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Challenging care: the role and experience of Health …

SDO Project 08/1819/222 Queen's Printer and Controller of HMSO 2010 1 Challenging care: the role and experience of Health Care Assistants in dementia wards Report for the National Institute for Health Research Service Delivery and Organisation programme September 2010 Prepared by: Justine Schneider School of Sociology, Social Policy and Social Work, University of Nottingham Kezia Scales, Simon Bailey and Joanne Lloyd School of Sociology, Social Policy and Social Work, University of Nottingham Address for correspondence: Justine Schneider School of Sociology, Social Policy and Social Work, University of Nottingham, University Park, Nottingham, NG7 2RD E-mail: SDO Project 08/1819/222 Queen's Printer and Controller of HMSO 2010 2 Acknowledgements The

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1 SDO Project 08/1819/222 Queen's Printer and Controller of HMSO 2010 1 Challenging care: the role and experience of Health Care Assistants in dementia wards Report for the National Institute for Health Research Service Delivery and Organisation programme September 2010 Prepared by: Justine Schneider School of Sociology, Social Policy and Social Work, University of Nottingham Kezia Scales, Simon Bailey and Joanne Lloyd School of Sociology, Social Policy and Social Work, University of Nottingham Address for correspondence: Justine Schneider School of Sociology, Social Policy and Social Work, University of Nottingham, University Park, Nottingham, NG7 2RD E-mail.

2 SDO Project 08/1819/222 Queen's Printer and Controller of HMSO 2010 2 Acknowledgements The research described here would not have been possible without the generous co-operation of the staff we observed, their managers and their employing Trust. We also wish to acknowledge and thank the local Alzheimer s Society members who participated in focus groups, the members of the Project Advisory Group and others who provided assistance to the study along the way: Patrick Callaghan Andrew Clifton Julian Eve Julia Jefferson Rob Jones Sharon Howe Stephanie Kings Nick Manning Ian Morton Rachel Munton Elizabeth Murphy Andrew Neel Gill Pinner Deborah Thompson Richard Turner Andrea Ward SDO Project 08/1819/222 Queen's Printer and Controller of HMSO 2010 3 1 First impressions: an introduction to the Research design and methods.

3 6 A spy on the wall?..7 You get used to it ..7 Routines and Stress and coping ..10 Learning from colleagues ..12 Response to aggression ..12 Conclusion: setting the scene ..13 2 Why look at inpatient dementia care?..14 Relevant Background to the present Research design ..17 Data collection and A brief note on 3 Context and duties of the HCA role ..23 The Job terms and conditions ..25 A day in the life of an Skills and capabilities ..27 Assisting with activities of daily living (ADLs).

4 27 Support and Managing patient Patient Information Laundry and cleaning ..29 Seldom-observed Clinical 4 Supports and drivers of the HCA role ..32 Staff relations and the team ..32 Team working ..33 Group identity ..35 The uses of humour ..37 Motivation and intrinsic Engagement in Coping Conclusion: challenges and rewards ..44 5 HCAs distinctive role and contribution ..45 Theoretical Patient care in the institutional Organising patient Knowing the Tactical Working within ward systems.

5 48 SDO Project 08/1819/222 Queen's Printer and Controller of HMSO 2010 4 Flexibility and energy Interacting with families ..50 Knowledge Us versus them ..54 Scope for greater involvement with families? ..55 Bonding and supporting the Practical Conclusion: expanded scope of the HCA 6 Policy informing HCA Relevance of policy to HCA Health and social care policy context ..59 Workforce development policy ..63 Policy and practice of person-centred Relationship-centred Application to the present Conclusion: HCAs and relationship-centred 7 Stress and coping: evidence from HCAs.

6 70 Stress management guidelines ..70 Achievable Autonomy and control ..74 Developing new skills ..75 Information and Role ..79 Change ..80 Conclusion: areas for management of 8 Staff recognition and involvement ..82 Appreciation and Input in Conclusion: development 9 Conclusion and Researchers Ward A Researcher ..88 Ward B Researcher ..88 Ward C Researcher:..89 Research questions revisited ..90 Caring, motivations and Managing the emotional Working with families.

7 91 Stress and coping ..91 Positive and negative functions of the Humour and desensitisation ..92 Performance against HSE benchmarks ..93 Implications for person-centred Questions for consideration and implications for the Implications for the Staff SDO Project 08/1819/222 Queen's Printer and Controller of HMSO 2010 5 Appendix ..101 SDO Project 08/1819/222 Queen's Printer and Controller of HMSO 2010 6 The Report 1 First impressions: an introduction to the study This section is presented as a preface to the report.

8 After briefly describing the background to the study, it aims to orientate the reader to the material by summarising the process of engagement which the researchers underwent and sharing some of their initial accounts of the field. Research design and methods The approach used in this study of Health care assistants (HCAs) was participant observation. The three researchers immersed themselves in the role of HCA; they put on the uniform and went through the standard job induction, which included training in lifting and handling and managing violence and aggression.

9 They were then included on the staffing rota as supernumerary HCAs, experiencing all the shifts for three consecutive months, working more or less half time. They were deployed on different wards, but all three clinical settings treated older people with dementia and problematic behaviour. Throughout their time on the wards, the researchers kept a record of their experiences, making brief notes during their breaks on shift and writing up fieldnotes when they were off duty. Participant observation encourages researchers to reflect on their experiences and how they feel, as well as on what they see around them, so the fieldnotes contain not only a record of what they observed and did, but also how they felt.

10 The researchers guiding task was to explore the research questions about the HCA workforce: What motivates staff? What obstacles to good care do they face? What do they find stressful and how do they cope? What appears to promote staff wellbeing? What differences exist between different groups of staff (older or younger HCAs, male or female, ethnic majority or minority)? What are the implications of these findings for person-centred care, which is set as a standard of good practice? In this introduction to the research report, we invite the reader to share the researchers initial responses to their role.


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