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INFECTION PREVENTION PROGRAM

Prepared for: Dr. Paige

Prepared by: The Health and Learning Group

Members:

Mark Chamberlain

Lisa Dangenais

Karen Fangman

Bruce Scanlon

Michelle Simmons

February 24, 2013

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Instruction Plan

Table of Contents

Who We Are ………………………………………………………………………………….... 4

Analysis Document ………………………………………………………………………….… 7

Project Description and Needs Analysis ……………………………………………..… 7

Learner Analysis and Performance Gap Analysis …………………………………..…. 9

Task Analysis and Procedural Analysis ……………………………………………..... 11

Task Analysis Data Sheets …………………………………..…..…………..... 19

Instructional Objectives……………………………………………………………….. 23

Design Plan ………………………………………………………………………..………….. 25

Sequencing Description ……………………………………………………………..... 25

Instructional Message ………………………………………………………………… 27

Strategies Table ……………………………………………………………………….. 30

Text Design ……………………………………………………………………….…... 31

Multimedia Design ………………………………………………………………….... 33

Development Plan …………………………………………………………………………….. 36

Instructional Materials …………………………………………………………….….. 36

Developing Sample Instructional Materials ……………………………………….….. 47

2Health and Learning Group

Instruction Plan

Delivery Methodology ………………………………………………………………... 43

Instructional Plan ……………………………………………………………………... 47

Implementation Plan and Facilitator’s Guide …………………………………………..…….. 51

Unit Overview ……………………………………………………………………….... 51

Pre-workshop Planning ……………………………………………………………….. 52

Instructional Delivery and Sequencing ……………………………………………….. 56

Assessment of Learning ……………………………………………………….…….... 58

Evaluation Plan ………………………………………………………………………………. 61

Alignment of Unit Goals to the Evaluation Process ………………………………….. 63

References …………………………………………………………………………………….. 73


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Who We Are

Mark Chamberlain

Mark received his undergraduate degree in biology from the University of Wisconsin –

Whitewater and is currently working on his Master’s in Instructional Design from Walden

University in Minneapolis MN. Mark has been involved in some aspect of training either with

the military, law enforcement, federal and state government and the private sector for over 25

years and is a certified trainer through the Bureau of Land Management's National Training

Center. Mark has worked the last four years with the federal government designing, monitoring

and analyzing existing courses and presentations and those being developed from the ground up.

Mark currently lives in Virginia.

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Lisa Dangenais

Lisa is currently the Education Manager at a hospital in Dover, NH where she manages a

Learning Management System and creates online learning content. Her interest in online

learning and course development led her to work on her Master’s in Instructional Design with

Walden University in Minneapolis MN. Lisa worked in the Education field for twelve years,

watching the healthcare landscape change and the workforce continues to evolve. She has looked

for innovative ways to deliver learning to staff of varying backgrounds, ages and skill levels.

Lisa’s goal is to capitalize on her existing experience, and continue to grow in the instructional

design and the online training fields.


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Karen Fangman

Karen works as a Health Science Teacher at a high school in Hereford Texas teaching 9th

through 12th grades. She has a Bachelor’s Degree in Nursing from West Texas A&M University

and a Master’s in Nursing from Texas Tech Health Science Center. Karen worked as a Certified

School Nurse for 23 years before accepting a position as a teacher. As a second year teacher

Karen has had 27 students test and become Certified Nurse Aides with another 36 students

preparing to test. Karen is pursuing Master's in Instructional Design & Technology from Walden

University feeling it would enhance and enable her to be a better teacher in the Health Science

Field. Karen is married with three sons.

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Bruce Scanlon

Bruce graduated from Linfield College in 1990 with a dual degree in Secondary Health

Education and Athletic Training. He received his Master’s in Education from Western Oregon

University in 1996. Bruce worked for over 20 years as a Health Teacher and Head Athletic

Trainer at McMinnville High School. He started a Health Services Career Pathway program and

taught most of the courses as dual credit with the local community college. Bruce decided to

pursue his Instructional Design Certificate and a position in higher education. Bruce currently

works in the construction industry while he completes his education goals and pursues new

position. Bruce currently lives in McMinnville, Oregon.


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Michelle Simmons

Michelle received her undergraduate degree in Theatre and Communication with an emphasis in

Telecommunications. During her tenure at the university, Michelle worked in a computer lab that

included Foreign Language, Mac Applications, and a Research and Development lab. Michelle’s

interest in Instructional Design & Technology developed as she helped faculty create computer

programs to be used in their classrooms. Michelle would like to use her Master’s degree helping

faculty and/or adult learners. Michelle currently resides in Indianapolis, Indiana.


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Analysis Document

Project Description and Needs Analysis

Our group’s project is to design an instructional program targeting Hospital Employees to address the need to reduce infection rates among patients and employees. Healthcare-associated infections are the cause of approximately 48,000 deaths in the United States each year according to recent research published in the American Journal of Infection Control (Edwards, Peterson, Andrus, Dudeck, Pollock and Horan, 2008). This number is considered unacceptable and one of the primary causes has to do with the spread of infection within the hospital/healthcare setting. Mandatory training for all healthcare employees currently exists in medical facilities. A study cited in a journal by the Joint Commission regarding education training stated, “This led the researchers to conclude that training in technique is key to health care workers’ proper hand hygiene performance.” (The Joint Commission, 2009, pg. 103) The CDC states that a primary goal in a successful prevention program is to, “Provide health-care workers (HCWs) with better education regarding the types of patient care activities that can result in hand contamination and cross-transmission of microorganisms.” (CDC, 2002, pg. 33) Our project will address the need to inform hospital workers concerning proper procedures for decreasing the chances of the spread of infection in the hospital setting.

The World Health Organization developed guidelines for hand hygiene that include a five-part multimodal hand hygiene improvement strategy for organizations to implement. The improvement strategy includes the following:

Structural system changes, such as making alcohol-based hand rub available at the point of care

Training and education Observation of hand hygiene performance and feedback Reminders in the workplace Creation of a safety culture

As a part of comprehensive infection prevention program the identified need that our project will address is for healthcare workers to be properly trained and educated regarding infection prevention practices and procedures and to provide a reliable means for employees to review the material regularly for recall of knowledge and skills. Other research supports this conclusion, stating that, “Researchers have found that many health care workers do not have a clear understanding of the opportunities for hand hygiene. While most staff believes that they are sufficiently knowledgeable about hand hygiene, training staff on the specific indications for hand hygiene can increase their awareness of the complexity of the indications and make them more sensitive to non-adherence. Because you may have a wide range of intended audiences, the level and amount of education and training that you provide should be tailored to each audience. Education and training should be easy to understand, culturally appropriate, and conducted in languages other than English, as necessary.” (The Joint Commission, 2009, pg. 138) Our project would encompass the areas of hand-washing and the use of personal protective equipment.


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Instruction regarding proper infection prevention practice and procedures is only part of the solution to the healthcare-associated infection problem. Adequate training and education lay the foundation for additional strategies designed to accomplish the desired behavior change.


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Learner Analysis and Performance Gap Analysis

The population of hospital employees requiring training varies greatly in age, education, gender and experience. Additionally, the audience may include culturally diverse populations whose primary language is not English. Of these differences the following have the potential to impact how training is developed and delivered:

Education: Workers in Food and Nutrition, Environmental Services are not required to have a high school diploma or equivalency in some cases while Physical Therapists, Nurses and Physicians will have four years of college or more. The course will be written at a level appropriate for the high school graduate. Written materials will be assessed for a Flesch-Kincaid level of 12 or less.

Experience: Workers may be new to Healthcare or even new to the workforce or have many years’ experience delivering patient care or providing support services in a hospital setting. Care will be taken to ensure language used specifically in hospitals and industry acronyms are explained thoroughly.

Primary Language: The training is designed in English but can be easily translated to other languages as needed.

As the audience varies greatly, learners’ preferred learning style will be difficult to accommodate. Instead the learning style most effective for the required training will be determined and used (Gilbert & Swanier, 2008).

Many experienced patient care providers as well as recent graduates of healthcare professions will have background knowledge of infection prevention. Clerical and support staff will likely have less experience but will still have background knowledge of infection prevention such as hand hygiene and covering a cough even if it is based in a home setting.

As this is required mandatory training offering no continuing education credit, some learners may lack motivation and interest. For this reason, the Health and Learning Group designed training that will not only meet the regulatory needs of the organization but also will be interesting and thought provoking for staff. Hospital workers already understand the basic requirements regarding infection prevention however studies show that there is a gap between the staff’s perception and reality. Hospital workers genuinely care about patient outcomes and are willing and open to learning ways to prevent infection as long as the information is up to date and relevant to their work. Our goal is to show hospital staff how they can help prevent Hospital-acquired Infections by doing their part.

Performance gap analysis:Proper infection prevention strategies including hand hygiene, covering coughs, and proper use of personal protective equipment can reduce the spread of infection greatly. Annual training on infection prevention is required for hospital workers. The Centers for Disease Control and Prevention reports that 1 in 20 hospitalized patients will contract a Hospital Acquired Infection (2012). The Joint Commission sites hand hygiene as the most important intervention for preventing HAIs (2012). For these reasons the Centers for Disease Control and Prevention, The


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World Health Organization and the Joint Commission have launched a joint campaign to re-educate hospital staff in order to reduce Hospital Acquired Infections.

Many resources have been published to assist organizations in the effort to train staff. The resources are so vast that some facilities may lack the personnel to review, refine and implement it. The Health and Learning Group has developed training that will fill this gap in any hospital setting. This can be used as a stand-alone training or in conjunction with training on the individual hospital’s policies, procedures and specifications.


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Task Analysis and Procedural Analysis

Task analysis seeks to address the following three questions for the instructional designer:

1. What is the content needed to fix the issue in performance?

Proper procedures and guidelines as established by Centers for Disease Control (CDC) and World Health Organization (WHO) or the facility according to policy.

Facts based on research identifying transmission based infections due to improper hand washing.

2. What are more subtle steps within the process of solving the problem?

Schedule yearly in-service training for employees involved with direct patient care. Administer a pre-test and a post-test during in-service. Provide return demonstration for skills mastery. Organize training to be completed within a 30-60 minute timeframe. Provide an evaluation. Monitor staff adherence to hand washing using an observation schedule. Monitor use of soap and antiseptic by measuring contents of containers.

3. How does the learning process look from the learner’s perspective?

Use of laptop or computer lab for pre-test and post-test. Use of power point presentations to deliver content and procedures. Use of various instructional videos.


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Hand washing

Personal Protective Equipment (PPE)

Cough Etiquette

I. HANDWASHING (Definition) WHAT CONCEPTS?

A. What are the basic recalled facts the learner needs to know?

1. The single most common transmission of health care-associated infections (HAIs) in a healthcare setting is via the hands of health care workers.

2. Microorganisms are on everything you touch.

3. Washing your hands is the single most important thing you can do to prevent the spread of disease.

4. Hand Hygiene is defined by the CDC as washing hands with either plain or antiseptic soap with water or using alcohol-based hand rubs.

B. What interpersonal skills are required?

1. Keep your nails short and clean.

2. Do not wear artificial nails or extenders because they harbor bacteria.

3. Rings and other jewelry collect bacteria and can cause infection.

C. What basic procedures are required?

1. Turn on water at the sink. Keep your clothes dry, because moisture breeds bacteria. Do not let your clothing touch the outside portion of the sink or counter.

2. Angle your arms downward, with your fingertips pointing down into the sink. Your hands should be lower than your elbows. Wet your hands and wrists thoroughly.

3. Apply skin cleanser or soap to your hands.

4. Rub hands together and fingers between each other to create a lather. Lather all surfaces of your fingers and hands, including your wrist. Use friction for at least 20 seconds


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5. Clean your nails by rubbing them in the palm of your hand.

