Abstract

BackgroundIn most developed countries, Health Care Assistants comprise a significant, and growing, proportion of the residential aged care workforce. Despite the fact that they provide the majority of direct care for residents, little is known about a key care aspect of their work, namely their experience of caring for dying residents.MethodsTwenty-six Health Care Assistants working in aged residential care facilities in Auckland, New Zealand participated in six focus group discussions. Focus groups were designed to explore the experiences of Health Care Assistants caring for imminently dying residents in aged care facilities and to identify barriers and facilitators to their work in this area. The focus groups were digitally recorded, transcribed verbatim and analysed using a general inductive approach.ResultsParticipants confirmed that Health Care Assistants provide the majority of hands on care to dying residents and believed they had a valuable role to play at this time due to their unique ‘familial’ relationship with residents and families. However, it was apparent that a number of barriers existed to them maximising their contribution to supporting dying residents, most notably the lack of value placed on their knowledge and experience by other members of the multidisciplinary team. Whilst a need for additional palliative and end of life care education was identified, a preference was identified for hands on education delivered by peers, rather than the didactic education they currently receive.ConclusionGiven ageing populations internationally coupled with a constrained health budget, the role of Health Care Assistants in most developed countries is likely to become even more significant in the short to medium term. This study makes a unique contribution to the international literature by identifying the barriers to caring for dying residents experienced by this valuable sector of the aged care workforce. These data have the potential to inform new, innovative, interventions to address the urgent need identified to improve palliative and end of life care management in aged care internationally.

Highlights

  • In most developed countries, Health Care Assistants comprise a significant, and growing, proportion of the residential aged care workforce

  • Such increased reliance on Health Care Assistants (HCAs) has been associated with chronic staff shortages and the need for cost-effectiveness [6, 14] Within New Zealand, HCAs are defined by the New Zealand Nurses Organisation as ‘an employee who is an auxiliary to the nursing team and is able to perform tasks in their position description relating to patient care and who works under direction of a registered nurse or midwife’ [15]

  • While it is known that HCAs are involved in the majority of direct care to residents [14] and have a critical role to play in the provision of chronic and end of life care [20], little research either within New Zealand or internationally has focused upon their experiences in caring for dying residents [21, 22]

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Summary

Introduction

Health Care Assistants comprise a significant, and growing, proportion of the residential aged care workforce. While research has identified a variety of barriers to optimum end of life care, such as a lack of palliative care competencies [9], an enduring focus on rehabilitation [10], and lack of time available for dying residents [11], the role that Health Care Assistants (HCAs) play in the provision of palliative care has been scarcely considered This is concerning for in line with many other developed countries, including the UK, US and Australia, ARC facilities in New Zealand are predominantly staffed by HCAs, who currently comprise 53 % of the workforce [12, 13] in contrast to Registered Nurses who make up 10 % of ARC staff. While it is known that HCAs are involved in the majority of direct care to residents [14] and have a critical role to play in the provision of chronic and end of life care [20], little research either within New Zealand or internationally has focused upon their experiences in caring for dying residents [21, 22]

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