Cross-boundary working: a generic worker for older people in the community

How lack of physiotherapist out-of-hours led to nurses developing their role: A UK case study

The aim of this article is to share the experience of how a multi-disciplinary team worked together to develop the nursing role to incorporate the practitioners supporting mobilisation of a patient. The role developed nurses' competence, ensuring that the information and instruction patients received were consistent between therapists and nursing staff, but also supported the Enhanced Recovery Programme (2010). There were issues with the level of therapy support, especially out of hours. The team agreed a vision together, with a solution to the problem on how the mobilisation of patients post-surgery could be achieved. This would ensure postoperative complications were reduced and that there was continuity in education for the patients. This experience is an example of how staff can be empowered to provide patients with a positive experience through challenging practices and behaviours and resulting in innovative practice and role development.

Mechanisms to enhance the effectiveness of allied health and social care assistants in community-based rehabilitation services: a qualitative study

This research aims to describe the factors associated with successful employment of allied health and social care assistants in community-based rehabilitation services (CBRS) in England. The research involved the thematic analysis of interviews and focus groups with 153 professionally qualified and assistant staff from 11 older people's interdisciplinary community rehabilitation teams. Data were collected between November 2006 and December 2008. Assistants were perceived as a focal point for care delivery and conduits for enabling a service to achieve goals within interdisciplinary team structures. Nine mechanisms were identified that promoted the successful employment of assistants: (i) Multidisciplinary team input into assistant training and support; (ii) Ensuring the timely assessment of clients by qualified staff; (iii) Establishing clear communication structures between qualified and assistant staff; (iv) Co-location of teams to promote communication and skill sharing; (v) Removing barriers that prevent staff working to their full scope of practice; (vi) Facilitating role flexibility of assistants, while upholding the principles of reablement; (vii) Allowing sufficient time for client-staff interaction; (viii) Ensuring an appropriate ratio of assistant to qualified staff to enable sufficient training and supervision of assistants; and (ix) Appropriately, resourcing the role for training and reimbursement to reflect responsibility. We conclude that upholding these mechanisms may help to optimise the efficiency and productivity of assistant and professionally qualified staff in CBRS.

Supporting evidence-based service delivery and organisation: a comparison of an emergent realistic appraisal technique with a standard qualitative critical appraisal tool

A major component of current policies aimed at promoting the delivery of an effective health service is to ensure that practitioners base their practice on research findings. Considerable attention has been focussed on the research community and developing appropriate methods and tools to support these objectives at the national and international level. The appraisal needs of individual practitioners, who might wish to inform local service delivery and organisation and who are often not methodological experts, has been hitherto ignored. This paper reports on the application and testing of a technique for the appraisal of evaluation studies, which is being developed for use by practitioners to inform local service delivery. This technique has previously been applied to a quantitative evaluation. In this paper we report on its application to the appraisal of a qualitative paper. Our aim is to compare it with a standard tool to establish which generates more meaningful information for use by practitioners for the purposes of informing service delivery and organisation. The emergent technique successfully extracted relevant methodological and contextual information, with developmental issues being identified.

Assessing the implementation process and outcomes of newly introduced assistant roles: a qualitative study to examine the utility of the Calderdale Framework as an appraisal tool

Internationally, the health workforce has undergone rapid transformation to help meet growing staffing demands and population requirements. Several tools have been developed to support workforce change processes. The Calderdale Framework (CF) is one such tool designed to facilitate competency-based training by engaging team members in a seven step process involving awareness raising, service and task analysis, competency identification, establishing support systems, training, and sustaining. This paper explores the utility of the CF as an appraisal tool to assess whether adherence to the tool influences outcomes. The CF was applied retrospectively to three complete evaluations of allied health assistant role introduction: a new podiatry assistant role (Australia), speech pathology assistant (Australia), and occupational therapy assistant practitioner role (UK). Adherence to the CF was associated with more effective and efficient use of the role, role flexibility and career development opportunities for assistants, and role sustainability. Services are less likely to succeed in their workforce change process if they fail to plan for and use a structured approach to change, assign targeted leadership, undertake staff engagement and consultation, and perform an initial service analysis. The CF provides a clear template for appraising the implementation of new roles and highlights the potential consequences of not adhering to particular steps in the implementation process.

Defining and identifying common elements of and contextual influences on the roles of support workers in health and social care: a thematic analysis of the literature

RATIONALE, AIMS AND OBJECTIVES

Support workers are the largest single group of staff involved in the delivery of health and social care in the UK; however, their roles are heterogeneous and are influenced by several contextual factors. The aim of this study was to elucidate the contribution of the elements and context of work undertaken by support workers in health and social care.

