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Crevacore C, Coventry L, Duffield C, Jacob E. Factors impacting nursing assistants to accept a delegation in the acute care settings: A mixed method study. J Clin Nurs 2024; 33:2153-2164. [PMID: 38556781 DOI: 10.1111/jocn.17127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 03/07/2024] [Accepted: 03/11/2024] [Indexed: 04/02/2024]
Abstract
AIMS To investigate the experience of nursing assistants being delegated nursing tasks by registered nurses. DESIGN Mixed method explanatory sequential design. METHODS A total of 79 nursing assistants working in an acute hospital in Australia completed surveys that aimed to identify their experience of working with nurses and the activities they were delegated. The survey data were analysed using descriptive statistics. Interviews with 11 nursing assistants were conducted and analysed using Braun and Clarke's thematic analysis. Results were triangulated to provide a richer understanding of the phenomena. RESULTS Most nursing assistants felt supported completing delegated care activities. However, there was confusion around their scope of practice, some felt overworked and believed that they did not have the right to refuse a delegation. Factors impacting the nursing assistant's decision to accept a delegation included the attitude of the nurses, wanting to be part of the team and the culture of the ward. Nursing assistants who were studying to be nurses felt more supported than those who were not. CONCLUSIONS Delegation is a two-way relationship and both parties need to be cognisant of their roles and responsibilities to ensure safe and effective nursing care is provided. Incorrectly accepting or refusing delegated activities may impact patient safety. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Highlights the need for implementing strategies to support safe delegation practices between the registered and unregulated workforce to promote patient safety. IMPACT Describes the experiences of nursing assistants working in the acute care environment when accepting delegated care from nurses. Reports a range of factors that inhibit or facilitate effective delegation practices between nurses and nursing assistants. Provides evidence to support the need for stronger education and policy development regarding delegation practices between nurses and unregulated staff. REPORTING METHOD Complied with the APA Style JARS-MIXED reporting criteria for mixed method research. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
- Carol Crevacore
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
- Centre for Research in Aged Care, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Linda Coventry
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
- Centre for Research in Aged Care, Edith Cowan University, Joondalup, Western Australia, Australia
- Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Christine Duffield
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
- Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Elisabeth Jacob
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
- Australian Catholic University, Fitzroy, Victoria, Australia
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Davison E, Semlyen J, Lindqvist S. Mentoring medical students as a means to increase healthcare assistant status: A qualitative study. Nurs Open 2024; 11:e2149. [PMID: 38622906 PMCID: PMC11019241 DOI: 10.1002/nop2.2149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 06/16/2023] [Accepted: 03/19/2024] [Indexed: 04/17/2024] Open
Abstract
AIM To offer a practical way in which the status of healthcare assistants (HCAs) can be increased by drawing on their experience, knowledge and skillset, whilst mentoring medical students during an HCA project. DESIGN Qualitative, reflexive thematic analysis. METHODS One-to-one semi-structured interviews were conducted between April and June 2019, with 13 participants. Participants included five healthcare assistants; three practice development nurses, two of whom were former HCAs; one registered general nurse and four clinical educators. RESULTS Two themes were identified: HCAs as silent, invisible caregivers (theme 1) and the formation of an HCA identity through mentoring (theme 2). HCAs are often silent performers of complex patient care with limited opportunity to engage in the interprofessional team dialogue. Social perceptions of HCAs describe them as a marginalised, poorly understood, 'unqualified' group with 'lowly status'. Mentoring medical students allows HCAs to draw on their experience, knowledge and skillset by actively contributing to the learning and development of future doctors. CONCLUSION The mentoring of medical students gave HCAs an active voice within the interprofessional team, instilling their confidence and self-worth. Mentoring allowed HCAs to move from a homogenous, group-based social identity to a role-based one that enabled HCAs to reveal the true extent of their work whilst negotiating their place and identity within the interprofessional team. IMPACT Leaders in healthcare will see that a re-evaluation of HCAs as performers of basic, hands-on patient care is needed to breakdown ingrained beliefs, eliminating a 'us and them' mentality. Involving HCAs in the mentoring of medical students will impact on the personal development of both HCAs and medical students in the cultivation of a future, person-centred, inclusive and collaborative workforce. REPORTING METHOD COREQ guidelines to enhance methodological rigour were strictly adhered to. PATIENT AND PUBLIC INVOLVEMENT There is no patient or public involvement.
