Role Of Healthcare Assistant Research Articles

Specialist healthcare assistant role allows best use of nurses' time

Specialist healthcare assistant role allows best use of nurses' time

Health promotion in family practice—a qualitative study on the role of health care assistants

Zusammenfassung Hintergrund Die Hausarztpraxis ist ein wichtiger Ort für Gesundheitsförderung und Prävention in Deutschland. Es besteht jedoch eine Forschungslücke bezüglich der Einbindung nichtärztlichen Praxispersonals in Aktivitäten der Gesundheitsförderung. Unser Ziel war es daher, einen vertiefenden Einblick zu gewinnen, welche Rolle Medizinische Fachangestellte (MFA) hinsichtlich Gesundheitsförderung in der Hausarztpraxis einnehmen. Methoden Wir führten 21 telefonische qualitative Leitfadeninterviews mit 14 Hausärzt:innen und sieben MFA und fragten beide Gruppen nach der Rolle der MFA in Bezug auf Gesundheitsförderung in der Hausarztpraxis. Die Interviews wurden nach thematischer Analyse gruppenspezifisch ausgewertet. Ergebnisse Neben organisatorischen Aufgaben wie der Terminvereinbarung übernehmen MFA vor allem als erste Kontaktperson eine Schlüsselfunktion hinsichtlich Gesundheitsförderung: Sie erkennen Bedarfe, kommunizieren Auffälligkeiten an Hausärzt:innen, filtern anspruchsberechtigte Patient:innen bereits am Empfang heraus und sprechen sie aktiv auf Vorsorgeleistungen an. In einigen Praxen führen MFA selbst gesundheitsfördernde Maßnahmen wie Schulungen durch. In Bezug auf weitere Aufgabenübertragung äußerten jedoch insbesondere Hausärzt:innen Hemmnisse, da sie die MFA nicht überlasten wollten. Schlussfolgerungen MFA übernehmen hinsichtlich Gesundheitsförderung in der Hausarztpraxis häufig organisatorische Tätigkeiten, können aber aufgrund ihrer Funktion in der Praxisstruktur die Hausarztpraxis auch als gesundheitsförderndes Setting für Patient:innen mitprägen. Insbesondere navigieren MFA die Patient:innen hinsichtlich präventiver und gesundheitsfördernder Angebote. Entsprechend ihrer Schlüsselfunktion als Erstkontakt sollte mit MFA gemeinsam erarbeitet werden, wie Gesundheitsförderung bereits am Empfang strukturiert adressiert werden kann.

The role of the healthcare assistant on a stroke unit: A scoping review

Objective This scoping review explores the role of a healthcare assistant on a stroke unit, potential barriers to role fulfilment and whether stroke-specific training could enhance rehabilitative practice. Data sources Searches were conducted on CINAHL, MEDLINE and APA PsycInfo in May 2021 and repeated in September 2022. Methods This scoping review was guided by Arksey and O’Malley's framework. Article selection and data extraction were conducted by one researcher using a structured proforma. A narrative approach to data synthesis was undertaken following the research questions. Results From a combined total of 533 articles, sixty-six full-text articles were assessed for eligibility. Sixteen full articles were included in this review. A healthcare assistants’ role was viewed as caring directly for patients – some individuals felt they contributed to rehabilitation during these tasks, and that they could be undervalued by multidisciplinary team members, patients and their families. The barriers identified to healthcare assistants’ role fulfilment were lack of time, training and staffing shortages. Training was perceived to improve healthcare assistants’ communication, confidence and knowledge but training needed to be flexible, ward based and accommodate staffing shortages. However, it is unclear whether training has any clinical benefit for patients. Conclusion Healthcare assistants are well placed to enhance rehabilitative practice with patients; however, there are clear perceived barriers to this occurring. Future research should aim to define the role of healthcare assistants and explore whether further stroke-specific training could cause clinical benefits for patients.

