Transcript Slide 1

Developing National Standards:
‘Determining the role of the health
care assistant within acute medicine’
Liz Lees
Consultant Nurse
& Senior Research Fellow
Heart of England NHS Foundation Trust
The Society for Acute Medicine, 7th International Conference, 3-4 October 2013
Session overview
•
•
•
•
•
•
Background drivers
Tensions
Four perspectives on role definition
A framework in evolution?
VITAL development for HCAs
Future practice
Background drivers
Broad Policy:
•2000 – European Working Time Directive
•2005 – Modernizing Medical Careers
•2006 – Modernizing Nursing Careers
Specific/related evidence /policy:
2010 – Nursing Midwifery Council (towards 2013)
2011 – NIHR – SDO (Kessler et al)
2011 – DH: Enabling excellence
2012- The Francis Report
2013 - The Cavendish Review
2014 …. The CQC – Certificate in Fundamental Care
Background drivers
• 2012 – “Joint response from RCN, RCM and
Unison on Minimum Training Standards and
Code of Conduct for health and social care
workers in England”
Five areas within this for consideration:
1. Code of conduct
2. Common induction standards
3. Core and Common competencies
4. Technical and social care – training framework
5. Technical and health care – training framework
Healthcare assistants 'should get standard training'
By Michelle Roberts
Health editor, BBC News online
•
•
•
•
•
•
•
Healthcare assistants provide vital support
Continue reading the main story
There is no minimum standard of training for healthcare assistants
before they can work unsupervised, an independent report has found.
Workers should get at least two weeks' training to prepare them for
providing basic care in hospitals, care homes and at home in England, its
author said.
Journalist Camilla Cavendish also said some staff were only given a training
DVD to watch before starting work.
The review was set up in the wake of the Stafford Hospital scandal.
Ms Cavendish found that HCAs - who provide basic care such as feeding
and washing patients - were given no "compulsory or consistent" training,
and said some were doing tasks usually performed by doctors or nurses,
such as taking blood.
Patients are at risk as hospitals axe 5,000 nurses, warns union
Royal College of Nursing claims switch to healthcare assistants is
putting lives in danger
• Carter said: "We are concerned that there is a
dilution, to the detriment of patient care, of the
ratio of qualified nurses to health care
assistants. That has been compounded by so
many employers not giving their health care
assistants any training.
• "So you have the double whammy of not having
enough registered nurses and replacing them
with people who do not have rudimentary
training."
‘Compulsory and Consistent’
EMERGENT
Tensions
•
•
•
•
•
•
Blurring the boundaries between RGN & HCA
Merge all the information?
Transferability of competencies across settings
Multiplicity of employers
Delegation and Accountability
Contextually specific issues – particularly in
social care
• One size will not fit all !!
The Cavendish Review , July 2013
Role Definitions
In looking specifically at Hospital settings there is
some clarity in the literature:
1.Relief
2.Substitute
3.Apprentice
4.Co-Producer
The Nature and Consequences of the Support
Workers in a Hospital Setting, NIHR, SDO, 2011
(Kessler et al)
Relief
‘The standard HCA is more likely to deliver direct
and in-direct care than the Registered nurse and is
generally valued for taking routine tasks away from
Nurses’
Substitute
‘In taking on routine technical tasks HCAs are
extending their role into traditional nurse activities.
A substitute for registered nurses’.
•The question is where do we draw the line?
•Some HCAs extend the role significantly beyond
this point - raises the issue of cheap labour.
Apprentice
‘Many HCAs show an enthusiasm for in-role
development but this can be frustrated by
weaknesses in the operation of the Trust or NVQ
frameworks. HCAs have enduring nurse
aspirational tendencies, but Trusts show little
inclination to manage or address these
expectations’.
Co- Producer
‘Health care assistants have distinctive
contributions to make to care. They find it easier
to deal with certain difficult patients and more
readily relate to patients than registered nurses. IF
the role of the HCA were made clearer to patients
this relationship to care contribution would be
even stronger’.
How would you describe the role?
• How would you describe the HCA role within
acute medicine - without describing the tasks
that a healthcare assistant or health care
support worker carries out?
