Welcome to the latest key papers and publications focussing mainly on Support Workers in the nursing profession and the role they play as part of a clinical team.
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Abstract: The healthcare support worker (HCSW) has long been an essential part of the nursing workforce (Stokes and Warden, 2004). However, as an unregistered worker increasingly at the frontline of care delivery (Kessler et al, 2012), the learning and development needs of HCSWs are an important issue for policymakers and practitioners.
Source: British Journal of Healthcare Assistants, Dec 2021; 15(11): 526-531
Understanding career development and progression from a healthcare support worker perspective. Part 2
Abstract: The picture on training programmes offered assumes added significance in the context of the survey findings on the development opportunities HCSWs would like to be offered. To what extent do the programmes offered align with the interests and perceived needs of HCSWs?
Source: British Journal of Healthcare Assistants, Jan 2022; 16(1): 6-10
From support worker to district nurse team manager: a narrative
Abstract: As the general population ages, so too does the nursing workforce. A recent Queen's Nursing Institute (QNI) report (2019a) stated that 1 in 10 qualified district nurse positions have been lost in the past 10 years—without a trained workforce to replace those who retire.
Source: British Journal of Healthcare Assistants, Jan 2022; 16(1): 6-10
From support worker to district nurse team manager: a narrative
Abstract: As the general population ages, so too does the nursing workforce. A recent Queen's Nursing Institute (QNI) report (2019a) stated that 1 in 10 qualified district nurse positions have been lost in the past 10 years—without a trained workforce to replace those who retire.
Workforce planning is central to ensure safe and effective care in the community setting. This article aims to provide a narrative account of one student who started her career at the University of Bolton as a trainee assistant practitioner and over time achieved her present position as a district nurse team manager.
The account will include her journey from support worker to assistant practitioner, studying at the University of Bolton as a trainee assistant practitioner on a ‘work, earn and learn’ programme.
It details the support she received from mentors in the trust, alongside her onward journey to registered nurse and specialist nurse practitioner qualifications.
Source: British Journal of Healthcare Assistants, Mar 2020; 14(3): 110-114
The public health role of maternity support workers
Abstract: Most of the work of midwives and obstetricians is directed at improving pregnancy outcomes. Part of this work is built on the public health strategy developed by the national health services around the UK. Pregnancy and early parenthood are times when expectant and new parents are receptive to public health information.
Midwives and maternity support workers work together to convey public health messages. The positive outcomes of this work include reductions in rates of stillbirth, preterm birth and low-birthweight babies.
Other outcomes are increased parental satisfaction, stronger family bonds and better family health. Specialist and consultant midwives' views on the role of maternity support workers in public health are included in this paper.
Source: British Journal of Healthcare Assistants, Dec 2020; 14(11): 542-547
Nursing associates … what are they and how does their role fit within the team?
Abstract: Let me start by introducing myself. My name is Sarah Giddings and I am a registered nursing associate within the mental health sector.
Do you know what a nursing associate is and why the role was introduced? If not, let me give you some background and share my journey from trainee nursing associate (TNA) to registered nursing associate. This hopefully will enlighten you and see how employing nursing associates within your team will enhance the care that is offered to the patients, as we are highly skilled and knowledgeable professionals.
Source: British Journal of Healthcare Assistants, Sep 2020; 14(8): 400-405
First year as a newly qualified nursing associate
Abstract: Hi my name is Maggie and I am a nursing associate! I have been qualified a year now, and if you come with me now, I will tell you a little about my role. I work at the Manchester Royal Infirmary, part of Manchester University NHS Foundation Trust (MFT), and am part of the fantastic team that works on Ward 30, older people's care, care of the elderly, although we are not restricted to a certain age bracket and can receive any age range of patient on our ward. Although I am not a nurse, we work very similarly to a nurse; there could be great debate about this statement and I don't mean to cause any, but I will tell you some of what I do in a working day and then you can maybe make your own mind up.
Source: British Journal of Healthcare Assistants, Jun 2021; 15(5): 246-249
Social prescribing and support workers
Abstract: Social prescribing is a relatively new term referring to non-pharmaceutical approaches to treatment and care, and healthcare assistants and support workers are becoming ever more familiar with this prescription choice.
Source: British Journal of Healthcare Assistants, 2021; 15(3): 149-151
Peer support workers’ role and expertise and interprofessional learning in mental health care: a scoping review
Abstract: Interprofessional learning (IPL), which is learning arising from the interaction between representatives of two or more professions, has not been studied extensively in relation to peer support workers (PSWs) in mental health care teams. PSWs support others who face challenges with their own experience of similar challenges of mental health problems. The role of PSWs has been studied in mental health care interprofessional teams. However, researchers have not paid attention to IPL where the PSWs contribute their knowledge. This paper is a scoping review that aims to highlight existing knowledge of the PSW role and expertise in IPL in the context of mental health care. The findings show knowledge of (a) the key factors and challenges when interprofessional teams include the PSW role, (b) the legitimacy of the PSWs’ role and expertise, and (c) the benefits of the PSW role. A knowledge gap was identified of teams’ use of PSWs’ expertise and its implications for IPL.