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Affiliation(s)
- Elizabeth Davison
- Faculty of Medicine and Health Sciences, Centre for Interprofessional PracticeUniversity of East AngliaNorwichUK
| | - Joanna Semlyen
- Faculty of Medicine and Health Sciences, Norwich Medical SchoolUniversity of East AngliaNorwichUK
| | - Susanne Lindqvist
- Faculty of Medicine and Health Sciences, Centre for Interprofessional PracticeUniversity of East AngliaNorwichUK
- Faculty of Medicine and Health Sciences, Norwich Medical SchoolUniversity of East AngliaNorwichUK
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Dewar J, Cook C, Smythe E, Spence D. A Heideggerian analysis of good care in an acute hospital setting: Insights from healthcare workers, patients and families. Nurs Inq 2023; 30:e12561. [PMID: 37199001 DOI: 10.1111/nin.12561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 05/19/2023]
Abstract
This study articulates the relational constituents of good care beyond techno-rational competence. Neoliberal healthcare means that notions of care are readily commodified and reduced to quantifiable assessments and checklists. This novel research investigated accounts of good care provided by nursing, medical, allied and auxiliary staff. The Heideggerian phenomenological study was undertaken in acute medical-surgical wards, investigating the contextual, communicative nature of care. The study involved interviews with 17 participants: 3 previous patients, 3 family members and 11 staff. Data were analysed iteratively, dwelling with stories and writing and rewriting to surface the phenomenality of good care. The data set highlighted the following essential constituents: authentic care: caring encompassing solicitude (fürsorge); impromptu care: caring beyond role category; sustained care: caring beyond specialist parameters; attuned care: caring encompassing family and culture; and insightful care: caring beyond assessment and diagnosis. The findings are clinically significant because they indicate the importance of nurse leaders and educators harnessing the potential capacity of all healthcare workers to participate in good care. Healthcare workers reported that participating in or witnessing good care was uplifting and added meaning to their work, contributing to a sense of shared humanity.
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Affiliation(s)
- Jan Dewar
- School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology North Campus, Auckland, New Zealand
| | - Catherine Cook
- School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology North Campus, Auckland, New Zealand
| | - Elizabeth Smythe
- School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology North Campus, Auckland, New Zealand
| | - Deborah Spence
- School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology North Campus, Auckland, New Zealand
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Schrader H, Ruck J, Borgulya G, Parisi S, Ehlers-Mondorf J, Kaduszkiewicz H, Joos S, Grau A, Linde K, Gágyor I. Stress experiences of healthcare assistants in family practice at the onset of the COVID-19 pandemic: a mixed methods study. Front Public Health 2023; 11:1238144. [PMID: 37732100 PMCID: PMC10507357 DOI: 10.3389/fpubh.2023.1238144] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 08/22/2023] [Indexed: 09/22/2023] Open
Abstract
Background At the beginning of the pandemic in 2020, healthcare assistants in general practices were confronted with numerous new challenges. The aim of the study was to investigate the stress factors of healthcare assistants in March/April 2020 as well as in the further course of the pandemic in 2020. Methods From August to December 2020, 6,300 randomly selected healthcare assistants in four German states were invited to participate in the study. We performed a mixed methods design using semi-structured telephone interviews and a cross-sectional survey with quantitative and open questions. The feeling of psychological burden was assessed on a 6-point likert-scale. We defined stress factors and categorized them in patient, non-patient and organizational stress factors. The results of the three data sets were compared within a triangulation protocol. Results One thousand two hundred seventy-four surveys were analyzed and 28 interviews with 34 healthcare assistants were conducted. Of the participants, 29.5% reported experiences of a very high or high feeling of psychological burden in March/April 2020. Worries about the patients' health and an uncertainty around the new disease were among the patient-related stress factors. Non-patient-related stress factors were problems with the compatibility of work and family, and the fear of infecting relatives with COVID-19. Organizational efforts and dissatisfaction with governmental pandemic management were reported as organizational stress factors. Support from the employer and team cohesion were considered as important resources. Discussion It is necessary to reduce stress among healthcare assistants by improving their working conditions and to strengthen their resilience to ensure primary healthcare delivery in future health crises.
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Affiliation(s)
- Hanna Schrader
- Department of General Practice, University Hospital Würzburg, Würzburg, Germany
| | - Jessica Ruck
- Department of General Practice, University Hospital Würzburg, Würzburg, Germany
| | - Gábor Borgulya
- Department of General Practice, University Hospital Würzburg, Würzburg, Germany
| | - Sandra Parisi
- Department of General Practice, University Hospital Würzburg, Würzburg, Germany
| | - Jana Ehlers-Mondorf
- Institute of General Practice, Christian-Albrechts University of Kiel, Kiel, Germany
| | - Hanna Kaduszkiewicz
- Institute of General Practice, Christian-Albrechts University of Kiel, Kiel, Germany
| | - Stefanie Joos
- Institute for General Practice and Interprofessional Care, Tübingen University Hospital, Tübingen, Germany
| | - Anna Grau
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
| | - Klaus Linde
- Institute of General Practice and Health Services Research, School of Medicine, Technical University Munich, Munich, Germany
| | - Ildikó Gágyor
- Department of General Practice, University Hospital Würzburg, Würzburg, Germany
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Cameron S, Parkinson B. Nursing students' experiences of working as healthcare support workers. Nurs Stand 2023; 38:32-37. [PMID: 37066698 DOI: 10.7748/ns.2023.e11892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2023] [Indexed: 04/18/2023]
Abstract
BACKGROUND Preregistration nursing students frequently seek employment as healthcare support workers (HCSWs). However, little is known about their experience of alternating between these two roles. AIM To explore the experiences of preregistration nursing students working as healthcare support workers. METHOD Semi-structured interviews were conducted with three preregistration nursing students working part-time as HCSWs in the NHS. The interviews were transcribed verbatim and analysed using interpretative phenomenological analysis. FINDINGS Analysis of the interview data produced the overarching theme of 'walking the tightrope'. The overarching theme contained four subthemes: 'preparing to get on the tightrope'; 'balancing on the tightrope'; 'having the stamina to stay on the tightrope'; and 'preparing to get off the tightrope'. CONCLUSION Nursing students gained experience and confidence while working as HCSWs, but were challenged by the limitations and demands of the role.
