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Train-the-trainer
manual
Manual for training in strengthening the competencies of
caregivers to choose a valid patient handling technique in
their daily practice
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Train-the-trainer handbook The eUlift project
Authors
Ollevier Aline: MSc in Occupational Therapy, Project Coordinator eUlift, VIVES University of
Applied Sciences, Bruges, Belgium
Baetens Tina: MSc, Ph.D. in Physical Therapy; Researcher at VIVES University of Applied
Sciences, Bruges, Belgium
Lutgarde Baes: BSc in Physical Therapy, Researcher at VIVES University of Applied Sciences,
Bruges, Belgium
Goderis Tania: BSc in Physical Therapy, Rehabilitation, AZ Alma Hospital, Eeklo, Belgium
Vandewalle Marleen: MSc in Physical Therapy, Rehabilitation, AZ Alma Hospital, Eeklo,
Belgium
Meijer Bastiaan: BSc in Sport Management, Operational Manager at Nordic Health Alkmaar, the
Netherlands
Tol Jan: CEO, Nordic Health in Alkmaar, the Netherlands
Schiettekatte Sylvie: BSc, R.N., MSc in Community Health, Ergonomist, Athlon S. Coop.,
Mondragon, Spain
Vàrhelyi Edit: CEO, David Gerincklinika, Budapest, Hongary
Benkovics Edit: MSc in Physical Therapy, David Gerincklinika, Budapest, Hongary
Grannenfelt Lotta: BSc Healthcare in Physiotherapy, Nordic Health in Helsinki, Finland
Parviainen Lauri: M.D., CEO, Nordic Health, Helsinki, Finland
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Inhoud 1. Introduction ............................................................................................................................. 4
2. Learning outcomes .................................................................................................................. 5
3. Framework............................................................................................................................... 6
4. Coaching and motivation ......................................................................................................... 6
4.1 Coaching ..................................................................................................................................... 6
4.1.1 Definition ............................................................................................................................. 6
4.1.2 Practical tips and tricks ........................................................................................................ 7
4.2 Motivation .................................................................................................................................. 7
4.2.1 Definition ............................................................................................................................. 7
4.2.2. Practical tips and tricks ....................................................................................................... 7
5. Interactive coaching and motivational strategies ........................................................................ 8
6. Self-regulated learning through education and training ........................................................... 15
6.1 Self-regulated learning ............................................................................................................. 15
6.2 Education and training .............................................................................................................. 16
6.3 Self-regulated education and training in healthcare ................................................................ 16
7. Didactics .................................................................................................................................... 21
7.1 Studies ...................................................................................................................................... 21
7.2 Conclusion ................................................................................................................................ 21
7.3 From theory to the eUlift-app(lication) .................................................................................... 22
Bibliography ................................................................................................................................... 28
Charts ............................................................................................................................................ 31
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1. Introduction
Healthcare workers are exposed to physical risks that frequently cause work related injuries. These disorders reduce their productivity and could lead to absence from work. (U.S. Bureau of Labor Statistics, 2010). Education in safe patient handling can reduce the cases of patient care related injuries (Antwi-Afari et al., 2017). There is evidence that safe patient handling and moving technologies can be effective into rehabilitation activities (Darragh, Huddleston & King, 2009) (Darragh et al., 2013). These programs can help to improve healthcare worker’s occupational safety. Most studies on these subjects describe the contents of the patient handling programs (Aslam, Davis, Feldman & Martin, 2015; Bos, Krol, Van Der Star & Groothoff, 2006; van der Molen, Sluiter, Hulshof, Vink & Frings-Dresen, 2005). Only a few include a clear description of the used didactics. However, the way of teaching these important skills is crucial.
In this train the trainer output, we do not focus on specific effects of patient handling programs, such as work related injuries and workload, nor on the risk factors such as repetitive motion and awkward postures when moving patients, but rather on the didactics of these programs. In the conceptual framework of Weston and Cranton (1986) the recommended didactical methods are classified as follow:
instructor-centred (lecture, questions or demonstrations), interactive (discussions, group projects or peer teaching), individualised (individual work with feedback) or experiential (learning in a natural context or through simulations).
More recent didactics such as blended learning or technology based training frameworks (Bates & Poole, 2003), cannot be classified within this older framework. Some aspects, such as peer evaluation are even not mentioned. At the moment, there is no consensus on what is the most effective didactic method in patient handling training. No research has yet been set up to compare different didactics. Still, training in patient handling is a key strategy to decrease work related injuries (Nelson & Baptiste, 2004), but the effects of safe patient handling and moving programs on rehabilitation practitioners are limited (Harwood, Darragh, Campo, Rockefeller & Scalzitti, 2018).