6. Being careful not to touch the sink, rinse thoroughly under running water. Rinse all surfaces of your hands and wrists. Run water down from wrists to finger tips. Do not run water over unwashed arms town to clean hands.

7. Use a clean, dry paper towel to dry all surfaces of your hands, wrists, and fingers. Do not wipe towel on unwashed forearms and then wipe clean hands. Dispose of towel without touching wastebasket. If your hands touch the sink or wastebasket, start over.

8. Use clean, dry paper towel to turn off the faucet. Do not contaminate your hands by touching the surface of the sink or faucet.

9. Dispose of used paper towels in proper waste receptacle after shutting off faucet. Avoid touching doorknobs, if possible, when leaving bathrooms. Use a paper towel to open the door.

D. Identify when to wash hands: (You must wash your hands at these times) WHAT RULES?

1. When you first arrive at work

2. Whenever they are visibly soiled

3. Before, between, and after all contact with residents

4. Before putting on gloves and after removing gloves

5. Before and after touching meal trays and/or handling food

6. Before and after feeding patients

7. Before entering a “clean” supply room

8. Before getting clean linen

9. Before leaving a “dirty” supply room

10. Before and after you eat

11. After contact with blood or any body fluids, mucous membrane, non-intact skin, or wound dressings

12. After handling contaminated items


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13. After contact with an object, including medical equipment, in the resident’s room

14. After touching garbage

15. After cleaning spills or picking up anything from the floor

16. After using the toilet

17. After coughing, sneezing, or blowing your nose

18. After smoking

19. After handling your hair or touching areas on your body, such as your nose, mouth, eyes, and face

20. After touching jewelry

21. After changing diapers

22. After handling animals/pets and after contact with pet care items

23. Before leaving work and after you get home from work before touching anything or anyone

II. PERSONAL PROTECTIVE EQUIPMENT (PPE) WHAT CONCEPTS?


1. Personal protective equipment (PPE) is a barrier (a block or obstacle) between a person and pathogens.

2. PPE is what you wear to help protect you from contact with potentially infectious material.

3. PPE includes gloves, gowns, masks, goggles, and face shields.

4. Gloves protect hands, and gowns protect the skin and clothing.

a) What interpersonal skills are required?

(1) Ability to properly demonstrate the proper method of donning and removing non-surgical gloves in a non-sterile environment.


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(2) Ability to recognize what kind of exposure is encountered.

(3) Ability to recognize that PPE use is determined by the type of task done.

(4) Understanding of non-sterile environments and sterile environments.

(5) Understanding of contamination and cross-contamination.

b) What basic procedures are required?

(1) Proper putting on or donning of gloves.

(2) Proper disposal of gloves.

(3) Use of sterile and non-sterile gloves.

(4) Return demonstration of PPE use.

c) Identify when to use PPE: WHAT RULES? (Putting on or donning gloves)

(1) Wash your hands

(2) If you are right-handed, slide one glove on your left hand (reverse if left handed).

(3) Using your gloved hand, slide the other hand into the second glove.

(4) Interlace fingers to smooth out folds and create a comfortable fit.

(5) Check for tears, holes, cracks, or discolored spots in the gloves. Replace the glove if needed.

(6) Adjust gloves until they are pulled up over the wrist and fit correctly.

(7) Remove gloves immediately after use and before caring for another patient.


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d) Removing (doffing) gloves

(1) Touch only the outside of one glove. Pull the first glove off by pulling down from the cuff toward the fingers.

(2) As this glove comes off the hand it should be turned inside out.

(3) With the fingertips of your gloved hand, hold the glove you just removed. With your ungloved hand, reach two fingers inside the remaining love at wrist. Be careful not to touch any part of the outside of the glove.

(4) Pull down, training this glove inside out and over the first glove as you remove it.

(5) You should now be holding one glove from its clean inner side. The other glove should be inside it.

(6) Drop both gloves into the proper container.

(7) Wash your hands.


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III. RESPIRATORY HYGIENE/COUGH ETIQUETTE WHAT CONCEPTS?


1. Masks protect the mouth and nose.

2. Goggles protect the eyes, and face shields protect the entire face - the eyes, nose, and mouth.

3. Guidelines for all persons entering facilities who show any signs of respiratory illnesses have been developed as a part of Standard Precautions.

B. The guidelines are listed below:

1. Covering the nose and mouth with a tissue when coughing or sneezing, or coughing or sneezing into the upper sleeve or elbow, not the hands.

2. Promptly disposing of the tissues in the nearest no-touch waste container.

3. Cleaning hands after coughing or sneezing by washing them with soap and water, using an alcohol-based hand rub, or antiseptic hand wash

4. Wearing special masks and turning the head away from others when coughing

5. Encouraging coughing persons to sit at least three feet from others in common waiting areas.

C. What interpersonal skills are required?

1. Ability to use cough etiquette using return demonstration.

2. Knowledge and Skills for applying a mask

D. Identify when to use cough etiquette: WHAT RULES? The guidelines are listed below:

1. Covering the nose and mouth with a tissue when coughing or sneezing, or coughing or sneezing into the upper sleeve or elbow, not the hands

2. Promptly disposing of the tissues in the nearest no-touch waste container.

3. Cleaning hands after coughing or sneezing by washing them with soap and water, using an alcohol-based hand rub, or antiseptic cleanser.


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4. Wearing special masks and turning the head away from others when coughing

5. Encouraging coughing persons to sit at least three feet from others in common waiting areas.


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Task Analysis Data Sheets

Skill: Washing Hands P = Physical FP = Faded Physical

Student:________________________________ S = Shadow I = Independent

DATE/INITIALS

1. Turn on water.

2. Keep clothes dry.

3. Angle arms downward.

4. Point fingertips down into the sink.

5. Wet hands and wrists thoroughly.

6. Apply soap or skin cleanser.

7. Rub hands together.

8. Rub between fingers to create lather.

9. Lather all surfaces.

10. Use friction for at least 20 seconds.

11. Clean nails by running them in the palm of other hand.

12. Rinse thoroughly under running water.

13. Rinse all surfaces of hands and wrists.

14. Run water down from wrists to fingertips.

15. Dry all surfaces with a clean, dry paper towel.

16. Dispose of paper towel without touching wastebasket.

17. Turn faucet off with clean paper towel.

18. Use paper towel to open door.


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Skill: Personal Protective Equipment (PPE) Putting on or donning gloves P = Physical

FP = Faded PhysicalStudent:________________________________ S = Shadow

I = IndependentDATE/INITIALS

1. Turn on water.

2. Wash your hands.

3. If you are right-handed, slide one glove on your left hand (reverse if left-handed).

4. Using your gloved hand, slide the other hand into the second glove.

5. Interlace fingers to smooth out folds and create a comfortable fit.

6. Check for tears, holes, cracks, or discolored spots in the gloves. Replace the glove if needed.

7. Adjust gloves until they are pulled up over the wrist and fit correctly. If wearing a gown pull the cuff of the gloves over the sleeve of the gown.

8. Remove gloves immediately after use.

9. Wash your hands.


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Skill: Personal Protective Equipment (PPE) Removing or (doffing) gloves P = Physical



1. Touch only the outside of one glove. Pull the first glove off by pulling down from the cuff toward the fingers.

2. As this glove comes off the hand it should be turned inside out.

3. With the fingertips of your gloved hand, hold the glove you just removed.

4. With your ungloved hand, reach two fingers inside the remaining glove at wrist. Be careful not to touch any part of the outside of the glove.

5. Pull down, turning this glove inside out and over the first glove as you remove it.

6. Drop both gloves into the proper container.

7. Wash your hands.


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Skill: Respiratory Hygiene/Cough Etiquette P = Physical



1. Cover mouth and nose with a tissue when coughing or sneezing into the upper sleeve or elbow, not the hands.

2. Promptly dispose of tissues in the nearest no-touch waist container.

3. Wash your hands.

4. Wear special masks and turn head away from others when coughing.

5. Encourage coughing persons to sit at least three feet from others in a common waiting room.


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Instructional Objectives

I. Hand-washing

TaskSuccessfully wash your hands in a clinical setting to prevent the spread of germs.

ConditionsGiven a sink with running water in a common clinical setting, paper towels, antiseptic soap and waste receptacle, wash your hands without letting getting your clothing wet, or touch the outside of the sink.

Performance Standards1. Turn on water at the sink. Keep your clothes dry. Do not let your clothing touch the

outside portion of the sink or counter.2. Angle your arms downward, with your fingertips pointing down into the sink. Your

hands should be lower than your elbows. Wet your hands and wrists thoroughly3. Apply skin cleanser or soap to your hands.4. Rub hands together and fingers between each other to create lather. Lather all surfaces of

your fingers and hands, including your wrist. Use friction for at least 20 seconds.5. Clean your nails by rubbing them in the palm of your hand.6. Being careful not to touch the sink, rinse thoroughly under running water. Rinse all

surfaces of your hands and wrists. Run water down from wrists to finger tips. Do not run water over unwashed arms town to clean hands.

7. Use a clean, dry paper towel to dry all surfaces of your hands, wrists, and fingers. Do not wipe towel on unwashed forearms and then wipe clean hands. Dispose of towel without touching wastebasket. If your hands touch the sink or wastebasket, start over.

8. Use clean, dry paper towel to turn off the faucet. Do not contaminate your hands by touching the surface of the sink or faucet.

9. Dispose of used paper towels in proper waste receptacle after shutting off faucet. Avoid touching doorknobs. If possible, when leaving bathrooms. Use a paper towel to open the door.

10. Hands should be dry and free of any visible dirt. Clothes should not have touched the sink and be dry. Paper towel waste should be in waste receptacle.

II. Personal Protective Equipment

TaskProperly demonstrate the method of donning and removing (doffing) non-surgical gloves in a non-sterile environment.

ConditionsGiven a sink with running water in a common clinical setting, paper towels, antiseptic soap and waste receptacle, demonstrate the proper technique for donning and doffing a pair of non-sterile surgical gloves to prevent the spread of germs.


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Performance StandardsDonning gloves

1. Wash your hands using the proper hand – washing techniques.2. If you are right-handed, slide one glove on your left hand. (Reverse if left handed).3. Using your gloved hand, slide the non-gloved hand into the second glove.4. Interlace fingers to smooth out folds and create a comfortable fit.5. Check for tears, holes, cracks, or discolored spots in the gloves. Replace glove if needed.6. Adjust gloves until they are pulled up over the wrist and fit correctly.7. Removed gloves immediately after use and before caring for another patient.

Removing (doffing) gloves1. Touch only the outside of one glove. Pull the first glove off by pulling down from the

cuff toward the fingers.2. As this glove comes off the hand it should be turned inside out.3. With the fingertips of your gloved hand, hold the glove you just removed. With your

ungloved hand, reach two fingers inside the remaining love at wrist. Be careful not to touch any part of the outside of the glove.

4. Pull down, training this glove inside out and over the first glove as you remove it.5. You should now be holding one glove from its clean inner side. The other glove should

be inside it.6. Drop both gloves into the proper container.7. Wash your hands.

III. Cough Etiquette

TaskIdentify when to use and properly demonstrate cough etiquette to prevent the spread of germs.

ConditionsIn a classroom setting identify the conditions why and demonstrate how to use cough etiquette technique.

Performance Standards1. Cover the nose and mouth with a tissue when coughing or sneezing, or2. Cough or sneeze into the upper sleeve or elbow, not the hands.3. Promptly dispose of the tissues in the nearest no-touch waste container.4. Wipe sleeve or elbow with tissue to remove any particulates.5. Cleaning hands after coughing, sneezing, or wiping particulates by washing them with

soap and water, using an alcohol-based hand rub, or antiseptic cleanser.6. Wearing special masks and / or turning the head away from others when coughing.7. Encouraging coughing persons to sit at least three feet from others in common waiting

areas.8. Offer surgical mask to persons who are coughing to decrease contaminations of the

surrounding environment.