Source: Journal of Interprofessional Care, Nov 2022; 36(6): 828-838
The need to capture the unharnessed expertise of overseas educated nurses working as care support workers in their host country
Abstract: The purpose of this editorial is not to highlight the already known strategies to address the nursing workforce shortage but to bring to the forefront that many internationally educated nurses are working as unqualified health care assistants in their host countries where they were recruited to at the first instance. For instance, more than 3000overseas nurses educated to professional registration levels overseas find it difficult to register at the appropriate level. This is both potentially discriminatory and inefficient use of human resources.
Source: Journal of Nursing Management, May 2022; 30(4): 847-848
More ‘milk’ than ‘psychology or tablets’: Mental health professionals’ perspectives on the value of peer support workers
Abstract: Background: Though growing numbers of peer support workers are employed in the UK National Health Service (NHS), conflicts persist between core values of peer support and values which exert power within these services.
Objectives: To explore what NHS mental health professionals value about the peer support worker role.
Design: Five professionals from different professions and mental health settings were interviewed twice. The first interviews explored their experiences of working with peers. Transcripts were analysed using discourse analysis and psychosocial theory. Second interviews allowed participants to respond to the analysis and influence subsequent analysis.
Results: Mental health professionals valued peers for the deeply empathic, relational approach they brought, based in their subjective experience. Peer work was also valued for the affect‐focused quality of this work, and the challenge peers pose to existing values in mental health services. The values of peer support troubled dominant ways of working based in forms of knowledge that favour objectivity and hence encountered challenges.
Conclusions: Peers fulfil the role of amplifying the status of diverse forms of knowledge, values and related ways of working that have become marginalized in NHS mental health services. It is important that peers are not seen as an isolated solution to the marginalization of these forms of knowledge and values, but that their way of working becomes reflected in other roles whilst evoking change throughout these services.
Patient or Public Contribution: Patient and Public Involvement groups were consulted both in the design and analysis stages of the study.
Source: Health Expectations, Apr 2021; 24(2): 234-242
Factors influencing initiation of health behaviour conversations with patients: Cross‐sectional study of nurses, midwives, and healthcare support workers in Wales
Abstract: Aim: To identify factors influencing healthcare professionals’ engagement in health behaviour conversations with patients.
Design: Cross‐sectional survey.
Methods: Between April and June 2019, an online survey of 1338 nurses, midwives and healthcare support workers was conducted. The survey assessed whether staff felt comfortable initiating health behaviour conversations with patients about five behaviours (reducing alcohol intake; stop smoking; being more active; reducing their weight; and improving their diet) and barriers to conversation initiation. Health professionals’ own health‐related behaviours, self‐rated health and mental wellbeing, and socio‐demographic characteristics were recorded. Logistic regression models were built to assess factors associated with feeling comfortable initiating health behaviour conversations for each topic.
Result: Less than 50% of respondents reported feeling comfortable initiating health behaviour conversations with patients. Female staff, young professionals (18 to 29 years), those in lower staff grades and those with poorer health and low mental wellbeing were less likely to report feeling comfortable having health behaviour conversations across all topics. Those who did not adhere to physical activity and dietary guidelines were less likely to initiate a conversation about being more active and having a healthy diet, respectively. Not having time to discuss the topic, suitable space to hold a conversation, and feeling worried about offending/upsetting patients were the main barriers reported.
Conclusion: Around 6 in 10 members of the nursing, midwifery and healthcare support workforce in Wales potentially do not feel comfortable to initiate a health behaviour conversation with patients about health and wellbeing. Feeling less comfortable to initiate a conversation was associated with staff demographics and organizational factors.
Impact: We identified those less likely to initiate health behaviour conversations as well as personal and organizational barriers to initiation. This will help to target and tailor interventions to ensure staff are equipped and enabled to hold health behaviour conversations with patients.
Source: Journal of Advanced Nursing, Nov 2021; 77(11): 4427-4438
Peer-Facilitated Decision Making in Mental Health: Promises, Pitfalls, and Recommendations for Research and Practice
Abstract: Recognition has grown that peer support workers serve an important role in facilitating decision making about treatment and recovery among people with mental health conditions. This article provides examples of peer-facilitated decision support interventions in the literature, discusses promises and potential pitfalls associated with peers serving in decision support roles, and offers recommendations for research and practice. Examples were selected from the literature on decision support interventions for people with serious mental illnesses, such as schizophrenia, bipolar disorder, and major depression. Promises, pitfalls, and recommendations were informed by this research and by the literature on lived experience perspectives, the helper-therapy principle, and reported barriers to and facilitators of peers assisting with decision making. According to the included studies, peers may facilitate decision making in several ways (e.g., by asking service users about their goals or preferences, assisting them with using decision support tools, sharing stories, and facilitating access to information and resources). Peer-facilitated decision support may be associated with positive decision making and health outcomes for service users and peer support workers. However, providers need to carefully consider barriers to implementation of this support, such as inadequate resourcing, poor integration, and compromising of peer support values.
Source: Psychiatric Services, Sep 2022; Online ahead of print
Contact the library for a copy of this article
Experiences of mental health support workers in mental healthcare practice: Three visual arts narratives
Abstract: Introduction: Mental health support workers (MHSWs) make positive contributions to mental health recovery practice yet their roles and support needs are often unclear. This research explored the occupational lived experiences of three MHSWs working in Irish mental healthcare services.
Aim: The study examined the experiences and perceptions of MHSWs regarding their mental health recovery work.