Recent systematic review on the didactical methods for patient handling does not provide sufficient evidence to conclude which didactical approach in safe patient handling and moving programs leads to the best learning effect. It is important to take a close look at the way current safe patient handling and moving programs are thought. This systematic review on didactical methods for enhancing patient handling suggest that simulation based training doesn’t always lead to the best results, although positive learning effects are clearly described with peer education and problem based training (Beckers, 2018 ). The self-regulated learning model, depending on the development of cognitive and metacognitive skills, is offered to support teaching and learning of reflective clinical reasoning (Kuiper, 2004).
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2. Learning outcomes
Various learning outcomes have been formulated for the eUlift project. The second learning outcome concerns the objectives regarding the didactic approach. The caregiver is able to handle patients in a safe way
Explains the effect of loads on the spine
Gains insight into the mobility levels of the patient
Able to make the choice to perform patient handling alone or with a second caregiver
Executes the postures and techniques of patient handling
Implements theoretical and practical principles for patient handling into daily practice
Choses to use aids for patient handling when necessary
The caregiver is able to work with the eUlift app
Has knowledge of the operation of the eUlift app
Understands and executes the content of the app
Implement the app in to daily practice
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3. Framework
This addendum offers you a framework to be used by you as a trainer in approaching your trainees. The framework is built on three pillars:
How to motivate and coach your caregivers (Chapters 3 and 4)? How to maintain self-regulated learning through the appropriate way of education and
teaching (Chapter 5)? How to choose the appropriate didactic in enhancing patient handling (Chapter 6)?
These three ingredients also give you the framework which can help you as a trainer to guide your trainees through the cases described in the digital training handbook and drawn in the eUlift App. In this addendum, we offer you tools to stimulate your trainees in the self-regulated learning process in patient handling achieved through simulation based training by the means of technology (eUlift-App) and through practice on the job.
4. Coaching and motivation
4.1 Coaching
4.1.1 Definition
At the moment, there are many different definitions describing what ‘coaching students’ actually entails. Parsloe & Wray (2000) argue that one the reasons for this lack of unanimity is due to the fact that “we are in the middle of an intellectual revolution.” ‘Coaching’ can refer to a form of mentoring (e.g. sports coaching), and this concept has also been applied in areas such as education and the workplace, leading to confusion about what coaching actually is.
While a consensus emerged that distinguished mentoring (instructional) from coaching (non-directive), the boundaries are not firmly set (Parsloe & Wray, 2000). Thus, while some approaches to coaching strenuously discourage the coach to give advice, others still regard the coach as a guide (e.g. Cavanagh, 2006).
Additionally, even as the coaching/mentoring dichotomy became more widely accepted, coaching increasingly came under the influence of a range of therapeutic or personal-development approaches. Whereas goal-oriented approaches to coaching are typically brief and aim for relatively immediate results, therapeutic and personal-development approaches tend to go deeper and are more prolonged. While coaching has been immeasurably enriched by the injection of new ideas and techniques, it has led to increased confusion about the precise nature of coaching and what it is designed to achieve. Consequently, coaching has become increasingly difficult to define (Stober & Grant, 2006).
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4.1.2 Practical tips and tricks
Trust trainees to take responsibility for their own learning Try not to act as an authority figure Be enthusiastic
Using the eUlift application could be a good and alternative coaching method to stimulate different work scenarios and a hands-on approach.
4.2 Motivation
4.2.1 Definition
Jovanovic & Matejevic (2014) (Relationship between Rewards and Intrinsic Motivation for Learning, in Procedia, 2014) concluded that pedagogues and psychologists have long recognized the importance of motivation for supporting students learning. In literature, motivation has been repeatedly reported as a key element for students' success in learning and workers’ performance, so motivation is often considered as an inner drive for behaving or acting in a certain manner. In the middle of the 70's, a different definition of intrinsic motivation has been proposed.
Intrinsic motivation
Deci (1971) defined intrinsically motivated behaviours as those that are engaged in for their own sake, in other words, for the pleasure and satisfaction of performing them. These are the activities that people voluntarily perform in the absence of material rewards or constraints (Deci & Ryan, 1985).