METHODS

Thematic review of the literature 2005/2006, updated in 2008.

RESULTS

A total of 134 papers were included in the review, from which we identified four domains of work and four core roles of support workers. The four domains of support worker work are direct care, indirect care, administration and facilitation. The four 'core' attributes of support worker roles were being a helper/enabler, a companion, a facilitator and a monitor. The more 'technical' components of support worker roles are then shaped by contextual factors such as staffing levels and the delegation processes.

CONCLUSION

Despite the heterogeneity of support worker roles, there are some uniting 'generic' features, which may form some or all of the role of these practitioners. Contextual factors influence the specific technical aspects of the support role, accounting in part for their heterogeneous role.

Support workers in social care in England: a scoping study

This paper reports the findings of a scoping study designed to describe the evidence base with regard to support workers in social care in the United Kingdom and to identify gaps in knowledge. Multiple bibliographic databases were searched for studies published since 2003. The results revealed that the support worker role, though not well-defined, could be characterised as one aimed at fostering independence among service users, undertaking tasks across social and health-care, and not being trained in, or a member of, a specific profession. The studies identified were predominantly small-scale qualitative projects which considered issues such as role clarity, training and pay, worker satisfaction, service user views and the amount of time support workers are able to spend with service users compared to other staff. The review concluded that the research base lacks longitudinal studies, there is definitional confusion and imprecision, and there is limited evidence about employment terms and conditions for support workers or about their accountability and performance. The desirability and value of training and how it is resourced need further analysis. It is concluded that moves to self-directed support or personalisation and the increased reliance on and use of support workers, in the form of personal assistants, call for closer scrutiny of the role.

Crossing professional and organizational boundaries: The implementation of generic Rehabilitation Assistants within three organizations in the northwest of England

PURPOSE

New generic support worker roles are being developed within rehabilitation and intermediate care services throughout the UK, as a consequence of staff shortages and the policy drive to look at new ways of working to meet the needs of older people. This paper describes a joint project between a Primary Care Trust, an Acute Trust and Social Services in one region in the northwest of England. It aims to describe the process of introducing new roles within rehabilitation and evaluates the acceptability and integration within different settings.

METHODS

Thirty support worker staff from an Acute Trust, Primary Care Trust and Social Services were trained over a period of 18 months to become generic Rehabilitation Assistants (RAs). A total of 55 semi-structured interviews of patients, associated professionals and RAs were conducted to examine the acceptability and integration of the new role. The interviews were tape-recorded, concurrently transcribed, inductively analysed and categorized into themes.

RESULTS

Several factors appeared to influence the acceptance and integration of the new role, namely: Prior experience and the degree of role change, familiarity and inter-staff relationships, role distinction and contribution and resources and management. Despite many challenges, patients, professionals and the RAs reported huge appreciation of the new role.

CONCLUSIONS

The evaluation demonstrates how an innovative, inter-organizational approach can deliver new solutions to address workforce issues. Further research is recommended nationally, to track the development and evaluate the effectiveness of similar roles.

New roles in rehabilitation--the implications for nurses and other professionals

RATIONALE, AIMS AND OBJECTIVES

The development of rehabilitation and intermediate care services, and roles therein, is part of current UK health policy to meet the demands of the ever-growing older population. One new role is the rehabilitation assistant (RA). This is a generic support worker trained at a basic level in nursing, physiotherapy, occupational therapy and social work who works under the supervision of the referring professionals, to deliver integrated rehabilitation programmes. RAs were introduced in one region in the north-west of England to increase the rehabilitation activity for patients. An empirical qualitative study was recently undertaken to evaluate the impact of the RAs from the perspectives of patients and associated nurses, therapists, managers and the RAs.

METHODS

Fifty-five semi-structured interviews were used to collect data, which was then inductively analysed into categories and then themes. The categories included variations in role, benefits of role, acceptance and integration of role, difficulties with role, training and retention. This paper focuses on the benefits and difficulties of the role.

RESULTS

It was found that patients, professionals and the RAs expressed great satisfaction with the new role. However, barriers to effective rehabilitation were reported owing to ward routines and organizational systems that interrupted and caused inconsistencies with the rehabilitation care programmes for patients.

CONCLUSIONS

If it is agreed that the majority of patients (unless end stage terminally ill, unwilling or unable) could benefit from some degree of rehabilitation, then there is an issue around how such skills could be widely implemented. This paper discusses the barriers to effective rehabilitation, the benefits and drawbacks of looking at new ways of working and the need for a unified approach by all care workers in rehabilitative care.