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New staff training aims to bridge the language barrier, foster stronger relationships between residents and carers

A new training kit has been developed to help foster stronger relationships between carers and aged care recipients.

The Little Things training kit was led by the Farnham Street Neighbourhood Learning Centre in partnership with Meaningful Ageing Australia and contains evidence-based intercultural language training materials for personal care assistants from culturally and linguistically diverse (CALD) backgrounds working, or training to work, in aged care.

It is all about increasing the confidence of students and help them engage with older Australians in a meaningful way in their future careers.

Approximately 6.9 million Australians were born overseas and 23.2 per cent of homes speak another language as well as English, and it is estimated that 32 per cent of RACF workers were born overseas, so finding a way to communicate in a diverse society is key for care workers.

The idea was formed by Pip Mackey, project coordinator of The Little Things training, as she taught English while studying for her master’s in applied linguistics. Mackey taught an Ethiopian student who often struggled with grammatical English and worked in aged care while she studied.

“I became interested in that, thinking of the complexity of the work of a personal care assistant, which we call PCAs. With that complex work, with this sort of low, strictly low level of English, how was she managing to bridge that divide?” said Mackey.

“I was also studying this use of pragmatic language, which is the rules and tools of how we make meaning between ourselves and the other person, and how we understand or misunderstand each other. So, she was my sort of person zero on that, and I did some study activities with her and looked at how she had all these pragmatic language skills, even though maybe her verbs didn’t agree with their pronouns, and was clearly very effective in the way she connected with an older person.”

This initial idea led Mackey to seek and receive funding through the Workforce Training Innovation Fund, the Department of Education and Training in Victoria.

Mackey spoke with Aged Care Insite to discuss the project and how it can improve the lives of aged care recipients.

What does the training include?

The key tools are six films. The Little Things project involved going and making recordings of personal carers working with older people. So, the participating PCAs, who were nominated as displaying best practice by older people living in aged care homes or by senior staff, were interviewed as were the senior staff and trainers in our TO’s to find out what they saw as the most important things that people needed to know and to learn. Best practice PCAs wore little audio recording devices and made recordings with older people who volunteered to be part of it over a course of three days.

We used those recordings, after coding and analysing them, to form the backbone of six films. Everything relies on authentic language use and the practise that we observed in the aged care homes, as well as what occurred in the recordings. They’re not scripted as such as using chunks of authentic language. It includes a lot of what we call ‘little words’ that are really quite important and often overlooked and rarely something that you teach a person, but they are those discourse markers. So, they’re the words like the ‘so’ or the ‘okay’ and the ‘aha.’

A lot of those little sounds are interspersed through our language and they perform really important functions in the way we communicate. So, the films highlight those as well as highlighting other language strategies people use, such as how they might connect with an older person as they go along.

How they might do things like use their voice. They might refer to a shared history. They might say, ‘We did that yesterday. Let’s do that together,’ and it’ll incorporate that sort of small talk in the chat. There might be a bit of fun. We found a lot of the PCAs that we met talked about how some of them like to sing, and join in singing a song with an older person.

The films describe six different situations that commonly occur. One of them is setting the dining room and some of the politics around serving of lunch and people sharing tables, attitudes to food, to alcohol.

There’s a shower scene. There’s a situation where an older person is reluctant to engage in an activity, and the PCA is aware that she needs to encourage that person to come out of her room for her mental health needs.

Lots of these issues that get commonly described, they’re our backbone. We have a trainer’s manual that describes how the training can be delivered, and it really focuses on it being very flexible training. We know that if a trainer wants to use this in an RTO, that trainer is going to have a lot more opportunities to spend more time and expand and engage their students, and those students will benefit from communicative activities.

So, all of this work eventually led to a pilot program. Can you tell us a bit about the places where you ran the program and, some of the things that you’ve seen arise?

