The Lighthouse Rehabilitation Center

The Lighthouse Rehabilitation Center specializes in the care of adults who have suffered a Traumatic Brain Injury. The mission is to assist each person in achieving their highest level of independence in the least restrictive environment possible, and to serve the whole person by striving to meet each person's need spiritually, emotionally, socially, physically and intellectually.

Working with in-patient (residential) and out-patient clients, there are different staff members. The professional staff at the Lighthouse is a team of professionals who take the clients through the rehabilitation process. The Rehabilitation aides provide the daily quality personal care, implement behavior plans, plan structured actives, attend medical appointments with the residents, assist in the completion of individual therapeutic actives program (ITAPS) and provide ongoing supervision to the residents. The Lighthouse Rehabilitation Aides are compassionate care givers that are eager and willing to be trained to the best of their ability to care for the clients.

Issue & Opportunity

As new hires, orientation topics include job responsibilities and rules (employee handbook), the care plan and care team, client rights, documentation and reporting, Safety topics include worker safety, accident prevention, disaster, and evacuation preparedness, hand washing and gloves, infection control and standard precautions, fire safety and nutrition. However, missing are important elements of how to speak, motivate, direct and educate a resident. This puts the staff at a disadvantage in not only safety, but the ability to enhance the life of the client and aide The Lighthouse is achieving its goal for the client, which is to live the most independent life possible.

Data

According to the American Journal of Physical Medicine Rehabilitation, irritability after traumatic brain injury is the most frequently observed behavioral problem and is a challenge to care providers, about one third of TBI patients exhibit agitation in the sub-acute stage of rehabilitation (BIAA 2012 ). Agitation not only reduces the opportunity for patients to engage in rehabilitation but also becomes a major stressor for patients and their caregivers.

Agitation and the violence that may occur contribute towards the very high staff turnover of 80% at The Lighthouse Rehabilitation Center in Kingsley, MI (Dennis 2012). It is also associated with reduced productivity, increased absenteeism and counseling costs and decreased staff morale. If we could better equip staff to understand and handle this agitation and aggressive behavior, this could reduce staff turnover.

Seventy-five percent of the respondents in a survey of 565 acute, sub-acute and post-acute programs regarding the training needs of licensed and non-licensed staff brain injury services indicated that specialized training is needed for licensed staff, and 84% indicated that training is needed for non-licensed staff (ACBIS About 2012). Also, 90% of the respondents agreed that the training curriculum needed to include cognitive, psychological and social consequences of brain injury, behavioral approach for managing challenging behaviors and promoting positive skills.

The Academy for the Certification for Brain Injury Specialists (ACBIS) offers a voluntary national certification program for both entry-level staff and experienced professionals working in brain injury services. ACBIS provides staff and professionals the opportunity to learn important information about brain injury, to demonstrate their learning in a written examination, and to earn a nationally recognized credential. Certification is based on a comprehensive training manual that covers the following topics: Incidence and epidemiology of brain injury, continuum of services, brain anatomy and brain-behavior relationships, functional impact of brain injury, effective treatment approaches, health and medical management, family issues and legal and ethical issues (ACBIS Home, 2012).

This certification, if made a mandatory prerequisite of working on the floor with residents, would set our staff and facility apart from the other rehabilitation facilities in Michigan and surrounding states. Not only would our staff feel more confident in handling the clients, but they would truly understand why the clients are reacting the way they are. This could reduce the feelings of resentment and allow for a more productive way of redirecting the behavior.

According to Dennis, it is clear from staff exit interviews and current staff feedback received in June of 2012 note that more training is both needed and desired by staff. When fifty of our current staff were surveyed, forty-four of them responded that addition training was needed to assist them in doing a better, more thorough job of taking care of the residents. Understanding the lack of impulse control, how to motivate, avoid manipulation, better communication and being supportive without 'counseling' clients were the top issues and concerns voiced (Dennis 2012).

The Lighthouse Rehabilitation Center fills out and reports all physical incidents of aggression that result in having to physically restrain a resident due to agitation on an Incident/Accident Report. There has been an average of two IA reports sent to the Licensing per month for the year 2012 (Dennis, 2012).

Course of Action

Potential course of action would be to enroll all current staff in the courses offered by ACBIS, after they have reached the 500 required hours of direct contract with residents. Training could range from 8-12 hours depending on activities chosen to be included by trainer. Pre-test and post-test will be used to determine effectiveness of training, along with employee feedback. Each section has a pre and post test, along with set objectives.

The biggest cost to implement this program would be time ensued by the employee in taking classes and tests totaling $38,915 for the first three years of the program (Appendix B). The cost of the exam is $175 per person for a group over thirty persons. Each application also includes a one year subscription to the Journal of Head Trauma Rehabilitation (BIA 2012). A $300 fee will be assessed to one of our Human Resources trainers in order to teach these study classes to our own employees, in order to save study fees and classes for staff (ASBIS. CBIST 2012).

The advantage of having a better trained, more confident staff will be an investment that returns itself in the confidence of not only doctors and hospitals that we work with, but family members and residents reliability and trust they place with The Lighthouse.

Criteria for Evaluating Alternatives

It is extremely important to assess the result

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