Scheduling traditional continuing education and required classes for homecare staff can be challenging, resulting in low attendance and compliance rates. Innovative, flexible, and accessible educational opportunities are needed to meet clinicians' educational needs. This article describes the affect of implementing online learning at one homecare agency. Implementation of online learning has resulted in an improvement in staff satisfaction, increase in compliance, and cost savings.

The healthcare environment is changing rapidly because of technological advances in patient care as well as the transformation from paper to electronic documentation systems. Computer literacy is increasingly becoming a necessary skill for healthcare clinicians. Healthcare clinicians, specifically those working in homecare, have the unique experience of caring for patients in their natural setting. This mobility can prove challenging for staff educators in providing continuing education that is both flexible and accommodating (Clifford, Goldschmidt, & O'Connor, 2007). Other challenges faced by the staff educator include providing cost-effective, accessible, and convenient education for orientation, professional growth and development, and annual requirements. The traditional, live inservice format meets the need for clinicians who are accustomed to passive learning, but younger generations are demanding active learner-centered experiences.

With several generations of healthcare clinicians in today's workforce, staff educators need to be creative in meeting the needs of different types of learners, and learners need to be more accountable to seek gaps in knowledge. According to Phillips (2005), learners in today's healthcare workforce belong to one of three generations: Net Generation (age 24 years and younger), Generation X (age 25-44 years), and Boomers (age 45-64 years). Each of these generations has preferred learning styles in addition to different levels of comfort in basic computer skills. The Health Resources and Services Administration 2004 National Sample of Registered Nurses Report (as cited in Rose, 2011) found that 41% of registered nurses (RNs) were 51 years and older. As most clinicians at Virtua Homecare are registered nurses, this was an important factor in formulating and developing future education.

Virtua Homecare employs an estimated 160 registered nurses, 47 therapists, and 57 home health aides. A demographic data analysis was conducted for the employee population. The data analysis results are presented in Table 1. It was anticipated that online learning for the Net Generation population would be relatively simple because they have grown up in the age of technology. Generation X learners vary in level of knowledge of technology and may need some direction from the staff educator. Boomers on the other hand are accustomed to passive learning in a classroom setting and need to be encouraged to explore new, active learning methods such as those provided by online modules (Phillips, 2005). The qualitative feedback from needs assessment surveys indicate the staff who initially were unsure of how this mode of learning was going to be beneficial has praised the utility and accessibility of online education. Staff comment that online learning is easy to complete and provides much needed education, and they can do it when it is convenient for them. Despite the variances in generational learning styles, staff development and computer support helped ease the transition and acceptance of online education.

TABLE 1 Virtual Home Care Staff Generational Data

Another important factor to consider is the way in which adults learn. According to Vandeveer, Knowles described adults as self-directed and in control of their learning. Online learning is a medium that is more self-directed and learner-centered and is accessible and accommodating to clinicians, allowing them the flexibility to learn at their own pace. Implementing principles of adult learning theory into educational experiences increases adult learners' self-directed ability, sense of accountability, and motivation to learn (Vandeveer, 2009).

VIRTUA HOMECARE

Three years ago, the staff development department at Virtua Homecare was challenged with the number of staff who needed to be educated: 120 nurses, 65 therapists, and 80 home health aides. Each discipline shared basic core requirements for annual education as well as job-specific requirements. In addition, every employee was required to complete corporate compliance training and education, which could be completed on paper or online. Nurses, therapists, and home health aides provide patient care in three counties in southern New Jersey. Many clinicians work in territories that are an hour or more away from the main or branch offices.

IDENTIFICATION OF PROBLEM

Homecare clinicians are unique in that they work and care for patients outside the confines of a controlled hospital setting. These mobile clinicians travel from home to home to provide care. This travel costs money in mileage reimbursement and lower clinician productivity. Attendance at continuing education and/or mandatory annual education sessions is difficult because of the unpredictability of clinician case loads and travel time. In addition, for large homecare agencies, tracking these educational activities can be challenging. Staff development educators must offer multiple sessions, including weekends and evenings, in order to provide opportunities for clinicians to attend annually required education.

Online learning was decided upon to streamline annually required education into one learning format. As cited in Carcich and Rafti (2007), previous research has supported the notion that self-learning modules are an effective teaching method, allow for self-pacing, are cost-effective, and can increase learner participation in professional development. Modules were developed using a format from an already-existing health system-wide online annual education.