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Design Plan

Sequencing Description

The three instructional tasks addressed in our training are hand-washing technique, covering a cough and the proper use of personal protective equipment. We will utilize a combination of learning-related sequencing and task expertise sequencing. The learning-related sequencing as proposed by Posner and Strike will consider both interest and difficulty. Given that our audience has a high level of familiarity with the tasks being presented it is important for us to gain learner involvement and motivation early in the sequence of presenting the instructional tasks. Leading off with the more interesting or informative tasks will help to address learner motivation. Additionally, we will begin with the least difficult task and proceed to the most challenging. Due to the procedural nature of our objectives and tasks we will use the same sequencing strategy for each of the given tasks. The tasks will proceed from least to most difficult and each step of the task will be presented in temporal sequence as it progresses toward task completion.

Task 1 Respiratory Hygiene/Cough Etiquette

Describe rationale and evidence for need of training. Describe the types of airborne pathogens. Describe the protective measures available for use from special masks to covering a

cough. Describe the steps used in applying skills. Demonstrate proper mask application procedures and cough cover etiquette.

Task 2 Hand Washing

Describe facts regarding hand washing and need for training. Identify when to wash hands. Describe steps used in hand washing procedure. Describe special considerations. Demonstrate proper hand washing procedure.

Task 3 Personal Protective Equipment (PPE)

Describe rationale and facts regarding the need for training. Describe what PPE includes. Describe sterile and non-sterile environments. Discuss considerations for when to apply PPE. Demonstrate the proper donning of gloves. Demonstrate proper glove removal and discard.


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References:

Morrison, G. R., Ross, S. M., Kalman, H. K., & Kemp, J. E. (2011). Designing effective instruction (6th ed.). Hoboken, NJ: John Wiley & Sons, Inc.


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Instructional Message

Pre-instructional strategies are used to introduce topics taught in the instructional course. Research shows that using pre-instructional strategies significantly aids learning. “In this sense, pretests alert, behavioral objectives inform, overviews prepare, and advance organizers clarify” (Hartley & Davies, 1976, p. 246). Four types of pre-instructional strategies are typically used:

Table 8-1 Pre-instructional Strategies (Morrison, Ross, Kalman & Kemp, 2011)

Strategy Function Content Structure Learner Task Attributes

PretestAlert student to what is expected

Length of the instruction is relatively short and loosely structured

Above-average IQ, older or more mature learners

Learners should have some familiarity with the content if the questions are to be meaningful

Behavioral Objectives

Precisely inform the student of what is expected

Used to preface a passage fewer than 2,500 words

Middle ability students

Works best with traditional methods such as lectures

OverviewsPrepare the learners for the learning task

Little or no structure

Lower ability studentsHigher ability students

Facts

Concepts

Advance Organizer

Conceptual framework needed to clarify content for the learner

Should have dominant structure

Above-average ability, maturity and sophistication

Factual Information

Pre-instructional strategies selected

Appropriate Pre-instructional strategies are shown above in red.

Pretests consist of a series of questions related to the material to be covered. The main point of using a pretest is to direct the learners attention to the topics the do not know (Hartley & Davies, 1976). We will develop a three question pretest citing facts about hospital acquired infections, asking the learners about their current hand hygiene practice and their knowledge of covering


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coughs. Neither the material nor the requirements are new so it is important to convince the learners of the necessity for this training. This pretest is designed to alert the learners to facts they may not be aware of such as the number of patients who contract hospital acquired infections. Additionally, it will inform them of the improvement that can be made to patient safety as it relates to infection control when hospital staff adheres to the practices outlined in the training. Alerting and then informing the learners what is expected of them will help the learner focus on what they do not know so that they pay closer attention to those portions of the course (Hartley & Davies, 1976).

Another pretest will be administered at the beginning of the instructor led session by demonstrating the learners’ current hand washing techniques and showing any deficiencies. Since staff have been washing their hands all of their lives, they may believe they are performing this task at an acceptable level. This pretest will demonstrate flaws in their practice if any exist and prime them to receive information on how to improve this skill.

Objectives are specifically designed to help the learner set an expectation of the course material (Hartley & Davies, 1976). If students become accustom to format closely following the objectives, the objectives will over time help direct the learning (Morrison, Ross, Kalman & Kemp, 2011). Pretest and Objectives can be used together as one pre-instructional method (Hartley & Davies, 1976). The pretests will address 2 of the three objectives. By asking staff the following question “True or False: As long as I cover my cough with a tissue, I don’t need to perform hand hygiene also.” we are emphasizing the objective “Demonstrate the proper procedure of coughing and sneezing without contaminating those around them.” The Hand washing pretest is based on the objective “Demonstrate the proper method to wash hands to prevent the spread of germs.” By calling attention to these objectives in the pretests at the beginning of the instructor led portion of the course, we prime the learner to receive further information about the topic.

The main purpose of an overview, sometimes called an introduction, is to prepare the learner for what will be covered in the course (Hartley & Davies, 1976). Overviews include introducing a problem that will be solved using the instruction, or a description of how the leaning will help the student (Morrison, Ross, Kalman & Kemp, 2011). After the pretest, a short overview covering the correct answers to the pretest questions and reiterating the need for the training in order will become the introduction to the instructor led portion of the instruction. Brief overviews will be added to the PowerPoint Presentation and video reiterating the number of patients contracting hospital acquired infections and calling attention to what hospital workers can do to reduce this number will be the main focus of the introduction and lead into further information regarding the tasks of hand washing, proper glove use and covering coughs.

Advance Organizers are intended to clarify tasks covered in training and provide a framework for understanding (Morrison, Ross, Kalman & Kemp, 2011). Though also usually written in


Instruction Plan

prose, advance organizers differ from overviews in that the focus is on context rather than content (Hartley & Davies, 1976). If students are familiar with the content, a comparative advance organizer is used to compare the knowledge they already have with what they are about to learn. If students have no former knowledge of the new material, expository advance organizers are used, which includes relevant information already known by the student. This pre-instructional strategy is not indicated for this course due to the heavy focus on content versus context. Additionally, with the great variety of learners’ abilities the advance organizer could actually detract from the learning.

References

Hartley, J., Davies, I. (1976). Preinstructional Strategies: The Role of Pre-tests, Behavioral Objectives, Overviews and Advance Organizers, Review of Educational Research, Vol. U6, Number 2, Pp. 239-265

Mannes, S. (1994) Strategic processing of text. Journal of Educational Psychology, 86, 577-588.

Morrison, G. R., Ross, S. M., Kalman, H. K., & Kemp, J. E. (2011). Designing effective instruction (6th ed.). Hoboken, NJ: John Wiley & Sons, Inc.


Instruction Plan

Strategies Table

Instructional Objective

Hand Washing – The learner will demonstrate the proper technique to thoroughly wash their hands without contaminating themselves.

Donning/Doffing Gloves – The learner will demonstrate the proper procedure to don and doff gloves without contaminating themselves.

Cough Etiquette – The learner will demonstrate the proper procedure of coughing and sneezing without contaminating those around them.

Instructional StrategyProcedure Example Strategy Initial Presentation and Generative Strategy

Hand Washing Demonstration and practice

While viewing the presentation the learner is encouraged to take notes.

After viewing the presentation the learner will demonstrate the steps required to wash their hands without contaminating themselves.

The demonstration can be done by return demonstration, verbally reciting the steps or by written test.

Donning/Doffing Gloves

Demonstration and practice


After viewing the presentation the learner will demonstrate the steps required to don and doff gloves without contaminating themselves.


Cough Etiquette Demonstration and practice


After viewing the presentation the learner will demonstrate the steps required to cough or sneeze without contaminating those around them.



Instruction Plan

Text Design

Research has shown that by designing the message, a learner’s cognitive processes can be affected.

Four Questions to consider:

1. What is the best way to introduce the content to a learner?2. What is the best way to implement your instructional strategies?3. How can you cue the learner to the most important information?4. Should you use pictures with your instruction?

Some considerations for using message design would include signals which are explicit, or typographical.Signals provide a model of expectations that will aid student comprehension (Mannes, 1994).Signals can be global and a part of the overall design.Explicit signals include

Text Structure Example Signaling Words

Lists

The following items are essential for infection control: Hand washing donning and doffing gloves cough etiquette

First, second, third, etc.; subsequent another;

Comparisons or Contrasts

Soap and water are cleansers of choice in hospital settings; however, antiseptic skin cleansers are also effective.

Sterile gloves are used in sterile environments, while non-sterile gloves are used in non-sterile environments.

But, in comparison, however, while, to differentiate, a distinguishing

Temporal Sequence

Turn water on, wash your hands, etc. Wash your hands, with your right hand, pick

up glove, etc. Before a cough or sneeze, one should cover

the cough or sneeze by first coughing or sneezing into the sleeve or bend of the elbow.

Beginning with, after, next, then, first, second, etc.

Cause and Effect

One result of proper hand hygiene is reduction in transmission-based illnesses.

Donning gloves improperly results in contamination and as a result, the learner must start over.

Failure to cover your cough results in airborne droplets consequently spreading to others, and

Consequently, as a result, if/then, the reason, one explanation


Instruction Plan

as a result, others are contaminated.

Definition and Example

Hand Hygiene is the process of proper hand washing to eliminate bacteria sometimes causing illness.

Donning and doffing gloves include step by step procedures for preventing spread of infection.

Covering your cough protects others from contamination of airborne droplets, for example, coughing or sneezing without covering your cough spreads infection to others.

For example, include, another

Pictures will be displayed representation, organization, interpretation and transformation.

References



Instruction Plan

Multimedia Design

I think that our three tasks (hand washing, donning and doffing gloves, and cough etiquette) could easily be demonstrated using one of three different media (video and /or power point or even photographs). In some cases the pros and cons to each media are the same for each task. However, some tasks lend themselves better to one media than the other (s). For example, each task could easily be made into a video that can be viewed at the learners own pace. Yet in a group setting a video speed is dictated by either the slowest or fastest learner depending on the group member’s dynamics. PowerPoint presentations allow for questions and answers (Q&A) but the media itself is very 2 dimensional. Illustrations and / or photographs lend themselves to being ideal job aids or posters that can be placed in specific areas to target a particular audience. However they lack the ability to receive feedback unless there is a link (website, phone number, etc.) for additional information. It is up to the Instructional Designer, the subject matter expert and facilitator/trainer to determine the best method for delivery given the needs of the client. A clinician could be video-taped demonstrating the proper technique for each task and edited to highlight any addition learning points such as focusing on the fingers when talking about proper nail length, lack of rings etc. The same thing could be done by just taking pictures but it is less effective in a classroom setting. However, the pictures could be posted on a laminated job aid by hand washing stations to re-enforce learning.

TASKTRAINING MEDIAVideo PowerPoint Illustration/Photography

Hand Washing Pros - Video can be played over and over again and viewed at learners own pace. Video can be edited to show technique at different angles. Can be placed in internal drive for controlled access and accountability for viewing.

Easy to put together and generate handouts.Face to Face instruction allows for Question & Answer.

Easy to create job aids from this media that can be multi-lingual and placed in high profile areas for targeted audience. Can be quick reference to review a particular step with all steps being shown at once.

Cons - Time consuming and costly to capture, edit, and narrate videos. Important to keep the video simple. To demonstrate hand washing for 30 seconds is very time consuming. Can be made into a Pro by introducing sing along (sing ABC song) while

Handouts tend to be thrown away after training. Very little retention without hands on demonstration.

Viewer fatigue/apathy can occur over time.


Instruction Plan

hand washing.

Donning/Doffing Gloves

Pros - Video can be played over and over again and viewed at learners own pace.Video can be edited to show technique at different angles. Can be placed in internal drive for controlled access and accountability for viewing.


Job Aids easy to create and can be multilingual. Placed in high profile areas for targeted audience.

Cons - Time consuming and costly to capture, edit, and narrate videos. Can’t ask Subject Matter Expert/Trainer questions. Unless video can be paused the video plays at one speed. Videos are conducive to groups.