Method: A narrative design was used incorporating participatory art‐based inquiry as a collaborative means of engaging participants. This innovative methodology enabled exploration and evocative expression of participants’ occupational experiences and stories.
Results: Participants revealed feelings of vulnerability and anxiety regarding personal mental health and supporting the mental health of others; a finding not commonly explored in previous research. MHSW skills and knowledge were evident; however, this expertise and recovery focus was not valued in mental health services.
Discussion: The strengths and challenges of MHSW engagement in service provision are discussed. Interdisciplinary team integration is explored in terms of contrasting recovery philosophies, practitioner vulnerability and professional demands and imperatives.
Implications for practice: Mental health teams need to engage with recovery principles, acknowledging strengths and vulnerabilities of all practitioners and establishing adequate supervision and support. Greater clarity and education is required concerning roles/scope of practice for MHSWs to enable productive interdisciplinary partnerships.
Source: Journal of Psychiatric and Mental Health Nursing, Dec 2021; 28(6): 1018-1028
Healthcare support workers' lived experiences and adaptation strategies within the care sector during the COVID-19 pandemic. A meta-ethnography review
Abstract: Support workers are an "invisible" part of the health sector often working during pandemics to support clients. This meta-ethnography screened 167 articles out of 211 results identifying 4 qualitative studies that explored the support worker's experiences during the COVID-19 pandemic. "Redundancy approach" was used to map non-essential criteria and the analysis was informed by the interpretative meta-ethnography method. Eight key themes identified from studies in UK and USA. The themes identified are: (1) job role; (2) marginalized profession; (3) impact of work; (4) concerns surrounding PPE; (5) transportation challenges; (6) level of support and guidance; (7) a higher calling and self sacrifice; (8) adaptation strategies. Adaptation strategies include purchasing their own masks, to policy and agency adaptation, cleaning, talk walks, meetings with colleagues or within the company. The adaptation strategies aim at tackling emotional distress and raise the level of appreciation that society or organizations show to the support workers.
Source: Home Health Care Services Quarterly, Jul 2022; Online ahead of print
Contact the library for a copy of this article
Midwives' and maternity support workers' perceptions of the impact of the first year of the COVID-19 pandemic on respectful maternity care in a diverse region of the UK: a qualitative study
Abstract: OBJECTIVES: To explore midwives' and maternity support workers' perceptions of the impact of the COVID-19 pandemic on maternity services and understand factors influencing respectful maternity care.
DESIGN: A qualitative study. Eleven semi structured interviews were conducted (on Zoom) and thematically analysed. Inductive themes were developed and compared with components of respectful maternity care. SETTING: Maternity services in a diverse region of the United Kingdom.
PARTICIPANTS: Midwives and maternity support workers who worked during the first year of the COVID-19 pandemic.
RESULTS: The findings offer insights into the experiences and challenges faced by midwives and maternity support workers during the first year of the COVID-19 pandemic in the UK (March 2020-2021). Three core themes were interpreted that impacted respectful maternity care: (1) communication of care, (2) clinical care and (3) support for families. 1. Midwives and maternity support workers felt changing guidance impaired communication of accurate information. However, women attending appointments alone encouraged safeguarding disclosures. 2. Maternity staffing pressures worsened and delayed care provision. The health service's COVID-19 response was thought to have discouraged women's engagement with maternity care. 3. Social support for women was reduced and overstretched staff struggled to fill this role. The continuity of carer model of midwifery facilitated supportive care. COVID-19 restrictions separated families and were considered detrimental to parents' mental health and newborn bonding. Overall, comparison of interview quotes to components of respectful maternity care showed challenges during the early COVID-19 pandemic in upholding each of the 10 rights afforded to women and newborns.
CONCLUSIONS: Respectful maternity care was impacted through changes in communication, delivery of clinical care and restrictions on social support for women and their infants in the first year of the COVID-19 pandemic. Future guidance for pandemic scenarios must make careful consideration of women's and newborns' rights to respectful maternity care.
Source: BMJ Open, Sep 2022; 12(9): e064731
Implementation Challenges and Recommendations for Employing Peer Support Workers in Emergency Departments to Support Patients Presenting after an Opioid-Related Overdose
Abstract: The placement of a peer support workers (PSWs) in emergency departments (ED) is a promising practice for supporting persons with opioid use disorder who are presenting with an overdose or related medical condition. However, this practice is underutilized. The objective of this study was to identify the challenges of employing PSWs in the ED and provide a checklist to increase the likelihood of their successful integration and retention in this environment. Qualitative methods were used to collect data from nineteen key stakeholders who worked in hospital settings. Using a social-ecological model, themes were identified at the system, hospital, and individual levels. To support integration of PSWs and buy in for the ED team, our findings indicate a need for a planning phase that includes collaboration between leadership, ED staff, and PSWs. Specifically, planning should address four areas: (1) hiring a PSW that is a good fit for the fast-paced ED setting, (2) education of ED staff on the value and role of PSWs, (3) establishing workflow protocols, and (4) providing PSWs with training and appropriate supervision.
