August 1 DELIVERABLE I	October 1 DELIVERABLE II	February 1 DELIVERABLE III	March 1 DELIVERABLE IV	April 1 DELIVERABLE V	May 1 DELIVERABLE VI	June 1 DELIVERABLE VII
Roos, Cheung The Vendor shall provide a report on TNH-supported activities in FY 2005-2006 containing the following: Listing of TNH partners and collaborators from FY 2005-2006 Detailed report on publications and manuscripts pertaining to TNH-supported activities List of names and educational history of each  trainee participating in the Teaching Nursing Home project during 2005-2006 Summary of the 2006 Quality Summit	Ruiz, McEntire Create a Geri-U Home Page Specific to Long-Term Care Staff The home page will provide LTC staff with links to training and education created by the Vendor.  This new home page will be used as an educational tool during the educational outreach trainings provided to nursing homes in various regions of the state.  This new webpage will: Be developed after working with a minimum of 15 nursing homes (5 large, 5 medium and 5 small nursing homes) to determine the most usable and useful design. Require no password for access to instructional materials. Provide a user friendly listing of the various major areas of concern to a Nursing Home (NH) staff person and allow the various professionals to click on the link pertinent to their training CNA, LPN, RN, DON, Risk Manager, and Medical Director. Include links to all TNH training or Quality Improvement (QI) tools. Provide instructions on how to use the GeriU website, including downloading instructions and contact information to allow the training to be mailed if the facility is unable to download the materials. Provide a customized password protected area of nursing home trainers to exchange and review instructional evaluation materials and training-related data with TNH faculty. Provide summaries of each TNH training tool which will include information on the intended audience and prerequisite training and experience for audience and trainers, and technical requirements (such as DVD or computer requirements). Provide a search function to allow education materials to be retrieved from the entire GeriU library, as well as identifying other LTC nursing education modules/sites with access to free training modules as determined by the TNH Steering Committee.	Ruiz, Qadri, Roos Pilot Development of Just-in-Time Training Tools for Staff It has been determined through meetings with associations and their members that there is a need for tools addressing common problems specific to nursing home residents.  The focus of this deliverable is to develop portable, inexpensive educational tools to assist and improve staff communication with persons who have dementia, and assist with the recognition of pain, depression and related problems in persons with dementia.  There are multiple formats that can be used with technology such as handheld electronic devices, or with tools such as pocket cards, laminate handouts and wall posters.  These tools will be easily accessible and aimed at providing the performance of nursing staff caring for residents with dementia.  This deliverable will: Pilot these various formats as tools for usability, utility and cost in three different size nursing homes, small, medium and large. Obtain input from staff to assist in the development of these tools. Determine which approach or approaches will be the most efficient and effective.  Provide a detailed report of the pilot project, including the various formats and approaches and tools used and final recommendations on the most efficient and effective approach or approaches to be developed.	A. Kelly Continue the Existing “Dining at Home” Project In 2005-2006,  a model for residential dining was implemented at one study site. Training was provided to nursing and administrative staff, along with collection and full analysis of data.  The Vendor shall continue the project and provide the following: Expand the project to at least one additional facility. Production and evaluation of a beta version of an educational DVD-based curriculum on the ”Dining at Home: project.  (The planned release of version 1.0 during the summer 2007 will provide the beginnings of a future module available for any facility to use to assist in implementation of the dining area of culture change). Provide the analysis and report of data related to culture change (dignity and QoL aspects). Provide a newly created checklist for assessing staff preparedness for using the dining experience to address quality-of-life improvement of residents and staff. Begin development of a formal assessment of culture change competency based on review of the dining experience at any facility that has implemented the ”Dining at Home” or AHCA related dining projects. Report on information gained from other dining projects in Florida and provide comparisons to other dining projects in terms of space, personnel, time, and other resources needed for project implementation.	Lieblich, Wilkes, Polivka-West Establish a New Workforce Development Project This new project will be called “Effects of Separate and Combined Implementation of Culture Change and Quality Improvement Technical Assistance on Reducing Nursing Home Staff Turnover and Retention.”  This is a 14-month TNH project to develop a unified no-cost approach (free curriculum, training and support).  The project will include: Analysis of the nursing home organization and resources to improve staff processes and communication. Technical assistance and consultation to overcome barriers to improvement throughout the transformation/culture change. Development of two nursing home workforce improvement protocols, one approach reflecting an emphasis quality improvement methodology used by the Quality Improvement Organization (QIO) and the other approach emphasizing culture change used by the Florida Pioneer Network (FPN). Expert consultation offering customized solutions to specific needs and wants for these two protocols, as well as informative trainings and consultative resources. Develop protocols/formal curriculum for both approaches delivered separately and in concert with appropriate technical assistance from the TNH project team drawn from the FPN, QIO, industry organizations, and the TNH’s university faculty members with expertise in study design and evaluation. Design and conduct a randomized block design study of staff satisfaction and turnover rate at baseline and multiple time points after project initiation.  