Handouts tend to be thrown away after training. Very little retention without hands on application.

For some illustrations / photos difficult to understand without editing or adding additional points.

Cough Etiquette

Pros - Video can be played over and over again and viewed at learners own pace.Video can be edited to show technique at different angles. Can be placed in internal drive for controlled access and accountability for viewing.


Job Aids easy to create and can be multilingual. Placed in high profile areas for targeted audience such as waiting room or cafeteria type settings.

Cons - Time consuming and costly to capture, edit, and narrate videos. Can’t ask Subject Matter Expert/Trainer questions.

Handouts tend to be thrown away after training. Very little retention without hands on application.

Difficulty explaining to non-medical persons to cough on sleeve or in antecubital space versus cough in elbow without being wordy or using multiple pictures.


Instruction Plan

References:

Hand washing poster - Retrieved from http://www.who.int/gpsc/5may/How_To_HandWash_Poster.pdf

Training - http://www.shea-online.org/Assets/files/IHI_Hand_Hygiene.pdf p. 14 & 15

Cover your cough - poster - retrieved from http://www.cdc.gov/flu/protect/covercough.htm

Poster retrieved from http://www.cdc.gov/HAI/pdfs/ppe/ppeposter1322.pdf

Educational materials/PowerPoint retrieved from http://www.cdc.gov/HAI/prevent/ppe.html


Instruction Plan

Development Plan

Instructional Materials

Our instructional program is designed to address infection prevention for patient care workers in a hospital setting. We have chosen several instructional strategies and various materials will be used as resources to deliver each instructional component. I have chosen three of the resources we will be utilizing to discuss in the overview.

The primary delivery system for course content in this program will be via power point presentation. Our course is designed to be instructor led with a blend of lecture, discussion and class activity. Power point will be used to provide a framework for the instructor when conducting lecture and discussion. It is being chosen because of its familiarity to instructors, its ability to have video, web and audio embedded, and the availability for this technology to be used in most any hospital setting. It is important to consider the guidelines for creating an effective power point presentation to avoid the common pitfalls that many educators and designers fall into. (Piskurich, 2005, pp. 223 – 224).

A second resource that we will be using is an audio file that is accessible through a personal listening device. This audio file will provide instruction for the learner to target the auditory learning style preference and it will give audible cues for the learning activity that will be occurring while the audio is playing. The learner will be given a personal listening device with the mp3 audio file preloaded. They will be instructed to play the file and listen to the instructions while performing the task. The audio file contains step by step instruction for the learning task coupled with music that is timed for the given learning to occur within.

Finally, as an additional resource we will use a commercially available product called Glo-germ. This product is available in a lotion that can be applied to a person’s hands. When viewed under black light the product will glow; thus simulating the presence of germs. For our purposes, we will use this product to evaluate the effectiveness of the learner in the hand washing task. The learner will apply the product to the hands prior to the hand washing activity. When they have completed the task the instructor will have the learner place their hands under the black light to check for thoroughness in removing the simulated pathogens. This instructional material adds a novel and visually presented feedback for the learner thus motivating them to conduct the hand washing task in the prescribed manner.


Instruction Plan

Developing Sample Instructional Materials

Pre-instructional Pretest:

The pretest will be administered at the beginning of each instructor led class as a way to direct the learner to the importance of infection prevention techniques. The three pretest questions have been loaded on the Poll Everywhere website: http://www.polleverywhere.com/multiple_choice_polls/LTc2Mjc3MjQzNw.

At the beginning of the instructor led class, the PowerPoint will show the instructions on how to participate in the polling via text or internet. Participants will be instructed that the polling is free however their individual mobile phone services may have a fee for texting. Each poll question will be displayed long enough for the group to respond. As responses are received, the chart is dynamically updated showing immediate feedback to the group. The instructor will determine the appropriate length of time to show each poll question.

Polling Questions [Word Format]

Polling Instructions and Questions [PowerPoint Format]

Pre-instruction Hand Hygiene Assessment:

This exercise is done prior to the instruction on proper hand hygiene techniques to get buy-in from staff. Many healthcare workers may think they are cleaning their hands adequately. This would show them there is room from improvement. Depending on the number of sinks available, this could be done either individually or in small groups. The room will be supplied with a sink(s), Glo-Germ hand cream, hand cleanser, paper towels, trash receptacle and audio device(s) with pre-recorded message. Student enters the room, audio plays with instructions:

Use dime-sized dollop of hand cream provided Rub into hands thoroughly Wash hands using cleanser provided paying close attention to fingernails and between

fingers (Audio plays the Happy Birthday song for timing) Dry hands using paper towel Hold hands under light so see how you did.

This exercise would then be followed by instruction on proper techniques and then would be repeated to show the improvement.

Audio File [MP3 format]


Instruction Plan

PowerPoint Presentation Outline

The bulleted items will not be on the PowerPoint presentation but will be points that the instructor will discuss. This will prevent the “slide readers” (Chamberlain, M, Discussion Board Post, February 6, 2013) that Chamberlain mentioned on the discussion board.

The Upper case letter items will be bulleted on the presentation. The previous item will go dim while the current item brighter. The numerical items will be presented with an appropriate picture to go with it.

I. Infection

A. What are the types of infection?

Localized infection Systemic infection Healthcare-associated infection (HAI) Nosocomial infection

B. Who are at risk?

“Very young people - premature babies and very sick children Very old people - the frail and the elderly Those with medical conditions - such as diabetes People with defective immunity - people with diseases that compromise their

immune system or people who are being treated with chemotherapy or steroids. “ (Better Health Channel, 2012)

II. Hand Washing

A. Why wash your hands?

To control and prevent infection

B. When should you wash your hands?

Before and after touching a patient After touching patient’s belongings Before performing a clean procedure After exposure to body fluids When hands are visibly dirty or contaminated with proteinaceous material or are

visibly soiled with blood or other body fluids. Before donning sterile gloves Before inserting indwelling urinary catheters, peripheral vascular catheters or

other invasive devices that do not require a surgical procedure.


Instruction Plan

After contact with a patient’s intact skin (e.g. when taking a pulse or blood pressure, and lifting a patient).

After contact with body fluids or excretions, mucous membranes, non-intact skin, and wound dressing.

If moving from a contaminated-body site to a clean-body site during patient care. After contact with inanimate objects (including medical equipment) in the

immediate vicinity of the patient. After removing gloves. Before eating and after using a restroom.

C. How should you wash your hands?

1. Wet hands with water

2. Apply an amount of product recommended by the manufacture to hands.

3. Lather all surfaces of hands, wrist, and fingers. Use friction for at least 20 seconds

(One round of singing Happy Birthday).

4. Clean your nails by rubbing your fingertips in palm of your other hand.

5. Rinse all surfaces of wrist, hands, and fingers. Keep your hands lower than your

elbows and your fingertips down.

6. Use a clean, dry paper towel to dry all surfaces of hands, wrists and fingers.

7. Use clean, dry paper towel to turn off the faucet and open the door. Do not

contaminate your hands by touching the inside of the sink, the faucet, or the door

handle at any time.

8. Dispose of used paper towel in wastebasket immediately.

III. Donning and Doffing Gloves

A. Why should you wear gloves?

To prevent contamination of healthcare personnel hands. To protect both patient and healthcare personnel from exposure to infectious

material that may be carried on hands.

B. When should you wear gloves?


Instruction Plan

During patient care It may be necessary to change gloves during the care of a single patient to prevent

cross-contamination of body sites and/or if there is interaction with mobile equipment that is transported from room to room.

Between patients

C. How should you don gloves?

1. Wash your hands.2. Select gloves according to hand size.3. If you are right-handed, slide one glove on your left hand (reverse if left handed).4. Using your gloved hand, slide the other hand into the second glove.5. Interlace fingers to smooth out folds and create a comfortable fit.6. Check for tears, holes, cracks, or discolored spots in the gloves. Replace the glove

if needed.7. Adjust gloves until they are pulled over the wrist and fit comfortable.

D. How should you doff gloves?

1. Touch only the outside of one glove. Pull the first glove off by pulling down from the cuff toward the fingers.

2. As the glove comes off the hand it should be turned inside out.3. With the fingertips of your gloved hand, hold the glove you just removed. With

your ungloved hand, reach two fingers inside the remaining glove at the wrist. Be careful not to touch any part of the outside of the glove.

4. Pull down, training this glove inside out and over the first glove as you remove it.5. You should not be holding one glove from its clean inner side. The other glove

should be inside it.6. Drop both gloves into the proper container.7. Wash your hands.

IV. Respiratory Hygiene & Cough Etiquette

A. Why should you practice respiratory hygiene and cough etiquette?

To prevent spreading infection to other people.

B. How should you practice respiratory hygiene and cough etiquette?

1. Cover the nose and mouth with a tissue when coughing or sneezing or2. Cough or sneeze into the upper sleeve or elbow, not the hands.3. Promptly dispose of the tissues in the nearest no-touch waste container.4. Wipe sleeve or elbow with tissue to remove any particulates.5. Cleaning hands after coughing, sneezing, or wiping particulates by washing them

with soap and water, using an alcohol-based hand rub, or antiseptic cleaner.


Instruction Plan

6. Wearing special masks and/or turning the head away from others when coughing.7. Coughing persons should sit at least three feet from others in common waiting

areas.8. Wear surgical mask when coughing to decrease contamination of the surrounding

environment.

Video Presentation

Video AudioText: Program Title Music

Text: InfectionCut to pictures of different infections.

(Music fades under the speaker then fades out)The narrator talks about the different types of infection caused by

Cut to pictures of premature babies in incubators, children in hospital beds, elderly people, someone doing a glucose reading, sick adults in bed and walking down hallways in a hospital gown pushing an iv pole, someone receiving chemo therapy

Narrator tells the viewer who are at risk.

Text: Hand Washing

Text: WHY? Narrator tells the viewer why hands should be washed.

Text: WHEN?Cut to images of each reason when the hands should be washed.Gloved hands:

Working on a patient Removing and item from a patient like jewelry or clothing. Cleaning a wound Taking a patient’s pulse Dressing a wound Typing on a keyboard Removing gloves Someone eating

Narrator tells the viewer when the hands should be washed.

Text: How should you wash your hands?The camera follows a person’s hands as they go through each step of washing them.

Narrator starts telling the viewer the steps for washing hands.

Text: Donning & Doffing Gloves

Text: WHY? Narrator tells the viewer why gloves should be used.

Text: WHEN?Cut to close up of gloved hands performing task that gloves should be worn.

Narrator tells the viewer when gloves should be used.

Text: How should you don gloves? Narrator starts telling the


Instruction Plan

The camera follows a person’s hands as they go through each step of donning gloves.

viewer the steps for donning gloves.

Text: How should you doff gloves?The camera follows a person’s hands as they go through each step of doffing gloves.

Narrator starts telling the viewer the steps for doffing gloves.

Text: Respiratory Hygiene & Cough Etiquette

Text: WHY?

Narrator tells the viewer why respiratory hygiene and cough etiquette should be practiced.

Text: HOW?Cut to someone demonstrating the steps.

Narrator starts telling the viewer the steps for practicing respiratory hygiene and cough etiquette.


Instruction Plan

Delivery Methodology

Our group’s project is to design an instructional program targeting Hospital Employees to address the need to reduce infection rates among patients and employees. Our group has decided to use Classroom training with Instructor and Blended learning which combines e-learning with instructor-led classroom training.