The vital role of healthcare assistants in pressure ulcer prevention: learning from research in practice

This article reports on the impact of an educational intervention to raise awareness of the prevention of pressure ulceration as an integral part of the PROACT project. This initiative took place in the north east of England in residential and non-residential care homes from May 2017 to March 2020, with a training programme on the need to raise awareness of the prevention of pressure ulceration delivered between January 2018 and September 2019. In total, 571 participants took part in the project. Of these, 493 (86%) were health and social care staff, including healthcare assistants, and the other 78 (14%) were informal carers. While many participants reported an increased level of confidence following the training programme, many could not bridge the theory–practice gap in terms of being able to articulate how they would prevent the development of pressure ulcers in practice. The study highlights the need for healthcare assistants to refer patients living with the earliest stages of pressure ulceration to other members of the healthcare team. Daily monitoring should include training about the key risk factors of ulceration, such as capacity for movement and being able to walk around, basic skin examinations and the continence status of patients. Training in the importance of monitoring and reporting weight loss, alongside adequate hydration, is also needed.

255 A QUALITATIVE STUDY OF OLDER ADULTS’ EXPERIENCES OF EMBEDDING PHYSICAL ACTIVITY WITHIN THEIR HOME CARE SERVICES

Abstract Background Physical activity programmes have been shown to improve older adults’ functional capacity, independence and quality of life. Research around structured exercise programmes has been completed in different groups of community-dwelling older people, however few studies have focused on the older population receiving formal home care. In a feasibility study, we embedded physical activity within older adults existing home care services through the ‘Care to Move’ (CTM) programme. The aim of this qualitative study is to explore older adults’ experiences of the CTM programme. Methods We conducted semi-structured telephone interviews with 13 older adults and one carer. Topics covered included participants overall experiences of the CTM programme, changes to their overall activity and participation, aspects of the programme that they liked or found valuable and issues that they found challenging. Interview transcripts were coded and analysed thematically to capture barriers and facilitators to programme delivery. Results Four themes emerged: i) ‘I’m feeling good about it’, ii) ‘safety and security is the name of the game’, iii) ‘we’re a team as it stands’, iv) ‘it’s [COVID] depressing for everybody at the moment’. Older adults identified benefits of CTM participation including improvements in physical and psychological wellbeing. However, frailty and multimorbidity influenced overall engagement. Participants expressed concerns around the logistics of programme delivery and competing healthcare assistant (HCA) interests. The broader role of HCA’s in supporting the CTM programme was highlighted as well as the emotional support that HCAs provided to older adults. HCA continuity was identified as a barrier to ongoing programme engagement. The impact of COVID on older adults physical and mental health negatively impacted programme delivery. Conclusion Our findings suggest that embedding the CTM programme within home support services is feasible. Restructuring of services, addressing HCA continuity, and adopting individual approaches to programme delivery may enhance the implementation of services.

A review of the clinical assistant workforce at a district general hospital during the COVID-19 pandemic

In April 2020, a new workforce of clinical assistants (CAs), comprising predominantly of medical students, began work at Northampton General Hospital. Clinical-years students had a role similar to final-year student assistants; pre-clinical students were offered a healthcare assistant role. This research aimed to evaluate both CAs' and clinicians' perceptions of this programme. Separate questionnaires were developed for CAs and clinicians, assessing the scheme's successes and failures. Data analysis was carried out using MS Excel and SPSS. Forty-nine CAs and 60 clinicians responded. CAs of all years were completing the higher-level role. They were perceived to improve continuity of care (74% CA agreement; 88% clinician agreement), reduce clinician workload (90% clinician agreement) and felt significantly more confident with practical and administrative tasks. Sixty-eight per cent of CAs and 72% of clinicians believed the role should be available to students before their final year.

“From doing to knowing”: medical students’ experiences of working as Healthcare Assistants

ABSTRACT There is growing recognition that doctors need to deliver person-centered care. More evidence is needed on how to best equip students in an already busy curriculum. Providing medical students with the opportunity to work as Healthcare Assistants (HCAs) can help them develop the desired skills. This study examined medical students’ experiences of working as HCAs and perceived impact on their future practice. Adopting an Interpretative Phenomenological Analysis approach, we analyzed narratives from two focus groups of 13 ‘Year 0ʹ and ‘Year 1ʹ medical students, who had completed an HCA project. This project allowed participants to experience a new dimension of patient care whereby learning by “doing” evolved to a deeper level of “knowing” patients, the HCA role and the wider team. Four major themes were identified: seeing the doctor: gaining new perspectives; building confidence: learning from and about patients; understanding the overall patient experience: providing personal care; finding “the person behind the patient”: exploring beyond the diagnosis. This study suggests that working as an HCA enables participants to develop sustainable skills that equip them for their future role as doctors able to deliver person-centered care as part of an interprofessional team. Recommendations for inclusion of this type of intervention into the medical curriculum are discussed.

