Volunteers as members of the stroke rehabilitation team: a qualitative case study

OBJECTIVES

Clinicians are facing increasing demands on their time, exacerbated by fiscal constraints and increasing patient complexity. Volunteers are an essential part of the many healthcare systems, and are one resource to support improved patient experience and a mechanism through which to address unmet needs. Hospitals rely on volunteers for a variety of tasks and services, but there are varying perceptions about volunteers' place within the healthcare team. This study aimed to understand the role of volunteers in stroke rehabilitation, as well as the barriers to volunteer engagement.

DESIGN

A qualitative case study was conducted to understand the engagement of volunteers in stroke rehabilitation services within a complex rehabilitation and continuing care hospital in Ontario, Canada.

PARTICIPANTS

28 clinicians, 10 hospital administrators and 22 volunteers participated in concurrent focus groups and interviews. Organisational documents pertaining to volunteer management were retrieved and analysed.

RESULTS

While there was support for volunteer engagement, with a wide range of potential activities for volunteers, several barriers to volunteer engagement were identified. These barriers relate to paid workforce/unionisation, patient safety and confidentiality, volunteer attendance and lack of collaboration between clinical and volunteer resource departments.

CONCLUSIONS

An interprofessional approach, specifically emphasising and addressing issues related to key role clarity, may mediate these barriers. Clarity regarding the role of volunteers in hospital settings could support workforce planning and administration.

Can trained volunteers improve the mealtime care of older hospital patients? An implementation study in one English hospital

OBJECTIVE

Multinational studies report undernutrition among 39% older inpatients; importantly, malnutrition risk may further increase while in hospital. Contributory factors include insufficient mealtime assistance from time-pressured hospital staff. A pilot study showed trained volunteers could safely improve mealtime care. This study evaluates the wider implementation of a mealtime assistance programme.

DESIGN

Mixed methods prospective quasi-experimental study.

SETTING

Nine wards across Medicine for Older People (MOP), Acute Medical Unit, Orthopaedics and Adult Medicine departments in one English hospital.

PARTICIPANTS

Patients, volunteers, ward staff.

INTERVENTION

Volunteers trained to help patients aged ≥70 years at weekday lunchtime and evening meals.

MAIN OUTCOME MEASURES

The number of volunteers recruited, trained and their activity was recorded. Barriers and enablers to the intervention were explored through interviews and focus groups with patients, ward staff and volunteers. The total cost of the programme was evaluated.

RESULTS

65 volunteers (52 female) helped at 846 meals (median eight/volunteer, range 2-109). The mix of ages (17-77 years) and employment status enabled lunch and evening mealtimes to be covered. Feeding patients was the most common activity volunteers performed, comprising 56% of volunteer interactions on MOP and 34%-35% in other departments. Patients and nurses universally valued the volunteers, who were skilled at encouraging reluctant eaters. Training was seen as essential by volunteers, patients and staff. The volunteers released potential costs of clinical time equivalent to a saving of £27.04/patient/day of healthcare assistant time or £45.04 of newly qualified nurse time above their training costs during the study.

CONCLUSIONS

Patients in all departments had a high level of need for mealtime assistance. Trained volunteers were highly valued by patients and staff. The programme was cost-saving releasing valuable nursing time.

TRIAL REGISTRATION NUMBER

NCT02229019; Pre-results.

Introducing on-ward volunteers to work with patients with dementia

This article reports on an evaluation of the effect of an on-ward volunteer service in an acute orthopaedic ward with a number of dementia patients. A mixed-methods evaluation was undertaken in 2012. This included interviews with individuals who have strategic, management, operational and clinical roles in the voluntary organisation and the NHS trust, focus group discussions with volunteers, non-participant observations of practice and focused conversations with ward staff. The service had a positive effect on patient experience. Patients were engaged through a variety of activities and enjoyed the volunteers' presence. Staff valued the initiative because they could see the difference that it made to patients and their own working lives. The lessons learned from the evaluation can inform the development of similar initiatives elsewhere and are relevant, given the emphasis in healthcare policy to improve patient experience.