ObjectiveDemonstrate the proper method to don and doff non-sterile gloves.Demonstrate the proper method to wash hands to prevent the spread of germs.Demonstrate the proper procedure of coughing and sneezing without

Methods of instruction Instructor led presentationBlended learningDiscussionDemonstrationExercise

AidsPower Point presentationPre-instructional Pretest:Pre-instruction Hand Hygiene Assessment:Audio File [MP3 format] (Audio plays the Happy Birthday song for timing)Demonstrations

1. Students will be given a demonstration on how to properly prepare for donning non-sterile gloves in a clinical setting.2. Students will be given a demonstration on how to don and remove (doff) the non-sterile gloves.3. Students will be given a demonstration on how to properly wash their hands in a clinical setting.4. Students will be given a demonstration on how to properly cough and sneeze without contaminating those around them with respiratory secretions.

HandoutsVideoColor SlidesComputer Pallet

Materials/Media Selection

A clinical setting with sink, hot/cold running water, soap, non-sterile gloves in a package, plastic garbage bag lined wastebasket, a counter at standard height, and a handout with the steps to do this procedure.

In a clinical setting with sink, tissues, hot/cold running water, soap, clinical uniform with long sleeves, plastic garbage bag lined wastebasket, a counter at standard height, and a handout with the steps to do this procedure.


Instruction Plan

The room will be supplied with a sink(s), Glo-Germ hand cream, hand cleanser, paper towels, trash receptacle and audio device(s) with pre-recorded message.

Time frame

One hour lecture/discussion One hour of five-minute mini-lectures

Content

The students will learn how to don and remove (doff) non-sterile gloves in a clinical setting.

The students will learn how to wash their hands in a clinical setting. The students will learn how to properly sneeze and cough to prevent the transmission of

all respiratory infections in healthcare settings, including influenza The lecture The lecture/discussion The Skill lesson

Approach

Selecting the Right Method

All the resources at your command must be used to make your instruction real and vital. The number and types of training methods you use during any presentation depend on many factors, and you must therefore have answers to the following questions before you decide how you will present your material.

The table below illustrates our decision based on strengths and weakness of each training delivery system.CLASSROOM TRAINING WITH INSTRUCTOR Most Effective When…. Least Effective

When….Participants attend training where an instructor presents material and there is an opportunity for interaction and hands-on learning or practice

ContentDeveloping interpersonal skillsDiscussion is neededInteractive experience is integral to learning

ResourcesAn appropriate space is availableThere’s only one instructor to many studentsCourse can be repeated with little updatingParticipantsThere are many smaller groups of

ContentObjective is that material needs memorization (large amount of factual material to be covered)There is a mismatch between the knowledge & skills of participantsResourcesAn appropriate location is not available There is not time to practice/apply skills learned during class


Instruction Plan

10-20 participantsParticipants can gather in the same locationParticipants will work in groups and independently during skills testing

ParticipantsOne-to-one coaching is necessaryParticipants cannot gather in one locationWhen skill level varies among participants

BLENDED LEARNINGCombines e-learning with instructor-led classroom training.

In addition to the guidelines outlined in each method above, consider this method when content is both interpersonal skill learning and involves large amounts of factual content.

Factors to be considered when selecting program delivery methods for a program delivery system

The targeted audience – Hospital Employees The educational objective - to address the need to reduce infection rates among patients

and employees The type and content of the message being provided – Educational Training The characteristics of the delivery method – Classroom Training with Instructor and

Blended Learning The method’s utility for providing desired learning support – Combines e-learning with

instructor-led classroom training

Experiential Methods Integrated Methods

Reinforcement Methods Other Methods

Allow the learner to gain experience with or “feel” the information presentedThis experience may occur through physical activity or it may involve the senses, emotions, or social interaction depending on the content of the educational program

Provide the learner opportunities to discuss, clarify, or otherwise gain greater understanding of new information

Provide informational, emotional, or social support for the learner to facilitate learning and enhance or maintain the motivation to continue in the learning process

Lists those methods that are applicable in a wide variety of systems or that can be used for limited or special situations

Audiocassette Workshop Fact sheet LectureMethod demonstration In-service Leaflet or pamphlet Pre-instructional Pre-test


Instruction Plan

At the beginning of the instructor led class; the PowerPoint will show the instructions on how to participate in the polling via text or internet. Participants will be instructed that the polling is free however their individual mobile phone services may have a fee for texting.Polling Questions [Word Format]Polling Instructions and Questions [PowerPoint Format]

Meeting Poster Video

Computer software

Pre-instruction Hand Hygiene AssessmentAudio File [MP3 format]MaterialsThe room will be supplied with a sink(s), Glo-Germ hand cream, hand cleanser, paper towels, trash receptacle and audio device(s) with pre-recorded message.


Instruction Plan

Instructional Plan

I. Instructional Plan Table Hand-washing Technique

Learning Objective Successfully wash your hands in a clinical setting to prevent the spread of germs.

Content Presentation

Content: The students will learn how to wash their hands in a clinical setting.Demonstration: Students will be given a demonstration on how to properly wash their hands in a clinical setting.

Materials and Media Selection: A clinical setting with sink, hot/cold running water, soap, non-sterile gloves in a package, plastic garbage bag lined waste basket, a counter at standard height, a handout with the steps to do this procedure, GloGerm and a black-light.

Student Participation

Student Grouping: Students will work in the large group for the demonstration; they will work individually when practicing the procedures.Practice Items and Activities:

1. Students will remove jewelry.2. Instructors will shake the bottle of GloGerm oil well and place a small amount, about the

size of a quarter, into the palm of one hand of the student.3. The student will spread the GloGerm oil over both hands completely as if applying hand

lotion. The student will be sure to cover hands completely, particularly under nails, around cuticles and between fingers.

4. The student will wipe off excess with paper towel. Do not let oil contact clothing as staining may result. If using white GloGerm gel, use same procedure with a pad of gel about the size of a nickel. Wiping off excess is usually not necessary.

5. Instructors will place student’s hands under UV lamp to view “glowing germs” that exist before hand washing. Demonstration will be done in a darkened room.

6. Students will turn faucet on with paper towel.7. Student will wet hands and wrists thoroughly with fingertips pointing down.8. Student’s hands should be lower than their elbows. Apply soap and lather hands. Rub

hands together and fingers between each other using friction for at least 20 seconds reciting either the ABC or "Happy Birthday" song as a guide for the required proper length of time. The amount of effort required to remove the simulated germs is equal to that of removing most bacteria.

9. Students should clean their nails by rubbing them in the palm of their other hand. Being careful not to touch the sink, rinse all surfaces of hands and wrists with fingertips pointing downward.


Instruction Plan

10. The students should dry their hands thoroughly from tips of fingers to wrists then discard paper towel in proper container.

11. The students should use a clean, dry paper towel to run off faucet and discard in proper container. The students should avoid touching inside of sink.

12. The students will place hands under UV lamp, paying special attention to thumbs, areas around nails and between fingers. If the UV lamp reveals any remaining “germs” the student will repeat the hand washing procedure until no GloGerm is detected under the UV light.

Feedback Students will give feedback of their understanding of the material covered, also the instructor will walk around and question student individually about hand washing techniques. The instructor will counsel students if GloGerm is found on their hands after the initial or subsequent hand washing.

II. Instructional Plan Table Personal Protective Equipment

Learning ObjectiveDemonstrate the proper method to don and doff non-sterile gloves.


Content: The students will learn how to don and remove (doff) non-sterile gloves in a clinical setting.

Demonstration:

1. Students will be given a demonstration on how to properly prepare for donning non-sterile gloves in a clinical setting.

2. Students will be given a demonstration on how to don and remove (doff) the non-sterile gloves.

Materials and Media Selection: A clinical setting with sink, hot/cold running water, soap, non-sterile gloves in a package, plastic garbage bag lined waste basket, a counter at standard height, and a handout with the steps to do this procedure.

Student Participation Student Grouping: Students will work in the large group for the demonstration; they will work individually when practicing the procedures.

Practice Items and Activities:

1. Students will remove jewelry.2. Students will wash hands.3. If the student is right-handed, they will slide one glove on their left hand (reverse if left-

handed.


Instruction Plan

4. Using their gloved hand, students will slide the other hand into the second glove5. Students will interlace fingers to smooth out folds and create a comfortable fit6. Students will check for tears, holes, cracks, or discoloration spots in the gloves. Students

will replace the gloves if needed.7. Students will adjust gloves until they are pulled up over the wrist and fit correctly. If

wearing a gown, pull the cuff of the gloves over the sleeve of the gown8. Students will keep hands above waist level the entire time. 9. Students will maintain proper technique throughout procedure by not contaminating self.10. Students will touch only the outside of one glove. 11. Students will first pull glove off by pulling down from the cuff toward the fingers. As

glove comes off the hand it should be turned inside out.12. The student will, with the fingertips of their gloved hand, hold the glove they just

removed. 13. The student will with their ungloved hand, reach two fingers inside the remaining glove

at wrist. The student will be careful not to touch any part of the outside of the glove.14. The student will pull down, turning the glove inside out and over the first glove as they

remove it.15. Student should now be holding one glove from its clean inner side. The other glove

should be inside it.16. Students will drop both gloves into the proper container.17. Students will wash their hands after de-gloving both hands.

Feedback Students will give feedback of their understanding of the material covered, also the instructor will walk around and question student individually about donning and doffing non-sterile gloves.

III. Instructional Plan Table Coughing and Sneezing Etiquette

Learning Objective

Demonstrate the proper procedure of coughing and sneezing without contaminating those around them.


Content: The students will learn how to properly sneeze and cough to prevent the transmission of all respiratory infections in healthcare settings, including influenza. The student will implement the following infection control measures at the first point of contact with a potentially infected person.

Demonstration: Students will be given a demonstration on how to properly cough and sneeze without contaminating those around them with respiratory secretions.

Materials and Media Selection: In a clinical setting with sink, tissues, hot/cold running water, soap, clinical uniform with long sleeves, plastic garbage bag lined waste basket, a counter at standard height, and a handout with the steps to do this procedure.


Instruction Plan

Student Participation Student Grouping: Students will work in the large group for the demonstration; they will work individually when practicing the procedures.

Practice Items and Activities:

1. Students will cover their mouth and nose with a tissue when they cough or sneeze.2. Students will then their used tissue in the waste basket.3. If students don't have a tissue, students will cough or sneeze into their upper sleeve or

elbow, not their hands.4. Students will be asked to put on a face mask to protect others.5. Students will wash their hands often with soap and warm water for 20 seconds.6. If soap and water are not available, students will use an alcohol-based to rub their hands.

Avoid touching your eyes, nose or mouth.7. Avoid close contact with people who are sick, if possible.8. Stay home when you are sick.9. Do not share eating utensils, drinking glasses, towels or other personal items or

contaminated objects/materials.

Feedback Students will give feedback of their understanding of the material covered, also the instructor will walk around and question student individually about hand washing techniques.


Instruction Plan

Implementation Plan & Facilitator Guide

Unit Overview

Current research suggests a need for improved and repeated instruction for healthcare professionals in the areas of hand washing, cough covering, and personal protective equipment (donning and doffing of non-sterile gloves). The purpose for this unit is to provide skills and information to patient care workers that will help to reduce the spread of infectious disease in the hospital setting. The program goals are as follows:

The facility is not cited by the state for infection There was little to no increase in the infection rate among the patients Perform a pre- and post-training test see how well the staff learned what was presented The staff found the in-service training more enjoyable than past in-service training

The following instructional program is designed to be used as a part of a comprehensive infection prevention program, targeting workers who have direct patient care responsibilities in the hospital setting. The hospital facility will determine the specific professional classifications of workers who possess these qualifications as part of their job descriptions. The learner will participate in all course content and activities in order to demonstrate competency and meet the stated learning objectives.

The instruction will take place in the hospitals classroom or conference facility and utilize hand washing stations or restrooms for laboratory practice and skills evaluation. Students will receive instruction regarding the importance of each of the learning components as well as detailed description and practice in proper procedures in carrying out the given task. Each task will involve concept attainment, demonstration and independent practice.