The study will make very effort to derive data from 40 participating nursing homes, but must have a minimum 36 participating nursing homes, a minimum of 9 adopting the QIO curriculum and approach, a minimum of 9 adopting the FPN curriculum and approach, a minimum of 9 experiencing both curricula and a combined approach, and a minimum of 9 nursing homes using no formal approach. Provide a summary of process and outcomes achieved by March 2007.  (Plans are to report the complete project in fall of 2007.)  The process and outcomes data obtained from participating nursing homes will include a description of the learning and implementation stages and available data pertaining to staff satisfaction and turnover rate just before implementation, and at approximately three month intervals after implementation. The complete data analysis and final report will be issued in the following year, with commentary on the benefits of various protocols/approaches and on the similarities and differences with LEAP, a project reporting benefits for staff development and culture change but whose implementation has been too costly for most nursing homes.	Newell, Roos, Mintzer, Williams Train-the-Trainer Outreach A formal outreach program will be conducted by TNH members, including an EdD-ARNP, an e-learning specialist, and other education technologists, on the introduction and distribution of TNH’s DVD-based curricula in dementia, depression, pain, and falls.  Outreach will be conducted for trainers, DONs, and risk managers in at least four separate regions of the state, including Miami, Naples, Tampa, Jacksonville, and/or West Palm Beach.   The program will involve the following: Invitations to all local nursing homes extended through the Florida Health Care Association (FHCA), Florida Association of Homes for the Aging (FAHA) and other industry organizations. Half-day regional sessions introducing the competency-based curricula, with demonstrations of the GeriU website and resources, a set of DVD-based training modules for nursing staff, and review of past results and current TNH research related to the further development of training in these topics. At each regional session, the collection of needs analysis data to identify training tools and consultation needs not provided by the TNH program. At each regional session, distribution to nursing home leadership attendees of a complete set of TNH’s DVD-based training tools and instruction on how to implement the training.  Training will also address the resources on GeriU, how to access additional interactive e-learning resources and data base tools at the website, and offer phone and e-mail support After each regional session, follow-up will be conducted to assess curriculum use in facilities implementing the training.  This assessment will include pre- and post-testing to evaluate curriculum utility and telephone interviews and focus groups to evaluate training usability. A report will be provided as part of this deliverable to describe the complete outreach program.	Brown, Roos Improving Clinical Communication in the Nursing Home Because of the growing acuity and complexity of NH residents, nurses (RNs and LPNs) must become able to identify and communicate complex clinical information to physicians and ARNPs responsible for the residents’ medical care.  Preliminary discussions with LTC leadership indicate the need to improve the efficacy and efficiency of communication dealing with the changing medical status of NH residents with certain common medical conditions such as Congestive Heart Failure (CHF) and Diabetes Mellitus (DM). Status changes in these conditions usually involve symptoms such as dyspnea, fatigue, and weakness and vital signs such as heart rate or rhythm, respiratory rate, fever, or blood sugar.  It is common for nursing staff to be unaware of the basic information physicians, physician assistants or ARNPs need to have when communicating a change in resident condition.  To address the increasing pressures for more efficient and effective health communication among nurses, physicians, and other medical professionals, TNH will design an develop a beta version of a DVD-based curriculum, “Improving Clinical Communication in the Nursing Home,” and evaluate it usability (nurse and trainer satisfaction) and utility (improved abilities for communication of information to medical care-providers in simulated situations).  Also included will be plans for packaging the curriculum for outreach and statewide training programs in the following year.  The training materials will include a facilitator’s guide and educational handout for the learners (staff nurses), outlining the learning objectives and strategies for improving nurse communications related to changes in resident symptoms, signs mood, and functional status and emphasizing complete, concise, and organized communication.  A template will be developed for organizing and presenting the ”nuts and bolts” of the change in clinical status of residents with CHF and DM and specific lectures and case studies (didactic foundation) with interactive skills-building exercises on communication.  The exercises will illustrate important problems (changes in symptoms and signs) associated with two common chronic medical conditions (CHF and DM) and how to apply the template to communications related to these changes.  The TNH curriculum development will include multimedia modeling of communications (“good” and “bad”), role-playing exercises, and competency test materials. The TNH will also provide a complete report on the design and development of the curriculum for improving clinical communication in the nursing home.

