[A version of this abstract appears in: Dementia: the Latest Evidence Newsletter (RWHT) Volume 1 Issue 8 March 2011].
An in-depth observational study of healthcare assistants (HCAs) in dementia wards has been commissioned to identify any workforce issues. This research is part of the Prevention of Abuse and Neglect in the Institutional Care of Older Adults (PANICOA) initiative. This major study, costing £¼Million, investigates the experiences of the staff who work directly with older people with dementia, with a view to improving front-line dementia care. It explores:
- What motivates these staff?
- What are the obstacles to good care?
- What is stressful and how do HCAs cope?
- What promotes staff well-being?
The study finds that HCAs typically work with compassion and find their caring roles to be very satisfying. HCAs often assume responsibility for the general emotional, social and environmental atmosphere on the ward.
HCAs do often consider their workplace to be understaffed, according to this research, and in some settings come to feel that they are largely ignored and undervalued by members of the multi-disciplinary team (except by fellow direct-care staff). They often cope with these issues by forming a close-knit team and supporting each other both
on and off the ward.
This report suggests that employers would do well to think beyond patient-centred care (important as this is), and bear in mind other perspectives and social dynamics on the ward, encompassing those between staff members, between staff and relatives and the all-important patient-focused behaviour at the “sharp end”. Relationship-centred care is proposed as a better description of this caring process at its best. The network of relationships on the ward is vital to dementia care. Staff need to be allowed to relate to each other and to communicate well with patients’ families if they are to work effectively.
Notably, the report finds that HCAs are skilled workers who make a distinctive contribution to the care experienced by patients with dementia. Their capabilities directly affect the quality of this care. This conclusion has clear implications for acute hospital provision. This report suggests it is high time to re-evaluate the contribution of HCAs in hospital dementia settings as quasi-professional practice in its own right, having a key role in the delivery of care to people with dementia.
The report finishes with questions for consideration and the implications of this research for the NHS. The nine most important considerations identified regarding the HCA workforce are staffing levels, training, professional support, team working, the importance of due recognition, roles (bearing in mind that HCAs often get to know the patients in dementia wards better than any other professional group), rewards, knowledge transfer (including the systems of communication on the ward) and their involvement in communication about change.
Schneider, J. (2010). Challenging care: the role and experience of Health Care Assistants in dementia wards. Report for the National Institute for Health Research (NIHR) Service Delivery and Organisation Programme. London: National Institute for Health Research: September 2010. (SDO Project 08/1819/222). There are numerous related supporting documents.
Schneider, J. (2010). Research: support workers play vital role in dementia care. British Journal of Healthcare Assistants, October 2010, Vol.4(10), pp.498 – 501.