Qualitative exploration of medical student experiences during the Covid-19 pandemic: implications for medical education

BackgroundDuring the Covid-19 pandemic medical students were offered paid roles as medical student healthcare assistants. Anecdotal reports suggested that students found this experience rich for learning. Previous studies have explored alternative models of student service, however this defined medical student support role is novel.MethodsIndividual semi-structured interviews were recorded with 20 medical students at a UK medical school exploring their experiences of placement learning and experiences of working as healthcare assistants. Responses were analysed qualitatively using a framework approach. The framework was developed into a model describing key findings and their relationships.ResultsInterviews yielded data that broadly covered aspects of (1) Medical students’ experiences of clinical placement learning (2) Medical students’ experiences of working as medical student healthcare assistants (3) Learning resulting from working as a healthcare assistant (4) Hierarchies and professional barriers in the clinical environment (5) Influences on professional identity.Participants described barriers and facilitators of clinical learning and how assuming a healthcare assistant role impacted on learning and socialisation within the multidisciplinary team. Students became increasingly socialised within the healthcare team, contributing directly to patient care; the resulting social capital opened new opportunities for learning, team working and enhanced students’ interprofessional identity. Students described the impact of these experiences on their aspirations for their future practice.ConclusionsChanges to work patterns in healthcare and delivery models of medical education have eroded opportunities for students to contribute to healthcare delivery and be embedded within a team. This is impacting negatively on student learning and socialisation and we suggest that medical curricula have much to learn from nursing and allied health professional training. Longitudinal embedment with a multidisciplinary team, where students have a defined role and work directly with patients may not only add value to clinical service, but also overcome current barriers to effective placement learning and interprofessional identity formation for medical students.

Protocol for a mixed methods exploratory investigation into the role and contribution of the healthcare assistant in out-of-hours palliative care

BackgroundMost people spend their last year of life at home, with many wishing to die there, but patients may need access to care after hours. Out-of-hours palliative care is delivered by multi-disciplinary teams including Health Care Assistants (HCA). However, little is known about the role, contribution and impact Health Care Assistants have on out-of-hours palliative care services. The aim of this study is to examine the Health Care Assistant role, contribution and impact on service delivery and patient care in out-of-hours community palliative care provided by hospice organisations.Methods and analysisA mixed methods exploratory study consisting of four phases. Phase one involves a scoping review to systematically map and identify gaps in policy and literature on the HCA role in out-of-hours palliative care. In phase two, all United Kingdom hospices will be invited to participate in an online census to enable the development of a typology of out-of-hours services and the contribution of the Health Care Assistant. During phase three organisational case studies representing different service types will collect information from Health Care Assistants, patients, caregivers and service managers to gather qualitative and quantitative data about out-of-hours service provision and the Health Care Assistant role. Finally, phase four will synthesize and refine results through online focus groups.Ethics and disseminationEthical approval has been obtained for phase two through Ulster University Research Governance Filter Committee, Nursing and Health Research. Findings will be disseminated through practitioner and/or research journals, conferences, and social media.

Expanding the Concept of End-of-life Care in Long-term Care: A Scoping Review Exploring the Role of Healthcare Assistants.

The context of care provided in long-term care homes is changing, as an increasing number of older adults are entering long-term care with advance stages of illness and higher care needs. Long-term care homes are quickly becoming the place of death for an increasing number of older adults, despite recent literature identifying inadequate and suboptimal levels of end-of-life care. Within long-term care, healthcare assistants represent 60%-70% of the unregulated workforce and provide 70%-90% of the direct care to residents. Research indicates that a high level of uncertainty exists surrounding the role of healthcare assistants in end-of-life care, with numerous studies reporting the role of healthcare assistants to be 'unclear' with varying levels of responsibilities and autonomy. The purpose of this scoping review was to explore healthcare assistants' experiences and perspectives of their role in end-of-life care in long-term care. We applied Arksey and O'Malley's methodological framework, with recommendations from Levac and colleagues' guiding principles. Electronic databases and the grey literature were searched for relevant articles. Search concepts included end-of-life care and healthcare assistants. Articles were included in this review if they explored healthcare assistants' experiences or perspectives of providing end-of-life care in long-term care. The peaceful end of life theory by Ruland and Moore (1998) was used to organise data extraction and analysis. A total of n=15 articles met the inclusion criteria. The most predominant role-required behaviours reported by healthcare assistants were as follows: psychosocial support to significant others, knows the resident's care wishes and physical care with respect and dignity. The most predominant extra-role behaviours reported by healthcare assistants were as follows: becoming emotionally involved, acting as extended family and ensuring residents do not die alone. Findings from this review expanded the concept of end-of-life care by illustrating the role-required and extra-role behaviours healthcare assistants perform when providing end-of-life care in long-term care. Findings from this scoping review highlight the numerous behaviours healthcare assistants perform outside their role description in order to provide end-of-life care to dying residents in long-term care. These findings could inform policymakers and managers of long-term care homes.

