Online training: coming soon to a computer near you; This might be more time-saving and effective than you thought

Nursing Homes, June, 2004 by Anna Rahman, John F. Schnelle, Sandra F. Simmons

The Internet can be a powerful training tool. With a few clicks of your mouse, you can use it to:

* (virtually) invite nationally acclaimed geriatrics experts into your facility to lecture your staff on a wide variety of topics (check out, for example, the recorded Web seminars available free from the American Society on Aging [ASA] at www.asaging.org/webseminars);

* access cutting-edge research on nursing home care from peer-reviewed journals such as the Journal of the American Geriatrics Society (www.blackwell-synergy.com/rd.asp?code=JGS&goto=journal); or

* browse through Web-based training modules developed specifically to help nursing homes improve their care (visit Gero T.I.P.S. Online Learning at www.nursing.upenn.edu/centers/hcgne/gero_tips to scroll through its free module on restraint-free care).

Sounds promising, doesn't it? But all this and more from the World Wide Web may be nearly useless to your staff. Ultimately, much depends on your ability to harness the power of Web-based training tools within a learning system that includes nursing home staff as students and your facility's technology resources.

Let's use a hypothetical example to see how the different elements, or variables, in this system might interact, whether successfully or unsuccessfully. Suppose, for example, that you want to access Web-based resources that will teach nurse aides how to provide prompted voiding as a means of improving continence among residents. Where do you start?

Start with the first variable in our learning system: the Internet itself. At last count, there were an estimated 49 million unique Internet Web sites, (1) yet it's possible that not one of them offers the type of online training you seek or anything close to it. Indeed, we came up short after considerable searching, using not only widely recommended search engines such as Google (www.goole.com) and Yahoo! (www.yahoo.com), but also within Web sites that specifically target long-term care providers, such as the American Medical Directors Association (AMDA) (www.amda.com) and state Quality Improvement Organizations (QIOs). To be sure, we found excellent written materials on the topic, including journal articles and clinical practice guidelines on managing incontinence through prompted voiding. But while these materials might be useful in a training seminar, none of them constituted one.

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In general, there is a scarcity of Web-based seminars and tutorials for nursing home staff on any topic of possible interest. One reason for this has been lack of demand. Let's face it: Nursing homes have been slow to embrace the Internet, and the Internet has returned the favor. But demand is rising, fueled largely by the Nursing Home Quality Initiative (www.cms.hhs.gov/quality/nhqi), which has created public pressure for nursing homes to enhance their care and has charged QIOs with helping facilities to make these improvements. In this era of reform, more providers are looking to the World Wide Web to help them offer ongoing, flexible, cost-effective training to a workforce characterized by rapid turnover.

On the supply side, long-term care educators (and we count ourselves among them) have shied away from the Internet as an untested teaching tool. As it is, there is plenty we don't know about using traditional education methods to improve nursing home care. While some training programs have led to increased knowledge among staff, few have been shown to produce sustained improvements in nursing behavior. (2) For years, that inability to effect change in practice has served as a brake on using more innovative but less familiar strategies to deliver continuing education to nursing home staff. Now, however slowly, long-term care educators are turning to Web-based programs in hopes that these can achieve what traditional training programs have not.

Current, pioneering programs for the Web and computers signal future directions for online training. Among these programs, three teaching models are discernible:

1. The online tutorial, as exemplified by the Gero T.I.P.S. training module on restraint-free care, offered by the Penn Nursing Hartford Center of Geriatric Nursing Excellence (www.nursing.upenn.edu/centers/hcgne/gero_tips), and the online Gerontological Nursing Certification Review Course offered by the John A. Hartford Foundation Institute for Geriatric Nursing (www.nyu.edu/education/nursing/hartford.institute/course/home.html). In essence, online tutorials are online training manuals. Although they may include a few multimedia features, they are largely word-based, so you have to read to learn.

2. The Web-based seminar, as exemplified by those offered by the ASA. These are audio-visual presentations featuring online lectures with PowerPoint presentations delivered by experts in the field. On the computer screen, you see the presentation, not the expert, but you hear this person lecturing.

3. The computer-based interactive video training module (not yet available on the Web). Highly visual and featuring few written words, these modules look like documentary films and may ask nursing home staff to think about and evaluate care routines that are demonstrated on the video.