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Affiliation(s)
- Sheila Cameron
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland
| | - Ben Parkinson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland
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6
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Crevacore C, Jacob E, Coventry LL, Duffield C. Integrative review: Factors impacting effective delegation practices by registered nurses to assistants in nursing. J Adv Nurs 2023; 79:885-895. [PMID: 36062891 DOI: 10.1111/jan.15430] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 08/01/2022] [Accepted: 08/20/2022] [Indexed: 11/30/2022]
Abstract
AIM To identify the evidence on factors that impact delegation practices by Registered Nurses to Assistants in Nursing in acute care hospitals. DESIGN An integrative review. DATA SOURCES Database searches were conducted between July 2011 and July 2021. REVIEW METHODS We used the 12-step approach by Kable and colleagues to document the search strategy. The (Whittemore & Knafl. 2005. Journal of Advanced Nursing, 52(5), 546-553) integrative review framework method was adopted and the methodological quality of the studies was assessed using Joanna Briggs critical appraisal instruments. RESULTS Nine studies were included. Delegation between the Registered Nurse and the Assistant in Nursing is a complex but critical leadership skill which is impacted by the Registered Nurse's understanding of the Assistant in Nursing's role, scope of practice and job description. Newly qualified nurses lacked the necessary leadership skills to delegate. Further education on delegation is required in pre-registration studies and during nurses' careers to ensure Registered Nurses are equipped with the skills and knowledge to delegate effectively. CONCLUSION With increasing numbers of Assistants in Nursing working in the acute care environment, it is essential that Registered Nurses are equipped with the appropriate leadership skills to ensure safe delegation practice.
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Affiliation(s)
- Carol Crevacore
- School of Nursing and Midwifery, Edith Cowan University Joondalup, Joondalup, Western Australia, Australia.,Centre for Research in Aged Care, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Elisabeth Jacob
- School of Nursing and Midwifery, Edith Cowan University Joondalup, Joondalup, Western Australia, Australia.,Australian Catholic University, Melbourne, Victoria, Australia
| | - Linda L Coventry
- School of Nursing and Midwifery, Edith Cowan University Joondalup, Joondalup, Western Australia, Australia.,Centre for Research in Aged Care, Edith Cowan University, Joondalup, Western Australia, Australia.,Centre for Nursing Research, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Christine Duffield
- School of Nursing and Midwifery, Edith Cowan University Joondalup, Joondalup, Western Australia, Australia.,Centre for Research in Aged Care, Edith Cowan University, Joondalup, Western Australia, Australia.,University of Technology Sydney, Sydney, New South Wales, Australia
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7
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Breen R, Savundranayagam MY, Orange JB, Kothari A. Quality home care for persons living with dementia: Personal support workers' perspectives in Ontario, Canada. Health Soc Care Community 2022; 30:e2497-e2506. [PMID: 34951066 DOI: 10.1111/hsc.13692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 11/29/2021] [Accepted: 12/06/2021] [Indexed: 06/14/2023]
Abstract
There is a global need to understand how the quality of home care for persons living with dementia is perceived by their most frequent formal caregivers, personal support workers (PSW), especially given the expected rise in the prevalence of dementia. The aim of this study was to explore the perceptions of PSW regarding what constitutes quality home care for persons with dementia. Qualitative content analysis was undertaken to interpret semi-structured interviews with PSW (N = 15). Study findings indicate that quality home care is perceived to be (1) person-centered; (2) provided by PSW with dementia-specific education and training; (3) facilitated by specific PSW experiences, abilities and characteristics; (4) enhanced by accessible information, services and education for persons with dementia and their caregivers; (5) provided by an inclusive dementia care team; and (6) facilitated by organisational supports and respect. However, findings also indicated differences in what PSW perceive as quality home care versus what they are experiencing when providing care for persons with dementia. Participants advocated for increased supports to them through ongoing dementia-specific education and training, increased teamwork among care providers, increased wages, sufficient and qualified staffing, and increased exchange of client information. The findings highlight the importance of exploring front-line workers' perspectives and how they can help revise current healthcare policies and inform future policy development.