The home page will provide LTC staff with links to training and education created by the Vendor.  This new home page will be used as an educational tool during the educational outreach trainings provided to nursing homes in various regions of the state.  This new Web page will:

1. Be developed after working with a minimum of 15 nursing homes (5 large, 5 medium, and 5 small nursing homes) to determine the most usable and useful design.
2. Require no password for access to instructional materials.
3. Provide a user-friendly listing of the various major areas of concern to a nursing home staff person and allow the various professionals to click on the link pertinent to their training: CNA, LPN, RN, DON, risk manager, and medical director.
4. Include links to all TNH training or quality improvement (QI) tools.
5. Provide instructions on how to use the GeriU Web site, including downloading instructions and contact information to allow the training to be mailed if the facility is unable to download the materials.
6. Provide a customized password-protected area of nursing home trainers to exchange and review instructional evaluation materials and training-related data with TNH faculty.
7. Provide summaries of each TNH training tool, which will include information on the intended audience and prerequisite training and experience for audience and trainers and technical requirements (such as DVD or computer requirements).
8. Provide a search function to allow education materials to be retrieved from the entire GeriU library, as well as identify other LTC nursing education modules/sites with access to free training modules as determined by the TNH Steering Committee.

It has been determined through meetings with associations and their members that there is a need for tools addressing common problems specific to nursing home residents. The focus of this deliverable is to develop portable, inexpensive educational tools to assist and improve staff communication with persons who have dementia and assist with the recognition of pain, depression, and related problems in persons with dementia. There are multiple formats that can be used with technology such as handheld electronic devices, or with tools such as pocket cards, laminated handouts, and wall posters. These tools will be easily accessible and aimed at improving the performance of nursing staff caring for residents with dementia. For this deliverable we will:

1. Pilot these various formats as tools for usability, utility, and cost in three different-size nursing homes, small, medium. and large.
2. Obtain input from staff to assist in the development of these tools.
3. Determine which approach or approaches will be the most efficient and effective.
4. Provide a detailed report of the pilot project, including the various formats and approaches and tools used and final recommendations on the most efficient and effective approach or approaches to be developed.

In 2005-2006, a model for residential dining was implemented at one study site. Training was provided to nursing and administrative staff, along with collection and full analysis of data. The Vendor shall continue the project and provide the following:

1. Expand the project to at least one additional facility. 2. Production and evaluation of a beta version of an educational DVD-based curriculum on the “Dining at Home” project. [The planned release of version 1.0 during the summer 2007 will provide the beginnings of a future module available for any facility to use to assist in implementation of the dining area of culture change. 3.Provide the analysis and report of data related to culture change (dignity and QoL aspects). 4.Provide a newly created checklist for assessing staff preparedness for using the dining experience to address quality-of-life improvement of residents and staff. 5.Begin development of a formal assessment of culture change competency based on review of the dining experience at any facility that has implemented the “Dining at Home” or AHCA related dining projects. 6.Report on information gained from other dining projects in Florida and provide comparisons to other dining projects in terms of space, personnel, time, and other resources needed for project implementation.

APPENDIXES
Appendix A: Meetings, Conference Calls, and Related Project Activities
Appendix B: “Dining and Dignity” PowerPoint and Narration Notes
Appendix C: Actors’ ScheduleAppendix D: Quality-of-Life Scales for Nursing Home Residents (Kane, 2001) 
Appendix E: Development of the Artifacts of Culture Change Tool (CMS; Bowman, 2006)
Appendix F: Artifacts of Culture Change Tool (CMS)
Appendix G: Beta Version of the DVD [DVD]
Appendix H: Prototype Facilitator’s Guide for the DVD-Based Curriculum

This new project will be called “Effects of Separate and Combined Implementation of Culture Change and Quality Improvement Technical Assistance on Reducing Nursing Home Staff Turnover.” This is a 14-month TNH project to develop a unified no-cost approach (free curriculum). The project will include:
1.  Analysis of the nursing home organization and resources to improve staff processes and communication.