Informal task-sharing practices in inpatient newborn settings in a low-income setting-A task analysis approach.

AimTo describe the complexity and criticality of neonatal nursing tasks and existing task‐sharing practices to identify tasks that might be safely shared in inpatient neonatal settings.DesignWe conducted a cross‐sectional study in a large geographically dispersed sample using the STROBE guidelines.MethodsWe used a task analysis approach to describe the complexity/criticality of neonatal nursing tasks and to explore the nature of task sharing using data from structured, self‐administered questionnaires. Data was collected between 26th April and 22nd August 2017.ResultsThirty‐two facilities were surveyed between 26th April and 22nd August, 2017. Nearly half (42%, 6/14) of the “moderately critical” and “not critical” (41%, 5/11) tasks were ranked as consuming most of the nurses' time and reported as shared with mothers respectively. Most tasks were reported as shared in the public sector than in the private‐not‐for‐profit facilities. This may largely be a response to inadequate nurse staffing, as such, there may be space for considering the future role of health care assistants.

Raising awareness of autistic spectrum disorders for healthcare assistants

This article provides an insight for healthcare assistants (HCAs) who may have limited knowledge of the implications of autistic spectrum disorder (ASD) for their everyday practice working with patients and their families and carers. The role of HCAs in this context is invaluable in providing compassion, support and much–needed reassurance in the different contexts within which healthcare is delivered. This article provides a basic overview of what the common presentations of ASD are and this is framed in an understanding of why a key consideration for patients living with the condition and their families and carers is where care is provided. Via raising awareness of how adaptations to HCA practice might best be made to facilitate high–quality care, the paper simultaneously raises the need for holistic management of a very vulnerable patient caseload. The article ends by facilitating HCAs in reflecting on their level of existing knowledge of autism and how they might better apply this in practice with patients living with the everyday challenges of ASD.

Impact of the Macmillan specialist Care at Home service: a mixed methods evaluation across six sites

BackgroundThe Midhurst Macmillan Specialist Palliative Care at Home Service was founded in 2006 to improve community-based palliative care provision. Principal components include; early referral; home-based clinical interventions; close partnership working; and flexible teamwork. Following a successful introduction, the model was implemented in six further sites across England. This article reports a mixed methods evaluation of the implementation across these ‘Innovation Centres’. The evaluation aimed to assess the process and impact on staff, patients and carers of providing Macmillan Specialist Care at Home services across the six sites.MethodsThe study was set within a Realist Evaluation framework and used a longitudinal, mixed methods research design. Data collection over 15 months (2014–2016) included: Quantitative outcome measures - Palliative Performance Scale [PPS] and Palliative Prognostic Index [PPI] (n = 2711); Integrated Palliative Outcome Scales [IPOS] (n = 1157); Carers Support Needs Assessment Tool [CSNAT] (n = 241); Views of Informal Carers –Evaluation of Services [VOICES-SF] (n = 102); a custom-designed Service Data Tool [SDT] that gathered prospective data from each site (n = 88). Qualitative data methods included: focus groups with project team and staff (n = 32 groups with n = 190 participants), and, volunteers (n = 6 groups with n = 32 participants). Quantitative data were analysed using SPPS Vs. 21 and qualitative data was examined via thematic analysis.ResultsComparison of findings across the six sites revealed the impact of their unique configurations on outcomes, compounded by variations in stage and mode of implementation. PPS, PPI and IPOS data revealed disparity in early referral criteria, complicated by contrasting interpretations of palliative care. The qualitative analysis, CSNAT and VOICES-SF data confirmed the value of the Macmillan model of care but uptake of specialist home-based clinical interventions was limited. The Macmillan brand engendered patient and carer confidence, bringing added value to existing services. Significant findings included better co-ordination of palliative care through project management and a single referral point and multi-disciplinary teamwork including leadership from consultants in palliative medicine, the role of health care assistants in rapid referral, and volunteer support.ConclusionsMacmillan Specialist Care at Home increases patient choice about place of death and enhances the quality of end of life experience. Clarification of key components is advocated to aid consistency of implementation across different sites and support future evaluative work.

