Cover

Health Care Assistant Program Supplement to the Provincial Curriculum Guide (2015) - Third Edition

Health Care Assistant Program Supplement to the Provincial Curriculum Guide (2015) - Third Edition

November 2021

Province of British Columbia

Health Care Assistant Program Supplement to the Provincial Curriculum Guide (2015) - Third Edition

Icon for the Creative Commons Attribution-ShareAlike 4.0 International License

Health Care Assistant Program Supplement to the Provincial Curriculum Guide (2015) - Third Edition by Province of British Columbia is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License, except where otherwise noted.

© 2022 BCcampus

The Creative Commons licence permits you to retain, reuse, copy, redistribute, and revise this book—in whole or in part—for free providing it is adapted and reshared content retains the same licence, and the author is attributed as follows

Health Care Assistant Program Supplement to the Provincial Curriculum Guide (2015) by Province of British Columbia is used under a CC BY-SA 4.0 License.

If you redistribute all or part of this book, it is recommended the following statement be added to the copyright page so readers can access the original book at no cost:

Download for free from https://opentextbc.ca/hcasupplement/

Sample APA-style citation (7th edition):

Province of British Columbia. (2022). Health care assistant program supplement to the provincial curriculum guide (2015), third edition, November 2021. BCcampus. https://opentextbc.ca/hcasupplement/

Cover image attribution:

The textbook cover is by Province of British Columbia and licensed under a CC BY-SA 4.0 License.

Ebook ISBN: 978-1-77420-148-0

Print ISBN: 978-1-77420-147-3

Visit BCcampus Open Education to learn about open education in British Columbia.

Accessibility Statement

2

The web version of Health Care Assistant Program Supplement to the Provincial Curriculum Guide (2015) has been designed with accessibility in mind by incorporating the following features:

Other File Formats Available

In addition to the web version, this book is available in a number of file formats including PDF, EPUB (for e-readers), MOBI (for Kindles), and various editable files. Here is a link to where you can download the guide in another format. Look for the “Download this book” drop-down menu to select the file type you want.

Those using a print copy of this resource can find the URLs for any websites mentioned in this resource in the footnotes.

Known Accessibility Issues and Areas for Improvement

While we strive to ensure that this resource is as accessible and usable as possible, we might not always get it right. Any issues we identify will be listed below.

Accessibility Standards

The web version of this resource has been designed to meet Web Content Accessibility Guidelines 2.0, level AA. In addition, it follows all guidelines in Accessibility Toolkit: Checklist for Accessibility. The development of this toolkit involved working with students with various print disabilities who provided their personal perspectives and helped test the content.

Introduction

3

The first Health Care Assistant Program Provincial Curriculum 2015 Supplement, released in August 2015, was produced to support the delivery and assessment of the required learning outcomes and course content set out in the Health Care Assistant Program Provincial Curriculum 2015. The third edition of the supplement was completed in November 2021 to ensure that materials and resources are current and reflective of educator and workforce needs. This edition, now called the Health Care Assistant Program Supplement to the Provincial Curriculum (2015), Third Edition, November 2021, (the Supplement) continues to be a supplement for the Health Care Assistant Program Provincial Curriculum 2015.

This third edition of the Supplement has been influenced by the changing health care context in British Columbia. In September 2020, the Premier released the B.C. Economic Recovery Plan announcing that thousands of new health care workers would be hired to help manage the response to the global COVID-19 pandemic and to ensure seniors get the quality care they need and deserve.Government of British Columbia. (n.d.). Stronger B.C. for Everyone: B.C.’s Economic Recovery Plan, p. 17. https://news.gov.bc.ca/files/StrongerBC_BCs-Economic-Recovery-Report.pdf) The Health Career Access Program was established to provide “a path for applicants with no health care experience to get hired and receive on-the-job training.”Government of British Columbia. (n.d.) Work in the Health Care Sector. (https://www2.gov.bc.ca/gov/content/covid-19/economic-recovery/work-in-health-care). The Ministry of Health and the Ministry of Advanced Education and Skills Training strategized on ways to introduce approximately 3,000 additional Health Care Assistants into the B.C. health care system. The Health Care Assistant Partnership Pathway (HCA-PP) project was born, enabling health authorities to hire Health Care Support Workers (HCSWs) to serve in a non-direct resident/patient/client care role in the long-term care or assisted living facilities where they were hired. Health authorities would partner with post-secondary institutions to enrol these HCSWs into HCA programs. The HCSWs would commit to attending an HCA program and their tuition and most educational expenses would be covered.

A Clinical Instruction Working Group of the HCA-PP project explored many strategies to help the project be successful. Considering the need to educate an additional 3,000 HCAs, there will also be a need to hire, orient, and support many new clinical instructors. Many of the strategies discussed by the Clinical Instruction Working Group involved augmenting current resources to support new and existing clinical instructors.

BCcampus was contracted in January 2021 to support the development of new resources as follows:

The above work was initiated with the distribution of an HCA Resources Environmental Scan to all approved post-secondary institutions in B.C.:

The Environmental Scan was sent to 38 HCA programs in B.C. and 32 programs responded (84% response rate).

An Advisory Committee was established to oversee the project and three working groups were created:

All amendments to the third edition are outlined in the Revisions Summary Table.

Note: The third edition has kept the many changes and additions that were made for the second edition, including the debate topics, research activities, role play/critical thinking activities, and case scenarios. The unfolding case study is still integrated throughout the third edition to emphasize concepts related to caring within each course, and resources are still formatted to support instructional delivery and student distribution. This edition also includes the standardized templates and sample evaluation tools that educators can adapt to support theory, lab, and clinical evaluation.

Using the Materials in the Supplement

Educational institutions delivering the Health Care Assistant Program may already have effective teaching and learning methodologies and assessment mechanisms in place. The resource material within the Supplement provides recommended activities, resources, and assessments and is not considered to be comprehensive. It should be noted that given the open licensing of the Supplement under Creative Commons, material within this document may be revised, remixed, and shared as long as attribution is given to the copyright holder, the Province of British Columbia; changes to the source material are noted and the adaptations are licensed with the same license. To streamline educator use, where student handouts are provided, attribution to the source has also been supplied.

 

Third Edition Revisions Summary Table

4

The following table provides an overall summary of the revisions.

Third Edition Updates
Updated Introduction and the Third Edition Revisions Summary Table.
Updated the Recommended B.C. Program Textbooks list.
Updated the Resources section for all courses in Section 1. The Online Resources and Online Learning Tools sections were updated: new resources were added, out-of-date resources were removed, and all broken links were updated. An extensive Online Videos section was also added to the Resources for all the courses.
Added a new section called Self-Assessment Video Scenarios to the Healing 3: Personal Care and Assistant course. This section includes links to five video scenarios for students to watch to prepare for their practice experiences. The videos focus on the following topics:
  • Roles and Responsibilities of the HCA
  • Communicating with the Health Care Team
  • Isolation Precautions
  • Lifts and Transfers
  • Morning Care
Changed title of Section 3 from Additional Content to Additional Content in Acute Care.
Added a new Section 4 called Preceptor and Clinical Instructor Orientation Tools. The new Section 4 contains links to these tools, which are available for download as Word or PDF files.
Changed the title of Section 4: Sample Tools to Section 5: Sample Evaluation Tools.
Updated the Acknowledgements.

Acknowledgements

5

The following individuals, organizations, and groups are gratefully acknowledged for their contributions to the HCA Program Supplement to Provincial Curriculum (2015), third edition, November 2021.

Thanks are also due to the many people who contributed to the HCA Resources Environmental Scan, which helped update the Resources and inform the Advisory Group on topics to cover in the self-assessment videos.

Health Care Assistant Partnership Pathway Advisory Group

Jocelyn Bergeron, College of New Caledonia

Lisa Beveridge, Vancouver Community College

Sarina Corsi, B.C. Care Aide and Community Health Worker Registry

Kim Fraser. Vancouver Island University

Jackie Godia, Stenberg College

Angela Goltz, Ministry of Advanced Education and Skills Training

Edith Kirkpatrick, Douglas College

Sarah Lechthaler, Selkirk College

Sharon Leitch, Kwantlen Polytechnic University

Joanne Maclaren, Ministry of Health

Nadja Matheson, Capilano University

Dawna Williams, University of the Fraser Valley

Creating Video Scenarios Working Group

Heather Frame, Camosun College

Kristi Jukes, Discovery College

Chantal Lortie, Selkirk College

Sophia Mattioli, College of New Caledonia

Kim Morris, Thompson Rivers University

Lara Williams, B.C. Care Aide and Community Health Worker Registry

Elena Zenzerova, Discovery College

Clinical Instructor and Preceptor Orientation Working Group

Jocelyn Bergeron, College of New Caledonia

Lynnette Fleury, Thompson Rivers University

Fe Patricia Forteza, Vancouver Career College/CDI

Sarah Lechthaler, Selkirk College

Hadiah Mizban, B.C. Care Aide and Community Health Worker Registry

Sonayna Rana, Kwantlen Polytechnic University

Test Bank Working Group

Lisa Beveridge, Vancouver Community College

Sarina Corsi, B.C. Care Aide and Community Health Worker Registry

Lorraine Guild, Kwantlen Polytechnic University

Sarah Lechthaler, Selkirk College

Nadja Matheson, Capilano University

Kim Morris, Thompson Rivers University

Note: It was decided that test banks would be reconsidered once the HCA Curriculum is updated.

Project Development Team

Robynne Devine, Project Manager, BCcampus

Barbara Johnston, Writer and Editor

Declan Robinson Spence, Program Coordinator, BCcampus

Debbie Sargent, Project Consultant

Liz Warwick, Instructional Designer

Kaitlyn Zheng, Pressbooks Coordinator, BCcampus

This was funded by the Government of British Columbia.

Section 1: Suggested Learning Activities, Assessments, and Resources for HCA Courses

I

Preamble

1

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.

Health and Healing: Concepts for Practice

3

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.

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:

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.

STUDENT HANDOUT
Situations: Reflections on Person-Centred Care

DIRECTIONS: Review and discuss the following situations. What is there about each situation that reflects person-centred care and what does not? Could the situation have been handled differently? If so, how?

Joan is a Health Care Assistant working in a complex care facility. She enjoys her work a lot – especially, as she says, “working with my sweet little old ladies.” Joan is well-organized and makes every effort to assure that the clients in her care are safe, clean, and comfortable. Today, when she completed bathing Mrs. DeVito, Joan dressed her in a flowery dress and placed a bright red bow in Mrs. DeVito’s white hair, saying, “There you go, dearie. You look so cute.” Mrs. DeVito is deaf so she didn’t hear Joan’s comment. She just smiled and nodded.


The instructor enters a room where a student, Evira, is giving a client a bed bath. The instructor stands on the opposite side of the bed from Evira and talks directly to her, saying, “We will have our group meeting at 11:00 a.m., Evira. See you then.” The instructor immediately hurries out of the room.


An HCA, Alex Ipe, is working for a home support service in a small city. He was recently assigned to provide care for a rather cantankerous older gentleman named Gordon. After his first two visits to Gordon’s small apartment, Alex feels frustrated and discouraged because he can’t seem to please Gordon. Alex decides to talk with an experienced colleague, Viv, in hopes of getting some helpful advice. After hearing his concerns, Viv responds by saying, “Well, you know how it is with these old guys. They are all like children – just so picky and needing attention. It can be pretty frustrating, I know, but you mustn’t let it get to you.”

© Province of British Columbia. This material is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License (CC BY-SA 4.0).

Download Student Handout: Situations: Reflections on Person-Centred Care [PDF].

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.

STUDENT HANDOUT
Unfolding Case Study: Caring for Peter Schultz
Providing Person-Centred Care

DIRECTIONS: You are an HCA working as a home support worker. You have been assigned to provide respite care to Peter for a four-hour period from 3:00 p.m. to 7:00 p.m. while his wife, Eve, attends an event. Keeping in mind the five principles of compassionate care, use the information provided about Peter to develop a schedule for how you could spend your time with him.

Client Profile: Peter Schultz

Peter was born on January 1, 1918. When he was seven years old, Peter emigrated from the former Yugoslavia to a small town in Alberta. After completing grade nine, Peter left school and worked as a farmer and logger. In the 1950s, Peter moved with his wife, Eve, and their family to the Lower Mainland of B.C., where he worked in construction, life insurance, and real estate. During the 1970s, Peter owned and operated a small hobby farm. He retired at the age of 75 and moved to a small city near Vancouver, B.C.

Born into a large family, Peter was the second oldest of eight siblings. Peter and Eve have two sons and three daughters, 17 grandchildren, and over 30 great-grandchildren. With the exception of one daughter who lives in Alberta, Peter’s children live within one hour of driving distance from him and his wife.

Peter comes from an ethnic German family and German culture and traditions are important to him. As a child, Peter learned to speak German, Serbian, and English. He learned many German songs, hymns, and poems and often recites his favourites. Peter also enjoys traditional German cooking. Peter is a Lutheran Christian and has been active in his faith since childhood. During his adulthood, Peter was involved in church leadership and is well regarded in his faith community. Until recently, Peter acted as Bible study leader.

Peter has always been a social and outgoing person. As a young man, he enjoyed going to community events and was known to be an excellent dancer. Peter and Eve entertained regularly and enjoyed playing pool, cards, and Scrabble with their guests. He and his wife were both avid gardeners. Peter always enjoyed large and small building projects. After retirement, Peter built simple furniture and made latch hook rugs for his grandchildren.

Recently, he has been unable to participate in these activities due to increasing confusion and an inability to make the calculations necessary to complete these projects.

Other than back problems resulting from physical work, Peter has always been healthy and active. When he was 77 years old, Peter experienced a stroke, also known as a cerebral vascular accident (CVA), which resulted in short-term speech difficulties and affected his swallowing ability. Following the CVA, Peter’s wife began to notice changes in his cognition, personality, and behaviour. He progressively lost the ability to participate in activities that he previously enjoyed. Approximately five years following the CVA, Peter started to receive community-based health services.

A Proposed Respite Care Schedule
Time Proposed/Possible Activity Rationale for Activities Principle of Person-Centred Care
3:00–4:00 p.m. Greeting and conversation about life and family; propose ideas for time together Create comfort and ease with client Independence and preference – so client can suggest and choose activities that interest him
4:00–5:00 p.m. Walk in garden
5:00–6:00 p.m.
7:00–8:00 p.m.

Metzger, Z. B. (2010). The Last Lap of the Long Run, Addendum to “On the Long Run”: An Account of our Travels with Dementia. This material is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License (CC BY-SA 4.0).

Download Student Handout: Providing Person-Centred Care [PDF].

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:

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:

Option Positive Consequence Negative Consequence
Withdraw from the program
  • No more study stress
  • Possibly more money (if I could get a job)
  • Would feel like a quitter
  • Would miss the group
  • Wouldn’t be able to work as an HCA
  • I’d disappoint my family

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.

STUDENT HANDOUT
Problem-Solving/Decision-Making Exercise

DIRECTIONS: Select a problem you now face and use the problem-solving, decision-making process you’ve learned in class to analyze the situation and come to a decision. Follow the points below and use the template on the next page to document your processes and outcomes.

  1. Describe a personal problem you now face.
  2. Analyze the problem:
    • Describe the problem.
    • Why does it exist? What caused it? Who is involved?
    • What is your goal or desired outcome (i.e., how will you know when the problem is “solved”)?
    • What options do you have? What are the consequences, positive and negative, of each of these options?
    • Are there people or resources that might give you assistance – either in analyzing the problem, considering alternatives, or deciding on the best course of action?
  3. Decide on the best course of action for YOU. Why is this the best course of action?
  4. Carry out your decision. What steps would you need to follow in order to carry out the plan?
  5. Evaluate: How did it turn out? What criteria would you use to evaluate your plan?

Self-Reflect: Was this a new way for you to deal with a problem? How did it feel to you? Were you happy with the outcome? What did you learn from the process?

Problem-Solving Exercise: Template for Report

PROBLEM:

ANALYSIS OF THE PROBLEM:

YOUR GOAL OR DESIRED OUTCOME:

Options Positive Consequences Negative Consequences

SOURCES OF ASSISTANCE:

YOUR DECISION:

EVALUATION / REFLECTION ON THE DECISION AND THE PROCESS:

Download Student Handout: Problem-Solving/Decision-Making Exercise [PDF].

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

STUDENT HANDOUT
A Case Example: Assisting a Patient to Mobilize with Oxygen in Acute Care

Ms. Jackson lives in an assisted living residence and is 87 years old. She receives assistance with housekeeping and meals, which are taken in the common dining room. She has a history of COPD and uses a four-wheeled walker. The walker is outfitted with a portable oxygen tank for use in the dining room, as well as for outings into the community.