2.  Technical assistance and consultation to overcome barriers to improvement throughout the transformation/culture change.
3.  Development of two nursing home workforce improvement protocols, one approach reflecting an emphasis quality improvement methodology used by the Quality Improvement Organization (QIO) and the other approach emphasizing culture change used by the Florida Pioneer Network (FPN). Expert consultation offering customized solutions to specific needs and wants for these two protocols, as well as informative trainings and consultative resources.
4.  Develop protocols/formal curriculum for both approaches delivered separately and in concert with appropriate technical assistance from the TNH project team drawn from the FPN, QIO, industry organizations, and the TNH’s university faculty members with expertise in study design and evaluation.
5.  Design and conduct a randomized block design study of staff satisfaction and turnover rate at baseline and multiple time points after project initiation. The study will make very effort to derive data from 40 participating nursing homes, but must have a minimum 36 participating nursing homes, a minimum of 9 adopting the QIO curriculum and approach, a minimum of 9 adopting the FPN curriculum and approach, a minimum of 9 experiencing both curricula and a combined approach, and a minimum of 9 nursing homes using no formal approach.
6.  Provide a summary of process and outcomes achieved by March 2007 (Plans are to report the complete project in fall of 2007). The process and outcomes data obtained from participating nursing homes will include a description of the learning and implementation stages and available data pertaining to staff satisfaction and turnover rate just before implementation and at approximately three-month intervals after implementation.
7.  The complete data analysis and final report will be issued in the following year, with commentary on the benefits of various protocols/approaches and on the similarities and differences with LEAP, a project reporting benefits for staff development and culture change but whose implementation has been too costly for most nursing homes.

A formal outreach program will be conducted by TNH members, including an EdD-ARNP, an e-learning specialist, and other education technologists, on the introduction and distribution of TNH’s DVD-based curricula in dementia, depression, pain, and falls. Outreach will be conducted for trainers, DONs, and risk managers in at least four separate regions of the state, including Miami, Naples, Tampa, Jacksonville, and/or West Palm Beach. The program will involve the following:

Invitations to all local nursing homes extended through the Florida Health Care Association (FHCA), Florida Association of Homes for the Aging (FAHA), and other industry organizations.

Half-day regional sessions introducing the competency-based curricula, with demonstrations of the GeriU Web site and resources, a set of DVD-based training modules for nursing staff, and review of past results and current TNH research related to the further development of training in these topics.

At each regional session, the collection of needs analysis data to identify training tools and consultation needs not provided by the TNH program.

At each regional session, distribution to nursing home leadership attendees of a complete set of TNH’s DVD-based training tools and instruction on how to implement the training. Training will also address the resources on GeriU and how to access additional interactive e-learning resources and database tools at the Web site and offer phone and e-mail support. After each regional session, follow-up will be conducted to assess curriculum use in facilities implementing the training. This assessment will include pre- and post-testing to evaluate curriculum utility and telephone interviews and focus groups to evaluate training usability.

Because of the growing acuity and complexity of NH residents, nurses (RNs and LPNs) must become able to identify and communicate complex clinical information to physicians and ARNPs responsible for the residents’ medical care.  Preliminary discussions with LTC leadership indicate the need to improve the efficacy and efficiency of communication dealing with the changing medical status of NH residents with certain common medical conditions such as Congestive Heart Failure (CHF) and Diabetes Mellitus (DM). Status changes in these conditions usually involve symptoms such as dyspnea, fatigue, and weakness and vital signs such as heart rate or rhythm, respiratory rate, fever, or blood sugar. 

It is common for nursing staff to be unaware of the basic information physicians, physician assistants or ARNPs need to have when communicating a change in resident condition.  To address the increasing pressures for more efficient and effective health communication among nurses, physicians, and other medical professionals, TNH will design an develop a beta version of a DVD-based curriculum, “Improving Clinical Communication in the Nursing Home,” and evaluate it usability (nurse and trainer satisfaction) and utility (improved abilities for communication of information to medical care-providers in simulated situations). 

Also included will be plans for packaging the curriculum for outreach and statewide training programs in the following year.  The training materials will include a facilitator’s guide and educational handout for the learners (staff nurses), outlining the learning objectives and strategies for improving nurse communications related to changes in resident symptoms, signs mood, and functional status and emphasizing complete, concise, and organized communication.  A template will be developed for organizing and presenting the ”nuts and bolts” of the change in clinical status of residents with CHF and DM and specific lectures and case studies (didactic foundation) with interactive skills-building exercises on communication.  The exercises will illustrate important problems (changes in symptoms and signs) associated with two common chronic medical conditions (CHF and DM) and how to apply the template to communications related to these changes.  The TNH curriculum development will include multimedia modeling of communications (“good” and “bad”), role-playing exercises, and competency test materials.

The TNH will also provide a complete report on the design and development of the curriculum for improving clinical communication in the nursing home.