Extrinsic motivation
On the other hand, extrinsic motivation pertains to a wide variety of behaviours where the goals of actions extend beyond those inherent in the activity itself. Therefore, there are behaviours that are engaged in as a means to an end and not for their own sakes (Deci, 1975; Kruglanski, 1975).
4.2.2. Practical tips and tricks
Give frequent, early, positive feedback that supports trainees ' beliefs that they can do well.
Ensure opportunities for trainees ' success by assigning tasks that are neither too easy nor too difficult.
Help trainees find personal meaning and value in the material. Create an atmosphere that is open and positive. Help trainees feel that they are valued members of a learning community
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5. Interactive coaching and motivational strategies
Engaging trainees in-class through interactive methods is an ideal way for teachers to connect with as many trainees as possible in person, supporting faculty interaction and active and collaborative earning. Prioritising interactive strategies in class allows trainees to make stronger connections to the course material and minimise time spent in passive listening. When interactive components are well integrated into lectures, trainees retain more information, having been exposed to different perspectives and critical discussion (Cavanaugh, 2011). Designing an engaging classroom environment can positively affect other course interactions, by helping trainees identify weak areas and new questions to discuss during office hours. Trainees are likely to take cues from instructor behaviour in class (Cotten & Wilson, 2006). A positive class meeting will generate similar expectations about meetings outside of class.
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Strategy Purpose Description of Strategy eUlift Examples coaching and motivation.
Implementation Suggestions and Variations
1. Background Knowledge Probes
Instructor determines effective starting points / appropriate levels of instruction for a given subject or class.
Trainees focus their attention on important material
A background knowledge probe (BKP) asks for basic, simple responses (short answers, circling / showing of hands, multiple choice questions) from trainees who are about to begin a session or study a new concept.
During a eUlift scenario introduction ask how the scenario takes place in their daily practice
Trainees may brainstorm together and work to arrive at a common answer prior to reporting out on their response.
2. Cases
Trainees apply theory to practice by discussing realistic, relevant scenarios.
Trainees encounter real-world, authentic contexts that expose them to viewpoints from multiple sources and help them to see why people may want different outcomes.
Provide scenarios trainees may encounter when they would need to use the information learned during the course. It is helpful to provide time for questions after the case scenario is introduced.
In the eUlift scenario, trainees are asked to match findings to interventions applied, and their implications for the patient.
Trainees first generate a couple of approaches to the case individually and then pair up. In pairs, trainees share their proposed scenarios, and then chose one to pursue further and elaborate upon.
Trainees can use wall space to brainstorm and organize their thoughts.
Mobile chairs allow group members to collaborate on different aspects of the cases.
Access to online resources facilitates timely research and case preparation.
The dual sources may be used to project both the case being considered and the trainees’ response to that case scenario.
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Strategy Purpose Description of Strategy eUlift Examples coaching and motivation.
Implementation Suggestions and Variations
3. Closing Summary (list key concepts or ideas)
Instructor ascertains whether trainees were able to identify / grasp the key topics.
Trainees reflect on their learning.
Have trainees write a closing or “exit summary” individually or in pairs, listing or summarizing the main ideas about the topic presented during the session. Trainees can compare and contrast their summaries in pairs to build upon one another’s understanding of the material.
What were the three key points or “takeaways” of today’s eUlift class?
What did you find most interesting? What did you find least interesting? What subject do you want to learn more about?
If you were to make two exam questions that consider the main points from today’s material, what would they be? How would you answer those two questions?
Make certain to set aside a couple of minutes at the end of class for this strategy. Teachers may selectively collect the lists and summarize the main points, addressing misconceptions at the beginning of the next class.
Ask trainees to summarize the previous class session at the beginning of the next one, to ensure continuity between class periods.
★ Trainees can create their closing
summaries on the computers, and then share them with others at their table using the screen-sharing capabilities.
4. Focused Listing
Instructor identifies trainees’ prior knowledge or attitudes
Trainees recall what they have learned about a topic
Encourage people to use
the app.
Trainees recall what they know about a subject by creating a list of terms or ideas related to it.
To begin, the instructor asks trainees to take out a sheet of paper and generate a list based on a given or chosen topic.
Instructors ask trainees to share their lists.
Note: Can be used before or after instruction. Focused listing need not take more than a few minutes.
Ask trainees to formulate scenarios in daily practise. Give some examples of scenarios from the eUlift app to motivate.
Impose a time limit and inform trainees.
Trainees share their lists in small groups.
Trainees make a focused list prior to the discussion and then add to the list (correcting any prior misconceptions) at the end of the class period.
