The hidden contribution of the health care assistant: a survey-based exploration of support to their role in caring for the acutely ill patient in the general ward setting.

AIM: To examine the feelings, support and feedback available to health care assistants (HCA) when caring for acutely ill ward patients. BACKGROUND: The role of the HCA continues to evolve with increased responsibility for patient care. Contextual issues that affect their contribution to acute care management of the ward patient have been given limited attention. METHODS: A survey of HCAs (n = 131) was conducted within two district general hospitals. RESULTS: There were a number of emotions and stressors associated with the care of acutely ill patients. While normal hierarchical systems were in place in order to obtain help HCAs additionally bypassed these normal channels. Support mechanisms included registered nurses, ward doctors, peers and family. Feedback regarding performance was limited. CONCLUSION: HCAs play a significant role in the care of the acutely ill patient. Feedback mechanisms need to be developed and associated emotions recognized. IMPLICATIONS FOR NURSING MANAGEMENT: HCAs support needs to be more evident and clinical feedback mechanisms need to be reviewed in order to improve care delivery.

Vital signs for vital people: an exploratory study into the role of the Healthcare Assistant in recognising, recording and responding to the acutely ill patient in the general ward setting.

AIM: To examine the contribution of the Healthcare Assistant (HCA) as the recogniser, responder and recorder of acutely ill patients within the general ward setting. BACKGROUND: Concerns have been highlighted regarding the recognition and management of the acutely ill patient within the general ward setting. The contribution of the HCA role to this process has been given limited attention. METHODS: A postal survey of HCAs was piloted and conducted within two district general hospitals. Open and closed questions were used. RESULTS: Results suggest that on a regular basis HCAs are caring for acutely ill patients. Contextual issues and inaccuracies in some aspects of patient assessment were highlighted. It would appear normal communication channels and hierarchies were bypassed when patients' safety was of concern. Educational needs were identified including scenario-based learning and the importance of ensuring mandatory training is current. CONCLUSIONS AND IMPLICATIONS FOR NURSING MANAGEMENT: HCAs play a significant role in the detection and monitoring of acutely ill patients. Acknowledgement is needed of the contextual factors in the general ward setting which may influence the quality of this process. The educational needs identified by this study can assist managers to improve clinical supervision and educational input in order to improve the quality of care for acutely ill patients.

The consultant nurse - expert practitioner and much more.

The consultant nurse (CN) role is usually described in terms of four domains devised by the Department of Health - clinical practice, education and training, leadership, and research and service development. This study set out to explicate the diversity and complexity of CN roles in an NHS trust; to describe aspects of extraordinary practice and to identify perceived differences between this role and other advanced practice roles. Accounts were written by six CNs and subjected to concept mapping to facilitate identification of extraordinary practice. Four themes emerged: entrepreneurial activity and innovation; clinical autonomy and role dynamism; influential national and international research conduct; consultancy and education across discipline boundaries. These included descriptions of higher order skills that surpass usual requirements of 'expert' or 'advanced' practice. Comparisons with other advanced practice roles are drawn from the literature and data collected in this study. Differences between the roles have implications for sustainability.

Increasing staff awareness of respiratory rate significance.

Respiratory rate is a significant predictor of critical illness and an important part of early-warning scoring. After an audit of patient records revealed a low incidence of respiratory-rate recording, a hospital-wide education programme was set up to raise awareness and improve critical care skills among ward staff. A repeat audit showed significant improvement in recording rates and identified new areas for training.

Implementing a multidisciplinary approach to comprehensive critical care.

Following recent government recommendations on critical care services, the skills and training opportunities within the critical care environment should be shared with staff on the general wards. This article discusses a one-day study course offered at one NHS trust that was developed to address the educational needs of staff working on general wards.