Twelve days ago, Ms. Jackson had a fall in her home getting up to go to the bathroom at night. As a result of the fall, she fractured her hip and required a dynamic hip screw surgery. She is now recovering in acute care and is being encouraged to mobilize daily. Her goal is to be walking independently with her four-wheeled walker, so that she is able to walk the 75 feet necessary to get to the dining room when she gets home. When walking, she is permitted to put her full weight, as tolerated, on her operated side. She is currently using 2.0 L of oxygen by nasal prongs. She is mobilizing with a two-wheeled walker and requires stand-by assistance for safety. As the HCA, you have been asked to assist Ms. Jackson with her mobilization routine, which involves walking up and down the hospital corridor.

The six steps below highlight some factors to consider.

  1. Confirm instructions
    • Determine who is asking you to complete this mobilization: the Registered Nurse (RN), the Licensed Practical Nurse (LPN), the Physiotherapist (PT), or the Occupational Therapist (OT). Determine the method to communicate should problems or issues arise.
    • Consider if you have the training or experience to complete this task. Have you ever assisted someone with a two-wheeled walker and oxygen? If not, you may need to ask for assistance and guidance.
    • Clarify the distance you are expected to assist with walking. Are there any breaks to be planned into the walk? If so, where? How does this line up with Ms. Jackson’s treatment goals at discharge (working towards ability to walk the 75 feet at home).
    • Ask if there are any specific details or techniques you should be reinforcing? (e.g., proper technique with a two-wheeled walker or positioning of the oxygen tank).
  2. Gather information
    • Look in the patient chart, nursing flow sheets, and/or walking board to see how Ms. Jackson did with her mobilizing on the previous shift. Was any additional assistance required? Did she sleep well? Did she have any confusion?
    • Confirm current weight-bearing status (full weight bearing) as well as expected oxygen delivery method. Does she have any movement precautions?
    • Ask nursing staff if there are any medications required prior to mobilizing that may increase Ms. Jackson’s comfort while walking.
    • See if Ms. Jackson has any other scheduled appointments that may conflict with her ability to complete mobilization at a certain time (e.g., medical imaging, group activity sessions).
  3. Perform activity
    • Have a member of the health care team check the oxygen delivery system (how it is applied, the rate of flow to the portable tank) and Ms. Jackson’s status prior to ambulating.
    • Complete a pre-handling checklist (or other pre-mobility assessment) to determine if Ms. Jackson is safe to ambulate. Health care team members can assist with this.
    • Ensure oxygen tubing (or other lines and tubes) does not pose a tripping hazard, but still has enough slack to allow for ease of movement. Depending on the portable oxygen tank, it may or may not be attached to the walker. Assist as necessary.
  4. Observe responses
    • Look for any of the following during the activity:
      • Signs of distress or discomfort
      • Signs of infection
      • Signs of change in anticipated performance level
  5. Report
    • Report back to the health care team member who requested that you assist with the mobilization.
    • Provide information regarding such factors as distance travelled, any observed changes in comfort, or performance, and any assistance offered to Ms. Jackson for handling the oxygen delivery system and/or mobility equipment.
  6. Record
    • Depending on the unit, there may be specific locations where you record that you completed the mobilization and any observed responses. Examples may be a walking communication clipboard or whiteboard, the patient chart, or a flow sheet.

Evaluate your performance and consider the following:

  • What worked well?
  • What didn’t work? Why? How would you approach this type of situation differently in the future?
  • Are there any areas where you may need to seek additional support? Who could you speak to get this support?

© Province of British Columbia. This material is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License (CC BY-SA 4.0).

Download Student Handout: A Case Example: Assisting a Patient to Mobilize with Oxygen in Acute Care [PDF].

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:

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.

STUDENT HANDOUT
Case Studies: Working with Diverse Clients and Families

DIRECTIONS: In groups, consider the following case studies and respond to the discussion questions below:

Juliana is an HCA who was recently hired by a home support agency. One of the first clients she is assigned to visit is Mr. James Johnson. Jim is a 63-year-old man and former intravenous drug user who is living with HIV and is receiving end-of-life care for Stage 4 liver cancer. He has been prescribed medical marijuana to manage his pain.

Jim’s wife, Karen, cares for him 24 hours per day. Juliana is assigned to visit for respite care, four hours, twice per week. On this first visit, Karen does not want to leave the house because she doesn’t know Juliana and is concerned Juliana won’t know what Jim wants or needs. Karen shows Juliana around the house and is friendly towards her, but spends most of the time sitting by Jim’s bedside, frequently patting his hand or hugging him. 

Juliana’s training did not include much information on HIV, drug use, or medical marijuana. Her personal values and beliefs make her uncomfortable with the situation. She is polite, but makes sure to wear gloves whenever she touches Jim, any of his belongings, or even when she shakes hands with Karen. When it is time to leave, she tells Karen that maybe another HCA will come for the next visit.


Manpreet works as a home support worker and is assigned to work with Mr. Brent Mead. Brent is a 43-year-old man who is paralyzed from the waist down as the result of a motor vehicle accident. Brent works as a freelance writer and lives with his husband, Jordan. Manpreet is assigned to assist with personal care, for two hours, five mornings per week.

On the first visit, Brent and Jordan show Manpreet the morning routine. This is Manpreet’s first time working with a gay couple and she hasn’t received much education about sexual diversity. Brent and Jordan are friendly towards Manpreet, but she feels uncomfortable and is unsure of how to respond when Brent and Jordan are affectionate towards one another. Manpreet avoids eye contact with Brent and Jordan and is quiet and reserved during the visit. She considers contacting her employer to ask if she can be excused from this assignment.

For each scenario, discuss:

  • Did the HCA exhibit professional behaviour? Why or why not?
  • Consider and discuss major concepts of this course that could help the HCA to act professionally. For example:
    • Providing person-centred care
    • Supporting personal preferences and choices of the client
    • Respecting individuality
    • Working with families
    • Valuing diversity
    • Respecting choice of alternative medicines and treatments
    • Protecting personal safety
  • As an HCA, how should you respond when you encounter a situation that is not in alignment with your personal values or beliefs?
  • As an HCA, how should you respond to a situation you are not familiar with? Where can you seek support to increase your understanding?
  • As an HCA, do you have the right to refuse an assignment? On what basis (if any) might this be possible?

© Province of British Columbia. This material is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License (CC BY-SA 4.0).

Download Student Handout: Case Studies: Working with Diverse Clients and Families [PDF].

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-

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

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

Health Care Assistant: Introduction to Practice

4

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:

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:

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.

STUDENT HANDOUT
Unfolding Case Study: Caring for Peter Schultz
Client and Family Experiences with Different Health Care Settings

DIRECTIONS: In your group, review your assigned scenario(s) describing the client and family experience with various health care agencies and settings. After reading, work together to identify the positive aspects and challenges described in the scenario and be prepared to share your observations with the larger group.

  1. Adult Day Program
    • Women from various agencies came to the house to interview Peter and myself. They arranged for Peter to spend one day a week at an Adult Day Program. Peter was cross about going and didn’t like it at first, but after a couple of weeks I think he quite looked forward to it. Peter was often called on to sing a song or recite one of the many poems he knew by heart. One of his favourite activities was the bell choir. By the time residential care was needed, he was attending the program three times a week, which was a Godsend to me.
  2. Home Support
    • Community services also introduced me to home support. This was such a wonderful help to me. An HCA came every morning and got Peter up, bathed and shaved him, dressed him, and prepared his breakfast. Unless you have had to do so, you can’t imagine how hard it is to help someone who resents being helped and thinks he doesn’t need to be bathed, shaved, toileted, or dressed, especially if you are the spouse. I can never thank these HCAs enough for all they did for me.

      I did the vacuuming and found it very tiring. I thought about someone to do it for me and people coming in to bathe Peter. I got myself all upset, feeling the intrusion of strangers in my home and then was filled with guilt because they were all here to help, then sadness that there were some places I couldn’t take him.
  3. Respite Care
    • Also available were respite times. If you were a caregiver, you were entitled to four weeks of respite a year. This meant your loved one could be cared for in a residence for a week while you had a rest. It didn’t help at first because I felt so guilty, but after a year or two, I really looked forward to some time by myself.
  4. Residential Care
    • I just came home from the residential care home. I took Peter there on the 26th of April, 2004. I took his clothes, his slippers, the toiletries, a harmonica, the large print Bible our daughter had given him, this German Bible written in old-fashioned script, which he could still read without glasses. Drove into the yard and parked.
    • “Where are we?” he asked.
    • “I need a little rest, honey, so you are going to stay here for a while.”
    • He accepted that. I hauled the suitcase out of the trunk. He insisted on carrying the heavy thing. I punched in the code and the door opened. We went through it. The door closed. It was the beginning of our “involuntary separation.”
    • ***
    • I am often amazed at the competence and kindly patience of the HCAs in the care home. Peter is at a table where five people need lots of help, but that never seems to bother the HCAs. They simply slide around from one to another on their wheeled chairs, keeping an eye on them all.
    • You might expect a dining room full of elderly people with cognitive and/or physical challenges to be a pretty gloomy place. Not so. Most of them look forward to meal times and most of them usually enjoy the food. The servers are all so friendly and pleasant, calling the clients by their names and remarking about their clothes or hairstyles, congratulating on birthdays and anniversaries. All over the room there is uplifting chatter and merriment, the HCAs joining in as they stroll around watching out for anyone needing help or attention, gracefully solving any dilemma that crops up. The clients could hardly be better cared for, in my opinion. I am thankful that Peter is living here.

Metzger, Z. B. (2010). The Last Lap of the Long Run, Addendum to “On the Long Run”: An Account of our Travels with Dementia. This material is licensed under a CC BY-SA 4.0 licence.

Download Student Handout: Client and Family Experiences with Different Health Care Settings [PDF].

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

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.

STUDENT HANDOUT
Problem-Solving and Decision-Making Exercise

DIRECTIONS: Consider the following problem:

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.

Use a problem-solving, decision-making process to analyze this problem and come to a decision that best fits for you at this point in time. Document each step in your process.

  • Analyze the problem:
    • What do you know about the choices available to you?
    • What are the pros and cons of employment in various settings (community, residential, acute care)?
    • What are the pros and cons of continuing your education at this time?
    • Are there other options you might consider?
    • Do you need more information? If so, how will you get it?
    • What are your particular talents, abilities, and preferences?
    • What roles and responsibilities do you have outside of work?
    • How do these fit with the choices you are considering?
    • What are your overall goals or desired outcomes? What is most important to you?

Use a table like the following to analyze the pros and cons (for YOU) of each choice.

Options Positive Consequences Negative Consequences
  • Based on your analysis, what is the best choice(s) for you at this time?
  • Based on your choice(s), what are your next steps? How will you evaluate your choice(s)?
  • Self-reflection: Was this a new way for you to come to a decision? How did it feel to you? Were you happy with the outcome? What did you learn from the process?

© Province of British Columbia. This material is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License (CC BY-SA 4.0).

Download Student Handout: Problem-Solving and Decision-Making Exercise [PDF].

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.
Major elements of a professional approach to practice What I’ll need to know and be able to do in order to reflect professionalism in my practice
EXAMPLE

Working collaboratively with other members of the health care team

Need to know and understand:
  • The health care system in British Columbia.
  • Roles and responsibilities of various members of the health care team within various settings.
  • The roles and responsibilities of HCAs within various settings.
  • Legal and defined limitations and obligations of HCAs.
  • What to do when a situation exceeds defined parameters of one’s role.
  • Supervision and delegation of tasks.
  • Lines of communication and how these might vary in different settings.
  • Basic concepts of team development and group processes.
  • Benefits and challenges of working in a team.
  • Facilitating effective team functioning – principles of collaboration.

Need to be able to:

  • Use caring, respectful communication with all members of the health care team.
  • Seek clarification, guidance, and assistance from other health team members when needed.
  • Contribute observations and information to care planning sessions.
  • Communicate changes in the client’s health status to the appropriate health team member in a timely fashion.
  • Communicate with confidence and appropriate assertiveness.
  • Offer support and assistance to other health team members as appropriate.
  • Report and record relevant information in a clear, concise, and objective manner.
  • Identify problems, concerns, and conflict within the health team and discuss these with appropriate team members.
  • Approach problems or conflict in a constructive manner.

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.
  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.

STUDENT HANDOUT
Case Scenarios – Ethical Practice Considerations and Employer Policy

DIRECTIONS: Consider and discuss the following scenarios involving ethical dilemmas. Put forward suggestions based on what you have learned in the course. As relevant, go to your health authority website to refer to a policy that could be used for guidance.

You are an HCA student and it is your first day of clinical. After the afternoon debrief, you receive a text message from a fellow student that states the following, “Can’t stand working with Susan – slowest partner possible!” You notice that the text message is addressed to the entire clinical group, except for Susan. What do you think of this text? How will you respond?


You enjoy working with your colleague, Sandy, because she is friendly and outgoing with the health care team and clients of the care home where you work. You have noticed that Sandy spends a lot of time on her smartphone, checking texts and emails during her shift. One day you are eating lunch with her and she shows you some pictures of her posing with one of the clients that she has taken with her phone. She shares that she has posted these pictures to her social media page. What do you think about Sandy’s use of her phone at work? How will you respond to the current situation?


You are an HCA working in acute care. One day, while you are assisting a client, his daughter takes a video of you and the client on her cell phone. She tells you that you have been very helpful to her father and she would like to post the video on his recovery blog so that friends and family can see the progress he has been making. How will you respond to this situation?


Mr. Singh was a well-known business man and was considered a leader in your community. You got to know him and his family well as you served as one of his many care providers during his final illness. Shortly after his death, you are approached by one of your neighbours who is a newspaper reporter. She asks you for information about Mr. Singh. You were fond of Mr. Singh and would like him to be remembered for the fine gentleman he was. What will you do?


Mrs. Rosen is a 93-year-old woman who is physically frail but able to walk. She has been exhibiting signs of moderate dementia. When you are at work, at the complex care facility where Mrs. Rosen lives, Mrs. Rosen often follows you and tries to gain your attention. This makes it difficult for you to get your work completed, as Mrs. Rosen also follows you into the rooms of other clients. Another HCA suggests that you take Mrs. Rosen into to the lounge and tie her in a chair in front of the TV so she can’t bother you so much. What do you think of this suggestion and how would you respond to it? What are some other approaches that you could take?


Mrs. Subin mobilizes with a wheelchair and requires assistance with transferring. While eating lunch, she tells you that she needs to go to the bathroom right away. You are very busy, but you quickly take Mrs. Subin to the bathroom and assist her onto the toilet. After washing your hands, you rush back to the dining room. You forget to go back to help Mrs. Subin off the toilet. She gets tired of waiting, tries to get herself back onto the wheelchair and falls. Fortunately, Mrs. Subin is not badly hurt, just a bit shaken by the incident. What happened in this situation that might be legally compromising? How might the situation have been avoided? What can be done now?


Ms. Cedar is a 57-year-old client of your home support agency. Her diagnosis is multiple sclerosis. She is a bariatric client and has poor muscle control. She requires two HCAs to provide care on the days she has a shower. Today, you and your co-worker Jessie are helping Ms. Cedar with her shower. You notice that Jessie is quite rough in the way she handles Ms. Cedar. She also sounds angry when she talks to Ms. Cedar and raises her voice, even though Mrs. Cedar has no hearing loss. While you and Jessie are helping Ms. Cedar to transfer from the shower to her wheelchair using the ceiling lift, Ms. Cedar reaches out and puts her hand on Jessie’s arm for stability. Jessie slaps Ms. Cedar’s hand away, saying, “Don’t grab me.” What will you do at that moment? What will you do later?


Mr. Garret is a 77-year-old man who is a client on the acute medical ward where you work. His admitting diagnosis was pneumonia, and he is finishing a course of IV antibiotics. His history includes a CVA six years ago which resulted in swallowing difficulties and an inability to walk. He mobilizes using an electric wheelchair. He has a permanent J-tube for nutrition and can also have fluids by mouth if they are thickened to pudding consistency. Mr. Garret has not been off the ward very much since he has been in hospital the past few days. At home, he usually travels about his local community in his electric wheelchair, shopping or attending various activities. He is feeling much better today and has left the ward “to get some air.” When you go to the cafeteria to get your lunch, you see him sitting at a table with two other hospital clients. He has a large bottle of soda pop. You know this is not safe for him to drink because of his swallowing problems. What will you do?

© Province of British Columbia. This material is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License (CC BY-SA 4.0).

Download Student Handout: Case Scenarios – Ethical Practice Considerations and Employer Policy [PDF].

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.

STUDENT HANDOUT
Workers’ Rights and Responsibilities

Workers have the right to:

  • Information, instruction, and training about safe work procedures and how to recognize hazards on the job.
  • Supervision to make sure they work without undue risk.
  • Equipment and safety gear required to do the job safely (workers are responsible for providing their own clothing to protect themselves against the natural elements, general purpose work gloves, safety footwear, and safety headgear).
  • Refuse to perform tasks and work in conditions they think are unsafe, without being fired or disciplined for refusing.
  • Participate in workplace health and safety committees and activities.