Source: International Journal of Environmental Research and Public Health, Apr 2022; 19(9): 5276
Role of peer support workers in improving patient experience in Tower Hamlets Specialist Addiction Unit
Abstract: The aim of the project was to improve patient experience for people in Tower Hamlets Specialist Addictions Unit in order to increase satisfaction by 25% in 12 months starting in August 2014. The team used the model for improvement as part of ELFT's quality improvement programme to support iterative cycles of testing and learning. This involved support from the Trust's quality improvement team. The theory of change was visualised through a driver diagram. A number of outcomes were measured and plotted over time - patient satisfaction, staff satisfaction, and attendance to peer support groups. The impact of changes was then observed using the plan, do, study, act (PDSA) cycles. The changes that positively influenced the outcomes were continued and ones without such impact were discontinued. The most successful intervention to improve patient satisfaction so far was the introduction of peer support facilitation for the "Breakfast club" - recovery orientated meeting of patients with less emphasis on the medical aspects of treatment. Staff satisfaction is proven to be one of the best determinants of patient experience, so this is also measured and plotted over time together with patient's satisfaction and attendance. Service user satisfaction improves attendance and outcomes in this difficult-to-engage group of patients (people with both substance misuse and mental health problems). Patient perspectives and priorities might be quite different to that of the clinical team, further supporting the importance of involving and engaging them in any quality improvement work. Involving peer support workers in improving engagement of people with substance misuse related problems appears essential.
Source: BMJ Quality Improvement Reports, 2016; 5(1): u205967.w2458
Implementing peer support workers in clinically oriented sub-acute mental healthcare teams: New approaches - new challenges
Abstract: Introduction: Arguably, an approach including peer support workers and peer-operated service provision is the future of the public mental health workforce. However, to date, the inclusion of peer support workers in clinical teams has not been trialled. This research reports qualitative data regarding the integration of peer support workers in clinical mental health care teams. Theory /
Methods: Normalization Process Theory guided data collection and analysis to answer the research question: "How were peer support workers integrated into care delivery processes?" Participants were recruited from a recently implemented sub-acute mental health care team in South East Queensland, aiming to provide intensive case-management for people with mental illness. Participants were interviewed face-to-face prior to the commencement of the program (n=24) and six months after the program was established (n=21). A total of 16 participants were interviewed at both time points. Data were digitally recorded, transcribed verbatim and checked for accuracy. Data were analysed thematically. Two researchers independently read each interview and developed initial categories. Data were then collectively aggregated into higher order themes, continuing until all data were accounted for and the most parsimonious representation of themes was achieved.
Results: Clinicians did not fully understand the role of the peer support worker, or how to engage them in clinical care. Beyond their lived experience of mental illness, a common ground from which peer support workers could develop their role was lacking. Some peer support workers were employed for their cultural background as much as, if not more than their lived experience of mental illness, which further diluted and diversified roles. Discussion: Although clinicians enthusiastically embraced the idea of including peer support workers in care teams, poorly defined parameters of care provision in the peer support worker role within interactions with consumers sometimes caused tension. Never-the-less, peer support workers were valuable brokers of existing community capacity to support people with mental illness; working effectively with, and facilitating relationships between consumers and non-government organisations. Conclusion: Peer support workers are new and valuable members of sub-acute clinically oriented public mental health teams. Their role is important in integrating service provision between public mental health teams and non-government service providers.
Lessons Learned: There are multiple complexities associated with introducing people without a defined disciplinary background into health service provision teams. However, peer support workers are valuable team members, clinicians do learn how to work with them over time and they are able to support people who experience mental illness in ways that clinicians are not. Limitations: This research occurred in the context of a pilot program. Therefore, generalizability beyond this context cannot be assured. Some of the issues regarding working with peer support workers may have been related to the formation of new teams, rather than because the peer support workers were non-clinicians.
Future Research: Further research is required to establish the influence of clinical staff on the work of non-clinicians within clinical service provision teams, and to better understand the impact of the integration and connecting role that peer support workers adopted in this team.
Source: International Journal of Integrated Care, Jul 2017; 17(3): 79
Implementation and evaluation of clinical supervision for support workers in a paediatric palliative care setting
Abstract: Support workers represent a large proportion of the NHS workforce and yet their supervisory needs are often overlooked. This study focused specifically on a cohort of support workers in a community paediatric palliative care setting. Peer supervision was implemented for this group, initially face to face and then virtually. The experiences of clinical supervision for this group were investigated through responses to an online survey (n = 25) and two focus groups (n = 7). Survey data were analysed concurrently with a thematic analysis. The following themes and sub-themes were developed from transcribed focus groups: (1) Barriers to engagement (2) Being Listened to (3) What Worked Well: Logistics. Overall, delivery of supervision was effective to a mixed degree - though support workers appreciated a space to be listened to, their distrust of colleagues and other barriers impeded the capacity of supervision to achieve more than support and catharsis for this group. Future projects should focus on introducing more preliminary interventions to promote reflection and peer support for these groups as well as continue to consider the supervisory needs of support workers.
Source: Clinical Child Psychology and Psychiatry, Apr 2022; 27(2): 369-384
Developing a training programme for midwives and maternity support workers facilitating a novel intervention to support women with anxiety in pregnancy
Abstract: BACKGROUND: The RAPID-2 intervention has been developed to support women with symptoms of mild-to-moderate anxiety in pregnancy. The intervention consists of supportive discussions with midwives, facilitated discussion groups and access to self-management materials. This paper reports the development of a training programme to prepare midwives and maternity support workers to facilitate the intervention.
