Come on down! (Not - for - Profit Report).

We haven't tried The Price Is Right yet, but whether they're playing a round of Family Feud, Jeopardy or Wheel of Fortune, the staff of Stonehill Franciscan Services in Dubuque, Iowa, is learning through participation and competition--and having fun. The Stonehill campus, with nearly 270 employees, includes Stonehill Care Center, a 250-bed licensed nursing home; Stonehill Adult Center, providing adult day care for an average of 15 clients per day; and Assisi Village, an independent living center.

At Stonehill, every employee must attend one Review Day each year. Prior to 1995, this in-service was presented in a traditional lecture/audiovisual/discussion format. We found that not only were staff bored, but so were the presenters. An area hospital consultant suggested using a game show format as a teaching method. Originally, we rejected the idea. But because learning, a lifelong process, occurs best when the participants are actively engaged, we reconsidered and decided to give it a try and the program has been in place ever since.

Scheduling 10 Annual Review Days throughout the year solved a variety of problems. Because this is a facility-wide in-service, approximately 30 people from a cross-section of departments participate in each monthly review session. Each group consists of staff from nursing, maintenance, dietary, activities, housekeeping--every Stonehill department. On Review Day, the in-service is their only job, thereby eliminating the previous problems of scheduling, end-of-shift fatigue and difficulty in arranging for child care, etc.

The program runs from 8:30 a.m. until 2:30 p.m. with one breakout session, when licensed nursing staff attend CPR review and unlicensed staff attend a class on conscious and unconscious choking. That is the only time there is a distinction in the class composition. For all other sessions, it is a mixed group and the questions are posed to everyone. For example, we pose infection control questions to our dietary and maintenance staff and lockout/tagout questions to our nursing and activities staff. Among the topics covered are Aging, Fire Safety, Ergonomics and Back Safety, Resident Elopement, Hazardous Materials, Communication, the Use of Personal Protection Equipment and more.

To illustrate how review material can be adapted to a game format, consider this popular and easy-to-implement game--bingo. Different versions of computer-generated bingo cards were created, with answers substituted for numbers. The leader asks a question, for example, "If a resident is found to have no pulse and is not breathing, the nursing staff must begin performing _____." If the answer, CPR, appears on a player's card, the player covers it. The game continues with wide-ranging questions, covering issues confronting any and all departments, until someone says "bingo!"

Another popular game is "Wheel of Aging." Our maintenance staff built an upright wheel with segments marked with dollar amounts, "lose a turn," "bankrupt" and "trip." The game is played the same way as its TV counterpart: The player spinning the wheel and guessing letters of the alphabet represents a team. The objective is to solve a word puzzle pertaining to a condition of aging. For example, one word puzzle might have letter spaces for the phrases "short-term memory loss," "diminished judgment" and "decrease in logic" written on the board. Then, just like on TV, after these phrases have been solved, the team has the opportunity to identify what these three things have in common. (The answer is Alzheimer's disease.) If they are correct, the team receives additional game money. The team player continues to spin the wheel until a wrong letter is guessed. Then, the opposing team takes over the wheel to try to solve the puzzle. The team with the most game money at the end wins a prize for each member of the tea m.

Other games are played, as well. "Who Wants to be a Millionaire?" covers Infection Control, Personal Protective Equipment and Hazardous Materials, while "Jeopardy" covers Fire, Tornado, Evacuation and other Disaster policies.

Staff members pick up on their own weaknesses and will stop the progress of a game to question something they don't understand. Every wrong answer or detailed question is reviewed until staff understand the correct answer and its rationale. If the question is a significant teaching point, we have several options to cover it. For example, we can take the concern back to the department managers so they can address it in their day-to-day communication and routines, or if needed, schedule a specific in-service to thoroughly examine the concern and review staff interventions and facility policy.

Throughout the day and throughout the games, prizes are awarded. On the "Wheel" there is a "trip" section. A player landing on that space receives 60 cents for a "trip" to the pop machine. Popcorn, decks of cards, sodas, chips and ice cream bars are also popular. Anything can be a prize. We even encourage staff who attend seminars, conferences and conventions to contribute their trade show "loot" (pens, pencils, notepads, canvas bags, Frisbees, etc.).

Our game show format works for several reasons:

* It stimulates learning and allows employees to draw upon their own experiences for the answers.

* The program exercises employees' affect or attitude. For example, in some games they role play at being an older person. Part of the game is to verbalize their losses of independence, finances, employment and loved ones.

* Staff stays active! The program combines thought with physical action. Learning is easier when more than one sense is involved; we combine auditory and visual senses with physical activity.

* Teamwork and camaraderie are encouraged. Because multidisciplinary groups are mixed, staff learn about each other's important contributions.

* We give staff permission to be wrong. Part of learning involves making mistakes. The important thing is that staff receive support, encouragement and corrective feedback to learn from those mistakes.

In-services can be fun. This low-cost, high-energy program is not difficult to replicate. One leader with the vision of the entire program should coordinate the development team so that details such as prizes and props are not overlooked. It's also a good idea to have extra "emcees" available.

The program's success also depends upon the initial thought, preparation and contributions offered by department heads. For example, the physical therapy department can supply information on back safety, ergonomics and back exercises. Prepared handouts and/or summaries of the material covered give staff helpful references to consult throughout the year.