ELearning Dementia Care Program for Health Care Teams in LongTerm Care Facilities

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E-Learning Dementia Care Program for Health Care
Teams in Long-Term Care Facilities

• Dr. Colla J. MacDonald (cjmacdon_at_uottawa.ca) and
  Dr. Emma Stodel, University of Ottawafor CANARIE
  Working Group

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Partners

• Funded by CANARIE-OLT
• Élizabeth Bruyère Research Institute Lead
  Organization
• SCO Health Service Project Development,
  Psychology Content
• University of Ottawa Faculty of Education and
  Centre for E-learning Evaluation and Course
  Design
• Royal College of Physicians and Surgeons of
  Canada
• Consortium National de Formation en Santé-Volet
  Université dOttawa
• Central Park Lodges
• Beausejour Regional Health Authority
• St. Patricks Home of Ottawa
• Résidence Saint- Louis

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To design, develop, deliver, and evaluate an
e-learning dementia care program aimed at
enabling healthcare teams deliver better service
to patients/residents and their families in
long-term care facilities.
Purpose
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Research Objectives

• Use the Demand-Driven Learning Model (DDLM,
  MacDonald et al., 2001) to design, develop, and
  deliver an e-learning dementia program
• Use the DDLM and companion online evaluation tool
  (MacDonald et al., 2002) to evaluate the process
  and outcomes of the program and gain an
  understanding of the stakeholders (learners,
  site coordinators, senior management, and design
  team) experiences and perspectives
• Identify the lessons learned by the stakeholders
  and provide recommendations for future e-learning
  initiatives.

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DDLM

• Five features make the DDLM an appropriate
  quality standard for e-learning
• Designed to address the needs of adult learners
  and educators
• Created to support appropriate workforce learning
  contexts
• Developed through collaboration between academics
  and industry
• Includes an outcomes component and
• Provides a companion online evaluation survey.
•  

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Project Overview

• Funded by CANARIE-OLT
• February 2003 March 2004
• Multi-partner
• Bilingual e-learning program
• Three Provinces, 6 sites
• Team oriented learning
• Four modules (2 hours per week, 10 weeks)
• Validated evaluation framework

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Participatory Evaluation

• community-based participatory research
  orientation (Minkler Wallerstein, 2003)
• aimed at understanding dynamics/socio-cultural
  factors that impact learning
• all community partners collaborated and become
  agents of change in this research endeavour
  (participation, cooperation, co-learning process,
  community building)
• empowering process through which community
  partners achieve a balance between research and
  action.

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Project Participants

• Pedagogy Team Project Manager, Content Experts,
  Programmer, Course Facilitator, Evaluation Team.
  (Collaborative weekly meetings advising,
  forming needs analysis questions, evaluation
  instruments)
• Site Coordinators (weekly meetings providing
  input and feedback)
• Learners (participated in needsanalysis and all
  data collection procedures)
• Senior Management of LTC facilities (input on
  impact ofprogram).

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Research Questions

• How can an e-learning program on dementia care be
  delivered to maximize effective team learning and
  performance?
• What learner and organizational characteristics
  affect the programs structure, content, delivery
  and outcomes?
• What have we learned about workplace-related team
  learning?
• What lessons were learned by the project
  participants to improve future e-learning
  initiatives?

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Needs Assessment

• three in-depth focus group interviews
• nine healthcare workers
• two different sites across Canada

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Needs Assessment Findings

• Five major themes
• Time
• Technology
• Content
• The Healthcare Team
• Delivery

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Recommendations

• 30 minute segments
• understand residents realities
• quality of life
• challenging behaviours
• application to work
• how to work effectively as a team
• communicate effectively
• quiet learning environment
• opportunities for interaction
• option of printable program documents
• accessible, precise, and concise

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Evaluation Methodology

• pre-program survey
• course transcripts
• temperature check
• post-program online survey
• post-program interviews.

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Pre-Program Survey

• Demographic survey completed by learners prior
  to beginning the program.