INNOVATIVE MODULE DEVELOPMENT

In the fall of 2008, the staff development educators investigated how to improve compliance and track attendance. After determining that the hospital-wide intranet could support online education and track module completion on each individual's education record, the staff development and quality team collaborated and began working on the first module. The overall goal was to improve the continuing education and professional development of homecare clinicians. The initial objective was to formulate three modules that covered required education that all clinicians must complete annually to meet regulatory guidelines: pain, end-of-life care, and infection control. One hurdle would be to familiarize clinicians with the change in education delivery. In addition, training some clinicians on basic computer skills would be necessary prior to teaching them how to use software or online educational programs.

After completion of the modules, several members of the management team and content experts conducted a review. Questions were developed for each module to provide positive reinforcement. Individuals were not able to progress through the module until the correct answer was selected. Education was first rolled out to professional clinicians because of their prior experience using an electronic documentation system. Staff development support and computer support were provided to inform clinicians on how to access and navigate the self-learning modules. On the following year, online modules were introduced to home health aides to provide individualized computer instruction.

OUTCOMES

Three years later, the homecare agency continues to use online learning modules as a method for providing annual and continuing education. Additional modules have been added to supplement the orientation needs of new hires transitioning into homecare practice (see Table 2). Future learning modules include fall risk assessment and mobility, home health documentation, and patient family education. The staff development team was the primary developer of the modules, with the input of content experts where applicable. Therefore, this team oversees the module review and revisions annually to ensure accuracy of information.

TABLE 2 Modules for Homecare Clinician Orientation

Feedback from field clinicians was elicited through voluntary surveys. There was approximately a 50% response rate from all disciplines, with professional nursing staff returning most of the surveys. Findings from the surveys indicated mixed responses from clinicians regarding logging onto their computer to complete online education. A gap in knowledge regarding annual requirements for each discipline was noted, particularly for clinicians who had worked for the agency for many years. Traditional live educational programs continued to be offered to meet mandatory annual requirements during the first year of online implementation. The following year, annually required education was solely provided by using the online format. Compliance with completing annually required education prior to initiating online education is estimated between 40% and 50%, because of challenges in tracking attendance on paper.

Because the inception of online education, the home health aides have shown increased ability to complete the online education, although one-to-one assistance is still required to access and navigate the self-learning modules. Overall compliance with completing annually required education is currently estimated at 98%. Clinicians have shown increased awareness of educational requirements and health system intranet access and navigation. In addition, managers can now track compliance because verification of completion of each module populates from the computer to the clinician's individual education record. Online education has been expanded to include some competency education, orientation modules, and continuing nursing education credit courses.

Online education has proven cost-effective. With 265 field clinicians requiring at least four mandatory inservice programs per year, the staff development department has cut travel time and mileage expenditures by not having the clinicians coming to the office. The modules can be completed from any computer, and the clinicians can complete them over the course of a calendar year. With variations in patient census, having online education readily available for times when the census is low allows for improved productivity. The average time invested in the development of one module was approximately 4 hours. At least half the amount of time that would be required to offer a live 1-hour program eight times, assuming 30 clinicians attend each session. In an employee opinion survey conducted in 2010, staff education received a 91% for satisfaction with program offerings, a significant increase from previous years.

RECOMMENDATIONS

Before developing online education, ensure that all clinicians receive education on basic computer skills. Conducting a needs assessment, followed by planned computer education and hands on training may be necessary. Two of the biggest challenges were the limited basic computer skills of home health aides and the unfamiliarity of all homecare staff in accessing and navigating the health system intranet. Reinforcing on-line access and navigation has required significant one-to-one education, but has proved fruitful in an effort to provide an accessible learner-centered, cost-effective solution.

References

Carcich G. M., Rafti K. R. (2007). Experienced registered nurses' satisfaction with using self-learning modules versus traditional lecture/discussion to achieve competency goals during hospital orientation. Journal for Nurses in Staff Development, 23, 241-220. [Context Link]

Clifford P., Goldschmidt K., O'Connor T. (2007). Staff nurses writing for their peers: Development of self-learning modules. Journal for Nurses in Staff Development, 23, 283-288. [Context Link]

Phillips J. M. (2005). Strategies for active learning in online continuing education. Journal of Continuing Education in Nursing, 36, 77-83. [Context Link]

Rose J. F. (2011). Charting challenges. Retrieved from http://news.nurse.com/article/20110610/NATIONAL01/106130039[Context Link]

Vandeveer M. (2009). From teaching to learning: Theoretical foundations. In Billings D. M., Halstead J. (Eds.), Teaching in nursing: A guide for faculty (3rd ed., pp. 189-226). St. Louis, MO: Elsevier. [Context Link]