METHODS: Kern's six-step approach for curriculum development was used to identify midwives and maternity support workers training needs to help support pregnant women with anxiety and facilitate a supportive intervention. The stages of development included feedback from a preliminary study, stakeholder engagement, a review of the literature surrounding midwives' learning and support needs and identifying and supporting the essential process and functions of the RAPID intervention.
RESULTS: Midwives' reported training needs were mapped against perinatal mental health competency frameworks to identify areas of skills and training needed to facilitate specific intervention mechanisms and components. A training plan was developed which considered the need to provide training with minimal additional resources and within midwives' scope of practice. The training plan consists of two workshop teaching sessions and a training manual.
CONCLUSION: Future implementation is planned to include a post-training evaluation of the skills and competencies required to fully evaluate the comprehensive programme and deliver the RAPID-2 intervention as planned. In addition, the RAPID-2 study protocol includes a qualitative evaluation of facilitators' views of the usefulness of the training programme.
Source: BMC Pregnancy and Childbirth, Aug 2022; 22(1): 662
The account will include her journey from support worker to assistant practitioner, studying at the University of Bolton as a trainee assistant practitioner on a ‘work, earn and learn’ programme.
It details the support she received from mentors in the trust, alongside her onward journey to registered nurse and specialist nurse practitioner qualifications.
Source: British Journal of Healthcare Assistants, Mar 2020; 14(3): 110-114
The public health role of maternity support workers
Abstract: Most of the work of midwives and obstetricians is directed at improving pregnancy outcomes. Part of this work is built on the public health strategy developed by the national health services around the UK. Pregnancy and early parenthood are times when expectant and new parents are receptive to public health information.
Midwives and maternity support workers work together to convey public health messages. The positive outcomes of this work include reductions in rates of stillbirth, preterm birth and low-birthweight babies.
Other outcomes are increased parental satisfaction, stronger family bonds and better family health. Specialist and consultant midwives' views on the role of maternity support workers in public health are included in this paper.
Source: British Journal of Healthcare Assistants, Dec 2020; 14(11): 542-547
Nursing associates … what are they and how does their role fit within the team?
Abstract: Let me start by introducing myself. My name is Sarah Giddings and I am a registered nursing associate within the mental health sector.
Do you know what a nursing associate is and why the role was introduced? If not, let me give you some background and share my journey from trainee nursing associate (TNA) to registered nursing associate. This hopefully will enlighten you and see how employing nursing associates within your team will enhance the care that is offered to the patients, as we are highly skilled and knowledgeable professionals.
Source: British Journal of Healthcare Assistants, Sep 2020; 14(8): 400-405
First year as a newly qualified nursing associate
Abstract: Hi my name is Maggie and I am a nursing associate! I have been qualified a year now, and if you come with me now, I will tell you a little about my role. I work at the Manchester Royal Infirmary, part of Manchester University NHS Foundation Trust (MFT), and am part of the fantastic team that works on Ward 30, older people's care, care of the elderly, although we are not restricted to a certain age bracket and can receive any age range of patient on our ward. Although I am not a nurse, we work very similarly to a nurse; there could be great debate about this statement and I don't mean to cause any, but I will tell you some of what I do in a working day and then you can maybe make your own mind up.
Source: British Journal of Healthcare Assistants, Jun 2021; 15(5): 246-249
Social prescribing and support workers
Abstract: Social prescribing is a relatively new term referring to non-pharmaceutical approaches to treatment and care, and healthcare assistants and support workers are becoming ever more familiar with this prescription choice.
Source: British Journal of Healthcare Assistants, 2021; 15(3): 149-151
Peer support workers’ role and expertise and interprofessional learning in mental health care: a scoping review
Abstract: Interprofessional learning (IPL), which is learning arising from the interaction between representatives of two or more professions, has not been studied extensively in relation to peer support workers (PSWs) in mental health care teams. PSWs support others who face challenges with their own experience of similar challenges of mental health problems. The role of PSWs has been studied in mental health care interprofessional teams. However, researchers have not paid attention to IPL where the PSWs contribute their knowledge. This paper is a scoping review that aims to highlight existing knowledge of the PSW role and expertise in IPL in the context of mental health care. The findings show knowledge of (a) the key factors and challenges when interprofessional teams include the PSW role, (b) the legitimacy of the PSWs’ role and expertise, and (c) the benefits of the PSW role. A knowledge gap was identified of teams’ use of PSWs’ expertise and its implications for IPL.
Source: Journal of Interprofessional Care, Nov 2022; 36(6): 828-838
The need to capture the unharnessed expertise of overseas educated nurses working as care support workers in their host country
Abstract: The purpose of this editorial is not to highlight the already known strategies to address the nursing workforce shortage but to bring to the forefront that many internationally educated nurses are working as unqualified health care assistants in their host countries where they were recruited to at the first instance. For instance, more than 3000overseas nurses educated to professional registration levels overseas find it difficult to register at the appropriate level. This is both potentially discriminatory and inefficient use of human resources.
Source: Journal of Nursing Management, May 2022; 30(4): 847-848
More ‘milk’ than ‘psychology or tablets’: Mental health professionals’ perspectives on the value of peer support workers
Abstract: Background: Though growing numbers of peer support workers are employed in the UK National Health Service (NHS), conflicts persist between core values of peer support and values which exert power within these services.