A framework in Evolution:
Basic tasks
•
•
•
•
•
•
•
•
•
Bathing
Feeding
Bed making
Collecting TTO
Escorting patients
Stocking up
Taking bloods
Cannulation
Simple dressings
• Taking observations
• ECG recording
• Blood glucose
monitoring
Modernization of the nursing workforce: Valuing the health care assistant:
2012. Kessler et al (Oxford University Press)
Framework in evolution:
Advanced tasks
•
•
•
•
•
•
•
Complex dressings
Female catheterization
Monitoring using diagnostic machines
Change of tracheotomy tubes
Giving an injections
Updating care plans
Relating medical information to relatives
Kings College Nation Nursing Research Unit: moving
forward with healthcare support workforce regulation
(2010)
Framework in evolution – Glasgow
Conference Research 2013
Purposeful Audience – research participants
•
•
•
•
•
Glasgow (October 2013).
Audience of 50 – voluntarily enrolled
Responses from 30
Methodology:
Framework analysis of free text responses to
key research questions
• Participant coding
• Existing HCA framework (basic & advanced) to
extract % data
• Vignettes to illustrate comments
Key research questions:
1. Were asked to describe the role of a HCA in
Acute Medicine.
2. Is the HCA role ‘different’ to elsewhere in acute
medicine?
3. Were asked to agree or refute basic tasks
4. Were asked to agree or refute advanced tasks
5. Finally if you had the opportunity to create a
certificate of specialist training – what would
you include?
1. Description of the HCA role in acute
medicine (framework analysis)
Core
themes:
Related
Construct 1
Related
Construct 2
(1) Support
registered
staff
Assist
Supervised by Directed by
RGN
RGN
(2) Meet
basic Care
needs
Essential care Tasks
(3)
Report to
Communicati
on
Feeds back
(4) Quality
care
Safety
Vital
Related
Construct 3
All care
Excerpt from whole content descriptions
P01: “ to work as a support to the nurse in
delivering care. The registered nurse will
supervise and direct this care, assessing all the
time, the capacity and capability of the HCA.
This situation will depend on the HCA as an
individual.
P30: “They are fundamentally vital people to
ensure patient safety as the eyes and ears of the
clinical environment, able to feedback clearly to
the registered nurse”
Excerpt from the whole content descriptions
P13: The HCA works with and under the direction
of the registered nurse to deliver safe and good
quality care. They are first in line to deliver nursing
care, washing, dressing and feeding – but under
the direction of the registered nurse.
P21: The HCAs form a team with trained nurses to
provide all aspects of patient care. The roles are
fluid and would depend on both sides of the
partnership – the experience of both RGN and
HCA – tasks can be agreed on this basis.
Q2. Is the role different for HCAs working in
acute medicine?
• 15 (n=30) 50% said YES
• 5 (n=30) 16.5% said NO
• 10 (n= 30) 33.5% said they were unsure
• Comments made:
• P15 – “they have to think on their feet, proactive’
• P02 – “they are far more skilled than a ward
HCA”
Q3. Are you in agreement with basic tasks?
Full agreement
Bathing
100% (30)
Feeding
100% (30)
Bed making
100% (30)
No agreement
Collecting TTO
6.5% (2)
Escorting patients
6.5% (2)
Stocking up
6.5% (2)
Taking observations
13.5% (4)
Blood glucose
16%
(5)
ECG recording
20%
(6)
Stocking up
23.5 % (7)
Cannulation
30%
Simple dressing
33.5% (10)
(9)
? Q4. Are you in agreement with advanced
tasks
Fully agree
Disagree
Female
catheterisation
10
Updating care plans
14
Monitoring using
diagnostic machines
15
Change of tracy tubes
15
Complex dressing
16
Giving injections
17
Relaying medical
20
information to
relatives
P10: Clear definition is needed to provide demarcation in
Pay Bandings (i.e.) Band 4 can do both Basic and
Advanced – depends where employed.
Q5. If you created a Certificate of Specialist
training – what would you include?
P09: Understanding of care of skin, dressings,
nursing assessment and interpretation of vital
signs (NEWs)
P12: Involve HCA in Nursing Risk assessments
P13: Understanding vital signs, dementia care and
acting as a special for patients.
P16: Aseptic technique training
P26: Infection control principles, ECG recording
P29: Care & Support of dying patients.
General discussion arising
• Titles of HCA role are potentially confusing and
this needs to be cleared up
1.
2.
3.
4.
5.