Healthcare assistants’ experiences on forensic mental health wards

PurposeIn forensic mental health wards, patients spend more time with healthcare assistants (HCAs) than qualified nurses. Despite this, there is no universally utilised standardised HCA training. The purpose of this paper is to assess the HCAs’ experiences in the HCA role in order to better understand how to build on the HCA role to ensure safe practice, and enhance staff well-being.Design/methodology/approachHCAs working on low and medium secure NHS forensic mental health units were recruited through purposive methods. HCAs engaged in a semi-structured interview, with questions surrounding their support needs, clinical decision making and perception of risks in the role. Template analysis was used, applying an a priori template based on the existing literature to interview transcripts.FindingsThe participants described the HCA experience to be defined by two master themes: “HCA factors” and “organisational factors”. HCAs valued a holistic patient view which prized patients’ experiences. The participants described a lack of role clarity which may be defined through ward expectations and professional experience.Originality/valueHCAs seek a holistic view of the patient; however, some overlooked patient offences in order to do their job. Future research should address how looking past offences impacts security and HCAs’ well-being long term.

Hydration: essential to life

Fluid is essential to life; however, older people admitted to hospital are vulnerable to dehydration. Dehydration can affect all aspects of health and wellbeing and can increase the risk of confusion, pressure ulcers and falls—and may require intensive medical intervention to correct. The healthcare assistant's role in enabling the older person to drink can reduce complications and promote health.

"Sometimes I've gone home feeling that my voice hasn't been heard": a focus group study exploring the views and experiences of health care assistants when caring for dying residents.

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.

Exploring the role of health care assistants as mobility activators for older people in an Assessment, Treatment, and Rehabilitation ward

IntroductionAs people live longer, the pressure on an already overstretched healthcare sector increases, and the expectation of an ever-increasing supply of registered health professionals to meet health care demands is unrealistic given workforce shortages. Finding viable alternatives to address workforce shortages is consequently becoming more of a focus for health services and the structure of nursing care delivery is changing to meet workforce demands. Contemporary care models show there is a trend towards a team approach, where the expertise of the registered nurse (RN) is employed in supervisory and delegation roles with second level clinical support from enrolled nurses and health care assistants (HCAs) in some settings (Cassie, 2014). Rehabilitation approaches are also changing to maximise the input and care required by older people. Specialised units in secondary care provide specific rehabilitation programmes designed by interdisciplinary teams focused on outcomes such as longevity, quality of life and even improved cognition (Ellis & Longhorne, 2005). However, when analysing how the interdisciplinary team works towards the goal of successful discharge of patients back to their community, the role RNs and HCAs play in enhancing mobility has been undervalued and underutilised (Kearney & Lever, 2010). The importance of mobility rehabilitation is supported by evidence of a positive impact on health outcomes such as increased strength, balance, flexibility and wider implications with reduced hospital stay, improved quality of life and reduction of falls (Atwal et al., 2008; Huijben-Schoenmakers, Gamel, & Hafsteinsdottir, 2009; Pryor, 2005).The HCA spends a significant amount of time with patients in Assessment, Treatment and Rehabilitation (ATR) wards. They are a logical, yet untapped source of contact to perform rehabilitation activities directed by staff who work limited hours such as allied health professionals (Pryor, Walker, O'Connell, & Worrall-Carter, 2009). This paper reports the findings from a research project examining the feasibility of health care assistants' participation in mobility rehabilitation for older people in an ATR ward.Literature reviewMobility is an important part of rehabilitation, and early mobilisation has proven to have significant positive outcomes in reducing length of stay, preventing deep vein thrombosis and pulmonary emboli, and improving overall physical function (Fox, Sidani, & Brooks, 2009; Pryor et al., 2009). Enhanced mobility can also reduce falls, and has a positive impact on aerobic and resistance exercises; a more active lifestyle improves cardiovascular and respiratory system function, and functional musculoskeletal ability well into older age (Intiso et al., 2012).Research on the role of the HCA in patient care, and specifically about mobility, is limited. The practice of HCAs is historically embedded in models of social care, but their scope of practice has changed over time due to public expectations, new technology and changing demographics, which has resulted in blurring of roles and boundaries with RNs (Department of Health, 2008). As RN roles and responsibilities increase, HCAs have become more responsible for patient care, making the modern HCA role multifaceted (Keeney, Hasson, McKenna, & Gillen, 2005). There is resultant role confusion due to issues around delegation, parameters of practice and accountability (Lizarondo, Kumar, Hyde, & Skidmore, 2010). Regardless of these changes over time there is still a heavy reliance on HCAs to meet patients' basic care needs, and provide cheaper alternatives to registered staff to address staffing and retention issues (Keeney, Hasson, McKenna, & Gillen, 2005).Researchers have explored the RN and HCA contribution to patient mobility and note deficits in current practice. Kneafsey, Clifford and Greenfield (2013) found, in a grounded theory study of the nursing team contribution to mobility rehabilitation, that RNs and HCAs focused primarily on risk assessment and patient safety. …