We worked with four aged care organisations and three RTOs as partners, and they fed into the project the whole time and that’s where we conducted our research. When it came to the pilot project, we delivered the training at the three RTOs to groups of students who were studying certificate three in individual support, and we also delivered it to groups of personal carers who were in the workplace at the aged care homes: Ourcare, Uniting AgeWell, Outlook Gardens; and the three RTOs were Levitan Community Education, The Centre in Wangaratta and the Westgate Community Initiatives Group.

We went and trialled the materials. We actually ran a first pilot program where we had three-hour training sessions. We surveyed the students or the PCA’s pre and post training and looked for what effects the training had. We had really good results from that, and we also used that as our main idea to help us improve the materials for the next round of trials, which we ran January through to March this year, and of course, COVID-19 hit as we were just finishing off.

Professor Yvonne Wells from La Trobe Uni conducted the evaluation. She used the pre and post surveys and she also ran a most significant change evaluation process. She interviewed 23 of the trainees, about two- or three-weeks post-training to ask them what the most significant change was that they experienced from the training. We also ran an online survey three or four weeks after and had pretty good responses from that too.

What was the sort of feedback you were getting from students and the recipients of care?

We weren’t surveying the recipients of care. We were surveying the PCAs and the RTO students, and the feedback we were getting was very much that this kind of training helped them relate better to people, think about relating to people, and relating as they went along.

Some of them said things like, ‘This training should be given to all carers.’ ‘The older person is going to feel safe, comfortable, and trustful to you.’ ‘It showed me how to connect with others in specific situations in day to day care.’ ‘I realised that this will improve the relationship between me and residents.’

And this one came up quite often and in discussion as well: ‘It made my job easier and now I can relate to my clients even more.’

So, it was self-perceived improvements, but the perceived impression of how their communication skills improved was 80 or 90 per cent.

So, it was probably a lot about confidence?

Yeah, confidence came up as a theme. The most significant change was the quality of evaluation process, and that was one of the key themes, that confidence had improved remarkably from this three hour session, and that they could see that they could apply it, that it was relevant, and they very much looked at how it could improve the quality of care that they could offer.

Was there any anecdotal evidence from the homes and recipients of care? I know there was no official survey, but was there any feedback, or just things that you guys noticed from the recipients?

There was a beautiful quote, someone saying of when, after they did the training and they were talking to an older man and he said stuff like, ‘What’s happened to you? You’re talking so differently.’ So, clearly they did notice, and it came up that they were just noticing they were a bit more efficient and coming up against less resistance from an older person.

About the name, The Little Things. It sounds like it is all about those little niceties, those little kind of bits of relationships that can be built through the small act of language and communication.

Yeah. I’d definitely agree. They are massive. So, there’s a couple of answers to that. One, it’s not just the niceties. They are really important ways of how you modify your practical type of language.

A PCA’s job is extremely practical, but also extremely relational at the same time. So, how they modify their language during some very tricky, practical tasks and very intimate and very invasive ones to make that person feel, as one of our trainees said, ‘comfortable and trustful to you’. Those are their words. That is really important, and you can do it with language in conjunction with body language and facial expressions.

They are the things that don’t necessarily transfer across a culture, but we don’t often have a discussion about how those cultural differences can apply and then just feel somebody is being rude because in their culture, your tone of voice goes down when you would like the tone of voice to go up. Those very subtle differences make a massive difference.

So, those are really little things that have a very big impact, and the other thing was just about everybody we interviewed to ask what those differences were in communication, they often said, ‘Oh, it’s just the little things. You know?’

It’s just saying hello before you take a nightie off or the little ‘Thank yous,’ or the ‘How are you?’ Or the taking an interest in a picture that’s on a wall. Those very little things make a big difference, and yeah, we almost heard it with every single person.

They said how important those little things were, because we know we can’t ask a PCA to add another big thing to their daily care routines, but they can incorporate these little things to the work that they’re already running around doing.

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