As a worker, you are responsible for working without undue risk to yourself or others.

To keep safe on the job:

  • Don’t assume you can do something you’ve never done before. Ask your supervisor to show you how to do it safely before you begin work. Ask your employer for safety training.
  • Use all safety gear and protective clothing when and where required.
  • Always follow safe work procedures and encourage your co-workers to do the same.
  • Immediately correct unsafe conditions or report them right away to your supervisor.
  • Know how to handle any hazardous materials or chemicals you use on the job.
  • If you have any doubts about your safety, talk to your supervisor.
  • Tell your supervisor of any physical or mental conditions that may make you unable to work safely.

Source Document: WorkSafeBC (2013). Student WorkSafe Infosheet: Workplace Rights and Responsibilities. https://www.worksafebc.com/en/resources/health-safety/information-sheets/student-worksafe-infosheet-workplace-rights-and-responsibilities?lang=en

Download Student Handout: Workers’ Rights and Responsibilities [PDF].

DISCUSSION GUIDE
Workers’ Rights and Responsibilities

WORKERS’ RIGHTS

  1. Right to a safe workplace
    • Consider: What makes a workplace safe?
      • Employers, owners, supervisors, workers who act in ways which keep themselves and others free of injury and disease.
      • Work is planned, anticipating and taking steps to minimize hazards.
      • Direct care workers are supervised so that issues can be addressed as they arise.
      • Everyone is encouraged to report both negative (“I saw something that wasn’t right”) and positive (“I think I found a possible way of helping a client demonstrating response behaviours”) situations that they experience.
      • Information about known hazards (including patient/resident/client) is given to the right people.
      • Workers get the equipment needed to do their jobs properly.
      • There are adequate numbers of workers with appropriate skills to provide required care.
      • Provisions are made to respond when things go wrong to restore a safe situation.
      • Lessons are learned from incidents and mistakes.
      • Work is viewed to be “proper” vs. “improper” not “safe” vs. “unsafe.”
  2. Knowledge of the hazards they face
    • Consider: What types of hazards do HCAs face in their daily work?
      • Overexertion/musculoskeletal injuries (MSI) from mobilizing people and equipment.
      • Falls resulting from slipping and tripping.
      • Violence (could result from aggression, responsive, reactive, or challenging behaviours). Greater risk with people with cognitive impairment, some active mental health disorders (psychosis, delusions), alcohol/drug impairment or withdrawal.
      • “Life” hazards, such as walking into objects, getting hit by doors, etc.
      • Infectious diseases, such as norovirus, hepatitis, HIV.
      • Other possible hazards (e.g., Hazardous chemicals, radiation, cytotoxic drugs).
    • Consider: How might hazards look different between facility and community settings?
      • There may be more unknowns and fewer interventions in a home setting.
      • Most homes were never built as places to provide care.
      • There may be fewer people to talk to if you aren’t sure about a situation.
      • Hazards related to care in the community that you aren’t as likely to be exposed to in a facility include: driving, animals, hoarding, and exterior stairs.
      • Hazards may also impact the people being cared for, such as unsafe handling, behavioural challenges, fall hazards, etc. The hazard may have greater impact on the resident (after a fall, a worker may be bruised, but a resident may have a broken bone (or worse).
  3. Safe Equipment
    • Consider: What types of equipment keep HCAs safe?
      • Lifting equipment
      • Shoes
      • Safety engineered needles and sharps containers
      • Soap and hand sanitizer
  4. Training (including orientation)
    • Consider: What types of safety-related education or training might HCAs receive at work?
      • Orientation
      • Safe resident handling (equipment specific training)
      • Violence prevention, including expected action in the event of an incident
      • Infectious disease prevention
      • Bullying and harassment
      • Safe driving
    • Consider: What is typically included in an orientation?
      • The name and contact information for the new worker’s supervisor.
      • The employer’s and worker’s rights and responsibilities including the reporting of unsafe conditions and the right to refuse to perform unsafe work.
      • Workplace health and safety rules.
      • Hazards to which the new worker may be exposed, including risks from robbery, assault or confrontation.
      • Working alone or in isolation.
      • Violence in the workplace.
      • Personal protective equipment.
      • Location of first aid facilities and means of summoning first aid and reporting illnesses and injuries.
      • Emergency procedures.
      • Instruction and demonstration of the new worker’s work task or work process.
      • The employer’s health and safety program.
      • Workplace Hazardous Materials Information System (WHMIS).
      • Contact information for the occupational health and safety committee.
  5. Supervision
    • Consider: Who are supervisors?
      • Anyone who instructs, directs, and controls workers in the performance of their duties.
      • Not always obvious from their job title – it isn’t a co-worker.
    • Consider: What are supervisors’ responsibilities?
      • Ensure the health and safety of all workers under their direct supervision.
      • Be knowledgeable about the regulations applicable to the work being supervised.
      • Ensure that the workers under his or her direct supervision are made aware of all known or reasonably foreseeable health or safety hazards in the area where they work.
    • Consider: What traits would you like to see in an effective supervisor?
      • Takes a personal interest in my well-being.
      • Gathers information before acting.
      • Has good listening skills and empathy.
      • Has a presence during the workday, without micromanaging.
      • Provides feedback in private, in measures appropriate to the size of the issue.
      • Creates an atmosphere in which people are willing to admit to mistakes.

WORKERS’ RESPONSIBILITIES

  • Consider: What are the responsibilities of the worker?
    • To protect their own health and safety as well as others affected by the worker’s acts or omissions.
  • Consider: Who are these “others”
    • Coworkers
    • Clients
    • Families/members of the public
  • Consider: As an HCA, how can you protect your own health and safety?
    • Follow instructions.
    • Use lifting equipment.
    • Back away from escalating situations.
    • Take a flexible approach to care.
    • Keep your vaccinations current.
    • Wash your hands, follow infection control protocols.
    • Stay within your role and parameters of practice.
    • Ask for clarification or help when you aren’t sure about the right thing to do.
    • Report little issues to your supervisor, before they become big ones.
    • Refuse work that you believe to be unsafe.
    • Do not work while impaired (sources of impairment can include fatigue, drugs or alcohol, medical conditions, distractions from your life outside work).

Download Discussion Guide: Workers’ Rights and Responsibilities [PDF].

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 Authorityhttp://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

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

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

  • An instructor’s guide and presentation for teaching core competencies in elder abuse prevention, detection, and response in British Columbia (6–8 hours).

British Columbia College of Nurses and Midwives, (n.d.). Social media scenarios: Complaints to the college. https://www.bccnm.ca/RPN/learning/socialmedia/Pages/Social_media_scenarios.aspx

  • Three case studies describing inappropriate sharing of client information on social media (10–15 minutes for review and discussion).

Social Care Institute for Excellence. ( n.d.). Dignity in care videos. https://www.scie.org.uk/search?sq=Dignity+in+Care+videos

  • A large selection of videos and messages that explore dignity in care. Topics include communication, practical assistance, social inclusion, pain management, choice and control, and nutrition for older adults (10–15 minutes for review and discussion of each video.)

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

  • Video and messages for practice to illustrate the importance of privacy and confidentiality (10–15 minutes for review and discussion).

WorkSafeBC. (n.d.). My handbook. https://www.worksafebc.com/en/law-policy/occupational-health-safety/searchable-ohs-regulation/personal-handbook

  • Students can use My handbook to search for and store parts of OHS Regulation (e.g., violence in the workplace, Ergonomic (MSI) Requirements, etc.). *The handbook is only stored for the duration of the web session, but can be downloaded or printed for future reference.

WorkSafeBC. (2011, July). Supervision in health care: Know your responsibilities. https://www.worksafebc.com/en/resources/health-safety/books-guides/supervision-in-health-care-know-your-responsibilities

  • A series of four videos and a discussion guide describing how supervision in health care settings contributes to safety.

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

  • A video and discussion guide describing how planning can increase safety when a two-person approach is used for care (15–20 minutes for review and discussion).

Health 1: Interpersonal Communication

5

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:

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:

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:

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.

STUDENT HANDOUT
Unfolding Case Study: Caring for Peter Schultz
Evaluating Communication Techniques

DIRECTIONS: Read the following conversation between Peter and his wife, Eve. Make a list of the communication techniques that Eve uses to connect with Peter during the conversation and then prepare to share your findings with the larger group.

I found Peter sitting alone on the loveseat just around the corner from the nurses’ station, so I sat down beside him. A couple of HCAs were passing us once in a while as they tended to their duties. Peter didn’t speak and neither did I for quite some time. Then he said, “Do you think you could arrange a wedding for some time in the fall?”

“Oh, who is getting married?”

“I am.”

“Who are you going to marry?”

“The girl next door.”

“Really? What is her name?”

“I don’t remember.”

“Is it Jenny?”

“Yes, that’s her name.”

Aha! Jenny lived across the road from Peter when he was a kid. “You can’t marry her. She is already married.”

He gave me a look of incredulity, but said nothing. A few minutes of silence. Then he said, “Well, do you think you can arrange a wedding for some time in the fall?”

“Peter, how old are you?”

“I am 15 in about half a year.”

“I really think you are too young to get married. A girl might be able to handle it, but it’s really much too young for a man to marry.”

“I’d really like your opinion, though. Do you think she would make a good farmer’s wife?”

“Yes, I do. I’m sure she would make an excellent farmer’s wife. She has lived on a farm all her life, and I’m sure she knows exactly how to be a good farmer’s wife, but I still feel you are both too young to be getting married.”

More silence. “Well, I’d like you to try to arrange a wedding for the fall.”

“But, Peter, do you have a farm?”

“No, I don’t.”

“Well, how can you think of getting married if you don’t have a farm? You would have to live with your parents. That wouldn’t be fair to Jenny.”

He thought that over for a while. “You’re right. I guess I’d better concentrate on getting a farm first.”

Who did Peter think I was as he asked for my opinion? Could it have been his mother or perhaps his elder sister? Soon the snack cart came along. We each enjoyed a cup of coffee and a cookie. I kissed him goodbye and went home smiling, because Jenny was still not married when Peter married me.

Metzger, Z.B. (2010). The Last Lap of the Long Run, Addendum to “On the Long Run”: An Account of our Travels with Dementia. This material is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License (CC BY-SA 4.0).

Download Student Handout: Evaluating Communication Techniques [PDF].

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.

STUDENT HANDOUT
Problem-Solving Exercise: Resolving Conflicts

DIRECTIONS: Consider the following problem/dilemma:

Carol and Jason, both in their early 30s, have been living together for less than a year. They have a lot in common and enjoy each other’s company – going to hockey games and movies together, skiing in the mountains in the winter and hiking in the summer. They share responsibilities around the apartment and each contributes equally to the costs.

A conflict has arisen, however, that is causing considerable strife in their relationship. Jason has a small group of buddies that he has socialized with since high school. Carol has made it clear that she does not want to socialize with these friends (all guys). She refers to them as “losers” and “adolescents.” Jason is devoted to his friends and enjoys the crazy and comfortable camaraderie he experiences when he is with them.

Both Carol and Jason had thought that their relationship had potential to blossom into a long-term commitment, even marriage. This conflict is causing them both to reconsider.

  1. Define the Conflict
    • Facts:
      • What is the relevant information here? How might Carol get more information on the rewards that Jason gets from these friends? How can Jason discover exactly what Carol doesn’t like about these friends?
    • Feelings:
      • How might Carol feel when Jason goes out with his buddies?
      • How might Jason feel when Carol refuses to spend time with his buddies?
    • Negative outcome:
      • How might this relationship deteriorate if Jason continues to spend time with his buddies?
      • How might the relationship deteriorate if Carol continues to comment negatively about these friends?
    • Positive benefits:
      • What opportunities might be gained if Jason continues to see these friends without Carol?
      • What is the best thing that could happen?

    Is there further information you need to adequately understand this problem? If so, what is it and where would you get this information?

  2. Examine Possible Solutions
    • Based on your discussion, consider as many possible solutions as you can to this conflict. Try to think of obvious and not-so-obvious alternatives. For each one, consider the positive and negative outcomes – for both Carol and Jason.
      Options Positive Consequences Negative Consequences
  3. Based on your analysis, what is the best choice for Carol and Jason at this time? Some questions to consider: Is this a win-win solution (i.e., do both partners gain) or, alternately, are the losses shared? Is the solution worth the costs to each person and/or to their relationship? Are the costs and rewards evenly distributed between both partners? Might other solutions be more effective?
  4. Evaluate the Solution: What questions would you want to ask to find out if the solution was, in fact, successful?
  5. Self-reflection: Was this a new way for you to come to a decision in a conflict situation? How did it feel to you? What did you learn from the process?

© Province of British Columbia. This material is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License (CC BY-SA 4.0).

Download Student Handout: Problem-Solving Exercise: Resolving Conflicts [PDF].

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:

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:

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:

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:

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

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:

Practising assertive communication

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

STUDENT HANDOUT
Practising Assertive Communication

DIRECTIONS: With a partner, practise using assertive communication. Alternate so each student has an opportunity to practise in the HCA role. Debrief after each scenario.

Student 1 (Team leader):

“Hi                       . I’m going on my lunch break now. Janice will cover this team as team leader while I’m on my break, but she is really busy, so you can go ahead and change Mr. Grey’s IV bag when it’s empty. The new one is on the bedside table all ready to go.”

Student 2 (HCA):

You know this is not in your defined role as an HCA. What will you say to the team leader?


Student 1 (Client’s daughter):

“We are so appreciative of what you do for our father. Please accept this bottle of wine as a thank you from our family.”

Student 2 (HCA):

You know you are not allowed to accept gifts from clients. What will you say?


Student 1 (HCA student on clinical in a complex care facility):

“Excuse me, could you help me to transfer Mrs. Jones? I know that the policy is to always have two people when using the ceiling lift.”

Student 2 (HCA at a complex care facility – acting as a mentor):

“Just do it on your own. We don’t have time to have two of us use the lifts. This is the real world.”

Student 1 (HCA student on clinical in a complex care facility):

How would you respond?


Debrief Questions

  • How comfortable were you saying “no” to the request?
  • Did you use assertive vs. aggressive communication?
  • Consider what you might say if the other party (i.e., team leader, client’s daughter or HCA) said to “just do it anyway?”
    What are possible outcomes of not using assertive communication in these situations (e.g., risk to client and personal safety, etc.)?

© Province of British Columbia. This material is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License (CC BY-SA 4.0).

Download Student Handout: Practising Assertive Communication [PDF].

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.

STUDENT HANDOUT
Scenarios: Practising Effective Communication Skills

DIRECTIONS: Read the scenarios you have been assigned. The student taking the role of the HCA should first take a few minutes to 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 using 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. After each role play, take a few minutes to complete the debrief discussion questions.

You are an HCA working for a home support agency. You have been asked to visit James Smith, a 72-year-old client with diabetes. When you arrive at his home, you notice that he has several candy wrappers at his bedside. You understand that you are required to report this to your supervisor and when you mention this, Mr. Smith becomes upset and shakes his cane at you.


You are an HCA working in a residential care home and have been assigned to care for Mrs. Chan, a 90-year-old lady who has just moved into the care home. Mrs. Chan emigrated from China and has been living in Canada for 10 years. When you enter her room, she is crying because she misses her daughter who is no longer able to care for her at home.


You are an HCA working in acute care. Today has been a challenging day for you; you are nearing the end of your shift and are feeling tired and impatient. Before you leave, the team leader asks you to check on Amit Singh. When you enter the client’s room, his daughter starts to complain about the care Mr. Singh has received from you that day.


You have recently been hired as an HCA in assisted living. Lately, you have noticed that one of the staff members, Jan, seems to be avoiding eye contact with you. One afternoon, when you greet her, Jan does not respond and walks away. A week later, another staff member tells you that Jan has been talking about you in the break room. How should you approach Jan about this situation?


You are an HCA student who has recently started your practicum placement in assisted living. It is flu season and two of the staff members have called in sick. You are helping Mr. Soong get ready for bed, and while he is in the bathroom, the LPN enters the room. “I’m swamped!” she says, setting down Mr. Soong’s medication. “Can you come and report back to me after Mr. Soong takes this Tylenol?” How will you respond to the LPN?


Today is the first day of your clinical placement in multi-level/complex care and you are assigned to shadow Ray, one of the HCAs. While you are assisting with Mr. Alveraz’s morning routine, Ray asks you to help him with the mechanical lift. You politely explain to Ray that you are not permitted to assist with lifts until your instructor has signed you off. Ray sighs loudly, and says, “Oh, brother. I’ve worked with your instructor before. Whenever she brings students here, everything takes twice as long!”


Debrief Discussion (after each role play):

After each role play has been completed, 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/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?