This Implementation Guide is designed to provide the instructor/facilitator with the instructional plan and layout for conducting the infection prevention course. It includes the learning objectives for the unit, preparation materials and precourse planning guide, outline of course sequence and progression, assessment strategies and evaluation tools. The learning objectives for this unit are:

The learner will demonstrate the proper hand washing technique to eliminate infectious material as measured by UV light.

The learner will employ the five opportunities for hand hygiene during patient care activities relative to the criteria discussed in class.

The learner will demonstrate the proper procedure to putting on (donning) and taking off (doffing) gloves to ensure no cross contamination as determined by the instructor.

The learner will list three ways to perform respiratory hygiene that will reduce the spread of infection as discussed in class.

The learner will demonstrate the proper procedure of coughing and sneezing without contaminating those around them as determined by the instructor.


Instruction Plan

Pre-workshop Planning

Preparing participants

Promotional material such as flyers, calendar events, advertisements on employee only web-sites, memos from management and any other communication strategy that has been used in the organization will contain background information regarding the need for the instructional program. Using this multipronged approach to advertise the training throughout the facility will help encourage participation as well as prime the participants for the information they will be receiving (Morrison, Ross, Kalman, & Kemp, 2011).

Participants must attend class prepared to answer three pre-instructional questions about their own behavior and understanding of infection prevention. If available, the facility will provide portable devices such as laptops, iPads, etc. to augment the attending staff members’ personally owned devices. The pre-test, administered through the Poll Everywhere website http://www.polleverywhere.com/multiple_choice_polls/LTc2Mjc3MjQzNw requires a smartphone or access to a computer with internet access. Participants are not required to participate however the results will more accurately reflect the answers of each specific session with a higher number of participating staff. The point of this exercise is to emphasize the need for additional training by pointing out inconsistencies in the individuals’ behavior and the number of people who answer the questions incorrectly. This can be achieved without full participation in the polling because every attendee will all see the results and hear the instructor explain proper procedure and state facts. This exercise could also be conducted using a paper pre-test if the facility does not have access to adequate devices nor has issues with internet access.

Participants must attend class prepared to wash their hands and have their hands examined under the Glo-Germ light in order to find deficiencies.

Student Groupings

This class could be presented one-on-one, in small groups, 2-15 hospital workers, or in larger groups however should be limited to no more than 20 staff members due to the limited sinks that may be available. Classes consisting of more than 20 participants could take excessive time for staff to cycle through the hand washing exercise causing too little time to cover the rest of the content. Initially, staff members enrolled in each session will be in one large group consisting of all attendees. They will participate individually during the pre-instructional polling as well as the pre-instructional hand washing exercise. At the conclusion, participants will rejoin the large group consisting of all attendees.

This instructional course could be delivered with several group variations:


Instruction Plan

By department incorporating department specific customizations. For example the course could be delivered to the entire Food and Nutrition department highlighting when food service workers would or would not need to use gloves. Department leaders can request that an instructor attend a regularly scheduled staff meeting or set up a training session open that will be customized for the requesting department.

By discipline to take advantage of like backgrounds in education and role. By delivering the course to only nursing staff, the facilitator could highlight the 5 opportunities to perform hand hygiene (WHO, 2009). If this option is utilized, the facility must set up an advertising and registration process that will ensure only staff of the right discipline attend the sessions for that disciple. For example, discipline-specific flyers could be e-mailed to all nursing staff for the proper sessions and upon registration, they would need to confirm that they are a nurse either verbally if registrations are accepted over the phone or by selecting yes to the question, “Are you part of the nursing staff?” if registration is performed online by the individual.

By shift to take advantage of existing staffing patterns. This approach may help increase attendance due to the added convenience. For example by scheduling sessions just before or just after a typical shift, staff may find less barriers to attending. If this option is selected, the instructor must consider all disciplines that work on a given shift. For example, any session may contain Environment Services staff as well as direct care providers such as Physical Therapists. Because of the vast difference between the roles, experience and educational backgrounds of these staff members, examples used during class must be broad enough to appeal to any staff member in attendance and be understood easily by those in attendance.

Open sessions without groupings may also be used though the instructor will need to be aware of the variety of backgrounds, roles, education and experience of the audience. Because of the vast difference between the roles, experience and educational backgrounds of these staff members, examples used during class must be broad enough to appeal to any staff member in attendance and be understood easily by those in attendance.

By language spoken so that staff members speaking languages other than English will not be hindered and have the greatest opportunity to learn the material. As indicated in the Learner analysis, the program is available in English but can easily be translated into any language depending on the needs of each facility. Facilities requiring additional languages must identify the languages needed based on the staff at their facility and request that all instructional materials (audio recording, PowerPoint presentation, posters, etc.) be translated into the given languages. An instructor speaking each language must be trained to deliver the class and answer questions regarding the content.

Giving participants advance informationThrough various promotional materials, participants will be given the educational objectives of the instructional program. Using posters available from the World Health Organization, staff will receive information regarding infection rates, hand washing techniques, respiratory hygiene and proper donning and doffing of gloves to increase awareness of the need.

Hand washing poster - Retrieved from


Instruction Plan

http://www.who.int/gpsc/5may/How_To_HandWash_Poster.pdfCover your cough - poster - retrieved from http://www.cdc.gov/flu/protect/covercough.htmPersonal Protective Donning and Doffing Poster retrieved from http://www.cdc.gov/HAI/pdfs/ppe/ppeposter1322.pdfFive Moments for Hand Hygiene brochure - Downloaded from http://www.who.int/gpsc/5may/Hand_Hygiene_Why_How_and_When_Brochure.pdf

Successful completion of the instructional course is not dependent on any written pre-work or prior studying of facts on the participants’ part so there will be no written advance information distributed other than promotional material such as flyers or advertisements.

References

Centers for Disease Control and Prevention,(n.d) retrieved February, 22, 2013 from http://www.cdc.gov/flu/protect/covercough.htmCenters for Disease Control and Prevention, (n.d.) retrieved February, 22, 2013 from http://www.cdc.gov/HAI/pdfs/ppe/ppeposter1322.pdfMorrison, G. R., Ross, S. M., Kalman, H. K., & Kemp, J. E. (2011). Designing effective instruction (6th ed.). Hoboken, NJ: John Wiley & Sons, Inc.World Health Organization, 2009, Brochure: Hand Hygiene: Why How and When? Downloaded February, 22, 2013 from http://www.who.int/gpsc/5may/Hand_Hygiene_Why_How_and_When_Brochure.pdfWorld Health Organization, 2009, Hand washing poster - Downloaded February, 22, 2013 from http://www.who.int/gpsc/5may/How_To_HandWash_Poster.pdf


Instruction Plan

Instructional Environment, Equipment and Materials

This unit is best given in a lecture format augmented by multimedia so the instructor can demonstrate how to properly wash hands, don/doff gloves and coughing/sneezing etiquette. The instructor will also be able to answer questions. A lecture works best because “large numbers of learners can be served at one time with a lecture” (Morrison, Ross, Kalman, & Kemp, 2011, p. 221). The limitations of a lecture is that when the instructor does the lecture and demonstration “the assumption is made that all learners are acquiring the same understanding, with the same level of comprehension, at the same time” (Morrison, Ross, Kalman, & Kemp, 2011, p. 222). This should not be an issue since this is a mandatory training that is for mostly experienced patient care providers as well as recent graduates of health care professions who have background knowledge of infection prevention. Part of the lecture will include the students demonstrating what they learned by return demonstration, verbally reciting the steps and/or by written test. In order for the participants to have the option to regularly review the information the lecture can be recorded and/or the multimedia presentation with voice over uploaded to the internet or the intranet so the participants have the option to regularly review the information.

Considerations for the delivery environmento Projector and screeno Speakerso Sink with running watero Adequate seating

Equipment and materialso Desktop or laptop computer with:

Microsoft Office Suite Flash CD/DVD player Wired internet or wifi

o Black lighto GloGermo Surgical maskso Writing utensils (Pens/Pencils)

Handouts and media supporto Test (if applicable)

COURSE CONTENT STUDENT OBJECTIVES & INSTRUCTOR NOTES

SECTION III INSTRUCTIONALENVIRONMENT, EQUIPMENT &MATERIALS

Methods of Instruction

1. Instructor led presentation2. Blended learning

SECTION III Notes to Instructor

1. This unit is best given in a lecture format so the instructor can demonstrate how to properly wash hands, don/doff gloves and coughing/sneezing etiquette.

2. Integrate the principles of infection control throughout this Instruction plan


Instruction Plan

3. Discussion4. Demonstration5. Exercise

Aids:

1. Power Point presentation2. Pre-instructional Pre-test3. Pre-instructional Hand Hygiene

Assessment4. Audio File [MP3 format] (Audio

plays the Happy Birthday song for timing)

5. Demonstrations

Materials and Equipment:

1. Handouts2. Video3. Color Slides4. Computer Pallet5. WiFi6. Internet

Materials/Media Selection

1. A clinical setting with sink, hot/cold running water, soap, non-sterile gloves in a package, plastic garbage bag lined wastebasket, a counter at standard height, and a handout with the steps to do this procedure.

2. In a clinical setting with sink, tissues, hot/cold running water, soap, clinical uniform with long sleeves, plastic garbage bag lined wastebasket, a counter at standard height, and a handout with the steps to do this procedure.

3. The room will be supplied with a sink(s), GloGerm hand cream, hand

3. The instructor will also be able to answer questions.

4. The Standard Precautions of this unit are based on the Center for Disease Control (CDC) “Guidelines for Isolation Precautions in Hospitals”, Infection Control and Hospital Epidemiology. Vol. 17, No. 1 (January 1996) pp 53-80.

5. Students will be given a demonstration on how to properly wash their hands in a clinical setting

6. Students will be given a demonstration on how to properly prepare for donning non-sterile gloves in a clinical setting

7. Students will be given a demonstration on how to apply (don) and remove (doff) the non-sterile gloves

8. Students will be given a demonstration on how to properly cough and sneeze without contaminating those around them with respiratory secretions

Pre-instructional Pre-test

1. At the beginning of the instructor led class, the PowerPoint will show the instructions on how to participate in the polling via text or internet. Participants will be instructed that the polling is free however their individual mobile phone services may have a fee for texting. If participants do not have cell phones, laptops and computers will be readily available for use

Polling Questions [Word Format]Polling Instructions and Questions [PowerPoint Format]Pre-instruction Hand Hygiene AssessmentAudio File [MP3format]

MaterialsThe room will be supplied with a sink(s), Glo-Germ hand cream, hand cleanser, paper towels, trash receptacle and audio device(s) with pre-recorded message.


Instruction Plan

cleanser, paper towels, trash receptacle and audio device(s) with pre-recorded message.

Time frame45 minutes-1 hours lecture/discussion

Content

Selecting the Right Method1.The targeted audience – Hospital Employees2.The educational objective - to address the need to reduce infection rates among patients and employees3.The type and content of the message being provided – Educational Training4.The characteristics of the delivery method – Classroom Training with Instructor and Blended Learning5.The method’s utility for providing desired learning support – Combines e-learning with instructor-led classroom training

UNIT 1. STUDENT OBJECTIVESDefine:a) Microorganisms- are living cells so small they can only be seen with a microscope. They are all around us in the air, water, food, plants and on our bodiesb) Pathogens-or “germs” are micro-organisms capable of causing diseasec) Infections-are conditions caused by the growth of pathogens in the bodyd) Medical asepsis-means the absence of pathogense) Infection Control-is the method used in health care facilities to prevent the spread of pathogensf) “Dis-infection-is a process which destroys most pathogensg) “Sterilization”-is a process which kills all micro-organisms

1. Discuss why infection control is important to both patients and the health care team

2. Describe how infections are spread3. Define and discuss examples of “cross-

contaminations”, “clean” and “dirty”.4. Demonstrate the proper method to was

hands to prevent the spread of germs5. Demonstrate the proper method to don/doff

non-sterile gloves6. Demonstrate the proper procedure of

coughing and sneezing without spreading airborne germs

7. Identify general measures that should be followed by health care workers to reduce the spread of infection

8. Describe the importance of hand washing9. State the times hand washing should be

done

10.Describe how to select the correct personal protective equipment (PPE) for the task you are performing11.State when Standard Precautions are to be used12.Describe the rules for Standard Precautions


Instruction Plan

Instructional Delivery and Sequencing

Describe all activities from both the facilitator and student perspectives. What will the facilitator and students do during each activity or event?Suggested sections:

Overview of lesson Sequence of activities Step-by-step process

Overview of lesson

The target audience is patient care workers in a hospital setting. The length of the training for the three classes will be completed within one 45-60 minutes. The goal of the classes is to address educate patient care workers on infection prevention. The objective is to train patient care workers on infection prevention techniques involving hand washing, donning and removing (doffing) non-sterile gloves, and cough / sneeze etiquette. The instructor will explains the importance of each activity using a blended learning approach, utilizing a combination of PowerPoint presentation, video and audio files, in addition to classroom demonstration. The expected outcome is that the patient care worker will demonstrate the proper technique for each discipline to be taught (hand washing, donning and doffing non sterile gloves, and cough/sneeze etiquette) and have access to audio/video files for refresher training if needed that can be applied for future use.