May be used in conjunction with the “Roundtable” strategy.
Trainees share their lists in small groups and identify the two to three most important points, which they then share with the class.
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★ Trainees brainstorm in small groups, typing their lists. Can also be combined with “write around the room” strategy.
★ Trainees can project their list using
the screen sharing facilities.
Strategy Purpose Description of Strategy eUlift Examples coaching and motivation.
Implementation Suggestions and Variations2
5. Pre- and Post-Quizzes
Trainees assess their comprehension and evaluate their learning over the course of the class period.
Instructor gathers information about trainees’ prior knowledge and assesses learning over the class period.
Encourage people to use
the app.
Create a 1-page quiz that covers the primary focuses of your session.
Have trainees take the quiz at the beginning of the session, and then set it aside.
When the trainees take the same quiz at the end of the lesson, they will see what they have learned instantly.
Having the trainees pass in their quizzes provides timely feedback to the instructor on their learning over the course of the session.
The eUlift handbook contains questionnaires to be filled out by the trainees prior to the training session and afterwards. Score the results and discuss the most common mistakes.
Ensure that sufficient time is allotted to convey the correct answers at the end of the session, and to answer any questions that arise as a result.
Student responses to the pre-quiz can be incorporated into review sessions later in the class.
Trainees might follow the post-quiz with a one-minute paper summarizing what they learned.
★When evaluating the quizzes, check
to see whether trainees sitting in the same tables have demonstrated similar or divergent levels of comprehension. If a certain group is doing quite well, while another one is struggling, try to find out why: Are trainees getting along well? Are they on-task? Is there confusion over use of the technology? Are you consistently teaching with your back to this group?
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Strategy Purpose Description of Strategy eUlift Examples coaching and motivation.
Implementation Suggestions and Variations2
6. Problem oriented
Trainees develop communication, problem-solving, and self-directed learning skills.
Encourage people to use the app.
Trainees individually or collaboratively solve problems, apply what they have learned in the course and reflect on their experiences.
Teachers take on the role as "facilitators" of learning.
Select one or a few complex patient handling scenarios.
Identify risks to both patient and trainee, ask for suggestions to solve the situation, using the resources, find background context, discuss in your team, and justify your response.
For collaborative problem solving, groups should be chosen carefully, to facilitate trainees’ interactions and promote a productive group dynamic.
Have trainees create their own problem-based learning prompts, vet them then re-distribute amongst their classmates.
Trainees reflect upon how different conditions might affect their response, or approach the same problem from a different point of view. (For instance, in the example given, they might propose solutions from the perspective of a patient and that of a healthcare professional) .
Different tables can work on different aspects of the problem. If they work on the same problem, you can use the dual-source projection to show different approaches.
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Strategy Purpose Description of Strategy eUlift Examples coaching and motivation.
Implementation Suggestions and Variations2
7. Questions
Trainees are actively involved in class as they apply concepts and content learned.
Instructor determines student comprehension of content
Encourage people to use the app.
The instructor provides engaging, challenging questions or asks for guidance during class time.
Trainees then provide answers either working individually, with a partner, or in a small group.
Questions should relate to learning outcomes and be thoughtful and reflective (Simple, yes/no, factual questions are not enough).
Ask trainees to suggest a handling or transfer decision given a certain patient’s mobility status
Ask trainees to make reference to concepts discussed in class, the eUlift-app or in the readings in their responses.
Trainees need sufficient time to respond. This gives trainees sufficient time to organize their thoughts and brainstorm to make their ideas more articulate.
Think about instruction in terms of the questions you hope are being answered – “If this session is the answer, what is the question?” and phrase your question prompts accordingly.
For more complex queries, instructors might consider providing questions in written form so trainees can continue to refer back to them.
Instructors might ask the same core question(s) on the first and last day of the course or unit as a method of formative and summative assessment.
Trainees formulate their own questions based upon what they see as the key points of the topic at hand. These questions are then opened up to the class for discussion, or discussed in small groups.
★Ask the class a question, and allow
trainees a moment to discuss it in their table groups prior to calling for responses. Trainees can take advantage of the microphones on their tables to ensure that they are heard by the larger group.
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Strategy Purpose Description of Strategy eUlift Examples coaching and motivation.
Implementation Suggestions and Variations2
8. Directed Questioning
Promote active student involvement in class
Determine student comprehension of content
Apply content
Encourage people to use the app.
The instructor provides engaging challenging questions or asks for guidance during class time.
