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This is Learning Module #2. It provides you with the Seven Basic Techniques for Instruction to increase your residents' ADL Independence. If you'll recall from Module #1, ADLs are activities of daily living, such as bathing, showering, eating, and washing your face and hands.
In the previous Learning Module, we discussed why independence is so important. If you'll recall, we talked about how you would feel if you had hurt your arm, and could not brush your hair, and had to ask for assistance. Sad? Frustrated? Depressed? Then we talked about the fact that a resident in your assisted living facility may have those same feelings. He or she may also feel sad, frustrated, and depressed because he or she is feeling in a helpless, childlike role.
What if you were living in a world where you could not fail and you felt loved and cared about? Would you define that as heaven? Well, I may be going to an extreme to get your attention and to make a point about verbal and nonverbal prompting, but you can make that heaven for your residents by providing them with an environment of success.
staff training module gives you seven basic techniques regarding
the use of instruction in such a way that it fosters and encourages
ADL independence, rather than dependence. The challenge for some
caregivers, in fostering or encouraging a resident's independence,
is feeling uncomfortable when standing by and watching a resident
struggle with a button while dressing, or reaching his or her
arm high enough to brush their hair. This is especially true if
you are new to working in health care for the elderly. Initially
it is much easier, and by far much quicker, for you to do this
for your resident or tenant.
If you were to have given an explanation or instructions about the reason before purchasing the cone, it is less likely that the expectation level would have been as great. Would your child be less likely to expect all future cones to be extra large if you would have said "Because you made an 'A' on the spelling test, this time I am going to do something special"? Thus, because of your explanation or instructions prior to the purchase, your child's expectation of your doing more each time will be much less. Agree?
Methods of Instruction
1. Asking instead of Telling
facilitate, or increase your resident's independence, ask your
resident if he or she wants to do something, rather than tell
them. Let's say that you have a resident in room 107, and her
name is Clarice. Rather than telling Clarice, ask, "Clarice,
are you ready for lunch?" or "Are you ready to wash
you face?" Asking, of course, gives your resident a feeling
of choice, dignity, and most of all independence.
key point regarding questions is to ask yourself, "Is this
resident alert enough to benefit from being offered a choice?"
Many residents with Alzheimer's are more likely to experience
success if he or she is told, "It's time to wash your face,"
rather than given a choice. Staff Training Module Four on Verbal
Prompts will give some very detailed techniques regarding the
use of questions.
how this works. Mary has been sitting, half dosing in the chair
in her room. Sound familiar? First, before you assist her to rise,
look at her eyes. Are they still only three-fourths of the way
open, indicating that she may mentally still be in a fog? Secondly,
as you ask her, "Are you ready to go to lunch?" do her
eyes move in your direction? Does she have direct eye contact
with you? As you know, all too often, residents who are shaky
upon rising from a chair, are at risk for falls. This risk can
be greatly decreased if you make it a habit to really look at
your resident's eyes.
resident's eyes seem to indicate that she isn't at full alertness
yet, talk to the resident for a few minutes until he or she
seems to come to full alertness. Mary will be much more likely
to be able to rise independently if she is fully awake and alert.
She will be much less at risk for a fall.
say you have a resident, Alice, who has had a stroke which affected
her left hand. To provide an environment of success, instead of
doing all of the these steps and washing her face for her, here
is what you do: You turn on the water. You adjust the flow and
temperature. You wet the cloth and wring it out. Then, hand Alice
the cloth in her right hand. You put the soap on the cloth for
It goes without saying that it is faster and easier to wash Alice's entire face for her. But, recall my story about the ice cream cone and your child. The more you do for someone, the less they feel they can do for themselves. If you jump in and do, do, do, for Alice, she does less and less for herself. I am sure you, like I, have seen many residents slide downhill into more and more dependence with no real physical reason.
key to remember with step-by-step instruction is, only do for
a resident what they cannot do for themselves. However, in order
to be able to do this, you need to be able to look at an ADL and
break it down into steps like I did. Then, take each step and
ask yourself, "What piece, or part of this ADL could the
resident be doing themselves?"
instruction only if the resident appears to be hesitant, and is
unsure of what to do. The key to providing an environment of success
with the fading technique is to watch what Alice does with her
hands as she is washing her face. If upon getting soap on the
cloth, she readily washes her forehead, cheeks, and chin, fade
out, or in other words don't provide verbal prompting like, "Now
your cheeks, now your other cheeks, now your chin." If you
provide too much step-by-step instruction, depending upon Mary's
alertness level, she may feel insulted, as if you are treating
her like a child. Going to the extreme, if over-instruction is
given on a consistent basis, she may become depressed and feel
Here's an example that I'll bet that you can relate to. Have you ever asked for an explanation of a repair to your car, and it sounded like they were speaking a foreign language? When you asked for more information, they just repeated the same words that you didn't understand in the first place. Or, worse, they raised the volume of their voice, and repeated the same words. How did you feel? Helpless? Hopeless about understanding what is going on with your car repair? Perhaps misunderstood, and frustrated?
if a resident has difficulty in understating what you are saying,
instead of admitting it, they may just say they don't want to
or cannot do something. The key to remember is, if you get a refusal,
try presenting your resident with the first small step of the
up definite transitions or verbal sign posts are invaluable to
someone with Alzheimer's disease, who has an interrupted thought
process. Here is an overview of the problem. The damage Alzheimer's
does to the brain has been described as being like a switchboard
that is transferring calls to the wrong locations. The disease
actually creates holes in the surface of the brain. For this reason,
the key to remember here is, discuss one topic at a time. When
you do move on to the next task, signal the change by stating,
"Let's talk about..." and then state the ADL.
you know, resident alertness level may vary from one time of day
to the next. So be prepared to give one word instructions to facilitate,
maintain, and encourage your resident's ADL independence.
In summary, seven instructional techniques to provide an environment of ADL success are:
#1: When possible, "ask" your resident to do an ADL, do not "tell" them. Then, evaluate if the resident understands the question.
#2: When initiating instruction, observe your resident's eye openness and eye contact as an indicator of their alertness level before proceeding with further ADL instruction. This alertness check is especially important for fall prevention during transfers and ambulation.
#3: Think of your ADL instruction in terms of a series of individual steps. Give ADL instructions and assistance only for the steps that the resident requires assistance.
#4: Fade out instruction, if it is not needed. Get in the habit of evaluating a resident's ability each time you work with them. Look for ways to support and encourage their independence.
#5: As a rule of thumb, repeat an ADL request two to three times, like, "It's time for lunch." If your resident's lack of movement indicates that they do not understand, request the resident do the first small step in performing the ADL. For example, "Mrs. Jones stand up now. It's time for lunch."
#6: Use a verbal sign post to signal a change in topics.
#7: Use one word instructions to aid transfers, ambulation, and other ADLs. Words like stand, sit, turn, move, etc. help to prompt your resident's movements. Use a word, then evaluate the ones that make the ADL performance easiest for the resident.
In this staff training module, number two, you've just learned about seven basic techniques for giving instruction in order to effectively increase your residents' ADL independence.
As stated at the beginning of this module, you need to have a working knowledge of the techniques just presented on instruction in order to take action to improve the quality of your residents' lives. That is what this Staff Training Module and entire series is all about, taking action. You now have what you need to be successful. You have just been provided with very concrete, specific examples of how to use instruction to increase your resident's ADL independence. The rest is up to you. In module three you will learn about the use of Demonstration. Remember take action!
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