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Affiliation(s)
- Rachel Breen
- School of Health Studies, University of Western Ontario, London, Ontario, Canada
| | | | - Joseph B Orange
- School of Communications Sciences and Disorders, University of Western Ontario, London, Ontario, Canada
| | - Anita Kothari
- School of Health Studies, University of Western Ontario, London, Ontario, Canada
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8
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Niznik JD, Harrison J, White EM, Syme M, Hanson LC, Kelley CJ, Porter L, Berry SD. Perceptions of COVID-19 vaccines among healthcare assistants: A national survey. J Am Geriatr Soc 2021; 70:8-18. [PMID: 34449885 PMCID: PMC8657352 DOI: 10.1111/jgs.17437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 11/30/2022]
Abstract
Background Limited COVID‐19 vaccination acceptance among healthcare assistants (HCAs) may adversely impact older adults, who are at increased risk for severe COVID‐19 infections. Our study objective was to evaluate the perceptions of COVID‐19 vaccine safety and efficacy in a sample of frontline HCAs, overall and by race and ethnicity. Methods An online survey was conducted from December 2020 to January 2021 through national e‐mail listserv and private Facebook page for the National Association of Health Care Assistants. Responses from 155 HCAs, including certified nursing assistants, home health aides, certified medical assistants, and certified medication technicians, were included. A 27‐item survey asked questions about experiences and perceptions of COVID‐19 vaccines, including how confident they were that COVID‐19 vaccines are safe, effective, and adequately tested in people of color. Multivariable regression was used to identify associations with confidence in COVID‐19 vaccines. Results We analyzed data from 155 completed responses. Among respondents, 23.9% were black and 8.4% Latino/a. Most respondents worked in the nursing home setting (53.5%), followed by hospitals (12.9%), assisted living (11.6%), and home care (10.3%). Respondents expressed low levels of confidence in COVID‐19 vaccines, with fewer than 40% expressing at least moderate confidence in safety (38.1%), effectiveness (31.0%), or adequate testing in people of color (27.1%). Non‐white respondents reported lower levels of confidence in adequate testing of vaccines compared to white respondents. In bivariate and adjusted models, respondents who gave more favorable scores of organizational leadership at their workplace expressed greater confidence in COVID‐19 vaccines. Conclusion Frontline HCAs reported low confidence in COVID‐19 vaccines. Stronger organizational leadership in the workplace appears to be an important factor in influencing HCA's willingness to be vaccinated. Action is needed to enhance COVID‐19 vaccine uptake in this important population with employers playing an important role to build vaccine confidence and trust among employees.
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Affiliation(s)
- Joshua D Niznik
- Division of Geriatric Medicine and Center for Aging and Health, University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, North Carolina, USA.,Division of Pharmaceutical Outcomes and Policy, University of North Carolina at Chapel Hill, Eshelman School of Pharmacy, Chapel Hill, North Carolina, USA.,Center for Health Equity Research and Promotion, Veterans Affairs (VA) Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Jill Harrison
- Department of Health Services, Policy, and Practice, Brown University, School of Public Health, Providence, Rhode Island, USA
| | - Elizabeth M White
- Center for Gerontology and Healthcare Research, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Maggie Syme
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA
| | - Laura C Hanson
- Division of Geriatric Medicine and Center for Aging and Health, University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, North Carolina, USA
| | - Casey J Kelley
- Division of Geriatric Medicine and Center for Aging and Health, University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, North Carolina, USA
| | - Lori Porter
- National Association of Health Care Assistants (NAHCA), Carl Junction, Missouri, USA
| | - Sarah D Berry
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, Massachusetts, USA.,Department of Medicine, and Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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Scheepers RA, Smeulders I, van den Broek T. The impact of an additional nurse assistant during evening shifts on nurses' perceptions of job demands, job resources and well-being. J Adv Nurs 2021; 77:1013-1016. [PMID: 33617038 PMCID: PMC7898701 DOI: 10.1111/jan.14698] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/07/2020] [Accepted: 11/09/2020] [Indexed: 11/27/2022]
Abstract
AIM Workloads and other job demands jeopardize nurses' well-being, especially during evening shifts when there are less resources than during the day. The current study aims to shed light on how the addition of a nurse assistant to ward staffing during evening shifts has an impact on nurses' perceptions of job demands, job resources, and well-being. DESIGN We performed a pre-post pilot study, whereby we compared nurses' perceptions of job demands, job resources, and well-being before and after the addition of a nurse assistant to ward staffing during evening shifts. METHODS All nurses at the ward of a top-clinical hospital (N = 28) completed a baseline and follow-up survey including validated measures on job demands (workload and physical demands), job resources (autonomy and task clarity), and well-being (recovery from work and sleep problems). RESULTS Compared with baseline, nurses reported fewer job demands (lower workloads and fewer physical demands) and sleep problems at follow-up. No statistically significant changes in job resources (autonomy and task clarity) and recovery difficulties were found. CONCLUSIONS We found preliminary evidence that the addition of a nurse assistant during evening shifts could reduce workloads, physical demands, and sleep problems among nurses. IMPACT This study highlighted that heavy job demands and sleep problems associated with evening shifts may be addressed by adding a nurse assistant to the nursing team. Future studies with larger samples and a control group are needed to provide better estimates of the magnitude of the beneficial effects and of the cost-effectiveness of an intervention of this kind.