Groups work on their responses.
Trainees then provide answers, either working individually, with a partner, or in a small group.
See strategy 7. ★Table configuration facilitates small
group discussions
9.Simulations
Trainees apply their knowledge of structures, concepts, and best practices to virtual or other situations that simulate real-life occurrences.
Instructors and trainees reflect upon the trainees’ response
Encourage people to use the app.
A person, system or computer program demonstrates an action, symptom or scenario to which trainees are expected to respond.
Given the information presented, trainees take the appropriate action or give a detailed verbal explanation of what they would do to solve the problem or address the situation.
Trainees and instructor debrief, discussing the simulation and trainees’ responses.
Trainees perform a patient handling- or transfer technique while explaining what they do and why they do it in that manner.
Ask trainees to make reference to concepts discussed in class, the eUlift-app or in the readings in their responses.
Discuss in the group whether the performance and also the assessment were according to their learning over the course of the session.
As a variation, trainees may take turns simulating (through role play) the appropriate action, symptom or scenario, to which classmates then respond.
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6. Self-regulated learning through education and training
6.1 Self-regulated learning
“Learning is the processing and assimilation of what we hear, see or experience that alters or improves our knowledge, skills and attitudes” (Stockley, 2014). There are different processes of learning (in skill-training). The most common ones are the instructor regulated learning and the self-regulated learning.
Instructor-regulated learning is controlled or initiated by the instructor. It includes a direct supervision during the skill training and it relies on feedback of the instructor or the peers.
Self-regulated learning is a cyclical process involving “self-generated thoughts, feelings and actions that are planned and cyclically adapted to the attainment of personal goals” (Zimmerman, 2000). Your trainee plans for a task, monitors his/her performance, reflects on the outcome and uses the reflection to adjust and prepare for the next task (Zimmerman, 2002). The figure below illustrates the key steps of the process. These steps are performed by your trainee, but you as a trainer, plays a vital role in guiding and coaching your trainee through each step.
The Cycle of Self-Regulated Learning Showing steps students can take throughout the process
(imagen de Karin Kirk)
Chart 1: Source: SAGE 2YC, 2017
Reflect on performance
Plan, set goals and lay out strategies
Use strategies and monitor performance
Use results from previous performance to guide the
next one
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It is an “active, constructive process whereby the trainees set goals for their learning and then attempt to monitor, regulate and control their cognition, motivation and behaviour, guided and constrained by their goals and the contextual features in the environment” (Pintrich, 2000). It’s a complex process, containing cognitive, motivational and contextual elements, in which there is an interplay between knowledge, strategy and motivation. Metacognition is the instrument that controls all these elements in learning strategies. It’s the knowledge of your own thinking. Various strategies are used to control this thinking process, such as organizing, monitoring, and adapting (Flavell, 1979).
Self-directed learning and self-regulated learning clearly share significant overlap (Evensen, Salisbury-Glennon & Glenn, 2001). In the process of self-directed learning, individuals take the initiative, with or without the help of others, in diagnosing their learning needs, formulating goals, identifying human and material resources for learning, choosing and implementing appropriate learning strategies, and evaluating learning outcomes (Knowles, 1975). Therefore motivation is directly linked to these learning processes. Self-regulated students are metacognitively, motivationally, and behaviourally active in their own learning processes and in achieving their own goals (Zimmerman and Schunk, 2008).
6.2 Education and training
“Training is the conscious and planned process of transferring knowledge, skills and attitudes to others” (Stockley, 2014). Over the years different types of education or training are developed: the classic classroom-education, distance-education, information-based education, online education, problem-based learning, video-lectures, flipped classroom, hands-on training … (Bernard et al., 2009; Bishop & Verleger, 2013). Lage et al. (2000) give a clear definition of a flipped classroom: “Inverting the classroom means that events that have traditionally taken place inside the classroom now take place outside the classroom and vice versa”. Simulated training by using technology and practice on the job offers trainees possibilities to improve themselves in patient handling in simulated environments. Training in patient handling is a skill training and requires practice. Starting from a theoretical introduction, an explanation of the several techniques and a practice of these in a simulated environment are needed.
6.3 Self-regulated education and training in healthcare
Self-regulation theory, as applied to medical education, describes the cyclical control of academic and clinical performance through several key processes that include goal-directed behaviour, use of specific strategies to attain goals, and the adaptation and modification to behaviours or strategies to optimise learning and performance “(Sandars, 2011).
