E d u c a tio n
The interviews revealed that the RNs’ leadership required them to evaluate the individual HCA’s competence and previous education, prior to a formal delegation of nursing tasks, mainly regarding delivery of medication. Education could consist of blood glu- cose measurements and insulin injec- tions, delivering pre-packed daily doses of tablets, and dressing changes for ulcerated patients – more seldom about foot ulcer preventive actions. RN: ‘Our goal, I will say it is our main goal, it is to educate staff.’ The RNs described how they spent a lot of time and effort educat- ing patients and next of kin, but most of all HCAs. Most of the patients have concomitant diseases that make education challenging. RN: ‘There is a little bit of dementia, and those who don’t really understand; patients with psychiatric problems. And I don’t think that the information really was understood.’ However, the RNs stated that they used different pedagogical strategies such as repeated information and involving the next of kin. A substantial number of patients had no relatives. The interviewed RNs were not always aware of the formal or real competence of the HCAs, and this was considered a problem in the educational situation. The RNs stated that some of the HCAs lacked formal competence, while others had exten- sive experience-based knowledge in addition to upper secondary school education. RN: ‘It can be anybody [sum- mer substitutes]. Here there are many who know nothing. Nothing.’ In the four municipalities, educa- tional activities were organised differ- ently. Education was centrally organ- ised for all HCAs in the two cities. The interviewed RNs stated that they had no influence over these courses. The courses were complemented by bed- side instructions by the RN who signed the written delegation. The rural municipalities’ education for HCAs was arranged within the assisted living facilities or on an individual basis. The main content focused on general knowledge about diabetes, blood glucose measurements and insulin injections. Prevention of foot ulcers was not a central issue in the written material, but all HCAs were instructed not to cut the toenails and to report any changes in foot status to the RN. RN: ‘It includes how important it is to work before there is ulceration, the entire foot, … that you shall dry well between the toes so that a lot of dirt doesn’t accumulate. Everything is written there: good shoes; chiropody.’ The bedside education of HCAs was described as role modelling, show- ing and imitating practical tasks. After completing the centralised course, the HCAs were evaluated regarding blood glucose measurements, hypo- and hyperglycaemia and insulin injections by a written examination. Foot ulcer prevention was not consis- tently an issue for evaluation.
E d u c a tio n
The interviews revealed that the RNs’ leadership required them to evaluate the individual HCA’s competence and previous education, prior to a formal delegation of nursing tasks, mainly regarding delivery of medication. Education could consist of blood glu- cose measurements and insulin injec- tions, delivering pre-packed daily doses of tablets, and dressing changes for ulcerated patients – more seldom about foot ulcer preventive actions. RN: ‘Our goal, I will say it is our main goal, it is to educate staff.’ The RNs described how they spent a lot of time and effort educat- ing patients and next of kin, but most of all HCAs. Most of the patients have concomitant diseases that make education challenging. RN: ‘There is a little bit of dementia, and those who don’t really understand; patients with psychiatric problems. And I don’t think that the information really was understood.’ However, the RNs stated that they used different pedagogical strategies such as repeated information and involving the next of kin. A substantial number of patients had no relatives. The interviewed RNs were not always aware of the formal or real competence of the HCAs, and this was considered a problem in the educational situation. The RNs stated that some of the HCAs lacked formal competence, while others had exten- sive experience-based knowledge in addition to upper secondary school education. RN: ‘It can be anybody [sum- mer substitutes]. Here there are many who know nothing. Nothing.’ In the four municipalities, educa- tional activities were organised differ- ently. Education was centrally organ- ised for all HCAs in the two cities. The interviewed RNs stated that they had no influence over these courses. The courses were complemented by bed- side instructions by the RN who signed the written delegation. The rural municipalities’ education for HCAs was arranged within the assisted living facilities or on an individual basis. The main content focused on general knowledge about diabetes, blood glucose measurements and insulin injections. Prevention of foot ulcers was not a central issue in the written material, but all HCAs were instructed not to cut the toenails and to report any changes in foot status to the RN. RN: ‘It includes how important it is to work before there is ulceration, the entire foot, … that you shall dry well between the toes so that a lot of dirt doesn’t accumulate. Everything is written there: good shoes; chiropody.’ The bedside education of HCAs was described as role modelling, show- ing and imitating practical tasks. After completing the centralised course, the HCAs were evaluated regarding blood glucose measurements, hypo- and hyperglycaemia and insulin injections by a written examination. Foot ulcer prevention was not consis- tently an issue for evaluation.
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