© Province of British Columbia. This material is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License (CC BY-SA 4.0).

Download Student Handout: Scenarios: Practising Effective Communication Skills [PDF].

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

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

Health 2: Lifestyle and Choices

6

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:

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

Emotional

Cognitive

Spiritual

Social

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

Components of Health Symptoms Causes Approaches
Physical
  • Pain
  • Fatigue
  • Constant infections (e.g., colds)
  • Insomnia
  • Constant accidents
  • Lack of energy
  • Unhealthy eating habits
  • Inadequate exercise
  • Using harmful substances (e.g., coffee, tobacco, drugs)
  • Not getting enough sleep
  • Sleeping too much
  • Unhealthy hygiene habits
  • Get more exercise
  • Eat better
  • Sleep more
  • Stop or modify bad habits (e.g., smoking, drinking, drugs)
  • Massage, chiropractic, or physiotherapy
  • Medication, surgery, or other physical therapies
Cognitive
  • Memory loss
  • Inability to concentrate
  • Loss of humour
  • Loss of imagination
  • Apathy
  • Confusion
  • Poor decision-making ability
  • Poor problem-solving ability
  • Too little mental challenge
  • Too much happening — feeling over-extended
  • Lack of goals
  • Boredom
  • Apathy
  • Find new pursuits and challenges
  • Read more on different topics
  • Go back to school
  • Write a diary
  • Take a course on decision-making/problem-solving
  • Watch less TV
  • Join a discussion group
  • Change jobs
Social
  • Loneliness
  • Feelings of being unloved or unappreciated
  • Withdrawal from friends and family
  • Extreme shyness
  • Avoidance of social interactions
  • Too many people to please
  • Loss of a job
  • Moving from one city to another
  • Change in status (e.g., from worker to student)
  • Join an interest group
  • Join a sports team
  • Reach out to others
  • Become more assertive
  • Change entertainment patterns
  • Smile more at others
  • Initiate contacts with family and friends
Emotional
  • Depression
  • Loss of confidence
  • Uncontrolled anxiety
  • Aggressive acting out
  • Feelings of rejection
  • A sense of being unworthy
  • Uncontrolled emotions
  • Feelings of constantly being stressed out
  • Failure
  • Lack of direction
  • Loss of self-confidence or self-esteem
  • Increasing demands and stress
  • Use positive self-talk
  • Learn a new way for handling negative emotions such as anger and aggression
  • Keep a mood diary
  • Get feedback from trusted friends
  • Find ways to be more accepting of self
Spiritual
  • Guilt
  • Despair
  • Loss of meaning
  • Helplessness
  • Emptiness
  • Doubts
  • Disappointments
  • Lack of commitment
  • Uncertainty about direction in life
  • Uncertainty about personal values
  • Clarify values
  • Spend time in nature
  • Make a commitment to something
  • Undertake personal reflection
  • Take up meditation
  • Engage in activities that give you joy or contentment

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

Have students work in small groups. Each group chooses, or is assigned, two to three determinants of health. The groups develop and write down scenarios to illustrate how the multiple determinants of health interrelate and influence health. The groups then share their scenarios with the rest of the class.

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.

STUDENT HANDOUT
Evaluating Health Information Online: A Checklist

When seeking health information online, it is important to keep in mind that the Internet is not regulated and anyone can set up a website. The criteria presented here will help to decide whether information found online is credible.

  • Does the website say who is responsible for the information and how you can contact them? Look for sections called About us, About this site, or Contact us. Be wary if you can’t find out who runs the site and how to contact them.
  • Is the purpose of the website to give information, or is it trying to sell you something? Commercial websites (with a URL address ending in .com) might provide information that supports what they are selling and not a balanced view. Be sure that the information presented on the website is suitable for the topic and is consistent with information seen from other sources.
  • Does the web address confirm that its scope and/or purpose is suitable? For example, .edu for educational sites, .gov/gc.ca for government sites, .org for non-profit organizations, etc. You can usually get reliable health information from non-profit educational or medical organizations and government agencies. Health information should be unbiased and balanced, based on solid medical evidence, and not just someone’s opinion.
  • Does the website give references to articles in medical journals or other sources to back up its health information? The most trustworthy health information is based on medical research. The website should provide links to other resources that can be accessed for information on this topic.
  • Is the information provided easy to understand and presented clearly? Technical or unfamiliar terms should be clearly explained.
  • Is there evidence that the website is well maintained and does not include misspellings or broken links? Websites should tell you when the information was prepared and updated, and resources and links should be recent.

Note: The material used to create this checklist has been obtained from the following sources:

  • Evaluating Information Found on the Internet, Johns Hopkins Sheridan Libraries. Retrieved from http://guides.library.jhu.edu/content.php?pid=198142&sid=1657518
  • Internet Research: Finding and Evaluating Resources, Simon Fraser University Library. Retrieved from https://www.lib.sfu.ca/help/research-assistance/finding-evaluating-resources

Download Student Handout: Evaluating Health Information Online: A Checklist [PDF].

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.

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.

STUDENT HANDOUT
Lifestyle Change Project

The purpose of this project is to provide you with an opportunity to apply knowledge learned in Health 1: Lifestyle and Choices to the development and implementation of a personal lifestyle change process.

  1. Identify the need for a health-related change or alteration.
    • Based on assessments you have done of your current lifestyle choices related to health, what one thing would you like to change or alter?
    • What will be the payoffs in making this change or alteration (i.e., why do you want to do it)?
  2. Set your goal(s).
    • When deciding on a goal, remember that it is best to start with small achievable goals rather than big life-changing goals that are more likely to fail. It is much better to have small successes than large failures.
    • Write one or two goal statements that describe the behaviour or lifestyle choices you want to change. Phrase your goal(s) in positive language e.g., “I will …”.
    • Your goal statement(s) should reflect specific, measurable behaviours rather than general outcomes. For example, “I will go for a 30-minute walk every day” is better than “I will get more exercise.” “I will eat five servings of fruit and vegetables every day” is better than “I will eat more fruits and vegetables.”
  3. Plan your change process by asking yourself:
    • What will I have to give up to make this change or alteration?
    • What difficulties or obstacles (habits, thoughts, feelings, attitudes, time demands, inadequate social supports, etc.) are presently holding me back or might be problems in achieving my goal(s)? How might I overcome these obstacles?
    • Who are the people in my life who will support me?
    • What other ways might I build in support for this change? Are there ways I can reward myself for success? Are there people who might join me in my activities?
    • What are the steps in the achievement of my goal(s)?
    • How can I make sure that I am recognizing my successes along the way?
  4. Carry out the change process.
    • Set yourself a target date for the achievement of your lifestyle change goal(s) and begin the process.
  5. Evaluate your experience. In reviewing your experience with the lifestyle change process, discuss:
    • Your achievements. Did you meet your goal(s) fully? Partially? Did you have to change your goal(s) as the process progressed?
    • Any problems or difficulties encountered in achieving your goal(s). How might these have been avoided or diminished?
    • What you learned about lifestyle change from undertaking this project. How might this learning be useful to you in your role as a care provider? What suggestions would you have for others who might want to make changes of a similar kind?

Remember: Even if you aren’t completely successful in meeting your original goal, you will be successful in learning something about yourself and your needs that can be very useful to you in the future as you strive to make health-enhancing lifestyle choices.

© Province of British Columbia. This material is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License (CC BY-SA 4.0).

Download Student Handout: Lifestyle Change Project [PDF].

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

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

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

Online Learning Tools and Apps

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

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

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

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

Healing 1: Caring for Individuals Experiencing Common Health Challenges

7

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.

STUDENT HANDOUT
Unfolding Case Study: Caring for Peter Schultz
Cerebral Vascular Accidents (CVAs)

DIRECTIONS: Read the following account describing the CVA experienced by Peter Schultz. Working in small groups, apply your 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?

What I thought was the beginning happened March 3, 1995, when Peter was 77 [years old]. I awoke in the night to hear Peter in the bathroom coughing and hacking as though to rip his throat out. He finally stumbled back to bed and went to sleep. I arose fairly early to prepare breakfast for his sister and her husband who had been visiting us and were leaving that morning for Alberta. We three were sitting at the table waiting for Peter who was slow making an appearance. When he did, we couldn’t understand a word he said as his speech was so confused. He didn’t seem to realize there was anything wrong. We struggled through breakfast trying to persuade him to see a doctor, but he insisted he simply had a little sore throat, so finally our guests left and we began our day.

Peter lay down on the couch and slept. Something was wrong, but I didn’t know what. Later I went to my daughter’s house to give the kids a piano lesson. When I told them what had happened, my son-in-law immediately phoned the doctor who said I must bring Peter into the office. I went home and did that.

“His blood pressure is out of sight,” the doctor said. “He’s had a stroke. I’ll arrange for a brain scan and we’ll see what the damage is.”

The scan showed that he had had several prior strokes that hadn’t been obvious. Medication for high blood pressure was prescribed and I made sure Peter took his pills each day. I had no experience looking after someone who was sick, but Peter didn’t seem sick anyway, just a bit confused sometimes. However, as time went on I began to notice some personality changes. He was often rude to me in front of friends, cried easily, and clung to me almost obsessively; table manners seemed to slip away and he was sometimes extremely impolite.

Metzger, Z.B. (2010). The Last Lap of the Long Run, Addendum to “On the Long Run”: An Account of our Travels with Dementia. This material is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License (CC BY-SA 4.0).

Download Student Handout: Cerebral Vascular Accidents (CVAs) [PDF].

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:

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:

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.

STUDENT HANDOUT
Common Patterns of Dying

Video Discussion Questions:

Consider these questions while watching Unprecedented – Common Patterns of Dying instructional video available on the Life and Death Matters website.

  • What key factors have changed the way we die?
  • What are the four common patterns of dying?
  • What information did you find most surprising or interesting?

Small Group Questions:

Read the case scenario below, describing the pattern of stuttering decline (“Stuttering Decline – The Roller Coaster”)

  • In your own words, describe the pattern of dying that is represented in this scenario.
  • What is the impact that this pattern of dying might have on Tom?
  • What is the impact on Sarah and the family?
  • As an HCA, identify ways that you can support Tom, Sarah, and the family.

As a Class:

  • Identify common health challenges that may result in the stuttering decline pattern of dying (e.g., organ failure, such as congestive heart failure, chronic obstructive pulmonary disease, end-stage kidney disease; or chronic progressive illnesses, such as Parkinson’s disease or dementia-related illnesses).
  • HCAs work with clients with chronic disease who may experience a prolonged period of dying that may occur over months or years. How can a palliative approach be integrated into providing care for these clients? How might different work settings (residential, community, or acute care) factor into this approach?

Stuttering Decline – The Roller Coaster

My name is Sarah. I am Tom’s wife and caregiver. Tom has chronic obstructive pulmonary disease, and although we have been dealing with it for over 15 years, the last eight years have been the hardest, with repeat hospital admissions, decreased abilities, and increased needs. I have heard it said that the typical patient with this disease goes to death’s door a number of times before dying. At least five times the children have gathered to say goodbye.

June 9: Last week the doctor came in and, squatting to make eye contact with Tom, asked us what we wanted. Tom said that he was tired – tired of hospitals, emergencies, tests, and more treatments. I very carefully suggested hospice. Tom and the doctor agreed.

June 15: We came home by transport ambulance. All the kids came home to help. In the middle of the night, I wept. I am exhausted. I wonder if he will die soon. I hope he will. I hope he won’t.

July 15: How long will this go on? It has already been eight years! The HCAs come five times a week now. I willingly let them help. Tom seems to enjoy them.

July 18: My, oh my, what a journey! This man of mine has always had a huge appetite. Now he is eating so little. It is hard for him to eat and digest and breathe at the same time. I try to feed him but even with all my effort, he eats very little.

August 9: Tom has been restless for the last three nights. He sits on the edge of the bed, tries to get up, then sits down. Then he wants up. We need to be with him because he is unsafe. He has more difficulty breathing. He is confused, sometimes talking to people who aren’t there. The other day he dreamt of his mom who died several years ago. His sentences are not making sense, his words jumbled. He was like this last year when he was really sick. He recovered then. I don’t think he will recover this time.

August 17: We celebrated our 60th anniversary two months early.

August 19: Tom is very weak, can manage sips of water. He is confused again.

August 20: It is with a sad heart that I tell you my Tom died this morning. He has been sick for 15 years.

Copyright © 2017, Life and Death Matters. This material is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License (CC BY-SA 4.0).

Download Student Handout: Common Patterns of Dying [PDF].

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.

Setting Up the Activity

A. Role Play

Have students work in pairs, with one acting as the client and the other as the HCA. Provide role play cards  in such a way that students do not see the card for the alternate role. The student acting as the client will read the Client Role Card and follow the directions provided. The student acting as the HCA will read the HCA Role Card and then use critical thinking skills to respond to the situation they are presented with. The Client Profile for each role play can be provided to both students and/or given to them to share.

Students playing the HCA role should be reminded to respond to the scenario based on their observations, communication with the client, and accompanying client profile (or assignment sheet and/or bedside care plan).

Students should be instructed to report any emergencies to the instructor, who could take on the role of the team leader.

Students should be directed to alternate roles after each role play and get new role cards from the instructor after completing required documentation (see B).

B. Documentation Exercise

After each role play is complete, the two students will prepare a written report describing the situation. If desired, the instructor could request that a specific documentation format is followed, such as the one to be used in the practice education setting. At a minimum, the following should be documented:

  • What the HCA observed, including symptoms the client reported to them.
  • What the HCA did.
  • When the HCA did it.
  • The client’s response, as observed by the HCA.

C. Debrief

After students have completed this activity, convene as a class to review the common health challenges presented. Discuss appropriate response(s) and reporting for each scenario, highlighting which situations would require immediate reporting to the team leader.

ROLE PLAY CARDS

ROLE PLAY 1: HCA ROLE CARD

You are working for a home support agency. Today you are visiting Jenny Smith for the first time. Enter the home, greet your new client and introduce yourself. Respond to the situation you are presented with.

ROLE PLAY 1: CLIENT ROLE CARD

Your name is Jenny Smith and you are 72 years old. After the HCA greets you, tell them you feel dizzy and sweaty and that you are hungry because you skipped breakfast today.

ROLE PLAY 2: HCA ROLE CARD

You are working in an assisted living residence. Today you will be escorting Mrs. Kaur to the dining room for lunch. Enter her room, greet her, and introduce yourself. Respond to the situation you are presented with.

ROLE PLAY 2: CLIENT ROLE CARD

Your name is Mrs. Kaur, and you are 88 years old. After the HCA provides introductions and checks your bedside care plan, they will ask you to walk to the dining room. As you get up from your chair, act dizzy. Sit down again and tell the HCA you feel dizzy.

ROLE PLAY 3: HCA ROLE CARD

You are working in a group home setting. Today you will be assisting Alicia Smith who has ataxic cerebral palsy. Enter her room, greet her, and introduce yourself. Respond to the situation you are presented with.

ROLE PLAY 3: CLIENT ROLE CARD

Your name is Alicia Smith, and you are 42 years old. You have ataxic cerebral palsy and are unable to speak. When the HCA arrives, use gestures to indicate that you are hungry.

ROLE PLAY 4: HCA ROLE CARD

You are working in an acute care setting. Today you will be providing care to Mr. Dhaliwal who has had hip replacement surgery. Enter his room, greet him, and introduce yourself. Respond to the situation you are presented with.

ROLE PLAY 4: CLIENT ROLE CARD

Your name is Mr. Dhaliwal. When the HCA enters your room, start coughing. Tell the HCA that you have chest pain and are feeling cold.

ROLE PLAY 5: HCA ROLE CARD

You are working in a residential care home. Today you will be assisting Rosa Martinez with her breakfast. Enter her room and greet her. Respond to the situation you are presented with.

ROLE PLAY 5: CLIENT ROLE CARD

Your name is Rosa Martinez. After the HCA greets you, act as if you are confused. Indicate that you have pain in your lower abdomen.

ROLE PLAY 6: HCA ROLE CARD

You are working in a residential care home. Today you will be assisting Julie Bates with her breakfast set up. Enter her room, greet her, and let her know that it’s time for breakfast. Respond to the situation you are presented with.

ROLE PLAY 6: CLIENT ROLE CARD

Your name is Julie Bates. After the HCA lets you know that it’s time for breakfast, tell her you don’t feel hungry. When the HCA follows up, tell her that you have a stomach ache.

CLIENT PROFILES

ROLE PLAY 1: CLIENT PROFILE

Jenny Smith is a 76-year-old female who lives alone.

Health Challenges/Diagnosis: Diabetes, neuropathy, significant visual impairment, history of falls, history of depression

ADLs: Partial assist with personal care

Mobility: One person assist with walker, unsteady on feet, history of falls

Nutrition: Diabetic diet, receives Meals on Wheels, family sometimes brings food (sweets), Jenny occasionally skips meals

Communication: English

ROLE PLAY 2: CLIENT PROFILE

Harpreet Kaur is a 92-year-old female living in an assisted living residence.