Objectives: To explore what NHS mental health professionals value about the peer support worker role.
Design: Five professionals from different professions and mental health settings were interviewed twice. The first interviews explored their experiences of working with peers. Transcripts were analysed using discourse analysis and psychosocial theory. Second interviews allowed participants to respond to the analysis and influence subsequent analysis.
Results: Mental health professionals valued peers for the deeply empathic, relational approach they brought, based in their subjective experience. Peer work was also valued for the affect‐focused quality of this work, and the challenge peers pose to existing values in mental health services. The values of peer support troubled dominant ways of working based in forms of knowledge that favour objectivity and hence encountered challenges.
Conclusions: Peers fulfil the role of amplifying the status of diverse forms of knowledge, values and related ways of working that have become marginalized in NHS mental health services. It is important that peers are not seen as an isolated solution to the marginalization of these forms of knowledge and values, but that their way of working becomes reflected in other roles whilst evoking change throughout these services.
Patient or Public Contribution: Patient and Public Involvement groups were consulted both in the design and analysis stages of the study.
Source: Health Expectations, Apr 2021; 24(2): 234-242
Factors influencing initiation of health behaviour conversations with patients: Cross‐sectional study of nurses, midwives, and healthcare support workers in Wales
Abstract: Aim: To identify factors influencing healthcare professionals’ engagement in health behaviour conversations with patients.
Design: Cross‐sectional survey.
Methods: Between April and June 2019, an online survey of 1338 nurses, midwives and healthcare support workers was conducted. The survey assessed whether staff felt comfortable initiating health behaviour conversations with patients about five behaviours (reducing alcohol intake; stop smoking; being more active; reducing their weight; and improving their diet) and barriers to conversation initiation. Health professionals’ own health‐related behaviours, self‐rated health and mental wellbeing, and socio‐demographic characteristics were recorded. Logistic regression models were built to assess factors associated with feeling comfortable initiating health behaviour conversations for each topic.
Result: Less than 50% of respondents reported feeling comfortable initiating health behaviour conversations with patients. Female staff, young professionals (18 to 29 years), those in lower staff grades and those with poorer health and low mental wellbeing were less likely to report feeling comfortable having health behaviour conversations across all topics. Those who did not adhere to physical activity and dietary guidelines were less likely to initiate a conversation about being more active and having a healthy diet, respectively. Not having time to discuss the topic, suitable space to hold a conversation, and feeling worried about offending/upsetting patients were the main barriers reported.
Conclusion: Around 6 in 10 members of the nursing, midwifery and healthcare support workforce in Wales potentially do not feel comfortable to initiate a health behaviour conversation with patients about health and wellbeing. Feeling less comfortable to initiate a conversation was associated with staff demographics and organizational factors.
Impact: We identified those less likely to initiate health behaviour conversations as well as personal and organizational barriers to initiation. This will help to target and tailor interventions to ensure staff are equipped and enabled to hold health behaviour conversations with patients.
Source: Journal of Advanced Nursing, Nov 2021; 77(11): 4427-4438
Peer-Facilitated Decision Making in Mental Health: Promises, Pitfalls, and Recommendations for Research and Practice
Abstract: Recognition has grown that peer support workers serve an important role in facilitating decision making about treatment and recovery among people with mental health conditions. This article provides examples of peer-facilitated decision support interventions in the literature, discusses promises and potential pitfalls associated with peers serving in decision support roles, and offers recommendations for research and practice. Examples were selected from the literature on decision support interventions for people with serious mental illnesses, such as schizophrenia, bipolar disorder, and major depression. Promises, pitfalls, and recommendations were informed by this research and by the literature on lived experience perspectives, the helper-therapy principle, and reported barriers to and facilitators of peers assisting with decision making. According to the included studies, peers may facilitate decision making in several ways (e.g., by asking service users about their goals or preferences, assisting them with using decision support tools, sharing stories, and facilitating access to information and resources). Peer-facilitated decision support may be associated with positive decision making and health outcomes for service users and peer support workers. However, providers need to carefully consider barriers to implementation of this support, such as inadequate resourcing, poor integration, and compromising of peer support values.
Source: Psychiatric Services, Sep 2022; Online ahead of print
Contact the library for a copy of this article
Experiences of mental health support workers in mental healthcare practice: Three visual arts narratives
Abstract: Introduction: Mental health support workers (MHSWs) make positive contributions to mental health recovery practice yet their roles and support needs are often unclear. This research explored the occupational lived experiences of three MHSWs working in Irish mental healthcare services.
Aim: The study examined the experiences and perceptions of MHSWs regarding their mental health recovery work.
Method: A narrative design was used incorporating participatory art‐based inquiry as a collaborative means of engaging participants. This innovative methodology enabled exploration and evocative expression of participants’ occupational experiences and stories.
Results: Participants revealed feelings of vulnerability and anxiety regarding personal mental health and supporting the mental health of others; a finding not commonly explored in previous research. MHSW skills and knowledge were evident; however, this expertise and recovery focus was not valued in mental health services.
Discussion: The strengths and challenges of MHSW engagement in service provision are discussed. Interdisciplinary team integration is explored in terms of contrasting recovery philosophies, practitioner vulnerability and professional demands and imperatives.
