Health-Care-Assistant-Literature-Review
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Provision of the Evidence to Inform the Future Education, Role and Function of Health Care Assistants in Ireland Professor Jonathan Drennan (Principal Investigator) Professor Josephine Hegarty Professor Eileen Savage Dr Noeleen Brady Mr. Cian Prendergast Ms Victoria Howson School of Nursing and Midwifery, University College Cork Dr Aileen Murphy Department of Economics, Cork University Business School, University College Cork Professor Karen Spilsbury School of Healthcare, University of Leeds September 2018 1 Contents Chapter 1 .............................................................................................................................. 3 1.1 Overview ..................................................................................................................... 3 Chapter 2 .............................................................................................................................. 6 2.1 Introduction ................................................................................................................ 6 2.2 Titles and Definitions of HCAs ...................................................................................... 7 2.3 Development and growth of the HCA Role .................................................................. 8 2.4 Profile of HCAs .......................................................................................................... 10 2.5 Roles and Impact of HCAs .......................................................................................... 11 2.6 Supervision and Delegation ....................................................................................... 19 2.7 Education and Training of HCAs ................................................................................. 20 2.7.1 Continuing Education ......................................................................................... 22 2.8 Professional Regulation of Healthcare Assistants....................................................... 23 2.9 Staffing and Skill-Mix ................................................................................................. 27 2.10 Relationships with other Health Professionals ......................................................... 32 2.11 Patient Experience with HCAs .................................................................................. 33 2.12 Job Satisfaction/Intention to Leave/Turnover/Absenteeism .................................... 33 2.13 Economic Impact ..................................................................................................... 35 2.14 Future Development of HCAs .................................................................................. 36 2.15 Conclusion ............................................................................................................... 39 References .......................................................................................................................... 42 Appendix A ......................................................................................................................... 50 2 Chapter 1 Introduction 1.1 Overview This chapter outlines the approach used to develop a report based on the literature (including grey literature) on the education, role and function of the Health Care Assistant in Ireland and internationally. It examined evidence from the literature on: • The role and function of the Health Care Assistant – including the provision of sample job descriptions/job specifications. • The educational preparation – content, level, duration etc. • The impact of Health Care Assistant skill-mix on quality of care and cost of that care. Aims: • As specified by the Health Service Executive Tender document, the aim was to present a report based on the literature, on the education, role and function of the Health Care Assistant in Ireland and internationally. Specific objectives of the research (as per the Tender) were to: o Review relevant national and international peer reviewed evidence and policy literature (including ‘grey literature’) in relation to health care assistants’ role and function and their educational preparation. o Analyse the education preparation of health care assistants nationally and internationally. o Outline the role and the function of health care assistants in all care settings in Ireland, and internationally, including but not limited to; the UK, Netherlands, Australia, Scandinavia, New Zealand, USA and Canada. o Analyse the literature relating the impact of health care assistants in addition to registered nurses (skill mix) relating to the quality of care o Analyse the literature relating the impact of health care assistants in addition to registered nurses (skill mix) relating to the cost of care. o Identify the enablers and barriers to the development of health care assistant roles nationally and internationally. • Identify the percentage ratio grade mix (Nurses: Health Care Assistants’) internationally used within services. The development of the report is guided by the principles of systematic review methodology. All databases (detailed below) were searched using relevant subject headings (e.g. MeSH, Emtree) and free text terms for title and abstract fields. Further assessment was made in terms of volume of material and relevance because of changes within and differences between health systems in order to determine a final scope. All searches were documented including the exact search strings, line-by-line retrieval numbers, the name of the loaded 3 databases, time and date. All references retrieved were saved as plain text file for audit purposes including their unique identifiers (if available). We searched for primary and secondary studies, systematic reviews and the grey literature. EBSCO host Online Research Databases were used to simultaneously search relevant health and psychosocial databases. Grey literature searches were completed using a number of sources, including: Grey Matters (CADTH), Google Scholar as well as dissertations, theses, databases and databases of conference abstracts. A search was performed in the Database of Abstracts of Reviews of Effects, the NHS Economic Evaluation Database, the Health Technology Assessment Database (all available through www.crd.york.ac.uk/CRDWeb ), the Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews (www.thecochranelibrary.com) and, Health Technology Assessment Database. Covidence was used for the screening process with two researchers screening the titles independently for inclusion or exclusion of the articles sourced. Following initial screening, 404 articles were included for full text review and the research team has located 334 of these full texts which have been added to the Covidence system. The scope of this review was very broad and this led to the inclusion of a large amount of articles for full text review. However, based on a preliminary analysis, a vast amount of the 404 articles consist of commentaries, opinion pieces, letters to the editor, editorials, and conference abstracts and thus, upon analysis, the papers identified did not consist of many high quality articles, such as RCTs, systematic reviews or meta-analysis. However, there were a small number of recent studies that used these higher quality methodological approaches. Table 1: Search strategy CINAHL MEDLINE S1 healthcare assistant* OR health care assistant* OR nurs* 41570 17384 assistant* OR nurs* aide* OR unregulated nurs* OR HCA* OR auxiliary nurs* OR unregulated care provider* OR licensed practical nurs* OR unlicensed assistive personnel OR enrolled nurs* OR assistants in nurs* S2 role OR function OR regulation OR qualification* OR 1657464 6069901 education OR registration OR job description OR job specification S3 acute hospital* OR acute setting* OR acute care OR 2333410 16058289 hospital* OR ward* OR unit* S4 S1 AND S2 AND S3 24504 4772 S5 S4 with limitations (years 2008-2018; peer reviewed) 10929 2349 4 # records identified through database searching n = 13278 Identification # records after duplicates removed n = 10691 Screening # of records screened # of records excluded n = 10691 n = 10287 # of records being assessed for eligibility n = 121 Eligibility Figure 1: Preliminary PRISMA Flowchart 5 Chapter 2 Literature Review 2.1 Introduction The review of the literature is outlined in 13 sections related to the themes identified in the search process. The sections include: 1) titles and definitions related to the Health Care Assistant1 (HCA) (section 2.2); 2) the development of the HCA role (section 2.3); 3) profile of HCAs (section 2.4); 4) the roles undertaken by HCAs (section 2.5); 5) supervision and delegation of responsibilities to HCAs (section 2.6); 6) education and training (section 2.7); 7) professional regulation (section 2.8); 8) skill-mix (section 2.9); 9) relationships with other health professionals (section 2.10); 10) the patient experience (section 2.11); 11) job satisfaction and turnover (section 2.12); 12) economic impact (section 2.13) and; 13) future developments (Section 2.14). Both published and unpublished literature included in this review used a variety of approaches in describing and evaluating the role of HCAs and depending on the question being addressed by the study. These have included qualitative approaches (for example individual and focus group interviews, case studies, observation, narrative reviews (Saks et al., 2000, Kessler et al., 2010, Butler-Williams et al., 2010,