Saari Margaret, Patterson Erin, Kelly Shawna, Tourangeau Ann E
School of Public Health and Health Systems, University of Waterloo, 200 University Ave West, Waterloo, ON, Canada.
Saint Elizabeth Research Centre, Saint Elizabeth Health Care, 90 Allstate Parkway, Suite #300, Markham, ON, Canada.
Health Soc Care Community. 2018 Mar;26(2):240-249. doi: 10.1111/hsc.12514. Epub 2017 Nov 8.
To meet increasing demand for home care, the role of personal support workers (PSWs) is shifting from providing primarily personal and supportive care to include care activities previously provided by regulated health professionals (RHPs). Much of the research examining this shift focuses on specialty programmes, with few studies investigating the daily care being provided by PSWs, frequency of care activities being provided by PSWs, and characteristics of the population receiving more complex tasks. Between January and April 2015, a review of 517 home-care service user charts was undertaken in Ontario, Canada, to: (1) describe the range of tasks being performed by PSWs in home care, (2) identify tasks transferred by RHPs to PSWs, and (3) examine characteristics of service users receiving transferred care. Findings indicate that normally, PSWs provide personal and supportive care commensurate with their training. However, in approximately one quarter of care plans reviewed, PSWs also completed more complex care activities transferred to them by RHPs. Service users receiving transferred care were older and had higher levels of cognitive and functional impairment. Although there is potential for the expansion of home-care services through increased utilisation of PSWs, healthcare leadership must ensure that the right provider is being utilised at the right time and in the right place to ensure safe and effective quality care. Thus, several actions are recommended: PSW core competencies be clearly articulated, processes used to transfer care activities from RHPs to PSWs be standardised and a team-based approach to the delivery of home-care services be considered. Utilisation of a team-based model can help establish positive relationships among home-care providers, provide increased support for PSWs, allow for easier scheduling of initial training and ensure regular reassessments of PSW competence among PSWs providing added skills.
为满足对家庭护理日益增长的需求，个人支持工作者（PSW）的角色正在从主要提供个人和支持性护理转变为包括以前由受监管的健康专业人员（RHP）提供的护理活动。许多研究这种转变的研究都集中在专业项目上，很少有研究调查PSW提供的日常护理、PSW提供护理活动的频率以及接受更复杂任务的人群的特征。2015年1月至4月期间，在加拿大安大略省对517份家庭护理服务用户图表进行了审查，目的是：（1）描述PSW在家庭护理中执行的任务范围；（2）确定RHP转移给PSW的任务；（3）检查接受转移护理的服务用户的特征。研究结果表明，通常情况下，PSW提供与其培训相称的个人和支持性护理。然而，在大约四分之一的审查护理计划中，PSW还完成了RHP转移给他们的更复杂的护理活动。接受转移护理的服务用户年龄更大，认知和功能障碍水平更高。尽管通过增加PSW的使用量有扩大家庭护理服务的潜力，但医疗保健领导层必须确保在正确的时间和地点使用正确的提供者，以确保安全有效的优质护理。因此，建议采取以下几项行动：明确阐述PSW的核心能力，规范将护理活动从RHP转移到PSW的流程，并考虑采用基于团队的方式提供家庭护理服务。采用基于团队的模式有助于在家庭护理提供者之间建立积极的关系，为PSW提供更多支持，便于安排初始培训，并确保对提供额外技能的PSW的能力进行定期重新评估。