Implications for practice: Mental health teams need to engage with recovery principles, acknowledging strengths and vulnerabilities of all practitioners and establishing adequate supervision and support. Greater clarity and education is required concerning roles/scope of practice for MHSWs to enable productive interdisciplinary partnerships.
Source: Journal of Psychiatric and Mental Health Nursing, Dec 2021; 28(6): 1018-1028
Healthcare support workers' lived experiences and adaptation strategies within the care sector during the COVID-19 pandemic. A meta-ethnography review
Abstract: Support workers are an "invisible" part of the health sector often working during pandemics to support clients. This meta-ethnography screened 167 articles out of 211 results identifying 4 qualitative studies that explored the support worker's experiences during the COVID-19 pandemic. "Redundancy approach" was used to map non-essential criteria and the analysis was informed by the interpretative meta-ethnography method. Eight key themes identified from studies in UK and USA. The themes identified are: (1) job role; (2) marginalized profession; (3) impact of work; (4) concerns surrounding PPE; (5) transportation challenges; (6) level of support and guidance; (7) a higher calling and self sacrifice; (8) adaptation strategies. Adaptation strategies include purchasing their own masks, to policy and agency adaptation, cleaning, talk walks, meetings with colleagues or within the company. The adaptation strategies aim at tackling emotional distress and raise the level of appreciation that society or organizations show to the support workers.
Source: Home Health Care Services Quarterly, Jul 2022; Online ahead of print
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Midwives' and maternity support workers' perceptions of the impact of the first year of the COVID-19 pandemic on respectful maternity care in a diverse region of the UK: a qualitative study
Abstract: OBJECTIVES: To explore midwives' and maternity support workers' perceptions of the impact of the COVID-19 pandemic on maternity services and understand factors influencing respectful maternity care.
DESIGN: A qualitative study. Eleven semi structured interviews were conducted (on Zoom) and thematically analysed. Inductive themes were developed and compared with components of respectful maternity care. SETTING: Maternity services in a diverse region of the United Kingdom.
PARTICIPANTS: Midwives and maternity support workers who worked during the first year of the COVID-19 pandemic.
RESULTS: The findings offer insights into the experiences and challenges faced by midwives and maternity support workers during the first year of the COVID-19 pandemic in the UK (March 2020-2021). Three core themes were interpreted that impacted respectful maternity care: (1) communication of care, (2) clinical care and (3) support for families. 1. Midwives and maternity support workers felt changing guidance impaired communication of accurate information. However, women attending appointments alone encouraged safeguarding disclosures. 2. Maternity staffing pressures worsened and delayed care provision. The health service's COVID-19 response was thought to have discouraged women's engagement with maternity care. 3. Social support for women was reduced and overstretched staff struggled to fill this role. The continuity of carer model of midwifery facilitated supportive care. COVID-19 restrictions separated families and were considered detrimental to parents' mental health and newborn bonding. Overall, comparison of interview quotes to components of respectful maternity care showed challenges during the early COVID-19 pandemic in upholding each of the 10 rights afforded to women and newborns.
CONCLUSIONS: Respectful maternity care was impacted through changes in communication, delivery of clinical care and restrictions on social support for women and their infants in the first year of the COVID-19 pandemic. Future guidance for pandemic scenarios must make careful consideration of women's and newborns' rights to respectful maternity care.
Source: BMJ Open, Sep 2022; 12(9): e064731
Implementation Challenges and Recommendations for Employing Peer Support Workers in Emergency Departments to Support Patients Presenting after an Opioid-Related Overdose
Abstract: The placement of a peer support workers (PSWs) in emergency departments (ED) is a promising practice for supporting persons with opioid use disorder who are presenting with an overdose or related medical condition. However, this practice is underutilized. The objective of this study was to identify the challenges of employing PSWs in the ED and provide a checklist to increase the likelihood of their successful integration and retention in this environment. Qualitative methods were used to collect data from nineteen key stakeholders who worked in hospital settings. Using a social-ecological model, themes were identified at the system, hospital, and individual levels. To support integration of PSWs and buy in for the ED team, our findings indicate a need for a planning phase that includes collaboration between leadership, ED staff, and PSWs. Specifically, planning should address four areas: (1) hiring a PSW that is a good fit for the fast-paced ED setting, (2) education of ED staff on the value and role of PSWs, (3) establishing workflow protocols, and (4) providing PSWs with training and appropriate supervision.
Source: International Journal of Environmental Research and Public Health, Apr 2022; 19(9): 5276
Role of peer support workers in improving patient experience in Tower Hamlets Specialist Addiction Unit
Abstract: The aim of the project was to improve patient experience for people in Tower Hamlets Specialist Addictions Unit in order to increase satisfaction by 25% in 12 months starting in August 2014. The team used the model for improvement as part of ELFT's quality improvement programme to support iterative cycles of testing and learning. This involved support from the Trust's quality improvement team. The theory of change was visualised through a driver diagram. A number of outcomes were measured and plotted over time - patient satisfaction, staff satisfaction, and attendance to peer support groups. The impact of changes was then observed using the plan, do, study, act (PDSA) cycles. The changes that positively influenced the outcomes were continued and ones without such impact were discontinued. The most successful intervention to improve patient satisfaction so far was the introduction of peer support facilitation for the "Breakfast club" - recovery orientated meeting of patients with less emphasis on the medical aspects of treatment. Staff satisfaction is proven to be one of the best determinants of patient experience, so this is also measured and plotted over time together with patient's satisfaction and attendance. Service user satisfaction improves attendance and outcomes in this difficult-to-engage group of patients (people with both substance misuse and mental health problems). Patient perspectives and priorities might be quite different to that of the clinical team, further supporting the importance of involving and engaging them in any quality improvement work. Involving peer support workers in improving engagement of people with substance misuse related problems appears essential.