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Affiliation(s)
- Renée A. Scheepers
- Research group Socio‐Medical SciencesErasmus School of Health Policy and ManagementErasmus University of RotterdamRotterdamThe Netherlands
| | | | - Thijs van den Broek
- Research group Socio‐Medical SciencesErasmus School of Health Policy and ManagementErasmus University of RotterdamRotterdamThe Netherlands
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10
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Magowan R, Smith K. Fast-track training of temporary healthcare support workers to supplement hospital staff during the COVID-19 pandemic. Nurs Older People 2020:e1303. [PMID: 33354960 DOI: 10.7748/nop.2020.e1303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2020] [Indexed: 11/09/2022]
Abstract
In March 2020, the World Health Organization declared the COVID-19 outbreak a pandemic, which generated concerns that the NHS could be overwhelmed. The predicted increase in the number of patients requiring hospitalisation prompted the need to increase the number of clinical staff working on hospital wards, particularly healthcare support workers (HCSWs), who play a crucial role in addressing the care needs of older people. This article describes how one health board in Scotland trained and redeployed volunteers among its staff to work as temporary HCSWs in its main hospital during the pandemic. A fast-track, one-day training course was delivered in March and April 2020 to 104 staff from various backgrounds - some non-clinical - by a team of volunteer trainers. Staffing during an emergency, such as the COVID-19 pandemic, presents significant challenges, but the experience at NHS Borders shows that it is possible to develop a training course rapidly and provide additional band 2 staff to supplement the support workforce in a time of crisis.
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Affiliation(s)
- Rachel Magowan
- Borders General Hospital, NHS Borders, Melrose, Scotland, and medical student, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, Scotland
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11
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Dhami CS, Donnelly LR. Exploring residential care aide experiences with oral malodour in long-term care. Nurs Open 2020; 7:1208-1216. [PMID: 32587741 PMCID: PMC7308701 DOI: 10.1002/nop2.497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 02/11/2020] [Accepted: 03/17/2020] [Indexed: 11/07/2022] Open
Abstract
Aim To determine what experiences do residential care aides (RCAs) have with individuals living with oral malodour in a long-term care (LTC) facility? Design Study investigation was done using an interpretive qualitative approach paired with a social constructivism interpretive framework. Methods The study was conducted in May of 2015 through face-to-face interviews with RCAs, which were recorded and transcribed verbatim, observations of RCAs in their work environment, as well as RCA personal logs of their daily experiences with odour during caregiving. Thereafter, data were analysed and coded for emerging themes. Results Five major themes were identified after grouping the codes: 1) attitudes and behaviours when caring for residents with malodour; 2)RCA knowledge of oral malodour; 3) level of job satisfaction among RCAs that care for residents with malodour; 4) culture and malodour; and 5) challenges of care giving compounded by malodour. These themes depict the overall experiences of study participants.
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Affiliation(s)
- Charanpreet Singh Dhami
- Department of Oral Biological and Medical SciencesFaculty of DentistryThe University of British ColumbiaVancouverBCCanada
| | - Leeann R. Donnelly
- Department of Oral Biological and Medical SciencesFaculty of DentistryThe University of British ColumbiaVancouverBCCanada
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12
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Attard R, Sammut R, Scerri A. Exploring the knowledge, attitudes and perceived learning needs of formal carers of people with dementia. Nurs Older People 2020; 32:25-31. [PMID: 32020790 DOI: 10.7748/nop.2020.e1225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND An appropriate level of knowledge, a positive attitude and awareness of learning needs are essential to provide high-quality care to people living with dementia. AIM To explore the knowledge, attitudes and perceived learning needs of formal carers of residents living with dementia in one long-term care facility. METHOD Questionnaires were sent to nurses and nursing assistants working in one long-term care facility in Malta. A total of 207 completed responses were received from these formal carers. The questionnaire comprised scales: the Alzheimer's Disease Knowledge Scale, the Dementia Attitude Scale and the Dementia Learning Needs Assessment tool. RESULTS Formal carers' knowledge about dementia was satisfactory. Increased knowledge was associated with being a nurse and working on a specialist dementia unit. Overall, formal carers' attitudes towards people with dementia were positive. Nurses identified managing behaviour that challenges as the most important learning need, while for nursing assistants it was how to assist family caregivers in coping with Alzheimer's disease. Nurses and nursing assistants considered learning about the use of technology to be the least important learning need. Being a nurse and working in a specialist dementia unit were predictors of better knowledge. Working in specialist dementia units was also a predictor of positive attitudes towards people with dementia. CONCLUSION Policymakers should be aware that continued investment in specialist dementia units should be an intermediate and long-term goal because of the projected increase in the number of people living with dementia and the need to ensure these individuals receive optimum care.