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In chart 2 below, the key steps of the process, mentioned in chart 1, are applied to manual patients transfer handlings with examples from the eUlift app and eUlift handbook.
Forethought phase
eUlift App Information + Possible questions Example
Plan Analyse the learning task.
Trainees are advised to read the handbook before using the eUlift App. Trainees determine the right patient handling task, using the Assess Patient Mobility (based on the BMAT). They ask themselves following questions:
What is the nature of the task?
Possibilities of the patient?
How to follow the questions of the Assess Patient Mobility to come to the right animation?
Which transfer?
How much time will it take?
eUlift App -> eUlift Handbook eUlift App -> Assess Patient Mobility BMAT: OK Question 1: Can the patient come and sit on the side of the bed without help? Yes Question 2: Can the patient reach and shake hand across? Yes Question 3: Can your patient stretch and point – only the leg(s) they are tending to stand on? No Mobility Level 2 Which lift you want to do? Higher Wheelchair level 2 Patient is not able to bear weight on his/her legs at all or has only partial weight bearing but has core stability. Animation with comments Bend knees to 90° and trunk forward Start with weight shift, then push leg
Trainees suggest potential outcomes and prioritize options how to reach the goal. They ask themselves following questions:
What is my goal?
What is my motivation?
The patient has to sit higher and straight in the wheelchair so he/she will not slip out of the wheelchair.
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Forethought phase
eUlift App Information + Possible questions Example
Lay out strategies
Plan the strategies.
With the example showed in the simulation, by means of the animations, the trainee plans the needed actions before starting. They summarize the key concepts.
They ask themselves following questions:
What kind of information and strategies do I need?
How to perform the transfer?
What are the steps to follow?
How much time and resources will I need?
Do I need to modify the environment?
Which tools are needed?
Number of caregivers:
One caregiver needed.
Preparation:
The caregiver is placing the feet of the patient backward. The caregiver does this action in a semi-squat. This posture can be found in the section postures.
Position of the patient and the caregiver:
The caregiver stands In front of the patient in semi-squat and fixates the knees of the patient. With the right hand, he will take the left shoulder of the patient backward the patient.
Moving:
The caregiver brings the patient in a sideway position. With the left hand he will push the right knee backward. Then he/she does the same at the other side until the patient is in a correct position.
Comments:
Left hand of the caregiver: ‘Always take support points.’
Don’t pull on the neck of the patient.
During the whole action the caregiver stays in semi-squat.
Set expectations for the outcome.
Trainees define the expectations of the outcome of the chosen technique.
They ask themselves following questions:
How can I get the patient straight in his/her wheelchair, using a safe patient handling technique, safe for both, the caregiver and the patient?
Given how much time I have available, my strengths and weaknesses, what type of outcome would I like? …
Taking into account that the patient has no or only partial weight
bearing, but has core stability, he/she has to sit higher and straight in
the wheel chair so he/she will not slip out of it.
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Performance phase Practice on the job
Possible questions Example
Self-observation They ask themselves following questions:
Do I have a clear understanding of what I am doing?
Does the task make sense?
Am I reaching my goals?
Do I need to make changes?
Do I need to modify my thoughts / emotions?
Do I need to modify the environment?
Trainees ask themselves if the intervention has the expected result and what the implications of it are on themselves and on the patient. They have to think about changing the furniture in the room, the position of the bed, … to optimize the conditions for doing the movement of the patient.
Plan for what to do when obstacles arise
(Flanagan, 2014)
They ask themselves the following question:
What do I do when things don’t work out?
If things do not work out like planned, the trainees have to think how to manage the possible obstacles.
They have to think about adjusting the moving techniques, and be flexible in applying them, though it may be tempting to revert back to known (but ineffective) strategies.
Stick with the strategies They ask themselves following question:
How can I do the movement-technique as good as possible according to the animations?
If everything goes like planned, it is good to memorise the key points/the steps and the stressed attention points of the movement technique and to carry it out as planned.
Monitor own progress
They ask themselves following questions:
How is the progress on my intermediate goals?
How is the progress on the strategies?
The trainees reflect on the performance of the patient handling technique, and the impact on the patient and themselves. You as a trainer can also monitor the progress and offer feedback.
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Self-reflection phase
Possible questions Example
Reflect on performance
Evaluate performance and results.
They ask themselves following questions:
Have I reached my goal?
Does the action the trainee has taken, support the result?
Did I follow through with the selected scenario?