Health Challenges/Diagnosis: Parkinson’s disease with history of falls, arteriosclerotic heart disease, orthostatic hypotension

ADLs: Supervision in bathroom, requires cueing, appropriate cultural attire, raised toilet seat, meal set up

Mobility: Uses four-wheeled walker

Nutrition: Soft diet with fluids, plate protector, adaptive utensils, cup with lid

Communication: Speaks Punjabi and English

Cultural: Attends temple every Sunday

ROLE PLAY 3: CLIENT PROFILE

Alicia Smith is a 42-year-old female client who lives in a group home.

Health Challenges/Diagnosis: Ataxic cerebral palsy, expressive aphasia

ADLs: Full assist with personal care

Mobility: Risk of falls, assist with range of motion exercises

Nutrition: Soft diet, encourage small snacks throughout the day

Communication: Understands English, uses gestures to communicate when hungry

ROLE PLAY 4: CLIENT PROFILE

Jagdish Dhaliwal is a 73-year-old male in hospital following hip replacement surgery.

Health Challenges/ Diagnosis: Osteoarthritis, history of falls, CVA at age 68, dysphagia

ADLs: Assist client to sit (dangle) at side of bed (Q.I.D), one-person assist for dressing, assist with mouth care, commode for toileting, and deep breathing and coughing exercises

Mobility: Two-person assist to dangle and commode

Nutrition: Thickened fluids, dysphagia diet, cultural food preferences

Communication: Speaks Punjabi and English

ROLE PLAY 5: CLIENT PROFILE

Rosa Martinez is a 79-year-old female who lives in an assisted living residence.

Health Challenges/Diagnosis: Blind due to glaucoma, history of urinary tract infections

ADLs: Requires partial assistance with personal hygiene

Mobility: Uses white cane, assist with walking

Nutrition: Assist with meal set up/eating, record fluid intake, cranberry juice with meals

Communication: Speaks Spanish and English

ROLE PLAY 6: CLIENT PROFILE

Julie Bates is an 88-year-old female who lives in residential care.

Health Challenges/Diagnosis: Arthritis, esophageal reflux, constipation, hemorrhoids

ADLs: Partial bath, set up with meals, assist with hearing aid and glasses

Mobility: Uses four-wheeled walker, assist with mobility

Nutrition: Low fibre diet, small appetite, encourage to drink fluids

Communication: Speaks English, shy and doesn’t like to bother staff

Other: Last recorded bowel movement was four days ago

© Province of British Columbia. This material is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License (CC BY-SA 4.0).

Download: Role Play Cards [PDF].

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:

STUDENT HANDOUT
The Dance by Elizabeth Causton

When we work with a conscious awareness of where we stand in relationship to patients and families, respecting their unique “dance” in response to grief and loss, we are less likely to become over involved or to get lost in our work.

The idea of a family dance is not new, but it works particularly well as an image that reminds us of the importance of paying attention to boundaries as we work with people who are “vulnerable and broken.” The image can also be used to describe the sense of continuity of the family dance, which has evolved over generations. It reminds us that every family dance has its own history and that every step taken on the family dance floor has a reason in the context of that shared history.

So, when one member of the family either sits down or lies down on the dance floor because of terminal illness, the dance may look quite clumsy as the family tries to modify their routine to accommodate the changes, but the new steps are not random. They, too, have meaning in the context of what has gone on before.

Still, as we watch families struggle with a difficult dance, to music that always gets faster and louder in a crisis, we may be tempted to get onto their dance floor to try and teach them a new dance, with steps from the dance that we are most familiar with – our own. Of course, this rarely works, for the obvious reason that our dance steps do not have a history or a reason in the context of another family’s particular dance. Our valuable and unique perspective is lost the moment we step out onto someone else’s dance floor. Regardless of our good intentions, we truly become lost in our work.

The greater value of our role is to stay on the edge of the dance floor and from that vantage point, to observe, comment on, and normalize the process that the family is going through. We may suggest options, new dance steps that the family hasn’t thought of, but we do so with the recognition that they can only consider new ideas in the context of their own history. This is what it means to work from a “therapeutic distance,” to work with an awareness of where we stand in relation to the people with whom we are working.

However, whereas working with this kind of clarity and respect for boundaries may be our goal, experience tells us that it is not easy to achieve. The edge of the family dance floor is often, in fact, a fluid border as difficult to define as it is to say exactly where the sea meets the sand. In addition, each of us has “hooks” – people or situations that may touch us in some deep, unconscious place. Because we have an obligation to do this work with awareness, it is important that we do our “homework”, seeking to identify our “hooks” and paying attention to signs that we may have stepped over the line.

The signs that we are losing our perspective are: 1) experiencing an extreme emotional reaction to a person or situation that (perhaps without our knowing it) resonates with an unresolved issue or a difficult relationship on our own dance floor; 2) feeling a sense of ownership as reflected in language such as “my patients” or “my families,” or difficulty in letting go or sharing individuals with other team members; and/or 3) experiencing a need to influence or control patients and families by directing their options and choices or by making ourselves indispensable to them.

Despite having identified signs of over-involvement, it is also important to understand the challenges inherent in our work and be gentle with ourselves as we strive to be “good enough.” We need to remember that maintaining a therapeutic distance does not preclude strong emotions and deep caring. Two of the great advantages of knowing where we stand and being clear about what we bring to our work are being able both to feel deeply and to act wisely.

Reprinted with permission of the author

Elizabeth Causton

elizabeth@caustonsonbeach.ca

Causton, Elizabeth. (2003). The Dance. In M. Cairns; M. Thompson; W. Wainwright (Eds.), Transitions in Dying and Bereavement: A Psychosocial Guide for Hospice and Palliative Care. (p. 202–203) Baltimore, MD: Health Professions Press.

Download Student Handout: The Dance by Elizabeth Causton [PDF].

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/#.

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

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

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

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

8

Course Guideline

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

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

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.

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

STUDENT HANDOUT
Communication Challenges and Impact: Supporting Clients with Dementia

Communication Challenges – Peter Schultz Impact on the Client and/or Family HCA Strategies
Difficulty initiating or following conversations.
Difficulty following instructions or rules related to a game or activity.
Difficulty understanding written material or communicating in writing.
Expressing confusion and/or the inability to understand what is being said.
Expressing resistance when directed to complete tasks related to personal care and hygiene.
Expressing anger and frustration related to the loss of ability to complete formerly known or routine activities (e.g., household repairs and maintenance).

Metzger, Z.B. (2010). The Last Lap of the Long Run, Addendum to “On the Long Run”: An Account of our Travels with Dementia. This material is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License (CC BY-SA 4.0).

Download Student Handout: Communication Challenges and Impact: Supporting Clients with Dementia [PDF].

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:

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.

DISCUSSION GUIDE
Ambiguous Loss and Grief

What is ambiguous loss and grief?

  • Ambiguous loss is a type of loss that happens when a person with dementia is physically present but is experiencing changed cognitive abilities.
  • A family member caring for a person with dementia may experience ongoing stress and grief due to the ambiguous loss of having a spouse or parent still here, but not present in the same way as before.

Why is ambiguous loss and grief different from other types of grief?

  • When a person is bereaved, they are likely to receive support from family and friends, and may eventually find closure through the natural grieving process.
  • Ambiguous loss complicates grief. It’s often hard for a caregiver to know whether or how to grieve.
  • Many aspects of the person with dementia are lost, but some remain. Family and friends may not recognize the caregiver’s need to grieve the many losses at different stages of the disease and receive support while the person with dementia is alive.
  • The caregiver may feel like he or she is living in limbo, unable to fully grieve or resolve the losses that have already occurred while anticipating other losses that lie ahead.

How can HCAs provide support to individuals and families experiencing ambiguous loss and grief?

  • Be sensitive to a wide range of caregiver grief reactions, including sadness, anger, anxiety, ambivalence, guilt, denial, and helplessness.
  • Use empathetic listening skills.
  • Validate the person’s feelings and experience in a non-judgmental way.
  • Acknowledge and affirm caregivers’ strengths, success, and resilience in coping with losses and adapting to changes.
  • Help families and individuals recognize and understand the feelings of ambiguous loss and work through them with the help of Alzheimer Society staff or other health care providers.
  • Provide strategies to help caregivers learn how to live with ambiguous loss, and remain healthy and resilient.
  • Help caregivers find creative ways to engage with the person with dementia.
  • Make a referral to the Alzheimer Society of B.C.
  • Encourage caregivers to practise good self-care, for example by staying socially and physically active, eating well, and engaging in the spiritual or religious practices that are important to them.

Download Discussion Guide: Ambiguous Loss and Grief [PDF].

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.

STUDENT HANDOUT
Scenarios: Supporting Clients with Dementia

DIRECTIONS: Identify key information and observations from the scenario and list in the first column. Next, identify important considerations that could provide context for the situation and list them in the second column. Finally, consider how to best respond to the situation.

Example, Scenario 1

It is 1:00 p.m. – time for Jean’s scheduled bath. Although she willingly goes to the bathing room with her regular HCA, she pulls away and cries out when the HCA starts to remove her clothing. She becomes extremely agitated and the HCA is unable to calm her and continue with the bathing process. For the third week in a row, Jean returns to her room without bathing.

Key Information Considerations HCA Responses
  • Jean has become too agitated to have her bath.
  • This is the third week in a row that this has happened.
  • What time of day did Jean usually bathe when she lived on her own? Could her bath time be adjusted?
  • How would I respond?

Scenario 2

Mary usually goes to bed around 8:00 p.m. but always gets up at 2:00 a.m. and wanders the halls. When staff take her back to bed, she gets up again, saying she has to take care of the baby.

Key Information Considerations HCA Responses

Scenario 3

Fiona has lived at a care home for the past two years. She has Alzheimer’s disease and now requires full assistance with personal care and dressing. She used to be a very classy lady – everything matching, makeup always impeccable. Her daughter, Marjorie, is having a hard time adjusting to her mother’s changing abilities.

Today the HCA, Maria, came in to help Fiona get ready for the day and Fiona was already dressed. Maria noticed that the buttons of her blouse were done up incorrectly and her clothing neither matched, nor was particularly clean. She had brushed her hair, leaving a large piece sticking up at the back. Maria was thrilled that Fiona had dressed and groomed independently and chose to leave Fiona’s hair and clothing as it was, saying, “Fiona, you look nice today. I like the blouse you’ve chosen!” Later in the day when Marjorie visited, she was furious that staff had not “corrected” her mother’s outfit and hair.

Key Information Considerations HCA Responses

Scenario 4

Albert is a newly graduated HCA. He feels fortunate to have secured full-time employment at a fairly new long-term care facility. During his HCA program, Albert took pride in taking the time to apply a person-centred approach with each of the clients he supported.

Despite his training and a sincere desire to help, he quickly feels discouraged and overwhelmed by the large workload and the attitudes of his colleagues, who Albert considers to be too “task focused.” He does not feel that he is able to use anything he learned, since every minute of his day is spent racing through a series of tasks.

Key Information Considerations HCA Responses

Copyright © 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).

Download Student Handout: Scenarios: Supporting Clients with Dementia [PDF].

DISCUSSION GUIDE:
Supporting Clients with Dementia

Key Information Considerations and Potential Responses
Scenario 1
  • Jean has become too agitated to have her bath.
  • This is the third week in a row that this has happened.
  • It happens in the bathing room.
  • Her regular HCA is the only one involved so far.
  • It seems that she doesn’t want her clothing removed.
  • It is going to require some kind of intervention soon, since she has not had a bath for three weeks now.
  • What time of day did Jean usually bathe when she lived on her own? Could her bath time be adjusted?
  • Has another HCA tried to bathe her? Perhaps Jean feels shy with the regular HCA for some reason.
  • How did the HCA approach Jean before attempting to remove her clothing? Could she have moved more slowly or communicated her plans more clearly?
  • Is Jean warm enough? If she is cold, perhaps this accounts for her reluctance to have her clothing removed. Check the temperature of the room. You could try wrapping her in a large warm towel before removing the clothing underneath. Is it necessary to remove her clothing or could she sit in the tub with her clothing on?
  • What is the bathing room like? Is it bare and sterile looking? Could it be painted a warmer colour? Would adding candles, plants, or calling it the “spa room” make it more inviting?
Scenario 2
  • It is difficult to keep Mary in bed after 2:00 a.m.
  • Mary gets up and starts to wander the halls at 2:00 a.m.
  • Only the night staff is involved; Mary does not go into the rooms of the other residents.
  • According to Mary, the reason is that she needs to take care of the baby.
  • It may not require intervention. If Mary is not upset, if she is safe, and if she is not disturbing others, there may not be a concern.
  • Is Mary getting too much sleep? Perhaps Mary could go to bed later. She is getting 6 hours of sleep, which may be enough for her. Perhaps Mary needs to walk off her extra energy and will then return to bed quietly on her own.
  • Staff might offer to walk with her. This could be reassuring to her, and might calm her down enough so that she feels ready to go back to bed.
  • Is Mary experiencing pain? If she is taking painkillers, her medication may have worn off by 2:00 a.m.
  • Is there a regular sound that occurs around 2:00 a.m. (e.g., staff doing rounds, something outside the building, or a furnace that starts noisily)? Something specific may be waking her up.
  • Does Mary have to go to the bathroom? She may be getting up because she needs to go to the bathroom, but then gets side tracked as she heads down the hallway. Try limiting her fluid intake at night.
  • Is Mary hungry? Staff could place a snack by her bedside, which may redirect her and prevent her from leaving her bed.
  • If Mary is worried about her baby, staff may tell her not to worry about the baby – a friend is caring for the baby tonight.
  • She may calm down if given a doll and then returned to bed. If a doll is used, Mary’s family should be informed. Despite the efficacy of using dolls for some people with more advanced dementia, families may see it as disrespectful or feel that their family member is being treated like a child if they do not understand why this approach is being taken.
Scenario 3
  • Marjorie is very upset with what she perceives to be the “poor care” her mother is receiving.
  • Though this is not typical, Marjorie may think that variations of this scenario occur periodically.
  • This is a situation involving Marjorie and the care staff. Fiona is happy.
  • Maria recognizes that Fiona’s actions today were significant since she has not dressed or groomed herself without help for some time. She knows that people with dementia, like everyone else, want to feel productive and her response was aimed at enhancing Fiona’s dignity.
  • Although Fiona has lived at the care home for a couple of years, Marjorie may still be grieving her mother’s loss of freedom or her own inability to care for her. She may be feeling like she has broken a promise by admitting her mom into a care home. She may be experiencing grief over the loss of her mother, as she once was.
  • Her mother is changing and Marjorie may feel that her mother is slipping away – the way she dresses herself feels like proof of that. She may feel that allowing her mother to be seen in an “unkempt way” robs her of her dignity as her appearance was always so important to her.
  • Families experience a unique kind of grief in these situations, since the person with dementia is still alive. This grief is not typically acknowledged or validated by others, who may even say things like, “At least you still have your mother.”
  • Perhaps the best gift Maria, or another staff member, could give Marjorie would be to name the grief and empathize. “It’s so hard seeing the changes in your Mom, isn’t it? It’s like one long grieving journey.”
  • Marjorie could connect with the Alzheimer Society of B.C. It might help to talk to someone separate from the home, or even to attend a support group.
  • The goal for Maria and the staff should be to collaborate with Marjorie in Fiona’s care. The best way to do that is through compassion. Getting upset with Marjorie because she doesn’t understand what an accomplishment her Mom’s dressing was, or dismissing her “obnoxiousness” by saying she is in denial, would only further antagonize the situation.
Scenario 4
  • The biggest challenge for Albert will be to maintain resilience. He will need to accept the situation at the facility, but work to make small changes. He cannot change the workload; he can change his attitude. Perhaps others will follow suit over time.
  • Albert may face discouragement from other people he works with. It might be hard to feel like he is the only person wanting to make a difference.
  • Despite his new job being task-oriented, Albert can still work to accomplish these tasks with kindness and respect for the clients he is caring for. His sincere desire to know as much as possible about his clients will help him to use a person-centred approach.
  • Using a person-centred approach might even help him reduce responsive behaviours, taking less time over all.
  • Albert might find opportunities to share his learning or successes with his colleagues at staff meetings, huddles, or through the communication book.
  • Over time, Albert may be able to find opportunities to support newer staff to contribute to a better culture.
  • If Albert sees situations or behaviours that are of concern, or if he is concerned about workload, he can speak to his supervisor and/or union.
  • Albert may decide to find a job where his values and the workplace culture are a better fit.

Copyright © 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).

Download Discussion Guide: Supporting Clients with Dementia [PDF].

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.