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Affiliation(s)
- Roberta Attard
- Dementia intervention team, Active Ageing and Community Care, Qormi, Malta
| | - Roberta Sammut
- Department of Nursing, Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Anthony Scerri
- Department of Nursing, Faculty of Health Sciences, University of Malta, Msida, Malta
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Omondi GB, Murphy GAV, Jackson D, Brownie S, English M, Gathara D. Informal task-sharing practices in inpatient newborn settings in a low-income setting-A task analysis approach. Nurs Open 2020; 7:869-878. [PMID: 32257274 PMCID: PMC7113512 DOI: 10.1002/nop2.463] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 01/10/2020] [Accepted: 02/03/2020] [Indexed: 11/20/2022] Open
Abstract
Aim To describe the complexity and criticality of neonatal nursing tasks and existing task-sharing practices to identify tasks that might be safely shared in inpatient neonatal settings. Design We conducted a cross-sectional study in a large geographically dispersed sample using the STROBE guidelines. Methods We used a task analysis approach to describe the complexity/criticality of neonatal nursing tasks and to explore the nature of task sharing using data from structured, self-administered questionnaires. Data was collected between 26th April and 22nd August 2017. Results Thirty-two facilities were surveyed between 26th April and 22nd August, 2017. Nearly half (42%, 6/14) of the "moderately critical" and "not critical" (41%, 5/11) tasks were ranked as consuming most of the nurses' time and reported as shared with mothers respectively. Most tasks were reported as shared in the public sector than in the private-not-for-profit facilities. This may largely be a response to inadequate nurse staffing, as such, there may be space for considering the future role of health care assistants.
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Affiliation(s)
| | - Georgina A. V. Murphy
- KEMRI‐Wellcome Trust Research ProgrammeNairobiKenya
- Nuffield Department of MedicineUniversity of OxfordOxfordUK
| | - Debra Jackson
- Faculty of HealthUniversity of TechnologySydneyNSWAustralia
| | - Sharon Brownie
- School of MedicineGriffith UniversityNathanQldAustralia
- PRAXIS ForumGreen Templeton CollegeUniversity of OxfordOxfordUK
| | - Mike English
- KEMRI‐Wellcome Trust Research ProgrammeNairobiKenya
- Nuffield Department of MedicineUniversity of OxfordOxfordUK
| | - David Gathara
- KEMRI‐Wellcome Trust Research ProgrammeNairobiKenya
- Aga Khan University HospitalNairobiKenya
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Pesut B, Greig M. Resources for Educating, Training, and Mentoring Nurses and Unregulated Nursing Care Providers in Palliative Care: A Review and Expert Consultation. J Palliat Med 2020; 21:S50-S56. [PMID: 29283870 DOI: 10.1089/jpm.2017.0395] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Nurses and nursing care providers provide the most direct care to patients at end of life. Yet, evidence indicates that many feel ill-prepared for the complexity of palliative care. OBJECTIVE To review the resources required to ensure adequate education, training, and mentorship for nurses and nursing care providers who care for Canadians experiencing life-limiting illness and their families. METHODS This is a systematic search and narrative review in the Canadian context. RESULTS Six previous reviews and 26 primary studies were identified. Studies focusing on regulated nurses indicated that even amid variability in content, delivery methods, and duration, palliative education improves nurses' knowledge, confidence, attitudes, and communication abilities, and decreases nurses' stress. Results from palliative education in undergraduate curriculum were less definitive. However, studies on palliative simulation in undergraduate education suggest that it improves knowledge and confidence. Studies focusing on educating nursing care providers, either alone or in collaboration with regulated nurses, indicated positive outcomes in knowledge, confidence, communication, identification of clients who are dying, abilities to interact with patients and families, and a better understanding of their own contributions to care. Curricular resources in Canada have been developed. However, there is no dedicated and funded capacity-building strategy. DISCUSSION Resources exist to support palliative education for nurses and nursing care providers. Furthermore, the evidence suggests good outcomes from this education. However, there is no dedicated strategy for implementing those resources. Furthermore, there is little evidence of the critical role of knowledge translation in preparing nurses and nursing care providers for evidence-informed palliative practice.
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Affiliation(s)
- Barbara Pesut
- 1 Canada Research Chair, Health, Ethics and Diversity, Faculty of Health and Social Development, University of British Columbia , Okanagan, Kelowna, British Columbia, Canada
| | - Madeleine Greig
- 2 Faculty of Health and Social Development, School of Nursing, University of British Columbia , Okanagan, Kelowna, British Columbia, Canada
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Michelle Haigh S, Garside J. Effects of the Care Certificate on healthcare assistants' ability to identify and manage deteriorating patients. Nurs Manag (Harrow) 2019; 26:16-20. [PMID: 31468837 DOI: 10.7748/nm.2019.e1798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2019] [Indexed: 11/09/2022]
Abstract
The Care Certificate, launched in England in 2015, safeguards patients by ensuring all new healthcare assistants (HCAs) undertake a structured educational programme so that they can provide appropriate, safe and high standards of care in clinical settings. This article describes a service evaluation that aimed to identify the effects of the Care Certificate on HCAs' confidence and ability to identify, and initiate management of, unwell patients independently.