The fundamentals of integrating service in a post-licensure RN to BSN program

Integrating service in a post-licensure registered nurse to bachelor of science in nursing (RN to BSN) program provides licensed registered nurse (RN) students the opportunity to learn, develop, and experience different cultures while serving the community and populations in need (McKinnon & Fitzpatrick, 2012). Service to the community, integrated with academic learning can be applied in a wide variety of settings, including schools, universities, and community faith-based organizations. Academic service-learning (ASL) can involve a group of students, a classroom, or an entire school. In the RN to BSN program, the authors use a student-directed service learning approach that integrates service-learning throughout the curriculum. RN students are introduced to service-learning at program orientation prior to the start of classes and receive reinforcement and active engagement throughout the curriculum. The students and volunteer agencies receive and give benefits from the services provided and the life lessons gained through mentorship, education, and hands-on experiences.

The Canterbury Charity Hospital: an update (2010-2012) and effects of the earthquakes

AIM

To update activities of the Canterbury Charity Hospital (CCH) and its Trust over the 3 years 2010-2012, during which the devastating Christchurch earthquakes occurred.

METHODS

Patients' treatments, establishment of new services, expansion of the CCH, staffing and finances were reviewed.

RESULTS

Previously established services including general surgery continued as before, some services such as ophthalmology declined, and new services were established including colonoscopy, dentistry and some gynaecological procedures; counselling was provided following the earthquakes. Teaching and research endeavours increased. An adjacent property was purchased and renovated to accommodate the expansion. The Trust became financially self-sustaining in 2010; annual running costs of $340,000/year were maintained but were anticipated to increase soon. Of the money generously donated by the community to the Trust, 82% went directly to patient care. Although not formally recorded, hundreds of appointment request were rejected because of service unavailability or unmet referral criteria.

CONCLUSIONS

This 3-year review highlights substantial, undocumented unmet healthcare needs in the region, which were exacerbated by the 2010/2011 earthquakes. We contend that the level of unmet healthcare in Canterbury and throughout the country should be regularly documented to inform planning of public healthcare services.

Patients "falling through the cracks". The Canterbury Charity Hospital: initial progress report

AIM

To present the early experience of establishing a community-funded and volunteer-staffed hospital in Christchurch, New Zealand. This was to provide free selected elective healthcare services to patients in the Canterbury region who were otherwise unable to access treatment in the public health system or afford private healthcare.

METHODS

Data were reviewed relating to the establishment, financing, staffing and running of the Canterbury Charity Hospital. Details were provided of patients referred by their general practitioners who were seen and treated during the first two and a half years of function.

RESULTS

Canterbury Charity Hospital Trust, established in 2004, completed the purchase of a residential villa in 2005 and converted it into the Canterbury Charity Hospital, which performed its first operations in 2007. By the end of December 2009, 115 volunteer health professionals and 79 non-medical volunteers had worked at the Hospital, provided a total of 966 outpatient clinic appointments, of which 609 were initial assessments, and performed 610 surgical procedures. Funding of $NZ4.3 million (end of last financial year) came from fundraising events, donations, grants and interest from investments. There has been no government funding.

CONCLUSIONS

There is a substantial unmet need for elective healthcare in Canterbury, and this has, in part, been addressed by the recently established Canterbury Charity Hospital. The overwhelming community response we have experienced in Canterbury raises the question of whether the current public health system needs attention to be re-focused on unmet need. We contend that unless this occurs it might be necessary to establish charity-type hospitals elsewhere throughout the country.

VolunteerGet--a novel information system for engaging society in volunteering for emergency care

This work presents VolunteerGet, a novel information system for engaging society in volunteering for emergency situations. We will use the social networking and location services infrastructure as a means of 1) registering volunteers and other users, 2) spreading the word on volunteering opportunities and increasing the volunteer database, 3) matching the users and volunteers at time and location of need. Such a system has the potential to promote volunteering as a social phenomenon and eventually reduce suffering and mortality.

