Historical Context – The Living Classroom

The Teaching Nursing Home Movement

“In the Teaching Nursing Home, as in the teaching hospital, the goals of patient care, teaching and research need to be mutually supportive and synergistic so that all parties to the affiliation can benefit.” — Weiler, 1987, as reported in Barnett, Abbey and Eyre, 2011

Our Living Classroom concept has its roots in the Teaching Nursing Home (TNH) movement. Definitions of TNH vary (Chilvers and Jones, 1997; Mezey, Mitty and Burger, 2008; Barnett et al., 2011), but generally agree on the following fundamental concepts.

A Teaching Nursing Home:

involves a collaboration between an academic institution and a LTC home;
aims to improve quality of education and clinical experiences to prepare a workforce with
knowledge, skills and interest in geriatric care;
fosters research and research integration designed to improve LTC;
creates synergy between research, education and clinical care; and
improves resident outcomes.

What are long-term care homes?

In Ontario, long-term care homes (formerly called nursing homes) are places where adults can live and receive help with most or all daily activities and access to 24-hour nursing and personal care. Residents can expect much more nursing and personal care in long-term care than they would typically receive in a retirement home or supportive housing.

For more information, see Long-Term Care Overview (Government of Ontario, 2014).

The idea of bringing students into a LTC home learning environment was first explored in the 1980s, in the United States. Two major groups of TNHs were created, one funded by the National Institute on Aging (NIA) and another by the Robert Wood Johnson Foundation (RWJF). Both groups of TNHs had similar objectives to establish collaborations between academic institutions and LTC homes, but were focused on different disciplines: the NIA program targeted medicine students, and the RWJF program focused on nursing students. The two programs also differed in their emphasis, with the NIA program focusing on research and the RWJF program focused on workforce development.

The RWJF also funded a comprehensive evaluation of its 11 TNH programs. The results indicated that involvement in a TNH increased nursing students’ perceptions of LTC homes as a more attractive career choice and also increased professional competencies (Barnett et al., 2011). In addition, residents experienced fewer transfers to acute care hospitals, had an improved functional status and reported higher satisfaction (Lipsitz, 1995).

Although these TNHs had some laudable results, the funding to support these initiatives ended and many of the TNHs were subsequently discontinued. Among those that were sustained, several key features were evident, including adaptability to local conditions and ensuring that all parties to the collaboration benefited. For example, the provision of educational opportunities to current staff in the LTC homes, as well as students preparing for their careers, benefited both the home and the academic institution, leading to improved staff retention, student recruitment, quality education, and a more positive image for LTC (Mezey et al., 2008).

There have been several international applications of the TNH movement originally conceived in the United States, including Australia, Norway, the Netherlands and recently, Canada. A comprehensive review of these programs (Barnett et al., 2011) has uncovered a number of lessons and core features for success (see Table 2). At the same time, successful application of the TNHs varies with local contexts, the expertise brought by the collaborating organizations, and the needs of students, organizations, and residents.

Table 2: Core Features and Lessons for Success of the Living Classroom from International Experience

Core Feature	Lessons Learned
Reciprocal relationship	The literature agrees that there must be a formal structure to the affiliation between a LTC home provider and a PSE. Planning the affiliation is of paramount importance to ensure roles and expectations are clearly defined, and that those involved have a shared and clear vision (Barnett et al., 2011).
Selective vs universal	Not all LTC homes can or should pursue this model. TNHs should be seen and developed as centres of teaching excellence that serve as models for the LTC sector (Barnett et al., 2011). The literature suggests that larger LTC homes are more likely to be successful in implementing and sustaining a TNH. Larger LTC homes have greater capacity to provide students with a diversity of learning opportunities.
Leadership	Just as teaching hospitals are the standard against which community hospitals compare themselves, TNHs should be the standard for all LTC homes to compare themselves. An expert panel from the Harford Institute of Geriatric Nursing developed criteria to distinguish LTC homes engaged in TNHs as teaching and learning leaders, having: a robust Quality Assurance Program; sufficient preceptors and mentors to train and support students; staff who are receptive to student participation in care planning and delivery; interdisciplinary collaboration and teamwork; excellent compliance record; accreditation; and stable leadership (Mezey et al., 2008).
Commitment to a collaborative “learning environment”	Both the LTC home and PSE must be committed to providing ongoing learning and training opportunities for staff and for students that integrate learning with care and living in LTC. A mutual commitment to collaborate on research to support continuous quality improvement is also important.
Exemplify best practice and innovation	The LTC home must value best practices that are evidence-informed and also demonstrate innovation in establishing new practices.
Promote culture change and interdisciplinary education and practice	Quality of life in LTC relies on a culture that provides good care, but not at the expense of living with quality. This culture change requires moving outside of professional and departmental silos and putting the resident at the centre of decision-making. TNHs must promote interdisciplinary education and practice to support the international culture change movement in LTC.
Physical infrastructure	An effective TNH requires adequate and appropriately designed physical spaces on-site in a LTC home to support effective and different learning experiences (i.e. classrooms, laboratory, simulation, etc.).
Resource allocation	The LTC home and PSE must each acquire and allocate resources to support the maintenance of high quality education in the LC, and high quality care in LTC. Costs must be shared fairly to support the TNH, including personnel, expertise, space, and operating costs.

The Living Classroom at Schlegel Villages

The learning from these TNH programs as context-based learning environments has informed and influenced our work at Conestoga College and Schlegel Villages in creating our Living Classroom. The LC takes the best of those experiences and tailors it to our environment in Ontario, Canada. A key difference is our focus on workforce development versus research.

For more information about Living Classroom at Schlegel Villages, see About Us.

⟪ PREVIOUS: Benefits of the Living Classroom | NEXT: References ⟫