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Affiliation(s)
| | - Joanne Garside
- University of Huddersfield School of Human and Health Sciences, Huddersfield, England
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Abstract
BACKGROUND Moral distress can be broadly described as the psychological distress that can develop in response to a morally challenging event. In the context of healthcare, its effects are well documented in the nursing profession, but there is a paucity of research exploring its relevance to healthcare assistants. OBJECTIVE This article aims to examine the existing research on moral distress in healthcare assistants, identity the important factors that are likely to contribute to moral distress, and propose preventative measures. RESEARCH DESIGN This is a survey of the existing literature on moral distress in healthcare assistants. It uses insights from moral distress in nursing to argue that healthcare assistants are also likely to experience moral distress in certain contexts. PARTICIPANTS AND RESEARCH CONTEXT No research participants were part of this analysis. ETHICAL CONSIDERATIONS This article offers a conceptual analysis and recommendations only. FINDINGS The analysis identifies certain factors that may be particularly applicable to healthcare assistants such as powerlessness and a lack of ethical knowledge. We demonstrate that these factors contribute to moral distress. DISCUSSION Recommendations include various preventative measures such as regular reflective debriefing sessions involving healthcare assistants, nurses and other clinicians, joint workplace ethical training, and modifications to the Care Certificate. Implementation of these measures should be monitored carefully and the results published to augment our existing knowledge of moral distress in healthcare assistants. CONCLUSION This analysis establishes the need for more research and discussion on this topic. Future research should focus on evaluating the effectiveness of the proposed recommendations.
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Abstract
BACKGROUND Palliative care is acknowledged as an appropriate approach to support older people in nursing homes. Ethical issues arise from many aspects of palliative care provision in nursing homes; however, they have not been investigated in this context. AIM To explore the ethical issues associated with palliative care in nursing homes in the United Kingdom. DESIGN Exploratory, sequential, mixed-methods design. METHODS Semi-structured interviews with 13 registered nurses and 10 healthcare assistants (HCAs) working in 13 nursing homes in the United Kingdom were used to explore ethical issues in palliative care. The 'Ethical Issues in Palliative Care for Nursing Homes' instrument was used to measure the frequency and level of distress arising from ethical issues through a cross-sectional survey with 69 registered nurses and 129 healthcare assistants. Data collection occurred between December 2014 and November 2015. ETHICAL CONSIDERATIONS Ethical approval was granted by Queen's University's School of Nursing and Midwifery Research Ethics Committee and governance sought from each nursing home's manager. FINDINGS The interviews revealed three themes: ethical issues in practice; relational issues; and organisational issues. No significant differences between registered nurses and healthcare assistants were evident, confirming the patterns emerging from the interviews. Relational issues, primarily issues with residents and families, occurred most frequently and caused greater distress. CONCLUSION The shared environment is key in the experience of ethical issues; therefore, multidisciplinary education is needed for ethical decision making in palliative care. Addressing staff knowledge and service organisation may reduce ethical issues locally and provide a benchmark for global change.
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Wilberforce M, Abendstern M, Tucker S, Ahmed S, Jasper R, Challis D. Support workers in community mental health teams for older people: roles, boundaries, supervision and training. J Adv Nurs 2017; 73:1657-1666. [PMID: 28122155 DOI: 10.1111/jan.13264] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2017] [Indexed: 11/28/2022]
Abstract
AIMS The aim of this study was to explore the support worker functions in community mental health teams for older adults in relation to roles, boundaries, supervision and training. BACKGROUND Support workers in community mental health teams provide important help to older people with complex mental and physical health needs in their own homes. Their numbers have grown substantially in recent years, but without professional registration there is concern that boundaries with qualified practitioners are insufficiently clear and that they do not receive the support they require. DESIGN Qualitative research using interview data and thematic framework analysis investigated support workers' and registered practitioners' perspectives on roles, boundaries, supervision and training. METHODS Semi-structured face-to-face interviews were undertaken in 2011, with 42 members of nine teams spread across England, including support workers and community mental health nurses. Coding of transcribed audio-recordings and subsequent analysis was undertaken by four researchers. RESULTS Support workers undertook diverse roles and had considerable autonomy over their duties. Participants agreed about what tasks support workers should not undertake, yet there was evidence of 'negotiated' boundaries and examples of these being breached. Lines of authority were complex, yet support workers were supported through open communication with the wider team. Training was problematic, with few courses tailored for support workers and efforts towards formal qualification hindered by low pay and time pressures. CONCLUSION Local and national attention is needed to prevent 'drift' into activities that both support workers and registered practitioners consider outside their remit. Barriers to training and further qualification need to be addressed.
