistant Program Learning Outcomes Verification [PDF].

Note: This sample tool has been included to align with Suggested Course Assessments 3 and 5 included in the Practice Experience in Multi-Level and/or Complex Care course and Suggested Course Assessment 2 included in the Practice Experience in Home Support, Assisted Living, and/or Group Home course. It could be further adapted for use as a self-assessment by the student.

The Professional Behaviour Development RubricNote: The Registry would like to acknowledge the Continuing Care Assistant Program in Nova Scotia, www.novascotiacca.ca, for developing the original version of this resource, which has been adapted for use in the B.C. Health Care Assistant Program. © Continuing Care Assistant Program. (2013). Professional Behaviour Development Rubric. Nova Scotia. sets out expectations for student conduct within the Health Care Assistant program with a view to effectively preparing graduates for success in today’s health care workforce. This rubric is intended to positively reinforce and support the development and application of professional behaviour. It responds to feedback from HCA educators and employers alike that HCA program students and graduates could gain from additional strategies to support their success in the program and allow for more productive employee integration and retention.

Given the associated learning outcomes and course content, it is suggested that this tool be introduced for learning and discussion during the HCA Introduction to Practice course. It could be used as a formative evaluation tool (either graded or non-graded) during both the HCA Introduction to Practice course and the Healing 3: Personal Care and Assistance course. Constructive feedback gained throughout the program could then guide further development and application when used as a final evaluation tool (graded) during practice education coursework. The behaviours addressed within this tool align with the learning outcomes for both the Practice Experience in Multi-Level/Complex Care course and the Practice Experience in Home Support, Assisted Living and/or Group Home course. Competent performance (in all areas) could be required for successful completion of practice education coursework.

Rubric Sections

There are four sections to the rubric:

• Section 1: Appropriate Behaviour includes Attitude, Appearance, Integrity, and Technology
• Section 2: Respect for Self and Others includes Communication (Verbal/Non-Verbal), Communication (Written), Nonjudgmental, Caring, and Team Player
• Section 3: Commitment includes Time Management, Adaptability, and Stress Management
• Section 4: Competence includes Accountability, Continuous Learning, and Problem-Solving

Integration and Assessment

A variety of approaches are encouraged to address the development of professionalism throughout the HCA program. By taking an ongoing, integrated approach, students can be supported in behaving in a way that will most greatly support their success when they move into their practice education experiences and into the workforce. When using this tool, it will be important for instructors (as well as practice education site mentors) to provide ongoing input,
informing and enabling students to reach a “competent” level for each of the behaviours by the end of the practice education placement. When assessing behaviours, specific examples and suggestions for development should be provided.

Professional Behaviour Development Rubric© Continuing Care Assistant Program. (2013). Professional Behaviour Development Rubric. Nova Scotia.

Student Name                                 Date                                

Download Professional Behaviour Development Rubric [PDF].