STUDENT HANDOUT
Scenario: Person-Centred Care in Practice

DIRECTIONS: Read the scenario and respond to discussion questions provided. While completing this activity, you may wish to refer to Guidelines for care: Person-centred care of people with dementia living in care homes framework.


Mr. Peterson has moderate dementia and has particular difficulty with his language. He never participates in any of the activities that the facility organizes. Today he walked over to the activity room and sat down at a table by himself. The recreation therapist, Dawn, asked one of the HCAs to take him back to his room. “He never participates anyway, so he probably just got lost,” she tells the HCA.


Small Group Discussion Questions:

  1. Is this a person-centred response? Why or why not?
  2. How could the HCA respond to Dawn’s statement and the situation?
  3. If Dawn or the HCA were to involve Mr. Peterson in the activity, what should they consider? (Refer to p. 31 of Guidelines for care: Person-centred care of people with dementia living in care homes framework.)
  4. Why is meaningful activity critical to a person-centred approach? (Refer to p. 28–30 Guidelines for care: Person-centred care of people with dementia living in care homes framework.)
  5. How could the HCA provide opportunity for meaningful activity while assisting Mr. Peterson with his activities of daily living (e.g., during the morning care routine)?
  6. How can you provide choices to the person who appears unable to choose and why is this important?

Copyright © 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).

Download Student Handout: Scenario: Person-Centred Care in Practice [PDF].

DISCUSSION GUIDE
Person-Centred Care in Practice

Person-Centred Care

  • Focuses on the individual, rather than the condition.
  • Focuses on the person’s strengths and abilities, rather than their losses.
  • Recognizes that the personality of the person with dementia is not lost, just increasingly changed by the disease.

How can HCAs provide person-centred care for people with dementia?

  • Focusing on people with dementia as individuals – understanding the person’s history, values, likes, and dislikes.
  • Trying to understand each person’s reality.
  • Remembering that all behaviour has meaning.
  • Mastering effective and meaningful communication.
  • Recognizing every person’s potential to engage socially and spiritually.
  • Talking to and about the person with dignified, non-judgmental and respectful language.
  • Providing choices, taking the person’s wishes into consideration, and obtaining consent, if possible.
  • Recognizing feelings and providing support.
  • Demonstrating empathy.
  • Involving and supporting family and friends.
  • Focusing on bringing out the best in the person and helping them to have a good day.
  • Bringing these values into the last stages of dementia and the end of life.

What does it mean to understand another person’s reality?

  • A person’s reality does not actually have to be objectively real to be their reality.
  • It is not helpful to try to “set the person straight” about what is really happening.
  • Sometimes understanding the world from the perspective of the person with dementia means not only speaking to them, but also to family and friends and being attentive to non-verbal cues. It helps to have a sense of where a person’s memory is at any given time. Putting their reality into a context of time and place can help you understand their reality; for example, if a person is talking or acting like they are in their 30s, it might make sense that they are talking about having a young daughter.

How can you involve and support family and friends?

  • First and foremost, the staff needs to recognize what a move to long-term care might represent for a family or care partner.
  • HCAs should recognize that grief is a constant companion for families who are on the dementia journey.
  • Families are valuable members of the care team.
  • Families provide a sense of continuity for the person with dementia and can familiarize staff with the person’s likes and dislikes, values, wishes, and personality.
  • A collaborative relationship with families benefits the person with dementia, their family members, and the staff of the care home.
  • Some families will be very difficult, for a variety of reasons. A referral to counselling or the Alzheimer Society of B.C. might be the best choice under such circumstances.

“Come on, sweetie. Let me help you get dressed.” Is there anything wrong with this statement?

  • Ask yourself if referring to someone under your care as “sweetie” is dignified and respectful.
  • Do you talk to your parents that way?
  • Most care staff would say that using endearments like “sweetie,” “dear,” “honey,” or “mama” is not done with bad intentions. They want to be nurturing, which is a commendable intention. But these terms are likely not appropriate under the circumstances.
  • What are other ways that you can be nurturing, yet respectful of the person’s dignity?

Would you say Dawn is providing person-centred care? Please explain why you answered the way you did.

  • This is not person-centred care.
  • Dawn does not speak to Mr. Peterson; she talks about him to the HCA, as if he was not there.
  • Just because he hasn’t participated in the past does not mean that he can’t change his mind and decide to participate today. Dawn is disregarding Mr. Peterson’s potential to engage socially.

How can you provide choices to the person who appears unable to choose? Why is this important?

  • Choice is a key component of personal agency; we are able to make choices for ourselves as adults. Removing any sense of choice from the person with dementia robs them of their independence.
  • You can incorporate the values, beliefs, cultural, and spiritual backgrounds of people with dementia and their families into the planning and delivery of care.
  • You can recognize that dementia does not diminish a person. Rather, it changes the person’s capacity to interact with their environment.
  • As dementia progresses and it becomes increasingly difficult to obtain fully informed consent from people with dementia, it is still possible to involve them in the decision-making process to some extent. Keep them informed and find out from their family, representative, or temporary decision-maker what their preferences are.
  • Respect dissent. This is often expressed through behaviour, like turning their head away, biting, pushing or walking away.
  • Frame your words and actions in “choice” language, so even if you really are only offering one choice, it still appears to be a choice and not an imposition.

Download Discussion Guide: Person-Centred Care in Practice [PDF].

Strategies that Focus on Professional Approaches to Practice

1. Discussion on Mental Illness

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

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:

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.

STUDENT HANDOUT
Scenarios: Addressing Myths and Stigmas – Promoting Person-Centred Language

DIRECTIONS: Working in partners, read the scenarios and consider the following questions. Prepare to share your answers with the larger group:

  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?

You are an HCA working in an acute care setting. Mr. Edwards, a 72-year-old man diagnosed with Alzheimer’s disease, has been admitted to the unit following a hip fracture. One of your colleagues has limited experience working with people who have dementia; you notice he tends to talk “over” Mr. Edwards instead of including him in conversations. He also uses terms such as “senile” and “demented” when referring to Mr. Edwards.


You are an HCA program graduate who has recently been hired at a residential care facility. When working with your new colleague, Sharon, you notice that she refers to the number of “feeders” that she will be assisting during lunch.


You are an HCA working in an assisted living home. You have been assigned to mentor John, who is an HCA student from a local college. One day while working with John, he refers to Betsy Smith, a client who is living with schizophrenia, as “the schizophrenic.”


You are an HCA student working at your first clinical placement. One day, while working with a staff member, you refer to the client you are working with as a past “user.” The staff member looks alarmed and rebukes you quite sharply for using this term. 

Download Student Handout: Scenarios: Addressing Myths and Stigmas – Promoting Person-Centred Language [PDF].

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).

STUDENT HANDOUT
Responding to an Individual Experiencing Cognitive Challenges

PURPOSE

  • To help you apply what you have learned in this course to your work with individuals experiencing cognitive challenges.
  • To assist you to identify the consequences of your communications, actions, and interactions.
  • To help you to increase your effectiveness in working with individuals experiencing cognitive challenges.

DIRECTIONS

Choose two separate interactions you have had with individuals experiencing cognitive challenges. Briefly document each interaction, what happened, and how you responded. You may use a table like the one below to document your two interactions.

For each interaction that you document, write your reflections on the incident using a format that’s similar to the outline below and identify what you have learned. This will assist you in future to increase your effectiveness with individuals experiencing cognitive challenges.

EXAMPLE: Documentation of Interactions
Situation My response Consequences of my actions Effectiveness of my actions What the client’s behaviour may have been communicating
Mrs. S. kept asking me over and over where she was and when her husband would be coming to get her. I told her I had already answered her question three times in the past half hour and the answer was still the same. I also reminded her that her husband had died several years ago. Mrs. S. looked distraught and anxious, wringing her hands and pacing about the hallway. Not very because Mrs. S. seemed even more anxious and confused. She kept asking the same question to whomever she encountered. I’m feeling lost. I want to see someone I recognize who will care for me.
Mr. T. kept wiping the kitchen counter over and over again, and it didn’t seem like he was going to
stop.
I asked Mr. T. why he kept wiping the counter. Mr. T. looked confused and troubled and continued to wipe the counter for several more minutes. Not very since he kept wiping the counter and seemed even more agitated. Need to expend nervous energy. Unable to stop the behaviour on his own.

For each interaction identify:

  • Why your response was or was not effective. How did you know it was effective or not effective?
  • Make a list of other responses you might have made that would be effective in the situation. Think of as many ideas as you can. Base your suggestions on what you’ve learned in this course and information you have gained from other health team members or other sources.
  • How does knowledge of the person as a unique individual – with a past, present, and future – help you to be more effective when caring for clients experiencing cognitive challenges?
  • Identify what you have learned from these two interactions that will help you be more effective when working with individuals experiencing cognitive challenges.

Download Student Handout: Responding to an Individual Experiencing Cognitive Challenges [PDF].

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

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

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

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/

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

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

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

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.

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

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

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

Healing 3: Personal Care and Assistance

9

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:

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:

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:

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.

STUDENT HANDOUT
Unfolding Case Study: Caring for Peter Schultz

Changing Client Health Status and Response to Care

DIRECTIONS: Read the following scenario. Then populate the table with observations based on the situation provided. For each observation, list possible responses that fall within the parameters of the HCA role.


You are an HCA who has been working at the same residential care home for the past five years. Today is your first day back after a two-month absence, and you are assigned to care for Peter Schultz. As you carry out the plan of care, you observe changes in Peter’s health status and response to care.

You have always enjoyed providing care for Peter. When he first moved to the care home four years ago, you used several strategies to include him in the morning care routine. He especially enjoyed singing old tunes and reciting poems while you were helping him to get ready for the day. He enjoyed his meals and was a regular participant in the music and exercise programs and daily social hour. You always appreciated Peter’s smile and hearing him laugh.

Since Peter has moved to the care home, he has been diagnosed with Alzheimer’s disease, in addition to the diagnosis of vascular dementia following a CVA. He now requires full assistance with his activities of daily living and is on a regular toileting schedule. Over the past year, Peter’s legs have gotten weaker and he is no longer able to bear weight. He is on medication for blood pressure and bowel control.

Over the past year, Peter has become progressively less responsive during the morning care routine. He says very little and usually just listens as you sing his favourite songs. You have also observed that he smiles less often. Usually, when you try to involve him in simple care- related activities, such as washing his face or combing his hair, he will reach out for the face cloth or hair brush that you offer him, but will not use them unless you guide his hands for him. This morning when you offer him the face cloth, he does not reach out his hand to take it.

Since losing his ability to walk, Peter has used a wheelchair to ambulate. The foot pedals on his chair are removed and he uses his feet or the side rail to move himself up and down the hallway. Today when you look for Peter to bring him to the lunch room, you notice that he has not moved from the place where he was one hour ago. When you assist Peter with his lunch, he doesn’t try to hold his cup as he used to. He eats very slowly and clears his throat often. You observe that he finishes half of his mashed potatoes, but coughs when you offer him small pieces of minced chicken. He eats all of his chocolate pudding. It takes Peter 55 minutes to eat his lunch.

This afternoon, Eve comes to attend a special music program with Peter. When you walk with her to his room, you find that he has fallen asleep in his chair. Eve tells you that Peter has fallen asleep every day after lunch for the past two weeks. Eve has a difficult time waking Peter up to listen to the guest musicians. It takes an hour for Peter to drink a cup of thickened coffee and when Eve gives him a cookie, it drops out of his hand.

Documenting Observations and HCA Response to Changes
Observation HCA Response
Peter did not reach out to take the face cloth when it was offered to him. Continue to offer the face cloth to Peter. If he does not reach out for it, place it in his hand and guide him in washing his face.
Minimize distractions during this care activity.
Continue to monitor Peter’s response to this approach.

Metzger, Z.B. (2010). The Last Lap of the Long Run, Addendum to “On the Long Run”: An Account of our Travels with Dementia. This material is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License (CC BY-SA 4.0).

Download Student Handout: Changing Client Health Status and Response to Care [PDF].

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:

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:

STUDENT HANDOUT
Putting Safety into PracticeIsland Health (2012).

DIRECTIONS: Read the scenario and make notes to consider how to best provide safe care using the four-step process to ensure patient safety.

Mary is a new HCA working on a general medicine unit.

She is about to go into Mr. Lee’s room to assist him to the bathroom for morning care. Mr. Lee shares his hospital room with one other gentleman.

Mary confirms instructions for morning care with the RN and finds out from his chart that Mr. Lee requires stand by assistance with his mobility and wears a gait beltA gait belt may also be called a walking, ambulation, or transfer belt, depending on the setting. HCA instructors may wish to lead a discussion about related equipment used by HCAs and other health care professionals in their local health authorities. while he is walking. Mary confirms that she will observe and supervise while Mr. Lee moves from a sitting to standing position and while he walks from his bed to the bathroom.

Mary begins to set up the space. She gathers towels, a change of hospital gown, and toiletries. She looks for his gait belt but cannot find one next to his bed. She notes there is one hanging by his roommate’s closet door.

Keeping in mind a standard process, Mary considers the “Prevent, Check, Respond, and Report” steps.


  • Prevent – What actions or measures should Mary put in place to minimize the chance of a safety event?
  • Check – How should Mary prepare herself, the environment, and others before proceeding with the task?
  • Respond – What actions should Mary take to eliminate or minimize an identified safety risk(s)?
  • Report – What and to whom should Mary report about safety concerns or incidents?

Download Student Handout: Putting Safety into Practice [PDF].

DISCUSSION GUIDE
Putting Safety into Practice

  • Prevent
    • Wanting to prevent spread of infection, Mary gets a new gait belt from the clean supply storage area and uses gloves during care.
    • Mary washes her hands both before and after assisting with care.
  • Check
    • Mary checks with the chart to see if Mr. Lee has special precautions to follow (e.g., gowning).
    • She checks how she is feeling – able to focus? Able to perform safe body mechanics?
    • Using her health authority’s pre-mobility check (e.g., cognition, cooperativeness, and physical ability), Mary confirms no changes to patient abilities from what the RN reported.
    • She checks to make sure the pathway to the bathroom is clear of clutter and safe to walk.
    • She ensures that the bed is at a good height to make it safer for Mr. Lee to go from sit to stand.
    • As per his chart, Mr. Lee has a gait belt on in case she needs to provide support.
  • Respond
    • After determining it is safe to proceed, Mary closely watches Mr. Lee as he gets up and walks. She is ready to call for help if required.
  • Report
    • Mr. Lee was able to walk to the bathroom and perform his own care with minimal support or direction. Mary reports this to the RN.
    • Mary knows that if Mr. Lee did have a slip or fall, she would follow her site’s procedures to report on this event.

Download Discussion Guide: Putting Safety into Practice [PDF]

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?


A flow chart of yes/no questions an HCA should consider when making decision about an assigned or delegated task.
Assigned/Delegated Task Decision Tree

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

Suggestions for Follow-Up Discussion

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

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).

STUDENT HANDOUT
Home Safety Assessment Guide

DIRECTIONS: In addition to conducting the assessment (indicating with a checkmark where met), make comments on safety issues identified (items unmet) and suggest ways that the environment could be made safer for the client/family and members of the health care team.

General Assessment
  • Is there adequate lighting outside and inside the home?
  • Are walkways and stairs dry, in good repair, and clear of clutter?
  • Are any pets in the home restrained during your visit?
  • Is the home generally clean and fairly tidy?
  • Do you note the absence of unpleasant odours?
  • Are there smoke detectors and a fire extinguisher in the house?
  • Are there indicators of hazardous chemicals in the house?
  • Is it possible to keep the house well-ventilated?
  • Are the materials and equipment required to care for the client (e.g., lift equipment) available and in working order?
  • Is the environment smoke free during your visit (no one smoking in the home while you are there or one hour prior)?
  • Are there indicators of use of illegal drugs by anyone in the home?
  • Do you feel safe entering this house?
  • What forms of security are in place to ensure your safety during the visit (e.g., locks, escape routes, mechanism for communication with your supervisor/employer)?
  • Do you feel safe while inside the home (e.g., in terms of the client, other people in the home, weapons inside the home, etc.)?
Comments:
Living Room
  • Are area rugs tacked down?
  • Are electrical cords safely out of the way and not frayed (check throughout the home)?
  • Have newspapers, magazines, or other flammable objects been removed?
  • Is the lighting adequate?
Comments:
Kitchen
  • Are kitchen appliances in good working order?
  • Is the kitchen clean? Look both externally and in cupboards and drawers, in the oven and microwave, and in the refrigerator.
  • Are appropriate cleaning products and equipment available?
  • Have spoiled foods been removed from the refrigerator?
  • Are there any indicators of rodent infestations?
Comments:
Bathroom
  • Does the size of the bathroom contribute to safety (e.g., availability of space to manoeuvre during caregiving procedures)?
  • Are grab bars available by the tub and toilet (if needed)?
  • Is the height of the toilet appropriate for client needs?
  • Does the location and height of the tub contribute to safe caregiving practice?
  • Is there a rubber mat in the tub?
  • Is there a bath bench or bath chair?
  • Is there a hand-held shower head?
  • Is the lighting adequate?
Comments:
Bedroom
  • Is the height and location of the bed appropriate for safe caregiving practice?
  • Is there adequate space to manoeuvre during caregiving procedures?
  • Is the lighting adequate?
Comments:

© Province of British Columbia. This material is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License (CC BY-SA 4.0).