The many roles of families in family-centered care--part V. Interview by Deborah Dokken

This article, the fifth of six in a series on roles for family members in family-centered care, focuses on the role of parents as educators of clinicians in the health care system. Two interviews highlight this role. The director of family services at a pediatric hospital, a parent of a child who suffered with a chronic illness, offers suggestions for institutions wanting to further develop this key role. This includes involving patient and family advisors at the "front end" of any initiative or new project; identifying champions (clinical staff, administrators, and patients/family members) for these roles within the institution; preparing family members for the educator role; following-up with thanks and feedback; and tracking successes of projects in which patient and family advisors participate. The father interviewed in this article describes the sense of fulfillment he experiences from teaching health care providers about child and family needs and the emotional side of care. He urges all parents to recognize the important education they can offer professionals when they both ask questions and share about their own child and family.

Inspiring start. Interview by Carol Davis

This is the Year of the Volunteer and in one hospital many volunteers go on to become nurses, thanks to the help and support they get from Terry Owen and her volunteering programme.

What do you pay your volunteers? The benefits and bases of a hospital volunteer program

All volunteers need something in return for their services, whether it's recognition, experience, or personal satisfaction. Successful volunteer programs identify and meet these expectations. Although this requires the same kind of commitment and energy administrators give their paid staff, the results--bottom-line and otherwise--are well worth the effort.

Don't volunteer for trouble

Gone are the days when volunteer activity was limited to delivering flowers and mail to inpatient rooms. Today's volunteers extend the capacity of health care organizations to provide compassionate and caring service by staffing immunization programs, conducting health screening activities and more. With increased reliance on volunteers and increased responsibility placed on volunteers, it is important that they are protected from any personal liability that may be incurred while working on behalf of your organization. It is equally important that the organization is protected from liability incurred by the acts or omissions of its volunteers.

Special report. The Oklahoma City bombing: mass casualties and the local hospital response

A morning blast at the Alfred P. Murrah Federal Building, Oklahoma City, OK, on April 19, 1995, killed 168 persons and injured more than 500 in the worst terrorist attack in U.S. history. Hospital workers, physicians, and volunteers at nine hospitals there mobilized, put their disaster emergency plans into operation, and treated 466 persons in emergency rooms--many of them later being admitted as patients. To complicate matters, two of the hospitals received bomb threats called in after the disaster. This report will look at the security plans put into force by each of the nine hospitals; the handling of the great influx of persons, including victims, relatives, friends, concerned persons, volunteers, and the news media; and the lessons hospital officials learned from their experiences.

Volunteer low-risk outpatient surgery for uninsured patients in San Francisco. The Ambulatory Surgery Access Coalition

OBJECTIVE

To provide uncompensated elective low-risk outpatient surgery for uninsured patients through a coalition of volunteer physicians, nurses, and hospitals.

DESIGN

Description of the process of establishing the Ambulatory Surgery Access Coalition (ASAC), the political and administrative obstacles encountered, and the clinical results of treatment of the first 25 patients in the pilot project.

SETTING

The ASAC includes the Kaiser Foundation Hospital, San Francisco, Calif, the University of California, San Francisco, the San Francisco General Hospital (SFGH), the San Francisco Department of Public Health, the San Francisco Consortium of Community Clinics, the Northern California Chapter of the American College of Surgeons, and the San Francisco Medical Society. A pilot program of uncompensated outpatient surgery was performed at the Kaiser Foundation Hospital.

PATIENTS

Twenty-nine patients were referred to the ASAC between January 1 and November 1, 1994. Twenty-six patients were judged to be candidates for surgery, and 25 patients met the criteria for the ASAC program. One patient was referred to SFGH for treatment because of a perceived increased risk for hospitalization after surgery.

RESULTS

Twenty-one patients underwent herniorrhaphy; three, excision of large inclusion cysts; and one, anal fistulotomy. Seventeen procedures were done under local anesthesia, seven under general anesthesia, and one under spinal anesthesia. None of the patients required hospital admission. No wound infections occurred.

CONCLUSION

The ASAC successfully provided uncompensated low-risk outpatient surgery to 25 low-income uninsured patients in San Francisco. The coalition hopes, first, to include other San Francisco hospitals and surgical specialties, and second, to serve as a model for other communities throughout the country.