Compare your performance to the original goal, the right patient
handling scenario for
Higher Wheel Chair variation 2
Reflect on the effectiveness of strategies used.
They ask themselves following questions:
Did I select an appropriate strategy?
What worked? What didn’t work?
Would I do things differently next time?
What is the impact on my motivation?
Did the trainee use their problem solving and self-directed learning skills?
Trainees express their experiences with the applied moving technique and the outcome.
Plan for the next task.
They ask themselves following questions:
How will I adapt my planning, strategy, time management, and self-monitoring?
What would you propose?
What would you suggest?
With that information the trainees learn how to adapt their planning and performing for the next task
Chart 2: based on source: SAGE 2YC, 2007
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7. Didactics
7.1 Studies
According to previous paragraphs, patient handling tasks could lead to disadvantages for the healthcare worker. So it’s important to avoid this by performing these tasks correctly. This could be achieved by training or educating healthcare workers in safe patient handling and moving techniques. Didactics are tools to educate. ‘Didaktikos’ is a Greek word that means ‘apt at teaching’. It comes from ‘didaskein’, meaning ‘to teach’. Sometimes it is considered to be the pedagogical core discipline. It’s often defined as the science of learning and teaching. The main focus is on instruction or the process of teaching (Carneiro, Lefrere, Steffens & Underwood, 2011).
It is important to choose the right education type for the right subject. In the preliminary research (Beckers, 2018), we were looking for the best and most effective didactic according to patient handling. This systematic review does not generate a most effective didactic method though it is noticeable that simulation based training in the form of practical training is frequently presented in articles on this subject. Positive learning effects are clearly described with peer education and problem based training. Although most of the different didactic methods are still being used, a combination of didactic methods can attribute to the learning process.
Two explorative studies (Wouke Hoet, 2018; Jonas Callens, 2018) measured the effect of learning retention in simulated based training, but found no conclusive evidence. Further research is recommended.
7.2 Conclusion
The use of video-material as a method of learning has added value when transferring knowledge (Soucisse et al., 2017). Also interactive learning methods and virtual lectures offer the possibility to an alternative transfer of knowledge (Sendra-Portero, Torales-Chaparro, Ruiz-Gomez & Martinez-Morillo, 2013).
Relearning is a successful aspect to raise the level of knowledge (Rawson & Dunlosky, 2011). It is a critical factor to keep the knowledge on the long term. But there is no answer yet how much relearning is needed (Dunlosky & Rawson, 2012). Nevertheless research in repeatedly and spread practice shows us a positive effect (Dunlosky, Rawson, Marsh, Nathan & Willingham, 2013).
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Simulation based teaching gives the opportunity to train over and over in a safe environment (Sigalet et al. 2014). Trainees can apply their knowledge and best practices to virtual or other situations that simulate real-life ones. It is a technique to replace and amplify real experiences with guided ones, often “immersive” in nature, which evokes or replicates substantial aspects of the real world in a fully interactive fashion (Lateef, 2010).
Technology can be used to create a simulated environment (Koller, Harvey & Magnotta, 2008) and can be an additional asset for hands-on training, peer-training and training on the job.
The eUlift digital training handbook is available for the trainees to increase their knowledge about anatomy, physiology and biomechanics. They can find information about ergonomics, musculoskeletal disorders and pathologies of the back, pain education and last but not least: common used postures and movements in patient handling.
7.3 From theory to the eUlift-app(lication)
The following chart describes ways to support your trainees in their self-regulation process. The possible supporting ways are provided through questions that students can ask themselves at every stage of the learning process.
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Used didactic Means? How to support your trainees in this self-regulating learning process?
Simulation Technology
App eUlift Encourage… your trainees to inform themselves about the theoretical background of patient lifting, using the digital training
handbook, going through the phases of the self-regulating learning process.
Handbook
Help them to ask themselves following questions:
FORETHOUGHT PHASE: PLAN, SET GOALS, LAY OUT STRATEGIES
How can I download the eUlift App?
Who can help me with this?
What kind of training handbook is this?
How much time do I have to get through this handbook?
What is my goal in studying this background information?
How much time do I need to go through the handbook to reach that goal?
How and when do I plan to take the information to myself?
Which expectation do I want to be filled in by informing myself about the theoretical background of patient lifting?
Can I reach my goal or do I have to change my strategy?
PERFORMANCE PHASE: USE STATEGIES, MONITOR PERFORMANCE
Do I reach my goal following the planned strategy?
Do I need to adjust my strategy, to set intermediate goals?
