Protocol for a mixed methods exploratory investigation into the role and contribution of the healthcare assistant in out-of-hours palliative care

Background Most people spend their last year of life at home, with many wishing to die there, but patients may need access to care after hours. Out-of-hours palliative care is delivered by multi-disciplinary teams including Health Care Assistants (HCA). However, little is known about the role, contribution and impact Health Care Assistants have on out-of-hours palliative care services. The aim of this study is to examine the Health Care Assistant role, contribution and impact on service delivery and patient care in out-of-hours community palliative care provided by hospice organisations. Methods and analysis A mixed methods exploratory study consisting of four phases. Phase one involves a scoping review to systematically map and identify gaps in policy and literature on the HCA role in out-of-hours palliative care. In phase two, all United Kingdom hospices will be invited to participate in an online census to enable the development of a typology of out-of-hours services and the contribution of the Health Care Assistant. During phase three organisational case studies representing different service types will collect information from Health Care Assistants, patients, caregivers and service managers to gather qualitative and quantitative data about out-of-hours service provision and the Health Care Assistant role. Finally, phase four will synthesize and refine results through online focus groups. Ethics and dissemination Ethical approval has been obtained for phase two through Ulster University Research Governance Filter Committee, Nursing and Health Research. Findings will be disseminated through practitioner and/or research journals, conferences, and social media.

Making sense of the individual experience of those who undertake new role development in the workplace

Purpose The purpose of this study is to generate an understanding of becoming an assistant practitioner (AP) through a work-based learning programme so that work-based learning programmes are designed and delivered to enable practitioners to develop the knowledge, skills and attitudes to undertake new roles from within. Design/methodology/approach The study, based on the lived experience of developing from a health-care assistant to an AP, was based on the philosophical assumption of understanding an experience at a particular time. Constructivism (Denzin and Lincoln, 2008) provided the conceptual framework and phenomenology of the theoretical perspective. Experiential learning, action, reflection and professional knowledge framed the literature review to inform understanding at the commencement of the study. Eight participants were selected, through purposive sampling, from one acute NHS Trust in South East England. Their matron and mentor were interviewed for contextualisation. Interviews occurred at 3 stages, 4 months after commencing the foundation degree (FD), 16 months after commencing the FD and 6 months after completing the FD. Each transcript was considered before moving to the next transcript, this allowed super-ordinate themes to be considered within groups before ascertaining similarities and differences across groups. The emergent and super-ordinate themes were synthesised to inform three over-arching super-ordinate themes. Findings The following over-arching super-ordinate themes emerged from the analysis of the participants’ transcripts from the three phases of the study: recognising the transition; the transition was not linear but was complex and influenced by the individuals’ behaviour, their ability to reflect and take action and to demonstrate professional knowledge. Supporting the journey; the workplace culture needed to support experiential learning and provide time and space to facilitate reflection. Being an AP; a change in professional knowledge and behaviour resulted in enhanced confidence and self-belief and the ability to be an AP. Originality/value This study, based on the lived experience of developing from a health-care assistant to the AP, where participants remained in their place of work rather than undertake placements which is a requirement of regulated programmes, demonstrated that individuals need to recognise the consequences of the behaviours, engage in experiential learning, take action and demonstrate a change in professional knowledge.

“All behaviour has meaning”: A qualitative exploration of dementia training of healthcare assistant students

Statement of the Problem: Nurses face a high level of risk of violence compared with other workers, with higher frequency towards those who are younger and less experienced. Risk of violence is similar for health care aides, and nursing students, with health care aides experiencing the highest rate of injury because much of their work and clinical practice is in long-term care settings where many residents are at risk for challenging behaviours due to cognitive changes. The purpose of this project was to evaluate the effects Gentle Persuasive Approaches© (GPA) training had on health care assistant students’ knowledge and ability to care for patients who have the potential for responsive behaviours. GPA is a training program recognized in Canada as best practice in the management of responsive behaviours of patients, providing learners with the skills to interact and intervene to diffuse escalating care situations. Methodology: A mixed-methods approach with a quasi-experimental, repeated measures design was used. Health care assistant (HCA) students received GPA training by certified faculty coaches prior to their clinical practice. Repeated measure questionnaires were administered pre-GPA, post-GPA, and post-clinical practice. Focus groups allowed students to reflect on how GPA prepared them for managing responsive behaviours post-clinical practice. Findings: The results demonstrate the effectiveness of offering evidence-based dementia training program while students are still in their educational program to better prepare them to provide person-centred care and keep themselves and their patients safe.