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Course Transcripts

• E-mails between the learners and the course
  facilitator
• Final reflective posting
• Tracking Students

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Temperature Check

• Completed part-way through the program
• Abbreviated DDLM online survey - questions
  related to content, delivery, service, structure,
  and outcomes of the program
• Comprised 20 questions on a 4-point Likert scale
  (strongly disagree, disagree, agree, strongly
  agree) and two open-ended questions
• 77 response rate from learners who completed the
  program (54 completed in French, 46 in English)

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Post-Program Online Survey

• DDLM companion survey (MacDonald et al, 2002)
  adapted to align with the content and needs of
  this program
• Five components content, delivery, service,
  structure, and outcomes
• 41 six-point Likert questions
• 4 open-ended questions.

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Post-Program Interviews

• semi-structured interviews (25-45 minutes)
• audio-taped, transcribed, and returned to
  participants for member check
• 15 participants 10 learners (2 who withdrew
  from the program) and 5 site-coordinators
• Short email interview with members of senior
  management

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Data Analysis

• The research questions and the DDLM were used
  as guidelines to search for themes and meanings
  emerging from the data. 

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Participants

• 95 learners started the program (4 were site
  coordinators)
• 49 (52) took the program in French 46 (48)
  took the program in English
• 16 (17.6) learners dropped out

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Preliminary Findings

• Learners reported that participating in this
  online course was both a challenging and
  rewarding learning experience
• These challenges and rewards will be discussed
  under the components of the DDLM structure,
  content, delivery, service, and outcomes.  

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Content

• Overall the participants reported that they
  liked and enjoyed the content. They said it was
  relevant, they learned a lot, and several
  reported applying what they learned in the
  workplace. Recommendations with regards to
  content included
• Clearer writing and simpler language
  (particularly but not exclusively in the French
  version)
• Make allowances for English as a second language
  learners
• Adapt to different knowledge/education levels
• Add additional activities quizzes problem
  solving clinical examples, less team
  assignments
• Make additional resources available offline
• Provide more time and training for developing
  computer skills.

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Delivery

• Technical Problems affected learner motivation at
  one site
• Learners with no previous computer experience had
  major problems with the delivery
• Navigation
• Mixed opinions regarding ease of navigation
• Printed version of content
• Very valuable to learners

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Service

• Support
• Online facilitator and site coordinator helpful
  and responsive
• Some participants received compensation while
  others did not
• Varying opinions regarding technical support
  generally positive
• Problems sometimes due to site coordinator and
  learner working different shifts
• Need for release time
• Learners found it extremely difficult to work on
  this program during work hours
• Those with computers at home worked on it on
  their own time.

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Structure

• Pace was too fast
• Learners needed more time to complete the
  modules
• The program was organized
• Too many written exercises
• Learners were used to verbalizing their thoughts
  rather than writing them down
• Difficult to find a team to work with.

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Outcomes

• Enjoyed it
• Acquired new and relevant skills and knowledge
• Better understanding of dementia
• Learned how to interact with patients/
• residents
• Learned how to assess behaviours
• Team functioning
• Applied new knowledge and added value
• to employer
• Learners attitudes changed
• Learners applied new skills in their workplace
• Learners felt they were providing a better
  service to the patients/residents

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Senior Management

• E-learning dementia program provided their staff
  with
• new and valuable information on dementia care,
• created a more knowledgeable work unit
• encouraged computer literacy
• reassured the staff they were doing a good job
• included practical information that staff could
• apply in every day situations, and
• ensured continuity of care by developing a team
• across all three shifts.

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We had no staff replacement costs nor costs
related to shift workers going online.
Face-to-face in-service for shift workers is very
difficult to achieve without having to replace
and pay employees to come to the in-service if
they are not working.  
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Conclusions and Lessons Learned

• Content and exercises were relevant
• Expectations too high for the time allotted
• Language level in the course too high
• Too many group exercises
• Needed more training for participants with no
  computer experience
• Need release time for participants

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Layers of complexity to findings due to learner
population (over 50 with no previous computer
skills various educations levels, approximately
75 at one site with English as a second
languagecultural issues, and technical
difficulties at one site.

• I have got people who are wanting to rush out
  and buy computers now they are so excited. So
  what is coming through in the program isnt
  necessarily reflecting all of the positives that
  have come out of it (SC5 post program
  interview).
• Developing online professional development
  courses for health care professionals may be a
  feasible and possibly a cost effective strategy
  for delivering high quality training to the
  field.

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The End