What do I do when there is not enough time to get through every part of the handbook?
How is the progress on my strategy?
SELF-REFLECTION PHASE: REFLECT ON PERFORMANCE
Have I reached my goal: to learn about the theoretical background of patient lifting through the handbook?
Could I follow the planned strategy?
Would it have been better to do things differently?
How can I adapt my strategies for the next task?
24
Used didactic Means? How to support your trainees in this self-regulating learning process?
(Simulation Technology)
Animations Stimulate…
them to learn the right techniques, the tricks and tips, through the animations on the App. In this phase it is no need to have a special case in mind. But if there is, it is good to take that case already in this learning process.
Help them to ask themselves following questions:
FORETHOUGHT PHASE: PLAN, SET GOALS, LAY OUT STRATEGIES
What is the right patient handling task using the Assess Patient Mobility?
Which variation of the transfer do I have to apply in this situation?
Has the patient special needs I have to consider?
Are there unexpected things that can arise during the transfer?
How can I manage these things?
What is my goal in learning from these animations?
Which key concepts are important to apply in the patient handling case?
Do I have to change the environment (the room, the bed)?
What is the expected outcome of the transfer?
PERFORMANCE PHASE: USE STATEGIES, MONITOR PERFORMANCE
Do I have a clear understanding of what is happening in the animation?
Can I apply this animation on the transfer I have in mind?
Do I need to change some things in the process of the transfer?
Do I have to modify the environment?
Do I know the key steps and the stressed attention points of the animation?
Am I prepared to apply these techniques showed in the animation on the real case?
Do I reach my goal in learning from the animation?
SELF-REFLECTION PHASE: REFLECT ON PERFORMANCE
Have I reached my goal: to learn from the right animation? Did I learn the key points from the selected animation?
25
Used didactic Means? How to support your trainees in this self-regulating learning process?
(Simulation Technology)
Coach… them to apply the self-regulating learning process in the performance of the moving technique.
Manual for trainers
Help them to ask themselves following questions:
FORETHOUGHT PHASE: PLAN, SET GOALS, LAY OUT STRATEGIES
What is self-regulating learning?
How can I get information about it?
What are the possibilities, the opportunities in applying this learning strategy?
How much time will it take, how much time will I gain by applying it?
PERFORMANCE PHASE: USE STATEGIES, MONITOR PERFORMANCE
Do I understand the phases of the self-regulated learning process?
Does it make sense to me?
How can I apply these phases in my preparing of a movement technique?
SELF-REFLECTION PHASE: REFLECT ON PERFORMANCE
Have I reached my goal: to understand the phases of self-regulating learning?
How will I adapt this knowledge in learning from the eUlift App?
26
Used didactic Means? How to support your trainees in this self-regulating learning process?
Practice on the job
Teach your trainees to… Training and supervision on the job
1. have an attitude to let the patient do as much as possible.
2. find the technique with the least load for both the trainee and the patient through the following the steps of the Assess Patient Mobility test and the animations.
Manual for trainers
3. use an adapted version of the animations, created through the self-regulating learning process.
4. explain how the transfer will take place.
5. support and guide the patient during the transfer.
Help them to ask themselves following questions:
FORETHOUGHT PHASE: PLAN, SET GOALS, LAY OUT STRATEGIES
What is my goal: the right transfer, carried out as good as possible?
Which animation is a good scenario to start with?
Are there possibilities or restrictions of the patient, of the environment?
How much time will I need?
Do I need a fellow worker to help me in this transfer?
Are there extra tools needed?
Given how much time I have available, what type of outcome would I like?
PERFORMANCE PHASE: USE STATEGIES, MONITOR PERFORMANCE
Is the transfer rightly performed?
What do I do when things don’t work out?
How is the progress of the applying of the animation on the real life situation?
SELF-REFLECTION PHASE: REFLECT ON PERFORMANCE
Did the adapted version of the chosen animation work out as planned?
Would I do things differently in the next real situation? How will I adapt my planning, strategy?
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Charts
Chart 1: The Cycle of Self-Regulated Learning
Kirk, K. (2017). The cycle of Self-Regulated Learning. Sage 2 YC. Retrieved from https://serc.carleton.edu/sage2yc/self_regulated/what.html
Chart 2: Different phases in Self-Regulated Learning
Kirk, K. (2017). The cycle of Self-Regulated Learning. Sage 2 YC. Retrieved from https://serc.carleton.edu/sage2yc/self_regulated/what.html