Download Student Handout: Home Safety Assessment Guide [PDF].

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/

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

WorkSafeBC. (2008). Assess every time [Video]. https://www.worksafebc.com/en/resources/health-safety/videos/assess-every-time?lang=en

WorkSafeBC. (2013). Ceiling lifts. Why aren’t they being used? [Video]. https://www.worksafebc.com/en/resources/health-safety/videos/ceiling-lifts

WorkSafeBC. Home care visits. Find the hazards in this staged photo [Photo collection].

WorkSafeBC. (2008). Leave when it’s unsafe [Video]. https://www.worksafebc.com/en/resources/health-safety/videos/leave-when-its-unsafe

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

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]

Practice Experience in Multi-Level and/or Complex Care

10

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.

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/

Practice Experience in Home Support, Assisted Living, and/or Group Home

11

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.

Section 2: Supporting HCA Students’ Fundamental Computer Literacy Skills

II

Computer skills are one of the key essential skills for success in the workplace, and upon completion of the HCA program, graduates should be prepared to use current computer technology in accordance with workplace standards.

While the specific technology used by HCAs will be dependent on their place of employment, baseline knowledge of computers and technology will help to prepare them to assume their workplace role.

Fundamental computer skills include basic knowledge of computers, word processing, and electronic communication using the internet and email; additional computer-related concepts applicable to HCAs are respectful and appropriate use of digital communication and technology in the workplace. While it is not within the scope of every HCA program to include computer skills training, it is possible to ensure that HCA students possess baseline computer skills upon graduation. The following table outlines suggested learning activities for incorporating these skills into existing HCA Curriculum. A Computer Skills Self-Assessment and a targeted resources list are also provided to support students’ self-development in this key employment skills domain.

Suggested Learning Activities

12

Computer Skills Suggested Learning Activities
1. Basic Knowledge of Computers
  • Ask students to complete the Computer Skills Self-Assessment, which assesses basic knowledge of computers, word processing, and electronic communication.
  • If further learning is required, refer students to the Computer Skills Resources List.
2. Word Processing
  • Ask students to submit one or more written assignments prepared on a computer using a word processing program.
  • Ask students to develop a letter of application and a resumé using a word processing program.
3. Electric Communication

a. Internet

  • Online search
  • Favourites/bookmark bar
  • Ask students to work in groups to research an HCA-related topic (e.g., cognitive or health challenge) or organization (e.g., seniors’ services organization or WorkSafeBC) on the internet and bookmark their findings. Students can submit a written report or make a presentation to the class on their findings.
b. Online Forms/Applications
  • Ask students to visit the careers page for their local health authority to set up an online profile.
c. Email
  • Send and receive email including attachments
  • Ask students to send an email with an attachment to their instructor.
d. E-Communication and Netiquette
  • Invite students to examine the content of the Health 1: Interpersonal Communications course, discussing e-communication information provided in the course.
e. Professional Use of Technology
  • Invite students to work in small groups to examine the scenario discussing the professional use of technology provided in the Health Care Assistant: Introduction to Practice course.

Computer Skills Self-Assessment

Student Name:                                 Date:                     

Computer Knowledge

I can identify the basic parts of a computer system Yes □      No/Not Sure □
I can properly start and shut down a computer system Yes □      No/Not Sure □
I can start and close a computer program Yes □      No/Not Sure □
I can describe some common uses of computers in society Yes □      No/Not Sure □
I can use a mouse/pointing device Yes □      No/Not Sure □
I can operate a printer (turn power on, put online/offline, load paper) Yes □      No/Not Sure □

Word Processing

I can create a new word processing document Yes □      No/Not Sure □
I can edit a document Yes □      No/Not Sure □
I can save a document to the storage drive Yes □      No/Not Sure □
I can print a document Yes □      No/Not Sure □
I can retrieve a document Yes □      No/Not Sure □
I can use tools such as spell check or thesaurus Yes □      No/Not Sure □

Electronic Communication

I can search online Yes □      No/Not Sure □
I can complete an online form Yes □      No/Not Sure □
I can add to favourites/bookmark bar Yes □      No/Not Sure □
I can send and receive email, including attachments Yes □      No/Not Sure □

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

Internet Searches

Email

If you do not have an email account, you can set one up by accessing one of the following:

*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

Section 3: Additional Content in Acute Care

III

Acute Care Content in HCA Courses

13

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 at a Glance
Content Added Courses and Strategies Time Added
1. The supervision structures in acute care that support HCA practice Health Care Assistant: Introduction to Practice 30 minutes
2. Similarities and differences between clients in acute care settings and clients in residential or community settings Healing 1: Caring for Individuals Experiencing Common Health Challenges 1 hour 30 minutes
3. Specific elements of the acute care environment Healing 1: Caring for Individuals Experiencing Common Health Challenges

Healing 3: Personal Care and Assistance

No additional time
4. How the role of the HCA may change in the acute care setting, depending on client acuity and intensity Healing 1: Caring for Individuals Experiencing Common Health Challenges 1 hour
Health Care Assistant: Introduction to Practice course 15 minutes
Health and Healing: Concepts for Practice 30 minutes
5. Key considerations for providing holistic, person-centred care for acute care clients with IV lines, tubes, wounds, and surgical incisions Healing 3: Personal Care and Assistance 2 hours theory/lab
6. Strategies for prioritizing tasks, demonstrating flexibility in work assignments, problem-solving and decision-making regarding care provision Health and Healing: Concepts for Practice

Healing 1: Caring for Individuals Experiencing Common Health Challenges

Healing 3: Personal Care and Assistance

1 hour theory/lab
7. Interprofessional collaborative practice in acute care settings Health Care Assistant: Introduction to Practice No additional time
8. The importance of knowing when and how often to communicate with the client and health care team Healing 1: Caring for Individuals Experiencing Common Health Challenges (specific examples related to acute care)

Healing 3: Personal Care and Assistance (specific examples/applications related to acute care)

Health Care Assistant: Introduction to Practice (concepts related to supervision)

30 minutes
9. The role of the HCA in responding to emergency codes Health and Healing: Concepts for Practice

Healing 3: Personal Care and Assistance (apply to lab scenarios)

30 minutes
10. Other acute care revisions Healing 2: Caring for Individuals Experiencing Cognitive or Mental Challenges 15 minutes

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

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

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:

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

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

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:

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:

Surgical drains

Ask: “What is a surgical drain?”

Answer: Surgical drains are:

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:

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:

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:

Catheters

Ask: “What does an HCA need to know about providing care to a client with a catheter?”

Answer: HCAs need to know that:

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:

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:

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:

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:

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:

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:

Describe: When teams work interprofessionally:

Highlight: The outcomes of interprofessional collaboration.

Clients and families have:

Health care providers:

The health care system:

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:

Reinforce the importance of frequent communication in acute care settings.

Emphasize that the other members of the health care team will base their analysis, synthesis, and evaluation of client care on their observations and information (such as care planning or physician’s orders).

Explain that other members of the hospital team will base their client access and flow decisions on the most recent client information (such as who can be discharged or who can be admitted to a room and when).

Identify any specific protocols or site-specific processes that HCAs may encounter that will highlight the need for urgent and frequent communication processes (such as reduced staffing levels and high client acuity levels). Explain what the HCA role and responsibilities will be within these processes (such as re-prioritizing care and care activities to attend to different unit requirements).

Reinforce that HCAs should:

  • Report any client care information during regular communication processes (in huddles, for example).
  • Report any observations or concerns with client care, such as changes in client condition or bleeding, to the health care team leader immediately.
  • Record any client care information they perform, such as bowel record or recording food or fluids, immediately after completing the task.

Emergent or emergency events may occur with a client or with a member of the health care team.

Acknowledge that sometimes communication processes do not go well. Explain the reporting structure that HCAs may use as a guide to facilitate difficult communication processes. Highlight any specific protocols, policies, or procedures that may be used at this site to address ongoing or unresolved communication difficulties (such as respectful workplace policies).

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:

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.

Question: What are the differences between a code white response in a hospital, residential care home, and in a community setting?

Code Yellow:

Content is covered by online orientation for students doing placements at health region sites.

Code Red:

Content is covered in the online orientation for students doing placements at health region sites.

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.

image description linked to in caption
British Columbia Hospitals Emergency Colour Codes [Image description]

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

[Return to image]

Section 4: Clinical Instructor and Preceptor Orientation Tools

IV

Clinical Instructor Orientation

14

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.

Preceptor Orientation

15

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.

 

Section 5: Sample Evaluation Tools

V

Based on the request for evaluation tools that are ready for use, the following section contains sample tools that could be applied to theory, lab, and practice education courses. As noted for each, the tools in this section align with suggested course assessments.

The following assessment tools are included in this section:

Assignment: HCA Workplace Settings

Assignment: Supporting Clients with Dementia or a Mental Health Disorder

Scenario-Based Lab Skills Assessment

HCA Skills Summary Checklist

Health Care Assistant Program Learning Outcomes Verification

Professional Behaviour Development Rubric

Assignment: HCA Workplace Settings

16

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:

You will be marked using the following criteria:

APA Citation Referencing Style

Rubric: HCA Workplace Settings Assignment

Criteria Exceeds Expectations Meets Expectations Partially Meets Expectations Does Not Meet Expectations
1. Required Components

Possible marks: 10/10

Required components are thoroughly and thoughtfully addressed Required components are adequately addressed Required components are partially addressed Required components are minimally, inadequately and/or not addressed
Describes the work setting, two rewards and two challenges of working in the chosen work setting The work setting is fully described and clear, detailed examples of two rewards and two challenges of working in the chosen setting are provided The work setting is described and examples of two rewards and two challenges of working in the chosen setting are provided The work setting is minimally described and/or examples of one or two rewards and one or two challenges of working in the chosen setting are provided A description of the work setting and appropriate examples of rewards and challenges are minimally or not provided
5 4 2-3 0-1
The mission/value statement of the employer has been submitted with the assignment and is appropriately referencedFor any assignment requiring referencing of resources, it would be expected that the program would indicate the referencing style (e.g., APA) to be used and provide the necessary instruction and supporting materials for students to be successful in this criterion of the assignment. It would also be expected that referencing resources would be included as a criteria in the marking rubric, with placement depending on the parameters of the assignment. The mission/value statement of the employer has been submitted with the assignment and is appropriately referenced The mission/value statement of the employer has been submitted with the assignment and is appropriately referenced The information submitted as the employer mission/value statement is not a mission/value statement and is appropriately referenced An employer mission/value statement has not been submitted OR is not appropriately referenced
1 1 0.5 0
A personal mission statement related to the values, beliefs, interests and career goals has been developed The personal mission statement is well prepared. It clearly addresses the beliefs, values, interests, and short- and long-term career goals of the student The personal mission statement adequately addresses the beliefs, values, interests, and short- and long-term career goals of the student The personal mission statement partially addresses the beliefs, values, interests, and short- and long-term career goals of the student A personal mission statement minimally or does not address the beliefs, values, interests, and short- and long-term career goals of the student
4 3 2 0-1
2. Reflection

Reflect on how the mission/value statement of the employer aligns/does not align with your own beliefs, values, goals, and interests

Possible Marks: 5/5

Response demonstrates an in- depth reflection on how the mission/value statement of the employer aligns with each of the following: personal beliefs, values, goals, and interests Response demonstrates an adequate reflection on how the mission/value statement of the employer aligns with the personal beliefs, values, goals, and interests Response demonstrates a partial reflection on how the mission/value statement of the employer aligns with the personal beliefs, values, goals, and interests Response demonstrates minimal or no reflection on how the mission/value statement of the employer aligns with the personal beliefs, values, goals, and interests
5 4 2-3 0-1
3. Writing Mechanics

Possible Marks: 5/5

Writing and Sentence Structure

Writing style is clear and concise, with excellent sentence/paragraph construction Writing style is mostly clear and concise, with adequate sentence/paragraph construction Writing style is partially clear, with a few errors in sentence/paragraph construction Writing is unclear and disorganized with errors in sentence/paragraph construction
2 1-1.5 0.5-1 0-0.5
Format and Presentation Content is presented in an organized and logical manner with appropriate headings and formatting Content is presented in a logical and organized manner Content is partially expressed in a logical manner Content is minimally or not presented in a clear and logical manner
2 1-1.5 0.5-1 0-0.5
Spelling and Grammar There are no more than three errors in spelling or grammar There are no more than five errors in spelling or grammar There are more than five errors in spelling or grammar There are many more than five errors in spelling or grammar
1 0.5 0-0.5 0
Total Possible Marks:

20/20

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: Supporting Clients with Dementia or a Mental Health Disorder

17

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:

You will be marked using the following criteria:

Online Resources

Rubric: Supporting Clients with Dementia or a Mental Health Disorder

Criteria Exceeds Expectations Meets Expectations Partially Meets Expectations Does Not Meet Expectations
1. Required Components

Possible Marks: 15/15

Required components are thoroughly and thoughtfully addressed Required components are adequately addressed Required components are partially addressed Required components are minimally, inadequately and/or not addressed
Briefly describe the type of dementia or mental health disorder The type of dementia or mental health disorder (causes, signs, and symptoms) are accurately and thoroughly described The type of dementia or mental health disorder is described, with some consideration of the causes, signs, and/or symptoms The type of dementia or mental health disorder is partially described. There may be important elements missing and/or some information may not be accurate The type of dementia or mental health disorder is minimally or not described and/or Information is not accurate
5 4 2-3 0-1
Describe how the diagnosis or symptoms may impact communication between the client and HCA How the diagnosis or symptoms may impact the ability to communicate is thoroughly described. The basic elements of interpersonal communication (sender, receiver, message, feedback) are considered How the diagnosis or symptoms may impact the ability to is described, with some consideration for the basic elements of interpersonal communication There is a partial description of how the diagnosis or symptoms may impact the ability of the client to communicate and/or the basic elements of interpersonal communication How the diagnosis or symptoms may impact communication and the basic elements of communication are minimally or not addressed
5 4 2-3 0-1
Describe and/or demonstrate a minimum of three communication techniques (verbal and non-verbal) that could be used by an HCA to communicate with the client A minimum of three appropriate communication techniques are fully demonstrated and/or described. Both verbal and non-verbal techniques are included. The value of each approach for the current context is fully explored Two to three communication techniques are described and/or demonstrated. Verbal and/or non-verbal techniques are considered There is a partial description of one to three communication techniques that may or may not be appropriate for the context There is minimal coverage of communication techniques and/or suggestions are not appropriate
5 4 2-3 0-1
2. Presentation

Possible Marks: 15/15

Delivery

*Individual mark

 

The presentation is delivered in an engaging manner. The speaker uses appropriate eye contact, appears relaxed and confident and speaks with appropriate volume and tone. There is a clear understanding of the subject matter, as evidenced by responses to questions from the audience The presentation is presented in a somewhat engaging manner. Eye contact, body language, tone and volume is satisfactory. Some reference may be made to notes. There is a good understanding of the subject matter The speaker sometimes demonstrates eye contact with the audience, speaks in an uneven or low tone and mostly reads from their notes. Audience engagement is minimal The presentation is delivered in a manner that does not interest or engage the audience or is inappropriate
5 4 2-3 0-1
3. Teamwork and Organization The group works well together to prepare and deliver the presentation.

Tasks are appropriately
divided between group members and there is evidence of respectful collaboration between group members.

Components of the
presentation are delivered in a logical sequence within the time frame allotted.

The group works together to prepare and/or deliver the presentation.

The division of tasks is satisfactory and there is evidence of adequate collaboration between group members.

Components of the presentation are delivered in a logical sequence and/or within the time frame allotted.

The team partially works together to prepare and/or deliver the presentation.

The division of tasks is not balanced and there is a low level of collaboration between group members.

Components of the presentation may not be delivered in a logical sequence and/or not delivered within the time frame allotted.

There is minimal to no evidence that the team has worked together to prepare or deliver the presentation.

The division of tasks is not balanced and there appears to be a low level of collaboration between group members.

The presentation is not delivered in a logical sequence or within the time frame allotted.

5 4 2-3 0-1
4. Visual Materials and Student Handout Visual materials and student handout are attractive and organized, with appropriate headings and formatting. There are minimal mistakes in spelling/grammar.

