Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK.
School of Health Sciences, University of Surrey, Faculty of Health and Medical Sciences, Rm 22, DK04, Duke of Kent Building, Guildford, Surrey GU2 7XH, UK(1).
Int J Nurs Stud. 2018 Mar;79:145-153. doi: 10.1016/j.ijnurstu.2017.11.010. Epub 2017 Nov 29.
Ever-growing demands on care systems have increased reliance on healthcare support workers. In the UK, their training has been variable, but organisation-wide failures in care have prompted questions about how this crucial section of the workforce should be developed. Their training, support and assessment has become a policy priority.
This paper examines: healthcare support workers' access to training, support and assessment; perceived gaps in training provision; and barriers and facilitators to implementation of relevant policies in acute care.
We undertook a qualitative study of staff caring for older inpatients at ward, divisional or organisational-level in three acute National Health Service hospitals in England in 2014.
58 staff working with older people (30 healthcare support workers and 24 staff managing or working alongside them) and 4 healthcare support worker training leads.
One-to-one semi-structured interviews included: views and experiences of training and support; translation of training into practice; training, support and assessment policies and difficulties of implementing them. Transcripts were analysed to identify themes.
Induction training was valued, but did not fully prepare healthcare support workers for the realities of the ward. Implementation of hospital policies concerning supervision and formal assessment of competencies varied between and within hospitals, and was subject to availability of appropriate staff and competing demands on staff time. Gaps identified in training provision included: caring for people with cognitive impairment; managing the emotions of patients, families and themselves; and having difficult conversations. Access to ongoing training was affected by: lack of time; infrequent provision; attitudes of ward managers to additional support workforce training, and their need to balance this against patients' and other staff members' needs; and the use of e-learning as a default mode of training delivery.
With the current and unprecedented policy focus on training, support and assessment of healthcare support workers, our study suggests improved training would be welcomed by them and their managers. Provision of training, support and assessment could be improved by organisational policy that promotes and protects healthcare support worker training; formalising the provision and availability of on-ward support; and training and IT support provided on a drop-in basis. Challenges in implementation are likely to be faced in all international settings where there is increased reliance on a support workforce. While recent policies in the UK offers scope to overcome some of these challenges there is a risk that some will be exacerbated.
医疗保健系统的需求不断增长，这增加了对医疗保健支持人员的依赖。在英国，他们的培训一直参差不齐，但整个护理系统的失败促使人们对如何发展这一至关重要的劳动力提出了质疑。他们的培训、支持和评估已成为政策优先事项。
本文研究了医疗保健支持人员获得培训、支持和评估的机会；培训提供方面的认知差距；以及在急性护理中实施相关政策的障碍和促进因素。
我们在 2014 年对英格兰三家急性国民保健服务医院的病房、科室或组织层面护理老年住院患者的工作人员进行了一项定性研究。
与老年人一起工作的 58 名员工（30 名医疗保健支持人员和 24 名管理或与他们一起工作的人员）和 4 名医疗保健支持人员培训负责人。
一对一的半结构化访谈包括：对培训和支持的看法和经验；培训转化为实践；培训、支持和评估政策以及实施这些政策的困难。对记录的文字进行分析以确定主题。
入职培训受到重视，但并未使医疗保健支持人员充分了解病房的实际情况。医院关于监督和正式评估能力的政策的实施在医院之间和内部有所不同，并且受到适当员工的可用性和员工时间的竞争需求的影响。培训提供方面的差距包括：照顾认知障碍患者；管理患者、家属和自身的情绪；以及进行困难的对话。持续培训的机会受到以下因素的影响：缺乏时间；培训不频繁；病房管理人员对额外支持劳动力培训的态度，以及他们需要平衡这一点与患者和其他员工的需求；以及将电子学习作为默认的培训交付模式。
鉴于当前和前所未有的政策重点是培训、支持和评估医疗保健支持人员，我们的研究表明，他们和他们的管理人员会欢迎提供更好的培训。通过组织政策来促进和保护医疗保健支持人员的培训，可以改善培训、支持和评估的提供；正式化病房支持的提供和可用性；以及提供按需的培训和 IT 支持。在所有依赖支持劳动力的国际环境中，实施方面的挑战都可能面临。虽然英国最近的政策为克服其中一些挑战提供了空间，但也存在一些挑战可能会加剧的风险。
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