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In Direct Care, Effective Entry-Level Training Is Key

By Kezia Scales, PhD (she/her) | July 16, 2018

Editor’s Note: This excerpt is from Growing a Strong Direct Care Workforce: A Recruitment and Retention Guide for Employers.

With limited time and resources, direct care instructors often fall back on traditional teaching methods such as lectures, videos, reading assignments, and tests. A different approach is needed, however, to prepare trainees with the confidence and competence to succeed and stay in their jobs.

Here are three steps for improving training outcomes:

Embed adult learner-centered methods

Prospective nursing assistants and home care workers bring a wealth of experiential knowledge to the classroom, but they may also have educational challenges, like limited literacy, English proficiency, or experience with formal education. With an adult learner-centered approach, instructors leverage trainees’ existing knowledge and facilitate their individualized learning process—modeling the same person-centered, culturally competent approach that is expected of workers when providing care. Emphasizing experiential learning and skills development, adult learner-centered training relies primarily on interactive methods, such as role plays, case scenarios, and small-group work.

Design training around core competencies

The primary goal of direct care training should be to develop trainees’ practical skills and competencies, not just impart textbook information. The building blocks of a competency-based curriculum include: client rights, ethics, and confidentiality; assistance with activities of daily living; clinical skills and infection control practices; safety and emergency protocols; and self-care. If provided in-house, training can also be adapted to include competencies related to the specific needs of your organization’s clients, such as providing dementia care or taking a palliative approach.

Develop problem-solving skills

Effective communication is the foundation of strong relationships and high-quality care. Teachable communication skills include: active listening; asking clarifying questions; self-awareness of personal assumptions and biases; the ability to self-manage, including “pulling back” from immediate reactions and responses; and giving and receiving constructive feedback. By exploring, understanding, and integrating these critical interpersonal skills, trainees will be well-positioned to work effectively in teams, build relationships with their clients, address problems as they arise, and deliver person-centered care.

*Remember: Adults learn best when:

  • They feel respected.
  • The learning environment is safe and supportive.
  • The content is relevant to their needs.
  • Learning activities address different learning styles and challenges.
  • Lessons encompass three learning domains: knowledge, skills, and attitudes.
  • Opportunities are provided for applying skills in realistic situations


How can long-term care providers improve their recruitment and retention? Read our new guide, where you can also find a list of citations.

Kezia Scales, PhD (she/her)
About The Author

Kezia Scales, PhD (she/her)

Vice President of Research & Evaluation
Kezia Scales leads PHI’s strategy for building the evidence base on state and national policies and workforce interventions that improve direct care jobs, elevate this essential workforce, and strengthen care processes and outcomes.

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