Sequence of activities

First, there will be a pretest administered at the beginning of each instructor led class as a way to direct the patient care worker / learner to the importance of prevention techniques. The instructor will place a pretest online for the learner / patient care worker to take. The pretest is on the Poll Everywhere website: http://www.polleverywhere.com/multiple_choice_polls/LTc2Mjc3MjQzNw. Learners / patient care workers can take the pretest utilizing their smart phones, on the institutions computer, or home computer. At the beginning of the online test the learner / patient care worker will be informed as to whether or not questions in the pretest will be timed. Pretest will not be used to “test out” (Piskurich, 2005, p. 194) of the classroom activity. Pretest results will automatically be updated for feedback to the classroom group for instructional purposes.

In the classroom setting, the learner / patient care worker will receive a PowerPoint presentation and / or a video presentation prior to demonstration of each of the testable classes from the Instructor. During the hand washing exercises the learner / patient care worker will be given a dollop of non-toxic substance (GloGerm) on their hands when they enter the classroom and instructed to rub it in similar to hand lotion. They will then be asked to wash their hands similar to how they would in a clinical setting. After thoroughly drying their hands, the Instructor will pass a black light over the learner / patient care worker’s hands to detect any residual GloGerm.


Instruction Plan

Step-by-step process

The instructor will arrange for training location and all training testing materials in advanced of the training and testing process. Mandatory pretest can be taken during work downtime or at an established period during work as determined by a supervisor (Morrison, Ross, Kalman & Kemp, 2011, p. 420). Learners / patient care workers will be enrolled in each class by their supervisors. Learners / patient care workers will be given adequate notice by their supervisors to enroll in the online pretest and complete it prior to the scheduled classroom activity. If the learner has difficulty accessing the pretest website or understanding the pretest due to a recognized learning challenge or disability (English as a second language or dyslexia), arrangements will be made during work hours with a representative from human resources to address their needs. (The Joint Commission, 2009, pg. 138)

During each activity (pretest/classroom activity) the facilitator will evaluate the learners / patient care worker’s performance. The supervisor’s will be provided copies of the course completion records to update the learners / patient care workers personnel/training records. Supervisors will have the opportunity to review the training material to verify compliance with hospital policy and procedures.

The facilitator will use checklist to indicate whether or not the learner / patient care worker has successfully demonstrated an ability to understand, recall and demonstrate the principles that they were given in the mandatory training.

References:Morrison, G. R., Ross, S. M., Kalman, H. K., & Kemp, J. E. (2011). Designing effective Instruction (6th ed.). Hoboken, NJ: John Wiley & Sons, Inc. Chapter 15, "Planning for Instructional Implementation", pp. 404-423

Piskurich, G. M. (2005) Rapid instructional design: Learning ID fast and right. San Francisco, CA: Jossey-Bass/Pfeiffer Chapter 5, "Doing it Right: Development", pp. 183-236

The Joint Commission. (2012, February 9) Hand Hygiene. Retrieved from: http://www.jointcommission.org/topics/hai_hand_hygiene.aspx


Instruction Plan

Assessment of Learning

This section should describe how student learning will be assessed by the facilitator throughout the instructional module. Note: you may want to peruse next week’s resources to assist you with this section.

Suggested sections:

Pre-assessment strategies (before learning) measure gains on measures of achievement and attitude.

o A pretest will be administered at the beginning of each instructor led class as a way to direct the patient care worker/learner to the importance of prevention techniques. A pre-test will be online for the patient care worker/learner to take.

Formative assessment strategies(during learning) Steps in planning formative evaluations

o Audience Who are the target recipients of the evaluation results? The target recipients of the evaluation results will be patient care workers in a hospital setting.

o Issues What are the major questions/objectives of the evaluation? The goal of the classes is to address educate patient care workers on infection prevention. The objective is to train patient care workers on infection prevention techniques involving hand washing, donning and removing (doffing) non-sterile gloves, and cough / sneeze etiquette.

o Resources What resources will be needed to conduct the evaluation? Through various promotional materials, participants will be given the educational objectives of the instructional program.

o Evidence What type of data or information will be needed to answer the evaluation questions? The facilitator will use checklist to indicate whether or not the learner / patient care worker has successfully demonstrated an ability to understand, recall and demonstrate the principles that they were given in the mandatory training.

o Data-gathering Techniques What methods are needed to collect the evidence needed? The supervisor’s will be provided copies of the course completion records to update the learners / patient care workers personnel/training records.

o Analysis How will the evidence collected be analyzed? During each activity (pretest/classroom activity) the facilitator will evaluate the learners / patient care worker’s performance.

o Reporting How, to whom, and when will the results of the evaluation be reported? Supervisors will have the opportunity to review the training material to verify compliance with hospital policy and procedures.

Summative assessment strategies(after learning)o Determining program outcomes.o Determines effectiveness of learner or trainee learning

To what degree did students accomplish the learning objectives prescribed for each unit of the course? Measurement of effectiveness can be ascertained from test scores, performance records and observations of


Instruction Plan

learners behavior and efficiency of learner or trainee learning. The expected outcome is that the patient care worker will demonstrate the proper technique for each discipline to be taught (hand washing, donning and doffing non sterile gloves, and cough/sneeze etiquette) and have access to audio/video files for refresher training if needed that can be applied for future use.

Phase/Time (Checkpoint) Questions to Consider Individuals Involved

Review the analysis phase of the project (Includes needs assessment, learner analysis, and objectives)Needs AnalysisA study cited in a journal by the Joint Commission regarding education training stated, “This led the researchers to conclude that training in technique is key to health care workers’ proper hand hygiene performance.” (The Joint Commission,2009,pg. 103)The CDC states that a primary goal in a successful prevention program is to, “Provide health-care workers (HCWs) with better education regarding the types of patient care activities that can result in hand contamination and cross-transmission of microorganisms.” (CDC, 2002, pg. 33)Learner AnalysisMany experienced patient care providers as well as recent graduates of healthcare professions will have background knowledge of infection prevention. Clerical and support staff will likely have less experience but will still have background knowledge of infection prevention such as hand hygiene and covering a cough even if it is based in a home setting.

Is the project worth doing? Healthcare-associated infections are the cause of approximately 48,000 deaths in the United States each year according to recent research published in the American Journal of Infection Control (Edwards, Peterson, Andrus, Dudeck, Pollock and Horan, 2008).Is the project a priority for the organization? This number is considered unacceptable and one of the primary causes has to do with the spread of infection within the hospital/healthcare setting.Do any off-the-shelf materials already exist? Many resources have been published to assist organizations in the effort to train staff. The resources are so vast that some facilities may lack the personnel to review, refine and implement it. The Health and Learning Group has developed training that will fill this gap in any hospital setting. This can be used as a stand-alone training or in conjunction with training on the individual hospital’s policies, procedures and specifications.

Project managerImmediate supervisorClient

Completion of task analysis and objectivesWhat is the content needed to fix the issue in performance?What are more subtle steps within the

Is the instructional program on target? Proper infection prevention strategies including hand hygiene, covering coughs, and proper use of personal protective equipment can

Project managerSubject-matter expert (to review a draft


Instruction Plan

process of solving the problem?How does the learning process look from the learner’s perspective?

reduce the spread of infection greatly

ofthe instructional materials to verifytechnical accuracy)Client (review the design phaseof the project including, prototypematerials and test items to obtainsupport and buy-in)External reviewer

Completion of prototype instructional materials (draft of Website) and posttest

Is the Instructional content accurate?Are the tests reliable and valid?

Subject-matter expertClient

Formative evaluation

Are the Instructional strategies effective?Does the instruction motivate the learner?Is the instruction effective?

Test subjectsDesigner or evaluatorSubject-matter expert

Confirmative evaluation Do advances in technology require modifying the instruction?

InstructorTraining department project owner


Instruction Plan

Evaluation Plan

Evaluation Process

The effectiveness of our instructional program will be determined using various assessment strategies targeted at determining the degree to which the instructional module has met the program goals. We will utilize a combination of pre-test, formative, summative and confirmative evaluation tools. (Morrison, Ross, Kalman & Kemp, 2011) Pre-assessment will occur prior to the instruction in two places. One will occur as students conduct the hand washing assessment utilizing the glo-germ lotion and are evaluated for effectiveness using blacklight examination. Secondly, learners will answer three questions prior to the instructor led portion via text messaging.

Prior to implementation of this instructional module the designers will arrange for a pilot test to be conducted. The Pilot will provide the designers with necessary feedback regarding the effectiveness of the plan in meeting the targeted goals and objectives. This test will utilize SME’s, Hospital Management, Instructional Design Experts and various levels of patient care professionals; thus giving the designers an appropriate cross section of subjects to provide appropriate feedback. The Pilot will be conducted in such a way that all participants will progress through the entire instructional unit prior to providing feedback. (Piskurich, 2005) A questionnaire for participants will be developed using the following questions:

1. Was the amount of material covered in the course appropriate for the time allotted?2. Was the analysis of the task sufficient?3. Were the instructional objectives clear and complete?4. Were all terms properly defined?5. Was the important content properly stressed?6. Was the plan for transferring training to the job adequate?7. Were the evaluations sufficient?8. Were the instructional objectives met?9. Were the directions to trainees clear and complete?10. Was the pace of instruction adequate?11. Was the instructional sequence logical?12. Were the trainee benefits explained in sufficient detail?13. Were links to previous training established where necessary?14. Was the content relevant to the trainee’s situation?15. Were practices implemented where needed and for proper time?16. Was feedback to trainee sufficient?17. Were the activities effective and timely?18. Were the transitions comfortable?19. Were reviews and summaries adequate?20. Do you have any additional comments?

Additional evaluation done by the Instructional Designer observing the pilot and the program facilitator will target other areas of concern. “Consideration of facilities, technology use, roles of


Instruction Plan

personnel, the learner reactions to instructional content and strategies, and other factors that might influence the learner’s optimal performance in achieving the instructional objectives” (Morrison, Ross, Kalman & Kemp, 2011).

During the implementation of the instructional module the facilitator will conduct informal assessments of course components and learner attitudes toward and progress in meeting objectives through observation, questioning, discussion and monitoring. The facilitator will make adjustments to course activities as needed to ensure that all learners achieve the targeted goals. Hand washing assessment and in-class observation of donning-doffing gloves and respiratory hygiene will provide the learner and facilitator with immediate feedback concerning proper technique and the need for further instruction as outlined below.

Assessments will also be conducted following the instruction as both summative and confirmative evaluations. These strategies are outlined below in the Work Setting Observations, Change in Patient Outcomes, and Learner Evaluation of Objectives sections. The results of the confirmative assessments will be used by the Hospital Administration as part of annual review process. The results will help to inform the administration regarding the effectiveness of the entire infection prevention program being conducted at the facility.