Support workers
Assistant Practitioners
Clinical Support workers
Health Care Assistants
Nursing Auxiliaries
–
Salaries do not represent skills
Desirable attitudes – recruitment to values
•
•
•
•
•
•
•
•
•
Listening
Observant
Diligent
Mature (stable emotionally)
Caring
Compassionate
Courage
Commitment
Communication
Concluding points
•
•
•
•
That there was a need for parity - nationally
Smaller and larger units do operate differently
Could put together a core framework
Could call it a specialist role and this raises the
profile of HCAs in acute medicine
• Think carefully about how to accredit existing
experienced HCAs
• Needs to be practice based framework
• Needs to rewarded with pay progression
VITAL ‘virtual interactive teaching and learning
for HCAs’ – HEfT work
1
2
3
4
5
Demographics
The learning experience
Impact on practice
Fit with 6Cs for Nursing
The Acid test
Survey Method
•
•
•
•
•
Surveyed all HCAs who had completed VITAL
Voluntary enrollment via email link
Survey Monkey platform with 23 questions
50 HCAs enrolled with 41 completed surveys
Used pre-piloted questions from a question bank
created by research team
Part 1 – HCA Demographics
Age range of HCA
Age:
0.0% 3.2%
16.1%
6.5%
9.7%
9.7%
18 to 24
25 to 29
30 to 34
35 to 39
40 to 44
45 to 49
50 to 54
55 to 59
Over 60
29.0%
9.7%
16.1%
Gender of HCAs
19.4%
Male
Female
80.6%
HCA Workbase
• Huge spread of areas (16)
• OPD, Theatres, Respiratory, Ophthalmology,
Dermatology, General Surgery, General medicine,
Renal and ENT
Highest educational attainment
0.0% 0.0%
13.3%
13.3%
GCSE
A-Levels
NVQ
Diploma
Undergraduate Degree
Postgraduate Degree
73.3%
Part 2 – Experience reported
Utilized variety of learning approaches
0.0% 0.0%
9.7%
Strongly Agree
22.6%
Agree
Unsure
Disagree
Strongly Disagree
67.7%
Rating the experience
Out of 10, how would you rate your experience of the course, in terms of: (1 being the lowest and 10 being the highest)
Usefulness of the materials
The course assessment (Scenarios)
Accessibility of the materials
The relevance of the materials
6.80
7.00
7.20
7.40
7.60
7.80
8.00
8.20
8.40
Part 3 – Impact on practice
Has VITAL has a positive impact on your
practice?
No
25.8%
Yes
No
Yes
0.0%
74.2%
20.0%
40.0%
60.0%
80.0%
Vignettes – positive impact
‘Informative, enabled me to have greater
confidence’ (p02)
‘The course has made me more aware, I think
what, why and when to do a task now’ (p04)
‘The information has re-instated my thirst for
learning’ (p23)
‘it has helped me to work better with doctors and
nurses in the team’ (p46)
If not positive impact – why?
• ‘The VITAL course was not relevant to my area of
work in clinic’ (p04)
• ‘I think we need a VITAL for theatre HCAs’ (p05)
• NB: 7 responses in this category only, same themes
Part 4 – fit with 6Cs
CARE
VITAL provided me with knowledge to effectively care for my patients
7.4%
Yes
92.6%
No
Care (safety)
My learning through VITAL has enabled me to identify
potential risks to patients in my clinical area.
Strongly Disagree
Disagree
Unsure
Agree
Strongly Agree
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
Compassion
You have become more compassionate as a result of completing
VITAL
Strongly Disagree
7.4%
Disagree
25.9%
Unsure
25.9%
Agree
33.3%
Strongly Agree
0.0%
7.4%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
Communication
Completing
VITAL has helped me to communicate better aspects of care with
.
patients and the team
18.5%
81.5%
Yes
No
Confidence (competence)
Undertaking the course has made you more confident in your
practice.
Strongly Disagree
Disagree
Unsure
Agree
Strongly Agree
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
Commitment
I am more committed to meeting patients’ needs in my clinical
area.
Strongly Disagree
Disagree
Unsure
Agree
Strongly Agree
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
Courage
• ‘By preventing complacency through ongoing
learning’ (p08)
• ‘Made me aware and to assess situations differently’
(p15)
The acid test!
I would recommend VITAL to other HCA’s.
3.2%
Yes
96.8%
No
A way forward?
• We need to provide clarity on what skills,
competencies & attitudes we want out HCSW or
HCAs to have to work in acute medical areas
• We need to set out minimum training standards
• We need to work with our educational providers
to achieve, these with continuity & quality
assured.
• National guidance will come along soon enough
– but we have to set our stall in acute medicine.
Thank you for listening
[email protected]