Afzal Arsalan, Stolee Paul, Heckman George A, Boscart Veronique M, Sanyal Chiranjeev
School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada.
Schlegel-University of Waterloo Research Institute for Aging, University of Waterloo, Waterloo, ON, Canada.
Int J Older People Nurs. 2018 Sep;13(3):e12190. doi: 10.1111/opn.12190. Epub 2018 Mar 25.
This scoping review explored: (i) the role of unregulated care providers in the healthcare system; (ii) their potential role on interprofessional teams; (iii) the impact of unregulated care provider's role on quality of care and patient safety; and (iv) education and employment standards.
Unregulated care providers in Canada assist older adults with personal support and activities of daily living in a variety of care settings. As the care needs of an aging population become increasingly complex, the role of unregulated care providers in healthcare delivery has also evolved. Currently, many unregulated care providers are performing tasks previously performed by regulated health professionals, with potential implications for quality of care and patient safety. Information is fragmented on the role, education and employment standards of unregulated care providers.
A scoping review was conducted following the methods outlined by Arksey and O'Malley (International Journal of Social Research Methodology, 8, 2005, 19) and Levac, Colquhoun, and O'Brien (Implementation Science, 5, 2010, 69). An iterative search of published and grey literature was conducted from January 2000 to September 2016 using Medline, CINAHL, SCOPUS and Google. Inclusion and exclusion criteria were applied to identify relevant studies published in English.
The search yielded 63 papers for review. Results highlight the evolving role of unregulated care providers, a lack of recognition and a lack of authority for unregulated care provider decision-making in patient care. Unregulated care providers do not have a defined scope of practice. However, their role has evolved to include activities previously performed by regulated professionals. Variations in education and employment standards have implications for quality of care and patient safety.
Unregulated care providers are part of an important workforce in the long-term care and community sectors in Canada. Their evolving role should be recognised and efforts made to leverage their experience on interprofessional teams and reduce variations in education and employment standards.
This study highlights the evolving role of unregulated care providers in Canada and presents a set of recommendations for implementation at micro, meso, and macro policy levels.
本范围综述探讨了：（i）非正规护理提供者在医疗保健系统中的作用；（ii）他们在跨专业团队中的潜在作用；（iii）非正规护理提供者的角色对医疗质量和患者安全的影响；以及（iv）教育和就业标准。
加拿大的非正规护理提供者在各种护理环境中为老年人提供个人支持和日常生活活动协助。随着老年人口护理需求日益复杂，非正规护理提供者在医疗服务提供中的作用也在演变。目前，许多非正规护理提供者正在执行以前由受监管的医疗专业人员执行的任务，这对医疗质量和患者安全可能产生影响。关于非正规护理提供者的角色、教育和就业标准的信息较为零散。
按照Arksey和O'Malley（《国际社会研究方法杂志》，8，2005，19）以及Levac、Colquhoun和O'Brien（《实施科学》，5，2010，69）概述的方法进行范围综述。2000年1月至2016年9月期间，使用Medline、CINAHL、SCOPUS和谷歌对已发表文献和灰色文献进行了迭代搜索。应用纳入和排除标准来识别以英文发表的相关研究。
搜索产生了63篇供审查的论文。结果突出了非正规护理提供者不断演变的角色、在患者护理中非正规护理提供者决策缺乏认可和权威。非正规护理提供者没有明确的执业范围。然而，他们的角色已演变为包括以前由受监管专业人员执行的活动。教育和就业标准的差异对医疗质量和患者安全有影响。
非正规护理提供者是加拿大长期护理和社区部门重要劳动力的一部分。应认识到他们不断演变的角色，并努力利用他们在跨专业团队中的经验，减少教育和就业标准的差异。
本研究突出了加拿大非正规护理提供者不断演变的角色，并提出了一套在微观、中观和宏观政策层面实施的建议。
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