Instruction Plan

Evaluation Process/Alignment of Unit Goals to Evaluation Process

Unit Goals Formative Evaluation

Summative Evaluation

Confirmative Evaluation

1. The facility is not cited by the state for infection X

2. There was little to no increase in the infection rate among the patients X

3. Perform a pre- and post-training test see how well the staff learned what was presented

X X

4. The staff found the in-service training more enjoyable than past in-service training

X X

Hand washing assessment:

The instructor will observe learners performing hand washing using the Glo-Germ as a pre-assessment strategy as well as after instruction. As a pre-assessment strategy it will be used to determine the degree to which the learner has improved in the critical competencies as a result of the instruction. Following instruction, the observation of the learners’ technique will be used as a summative evaluation of the instructor led class (Morrison, Ross, Kalman & Kemp, 2011). The instructor will observe the following using the Task Analysis Data Sheet:

Hand-Washing

1. Turn on water2. Keep clothes dry3. Angle arms downward4. Point fingertips down into the sink5. Wet hands and wrists thoroughly6. Apply soap or skin cleanser7. Rub hands together8. Rub between fingers to create a lather9. Lather all surfaces10. Use friction for at least 20 minutes11. Clean nails by rubbing them in the palm of other hand12. Rinse thoroughly under running water13. Rinse all surfaces of hands and wrists14. Run water down from wrists to fingertips15. Dry all surfaces with a clean, dry paper towel16. Dispose of paper towel without touching wastebasket17. Turn faucet off with clean paper towel


Instruction Plan

18. Use paper towel to open door

In-class Observations:

The instructor will observe learners donning and doffing gloves during class to ensure proper technique after instruction. This observation of the learners’ technique will be used as a summative evaluation during the instructor led class (Morrison, Ross, Kalman & Kemp, 2011). The instructor will observe the following using the Task Analysis Data Sheet:

Donning Gloves

1. Turn on water2. Wash your hands3. If you are right-handed, slide one glove on your left hand (reverse if left-handed)4. Using your gloved hand,slide the other hand into the second glove5. Interlace fingers to smoothout folds and create a comfortable fit6. Check for tears, holes, cracks, or discolored spots in the gloves.Replace the glove if

needed7. Adjust gloves until they are pulled up over the wrist and fit correctly.If wearing a gown

pull the cuff of the glovesover the sleeve of the gown8. Remove gloves immediately after use9. Wash your hands

Doffing Gloves

1. Touch only the outside of one glove. Pull the first glove off by pulling down from the cuff toward the fingers

2. As this glove comes off the hand it should be turned inside out3. With the fingertips of your gloved hand, hold the glove you just removed.4. With your ungloved hand, reach two fingers inside the remaining glove at wrist. Be

careful not to touch any part ot the outside of the glove5. Pull down, turning this glove inside out and over the first glove as you remove it.6. You should now be holding one glove from its clean inner side. The other glove should

be inside it7. Drop both gloves into the proper container8. Wash your hands

Respiratory Hygiene

1. Cover mouth and nose with a tissue when coughing or sneezing into the upper sleeve or elbow, not the hands

2. Promptly dispose of tissues in the nearest no-touch waist container3. Wash your hands4. Wear special masks and turn head away from others when coughing5. Encourage coughing persons to sit at least three feet from others in a common waiting

room


Instruction Plan

Work-setting Observations:

In order to ensure that learners continue to perform the skills required consistently while at work, an observation program will be instituted and included in the confirmative evaluation (Morrison, Ross, Kalman & Kemp, 2011). Data will be collected during observations that take place while staff are performing their daily activities. Observers can be supervisory staff or any staff member that has been trained and evaluated on the performance of the skills. The data will be reported back to the leadership. If the number of observations of correct performance of skills does not meet minimum requirements set by the facility, the leadership will address the deficiency.

Change in Patient Outcomes

Data regarding Hospital Acquired Infections will be collected by the facility before and after the implementation of the training. Though we expect to see infection rates decrease, other factors influence the rate so any change in the data should be investigated. This confirmative evaluation (Morrison, Ross, Kalman & Kemp, 2011) will be used to see if the training correlates to the change and if changes to the instructional program are indicated.

Learner Evaluation of Objectives

The paper-based evaluation tool will include the Likert scale strongly agree, agree, disagree and strongly disagree on the following:

Effectiveness of instructor(s) How week each objective was met:

o Objective 1 : The learner will demonstrate the proper hand washing technique to eliminate infectious material as measured by UV light.

o Objective 2 : The learner will employ the five opportunities for hand hygiene during patient care activities relative to the criteria discussed in class.

o Objective 3 : The learner will demonstrate the proper procedure to putting on (donning) and taking off (doffing) gloves to ensure no cross contamination as determined by the instructor.

o Objective 4 : The learner will list three ways to perform respiratory hygiene that will reduce the spread of infection as discussed in class.

o Objective 5 : The learner will demonstrate the proper procedure of coughing and sneezing without contaminating those around them as determined by the instructor.

Appropriateness of the facilities (room size and location)

Additionally, the evaluation tool will ask for feedback from the learners by using the following open ended questions:

What part of this training will be most helpful to you in your daily work? How could this training be improved? Do you have any other comments?


Instruction Plan

This summative evaluation will be conducted at the end of the instructor-led class (Morrison, Ross, Kalman & Kemp, 2011).

Overview of lesson

The target audience is patient care workers in a hospital setting. The length of the training for the three classes will be completed within one 45-60 minutes.

Educational Goals of the class include:

The facility is not cited by the state for infection There was little to no increase in the infection rate among the patients Perform a pre- and post-training test see how well the staff learned what was presented The staff found the in-service training more enjoyable than past in-service training To educate patient care workers on infection prevention. To train patient care workers on infection prevention techniques involving hand washing To train patient care workers on donning (applying) and removing (doffing) non-sterile

gloves, To train patient care workers on and cough / sneeze etiquette.

The learning objectives for this unit are:

The learner will demonstrate the proper hand washing technique to eliminate infectious material as measured by UV light.

The learner will employ the five opportunities for hand hygiene during patient care activities relative to the criteria discussed in class.

The learner will demonstrate the proper procedure to putting on (donning) and taking off (doffing) gloves to ensure no cross contamination as determined by the instructor.

The learner will list three ways to perform respiratory hygiene that will reduce the spread of infection as discussed in class.

The learner will demonstrate the proper procedure of coughing and sneezing without contaminating those around them as determined by the instructor

The instructor will explain the importance of each activity using a blended learning approach, utilizing a combination of PowerPoint presentation, video and audio files, in addition to classroom demonstration. The expected outcome is that the patient care worker will demonstrate the proper technique for each discipline to be taught (hand washing, donning and doffing non sterile gloves, and cough/sneeze etiquette) and have access to audio/video files for refresher training if needed that can be applied for future use.

Sequence of activities


Instruction Plan

First, there will be a pretest administered at the beginning of each instructor led class as a way to direct the patient care worker / learner to the importance of prevention techniques. The instructor will place a pretest online for the learner / patient care worker to take. The pretest is on the Poll Everywhere website: http://www.polleverywhere.com/multiple_choice_polls/LTc2Mjc3MjQzNw.

Learners / patient care workers can take the pretest utilizing their smart phones, on the institution’s computer, or home computer. At the beginning of the online test the learner / patient care worker will be informed as to whether or not questions in the pretest will be timed. Pretest will not be used to “test out” (Piskurich, 2005, p. 194) of the classroom activity. Pretest results will automatically be updated for feedback to the classroom group for instructional purposes.In the classroom setting, the learner / patient care worker will receive a PowerPoint presentation and / or a video presentation prior to demonstration of each of the testable classes from the Instructor. During the hand washing exercises the learner / patient care worker will be given a dollop of non-toxic substance (GloGerm) on their hands when they enter the classroom and instructed to rub it in similar to hand lotion. They will then be asked to wash their hands similar to how they would in a clinical setting. After thoroughly drying their hands, the Instructor will pass a black light over the learner / patient care worker’s hands to detect any residual GloGerm.

Step-by-step process

The instructor will arrange for training location and all training testing materials in advanced of the training and testing process. Mandatory pretest can be taken during work downtime or at an established period during work as determined by a supervisor (Morrison, Ross, Kalman & Kemp, 2011, p. 420). Learners / patient care workers will be enrolled in each class by their supervisors. Learners / patient care workers will be given adequate notice by their supervisors to enroll in the online pretest and complete it prior to the scheduled classroom activity. If the learner has difficulty accessing the pretest website or understanding the pretest due to a recognized learning challenge or disability (English as a second language or dyslexia), arrangements will be made during work hours with a representative from human resources to address their needs. (The Joint Commission, 2009, pg. 138)

During each activity (pretest/classroom activity) the facilitator will evaluate the learners / patient care worker’s performance. The supervisor’s will be provided copies of the course completion records to update the learners / patient care workers personnel/training records. Supervisors will have the opportunity to review the training material to verify compliance with hospital policy and procedures.

The facilitator will use checklist to indicate whether or not the learner / patient care worker has successfully demonstrated an ability to understand, recall and demonstrate the principles that they were given in the mandatory training.


Instruction Plan

References

Centers for Disease Control and Prevention. Guideline for Hand Hygiene in Health-Care

Settings: Recommendations of the Healthcare Infection Control Practices Advisory

Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. MMWR

2002

Dugan, D.L., 2012 Nursing Assisting: A Foundation in Caregiving. Third Ed. Hartman

Publishing, Inc. 8529 Indian School Road, NE Albuquerque, New Mexico 87112

Edwards JR, Peterson KD, Andrus ML, Dudeck MA, Pollock DA, Horan TC. National

Healthcare Safety Network (NHSN) Report, data summary for 2006 through 2007, issued

November 2008. Am. J Infect Control. Nov 2008;36(9):609-26.

Hartley, J., Davies, I. (1976). Preinstructional Strategies: The Role of Pre-tests, Behavioral

Objectives, Overviews and Advance Organizers, Review of Educational Research, Vol.

U6, Number 2, Pp. 239-265


Morrison, G. R., Ross, S. M., Kalman, H. K., & Kemp, J. E. (2011). Designing effective

instruction (6th ed.). Hoboken, NJ: John Wiley & Sons, Inc.

Morrison, G. R., Ross, S. M., Kalman, H. K., & Kemp, J. E. (2011). Designing effective

Instruction (6th ed.). Hoboken, NJ: John Wiley & Sons, Inc. Chapter 15, "Planning for

Instructional Implementation", pp. 404-423

Piskurich, G. M. (2005) Rapid instructional design: Learning ID fast and right. San Francisco,

CA: Jossey-Bass/Pfeiffer Chapter 5, "Doing it Right: Development", pp. 183-236

Poll Everywhere. Retrieved from

http://www.polleverywhere.com/multiple_choice_polls/LTc2Mjc3MjQzNw.


http://www.polleverywhere.com/multiple_choice_polls/LTc2Mjc3MjQzNw

Instruction Plan

The Joint Commission, 2009, Measuring Hand Hygiene Adherence: Overcoming the Challenges,

Retrieved from: http://www.jointcommission.org/assets/1/18/hh_monograph.pdf

The Joint Commission. (2012, February 9) Hand Hygiene. Retrieved from:

http://www.jointcommission.org/topics/hai_hand_hygiene.aspx

World Health Organization, 2009, Brochure: Hand Hygiene: Why How and When? Downloaded

from

http://www.who.int/gpsc/5may/Hand_Hygiene_Why_How_and_When_Brochure.pdf


http://www.who.int/gpsc/5may/Hand_Hygiene_Why_How_and_When_Brochure.pdf

http://www.jointcommission.org/topics/hai_hand_hygiene.aspx

http://www.jointcommission.org/assets/1/18/hh_monograph.pdf

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