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Affiliation(s)
- Mark Wilberforce
- Personal Social Services Research Unit, University of Manchester, UK
| | | | - Sue Tucker
- Personal Social Services Research Unit, University of Manchester, UK
| | - Saima Ahmed
- Personal Social Services Research Unit, University of Manchester, UK
| | - Rowan Jasper
- Personal Social Services Research Unit, University of Manchester, UK
| | - David Challis
- Personal Social Services Research Unit, University of Manchester, UK
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Abstract
Aim The aim of this research was to explore how newly qualified nurses learn to organise, delegate and supervise care in hospital wards when working with and supervising healthcare assistants. It was part of a wider UK research project to explore how newly qualified nurses recontextualise the knowledge they have gained during their pre-registration nurse education programmes for use in clinical practice. Method Ethnographic case studies were conducted in three hospital sites in England. Data collection methods included participant observations and semi-structured interviews with newly qualified nurses, healthcare assistants and ward managers. A thematic analysis was used to examine the data collected. Findings Five styles of how newly qualified nurses delegated care to healthcare assistants were identified: the do-it-all nurse, who completes most of the work themselves; the justifier, who over-explains the reasons for decisions and is sometimes defensive; the buddy, who wants to be everybody's friend and avoids assuming authority; the role model, who hopes that others will copy their best practice but has no way of ensuring how; and the inspector, who is acutely aware of their accountability and constantly checks the work of others. Conclusion Newly qualified nurses require educational and organisational support to develop safe and effective delegation skills, because suboptimal or no delegation can have negative effects on patient safety and care.
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Abstract
The study aimed to explore the experiences of healthcare assistants working with people with dementia in UK residential care homes. Eight participants completed semi-structured interviews which were analysed by interpretative phenomenological analysis. Data analysis revealed three main themes representing healthcare assistants' experiences: the importance of relationships, which referred to the importance of their relationships with clients, families and colleagues as well as their attachment to clients; something special about the role, which referred to their perception that their role was unique and rewarding as well as their personal commitment to the job; and the other side of caring, which referred to the more difficult aspects of their role, including managing emotions and conflicts within the caring role. The findings indicate that staff should be supported to build strong and supportive relationships within their role and have opportunities to explore their emotional reactions to reduce any adverse impact on care provision. It is possible that this could be facilitated through reflective practice groups or clinical supervision.
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Abstract
Aim To conduct a scoping project to identify perceived barriers to UK nurse registration as experienced by internationally educated nurses working as healthcare assistants in the UK. Method Eleven internationally educated nurses working as healthcare assistants in two London hospitals attended two facilitated focus groups. Qualitative thematic analysis was used to analyse the data. Findings Study participants articulated frustration with UK English language testing requirements and a sense of injustice and unfairness relating to: double standards for nurses educated within and outside of the European Union (EU) and European Economic Area (EEA); and what was perceived, by some, as arbitrary English language testing with unnecessarily high standards. Differences among study participants related to issues of competency and accountability regarding English language skills and passing English language skills tests, with many feeling they were playing 'a game' where the rules kept changing. Conclusion Language testing barriers are impeding UK nurse registration for some internationally educated nurses from outside the EU and EEA who, as a result, are working as healthcare assistants. The provision of English language training by employers would improve their prospects of achieving nurse registration.
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Abstract
AIM To examine healthcare assistants' (HCAs) attitudes towards older people in long-term care settings and their knowledge of ageing. METHOD A survey was conducted with a convenience sample of HCAs in three long-term care settings in the Republic of Ireland. RESULTS Overall, positive attitudes towards older people were found and there was a relationship between greater knowledge about ageing and more positive attitudes. CONCLUSION Health services face challenges as a result of changing population demographics and nursing shortages. Continuing education in practice is important and nurses should lead innovations in education for HCAs.
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Bosley S, Dale J. Healthcare assistants in general practice: practical and conceptual issues of skill-mix change. Br J Gen Pract 2008; 58:118-24. [PMID: 18307856 PMCID: PMC2233962 DOI: 10.3399/bjgp08x277032] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2007] [Revised: 09/14/2007] [Accepted: 11/26/2007] [Indexed: 10/31/2022] Open
Abstract
The emergence of healthcare assistants (HCAs) in general practice raises questions about roles and responsibilities, patients' acceptance, cost-effectiveness, patient safety and delegation, training and competence, workforce development, and professional identity. There has been minimal research into the role of HCAs and their experiences, as well as those of other staff working with HCAs in general practice. Lessons may be learned from their role and evidence of their effectiveness in hospital settings. Such research highlights blurred and contested role boundaries and threats to professional identity, which have implications for teamwork, quality of patient care, and patient safety. In this paper it is argued that transferability of evidence from hospital settings to the context of general practice cannot be assumed. Drawing on the limited research in general practice, the challenges and benefits of developing the HCA role in general practice are discussed. It is suggested that in the context of changing skill-mix models, viewing roles as fluid and dynamic is more helpful and reflective of individuals' experiences than endeavouring to impose fixed role boundaries. It is concluded that HCAs can make an increasingly useful contribution to the skill mix in general practice, but that more research and evaluation are needed to inform their training and development within the general practice team.
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Affiliation(s)
- Sara Bosley
- Health Sciences Research Institute, Warwick Medical School, University of Warwick, Coventry.
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