Exploring the role of health care assistants as mobility activators for older people in an assessment, treatment and rehabilitation ward

Abstract

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. …