Resources used are identified and appropriately referenced.For any assignment requiring referencing of resources, it would be expected that the program would indicate the referencing style (e.g., APA) to be used and provide the necessary instruction and supporting materials for students to be successful in this criterion of the assignment. It would also be expected that referencing resources would be included as a criteria in the marking rubric, with placement depending on the parameters of the assignment. criteria of the assignment. It would also be expected that referencing resources would be included as a criteria in the marking rubric, with placement depending on the parameters of the assignment.

Visual materials and student handout are presented in organized manner with appropriate headings. There may be a few mistakes in spelling/grammar.

Resources used are identified and appropriately referenced.

Visual materials and/or student handout are not clearly tied to the presentation. There may be mistakes in spelling/grammar.

Resources used are identified and appropriately referenced.

Visual materials are minimally or not adequate or resources are not appropriately referenced.
5 4 2-3 0-1
Total Possible Marks:

30/30

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].

Scenario-Based Lab Skills Assessment

18

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:

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:

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:

Skill performed Unsatisfactory
(Indicate where applicable with a check mark)
Satisfactory
(Indicate where applicable with a check mark)
P=PASS
F=FAIL
R=Redo
Assists with a bedpan □ Ineffective organization and prioritization (did not gather required supplies and managed time improperly) □ Effective organization and prioritization (gathered required supplies and managed time properly)
□ Did not perform skill following correct lab procedures □ Performed skill following correct lab procedures
□ Performance of skill was unsafe □ Safe performance of skill
□ Improper medical asepsis □ Proper medical asepsis
□ Incorrect body mechanics □ Correct body mechanics
□ Inadequate communication with client □ Adequate communication with client
□ Does not attend to client comfort and/or support dignity □ Attends to client comfort and supports dignity
Instructor Comments
Partial bed bath □ Ineffective organization and prioritization (did not gather required supplies and managed time improperly) □ Effective organization and prioritization (gathered required supplies and managed time properly)
□ Did not perform skill following correct lab procedures □ Performed skill following correct lab procedures
□ Performance of skill was unsafe. □ Safe performance of skill
□ Improper medical asepsis □ Proper medical asepsis
□ Incorrect body mechanics □ Correct body mechanics
□ Inadequate communication with client □ Adequate communication with client
□ Does not attend to client comfort and/or support dignity □ Attends to client comfort and supports dignity
Instructor Comments
Assists with dressing □ Ineffective organization and prioritization (did not gather required supplies and managed time improperly) □ Effective organization and prioritization (gathered required supplies and managed time properly)
□ Did not perform skill following correct lab procedures □ Performed skill following correct lab procedures
□ Performance of skill was unsafe □ Safe performance of skill
□ Improper medical asepsis □ Proper medical asepsis
□ Incorrect body mechanics □ Correct body mechanics
□ Inadequate communication with client □ Adequate communication with client
□ Does not attend to client comfort and/or support dignity □ Attends to client comfort and supports dignity
Instructor Comments
(sample skill)

Transfer from bed to wheelchair

□ Ineffective organization and prioritization (did not gather required supplies and managed time improperly) □ Effective organization and prioritization (gathered required supplies and managed time properly)
□ Did not perform skill following correct lab procedures □ Performed skill following correct lab procedures
□ Performance of skill was unsafe □ Safe performance of skill
□ Improper medical asepsis □ Proper medical asepsis
□ Incorrect body mechanics □ Correct body mechanics
□ Inadequate communication with client □ Adequate communication with client
□ Does not attend to client comfort and/or support dignity □ Attends to client comfort and supports dignity
Instructor Comments

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:

1. Maintains the comfort and dignity of the client NI NS S
Examples and comments

 

2. Maintains the safety of the client, self, and other members of the health care team NI NS S
Examples and comments

 

3. Communicates effectively with the client and other members of the health care team, where appropriate NI NS S
Examples and comments

 

4. Provides care in an organized manner, gathers supplies, and manages time appropriately NI NS S
Examples and comments

 

5. Maintains medical asepsis and infection control throughout the scenario NI NS S
Examples and comments

 

6. Uses proper body mechanics throughout the scenario NI NS S
Examples and comments

 

7. Performs personal care and assistance skills competently (scenario specific) NI NS S
Examples and comments

 

i. Assist with bedpan (performed according to correct lab procedures)

NI NS S
Examples and comments

 

ii. Partial bed bath (performed according to correct lab procedures)

NI NS S
Examples and comments

 

iii. Transfer from bed to chair using full mechanical lift (performed according to correct lab procedures)

NI NS S
Examples and comments

 

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.

HCA Skills Summary Checklist

19

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.

HCA Skills Summary List Peer Review (in Lab) Instructor Review (in Lab) Instructor Review (in Clinical)
Prevents Infection
Handwashing

Reviewed by:

Date:

Reviewed by:

Date:

Reviewed by:

Date:

Gloving

Reviewed by:

Date:

Reviewed by:

Date:

Reviewed by:

Date:

Donning and removing gloves

Reviewed by:

Date:

Reviewed by:

Date:

Reviewed by:

Date:

Donning and removing gloves

Reviewed by:

Date:

Reviewed by:

Date:

Reviewed by:

Date:

Donning and removing mask

Reviewed by:

Date:

Reviewed by:

Date:

Reviewed by:

Date:

Other, e.g., double bagging

Reviewed by:

Date:

Reviewed by:

Date:

Reviewed by:

Date:

Promotes Personal Hygiene
Oral hygiene

Reviewed by:

Date:

Reviewed by:

Date:

Reviewed by:

Date:

Denture care

Reviewed by:

Date:

Reviewed by:

Date:

Reviewed by:

Date:

Partial bath

Reviewed by:

Date:

Reviewed by:

Date:

Reviewed by:

Date:

Complete bed bath

Reviewed by:

Date:

Reviewed by:

Date:

Reviewed by:

Date:

Perineal care □ Perineal care of the penis

Reviewed by:

Date:

□ Perineal care of the vulva

Reviewed by:

Date:

□ Perineal care of the penis

Reviewed by:

Date:

□ Perineal care of the vulva

Reviewed by:

Date:

□ Perineal care of the penis

Reviewed by:

Date:

□ Perineal care of the vulva

Reviewed by:

Date:

Grooming □ Male

Reviewed by:

Date:

□ Female

Reviewed by:

Date:

□ Male

Reviewed by:

Date:

□ Female

Reviewed by:

Date:

□ Male

Reviewed by:

Date:

□ Female

Reviewed by:

Date:

Dressing and undressing

Reviewed by:

Date:

Reviewed by:

Date:

Reviewed by:

Date:

Applying compressing stockings

Reviewed by:

Date:

Reviewed by:

Date:

Reviewed by:

Date:

Skin care

Reviewed by:

Date:

Reviewed by:

Date:

Reviewed by:

Date:

Relieving pressure

Reviewed by:

Date:

Reviewed by:

Date:

Reviewed by:

Date:

Assists with Movement
Body mechanics

Reviewed by:

Date:

Reviewed by:

Date:

Reviewed by:

Date:

Moving a client

Reviewed by:

Date:

Reviewed by:

Date:

Reviewed by:

Date:

Positioning a client in chair

Reviewed by:

Date:

Reviewed by:

Date:

Reviewed by:

Date:

Positioning a client in bed – supine

Reviewed by:

Date:

Reviewed by:

Date:

Reviewed by:

Date:

Positioning a client in bed – lateral

Reviewed by:

Date:

Reviewed by:

Date:

Reviewed by:

Date:

Positioning a client in bed – Sims

Reviewed by:

Date:

Reviewed by:

Date:

Reviewed by:

Date:

Positioning a client in bed – Fowlers

Reviewed by:

Date:

Reviewed by:

Date:

Reviewed by:

Date:

Transferring a client; one-person transfer

Reviewed by:

Date:

Reviewed by:

Date:

Reviewed by:

Date:

Transferring a client; hemi transfer

Reviewed by:

Date:

Reviewed by:

Date:

Reviewed by:

Date:

Use of a sit-to-stand lift

Reviewed by:

Date:

Reviewed by:

Date:

Reviewed by:

Date:

Use of a full lift

Reviewed by:

Date:

Reviewed by:

Date:

Reviewed by:

Date:

Use of a ceiling lift

Reviewed by:

Date:

Reviewed by:

Date:

Reviewed by:

Date:

Promotes Exercise and Activity
Assisting with walking devices

Reviewed by:

Date:

Reviewed by:

Date:

Reviewed by:

Date:

Assisting with wheelchairs

Reviewed by:

Date:

Reviewed by:

Date:

Reviewed by:

Date:

Preventing falls

Reviewed by:

Date:

Reviewed by:

Date:

Reviewed by:

Date:

Responding to falls

Reviewed by:

Date:

Reviewed by:

Date:

Reviewed by:

Date:

Assisting with range of motion exercises

Reviewed by:

Date:

Reviewed by:

Date:

Reviewed by:

Date:

Provides Elimination Assistance
Application of continence products (1 piece/2 piece)

Reviewed by:

Date:

Reviewed by:

Date:

Reviewed by:

Date:

Assisting with bedpans

Reviewed by:

Date:

Reviewed by:

Date:

Reviewed by:

Date:

Assisting with urinals

Reviewed by:

Date:

Reviewed by:

Date:

Reviewed by:

Date:

Assisting with commodes

Reviewed by:

Date:

Reviewed by:

Date:

Reviewed by:

Date:

Enema administration

Reviewed by:

Date:

Reviewed by:

Date:

Reviewed by:

Date:

Ostomy care

Reviewed by:

Date:

Reviewed by:

Date:

Reviewed by:

Date:

Care of indwelling urinary catheter

Reviewed by:

Date:

Reviewed by:

Date:

Reviewed by:

Date:

Applying a condom catheter

Reviewed by:

Date:

Reviewed by:

Date:

Reviewed by:

Date:

Collecting specimens

Reviewed by:

Date:

Reviewed by:

Date:

Reviewed by:

Date:

Promotes Client Well-Being
Supporting transitions

Reviewed by:

Date:

Reviewed by:

Date:

Reviewed by:

Date:

Supporting comfort

Reviewed by:

Date:

Reviewed by:

Date:

Reviewed by:

Date:

Supporting rest

Reviewed by:

Date:

Reviewed by:

Date:

Reviewed by:

Date:

Changes Bed Linens
Occupied bed

Reviewed by:

Date:

Reviewed by:

Date:

Reviewed by:

Date:

Unoccupied bed

Reviewed by:

Date:

Reviewed by:

Date:

Reviewed by:

Date:

Promotes Healthy Nutrition and Fluid Intake
Assisting a client with eating/fluid intake

Reviewed by:

Date:

Reviewed by:

Date:

Reviewed by:

Date:

Feeding a client

Reviewed by:

Date:

Reviewed by:

Date:

Reviewed by:

Date:

Measuring and recording intake

Reviewed by:

Date:

Reviewed by:

Date:

Reviewed by:

Date:

Measures Vital Signs
Height

Reviewed by:

Date:

Reviewed by:

Date:

Reviewed by:

Date:

Weight

Reviewed by:

Date:

Reviewed by:

Date:

Reviewed by:

Date:

Pulse

Reviewed by:

Date:

Reviewed by:

Date:

Reviewed by:

Date:

Respiration

Reviewed by:

Date:

Reviewed by:

Date:

Reviewed by:

Date:

Temperature

Reviewed by:

Date:

Reviewed by:

Date:

Reviewed by:

Date:

Reporting and recording

Reviewed by:

Date:

Reviewed by:

Date:

Reviewed by:

Date:

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].

Health Care Assistant Program Learning Outcomes Verification

20

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.

1. Provide person-centred care and assistance that recognizes and respects the uniqueness of each individual client. Met Not Met
Examples and comments:

 

2. Use an informed, problem-solving approach to provide care and assistance that promotes the physical, psychological, social, cognitive, and/or spiritual
well-being of clients and families.
Met Not Met
Examples and comments:

 

3. Provide care and assistance for clients experiencing complex health challenges. Met Not Met
Examples and comments:

 

4. Provide care and assistance for clients experiencing cognitive and/or mental health challenges. Met Not Met
Examples and comments:

 

5. Interact with other members of the health care team in ways that contribute to effective working relationships and the achievement of goals. Met Not Met
Examples and comments:

 

6. Communicates clearly, accurately, and in sensitive ways with clients and families within a variety of contexts. Met Not Met
Examples and comments:

 

7. Provides personal care and assistance in a safe, organized, and competent manner. Met Not Met
Examples and comments:

 

8. Recognizes and responds to own self-development, learning, and health enhancement needs. Met Not Met
Examples and comments:

 

9. Performs the care provider role in a reflective, responsible, accountable, and professional and ethical manner. Met Not Met
Examples and comments:

 

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.

 

Professional Behaviour Development Rubric

21

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:

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.

Measurement Definition
Developing The student is in the process of learning and applying the behaviour.
Competent The student meets expectations for the behaviour.
Exemplary The student exceeds expectations of the desired behaviour.

Professional Behaviour Development Rubric© Continuing Care Assistant Program. (2013). Professional Behaviour Development Rubric. Nova Scotia.

Student Name                                 Date                                

1. Appropriate Behaviour Developing Competent Exemplary
Attitude: The attitude of the student is positive, friendly, helpful, courteous, person-centred, optimistic, and team oriented.
Appearance: The appearance of the student is appropriate: hair and body are clean; no noticeable body odour and scent free; clothes are clean, wrinkle free, and appropriate; wears name tag; appropriate footwear and minimal jewellery and nails are clean, short, and polish-free.
Integrity: The student interacts with people in a respectful manner: their manner is honest, ethical, sincere, reliable, empathic, and committed.
Technology: The student uses technology (e.g., mobile phone, including photo and video recording features; computer; social media) in alignment with established policies and procedures. Does not use personal communication or media devices inappropriately.
Comments (examples and suggestions):

 

2. Respect for Self and Others Developing Competent Exemplary
Communication (verbal and non-verbal): The student communicates in an appropriate manner, verbally and non- verbally. Verbal communication is appropriate: able to speak in turn without interrupting others, takes into consideration tone and volume, does not speak too quickly or unclearly, avoids use of profanity and slang, appropriate self-disclosure. Is considerate of non-verbal communication (e.g., posture, facial expressions, and other body language).
Communication (written): The student communicates in an appropriate manner in written communication. Written documentation is legible, with correct spelling and grammar, objective (fact-based), and uses appropriate terms and abbreviations. E-communication, such as text messages and emails, are written in a suitable manner, taking into consideration the relationship with the recipient. For example, informal “SMS language” such as common texting abbreviations are avoided when communicating with the instructor or practice education site personnel.
Nonjudgemental: The student demonstrates a nonjudgmental attitude in all settings: respecting diversity, differing opinions, and beliefs. Displays a positive approach to differences.
Caring: The student displays a caring attitude with clients/team in all settings. Actively listens, and is kind, respectful, gentle, thoughtful, considerate, compassionate, sincere, person-centred, concerned, team oriented.
Team player: The student demonstrates they are a positive team player. Contributes to the group, committed to team goals, shares the workload, participates in tasks, accountable for actions, takes a multi-disciplinary approach.
Comments (examples and suggestions):

 

3. Commitment Developing Competent Exemplary
Time management: The student manages their time effectively. Student is punctual, prepared, and efficient. Student can effectively prioritize and multitask and is dependable.
Adaptability: The student displays a positive attitude when adapting to changes such as shifts in team/group members or shifts in environment such as increased workload, changes in client assignment, and practising in diverse settings.
Stress management: The student manages their stress appropriately by demonstrating: awareness of and management of triggers (precipitating factors), able to accept when situations cannot be changed, utilizes and continues to develop individual coping skills, maintains professional boundaries effectively (leaves personal life at home), prioritizes appropriately.
Comments (examples and suggestions):

 

4. Competence Developing Competent Exemplary
Accountability: The student demonstrates accountability through appropriate application of skills and knowledge, staying informed of learning goals and requirements, asking questions and seeking guidance, recognizing client status, reporting issues and changes, and advocating for the client.
Continuous learning: The student demonstrates continuous learning by openly offering, receiving, and applying feedback; seeking out learning opportunities; attending available in-services and workshops; and focusing on personal and professional development.
Problem-solving: The student demonstrates problem-solving skills: uses critical thinking skills, follows policies and procedures, understands chain of command, maintains calm and competent presence in unforeseen situations/circumstances.
Comments (examples and suggestions):

 

Download Professional Behaviour Development Rubric [PDF].

Versioning History

1

This page provides a record of edits and changes made to this book since its initial publication. Whenever edits or updates are made in the text, we provide a record and description of those changes here. If the change is minor, the version number increases by 0.01. If the edits involve substantial updates, the version number increases to the next full number.

The files posted by this book always reflect the most recent version. If you find an error in this book, please fill out the Report an Error form.

Version Date Change Details
1.00 February 1, 2022 Book published.
1.01 April 29, 2022 Add link to resource. Add link to “AM Skills Care” videos in Healing 3: Personal Care and Assistance.