Current role challenges in New Zealand aged residential care: the potential consequences for healthcare assistant role expansion

Background: Challenges facing healthcare assistants in aged residential care are a focus of global debate. These challenges involve remuneration, education, skill mix, work conditions and organisational structures. Objectives/Aims: We enter the discussion by acknowledging current work, education and remuneration for healthcare assistants. We then consider the supervisory relationships between registered nurses (RNs), enrolled nurses (ENs) and healthcare assistants, educational levels for RNs, ENs and healthcare assistants, and the interplay between organisation and practice in aged residential care. We suggest that improving work for the healthcare assistant has the potential to lead change in all role levels.Design: Discussion paper. Conclusions/Implications for practice: We argue that adjustments to work structures, education and skill advancement of RNs, ENs and healthcare assistants could improve staff working conditions and clarify practice boundaries. The ultimate result is likely to be an improvement to quality of care and the life of residents in aged residential care.

Well-being and Lack of Well-being among Nursing Home Residents

The aim of the present paper is to analyze the well-being of elderly people in institutions, particularly in relation to the use of space in the Nursing Home (NH). Little research has been done on how older people experience the environment of the NH. Semi-structured interviews were conducted with 18 Nursing Home residents between the ages of 67 and 90. The findings indicate that the informants’ expressions of well-being belong to two main categories: “Well-being in public and private spaces” “Lack of Well-being in public and private spaces”. Two comprehensive themes were identified as relevant to a better understanding of the residents’ expressions of well-being: Emotional states, Own/Others’ behaviors and activities. From results emerged that in residents’ room, peacefulness is fundamental to relaxation and sleep; in lounge, being excluded from the group can be a source of negative feelings. Lack of well-being in the bathroom is related to feelings of incapacity and to violations of privacy. Practical implications of findings are discussed with regard to the role of health care assistants, nurses and activities co-ordinators in the promotion of residents’ well-being.

Effect of a training programme on the work of GP-based HCAs

Aims: The aims of this study were to explore how the health care assistant (HCA) is deployed in primary care, to investigate the impact of education on individual role/career development and to understand the perceived effect it has had, if any, on the general practice team in terms of service delivery. Method: The 18 respondents came from a whole population sample which was drawn from the 106 GP surgeries that had submitted their HCAs for Knowledge and Skills in Primary Care (KaSPaC) training in 2005–10, encompassing three NHS Primary Care Trusts in the South East of England. Results: Eight (KaSPaC trained) HCAs, four practice nurses and six practice managers completed the survey. The analysis revealed that the programme had provided individuals with a foundation for good practice; had been beneficial in terms of skill mix and service delivery; and had increased practice nurse confidence in task delegation. Conclusions: This study highlights the positive impact of structured accredited education on staff working in general practice but it also reveals that there is still a lack of standardization regarding the deployment and utilization of the HCA role within primary care.