Source: BMJ Quality Improvement Reports, 2016; 5(1): u205967.w2458
Implementing peer support workers in clinically oriented sub-acute mental healthcare teams: New approaches - new challenges
Abstract: Introduction: Arguably, an approach including peer support workers and peer-operated service provision is the future of the public mental health workforce. However, to date, the inclusion of peer support workers in clinical teams has not been trialled. This research reports qualitative data regarding the integration of peer support workers in clinical mental health care teams. Theory /
Methods: Normalization Process Theory guided data collection and analysis to answer the research question: "How were peer support workers integrated into care delivery processes?" Participants were recruited from a recently implemented sub-acute mental health care team in South East Queensland, aiming to provide intensive case-management for people with mental illness. Participants were interviewed face-to-face prior to the commencement of the program (n=24) and six months after the program was established (n=21). A total of 16 participants were interviewed at both time points. Data were digitally recorded, transcribed verbatim and checked for accuracy. Data were analysed thematically. Two researchers independently read each interview and developed initial categories. Data were then collectively aggregated into higher order themes, continuing until all data were accounted for and the most parsimonious representation of themes was achieved.
Results: Clinicians did not fully understand the role of the peer support worker, or how to engage them in clinical care. Beyond their lived experience of mental illness, a common ground from which peer support workers could develop their role was lacking. Some peer support workers were employed for their cultural background as much as, if not more than their lived experience of mental illness, which further diluted and diversified roles. Discussion: Although clinicians enthusiastically embraced the idea of including peer support workers in care teams, poorly defined parameters of care provision in the peer support worker role within interactions with consumers sometimes caused tension. Never-the-less, peer support workers were valuable brokers of existing community capacity to support people with mental illness; working effectively with, and facilitating relationships between consumers and non-government organisations. Conclusion: Peer support workers are new and valuable members of sub-acute clinically oriented public mental health teams. Their role is important in integrating service provision between public mental health teams and non-government service providers.
Lessons Learned: There are multiple complexities associated with introducing people without a defined disciplinary background into health service provision teams. However, peer support workers are valuable team members, clinicians do learn how to work with them over time and they are able to support people who experience mental illness in ways that clinicians are not. Limitations: This research occurred in the context of a pilot program. Therefore, generalizability beyond this context cannot be assured. Some of the issues regarding working with peer support workers may have been related to the formation of new teams, rather than because the peer support workers were non-clinicians.
Future Research: Further research is required to establish the influence of clinical staff on the work of non-clinicians within clinical service provision teams, and to better understand the impact of the integration and connecting role that peer support workers adopted in this team.
Source: International Journal of Integrated Care, Jul 2017; 17(3): 79
Implementation and evaluation of clinical supervision for support workers in a paediatric palliative care setting
Abstract: Support workers represent a large proportion of the NHS workforce and yet their supervisory needs are often overlooked. This study focused specifically on a cohort of support workers in a community paediatric palliative care setting. Peer supervision was implemented for this group, initially face to face and then virtually. The experiences of clinical supervision for this group were investigated through responses to an online survey (n = 25) and two focus groups (n = 7). Survey data were analysed concurrently with a thematic analysis. The following themes and sub-themes were developed from transcribed focus groups: (1) Barriers to engagement (2) Being Listened to (3) What Worked Well: Logistics. Overall, delivery of supervision was effective to a mixed degree - though support workers appreciated a space to be listened to, their distrust of colleagues and other barriers impeded the capacity of supervision to achieve more than support and catharsis for this group. Future projects should focus on introducing more preliminary interventions to promote reflection and peer support for these groups as well as continue to consider the supervisory needs of support workers.
Source: Clinical Child Psychology and Psychiatry, Apr 2022; 27(2): 369-384
Developing a training programme for midwives and maternity support workers facilitating a novel intervention to support women with anxiety in pregnancy
Abstract: BACKGROUND: The RAPID-2 intervention has been developed to support women with symptoms of mild-to-moderate anxiety in pregnancy. The intervention consists of supportive discussions with midwives, facilitated discussion groups and access to self-management materials. This paper reports the development of a training programme to prepare midwives and maternity support workers to facilitate the intervention.
METHODS: Kern's six-step approach for curriculum development was used to identify midwives and maternity support workers training needs to help support pregnant women with anxiety and facilitate a supportive intervention. The stages of development included feedback from a preliminary study, stakeholder engagement, a review of the literature surrounding midwives' learning and support needs and identifying and supporting the essential process and functions of the RAPID intervention.
RESULTS: Midwives' reported training needs were mapped against perinatal mental health competency frameworks to identify areas of skills and training needed to facilitate specific intervention mechanisms and components. A training plan was developed which considered the need to provide training with minimal additional resources and within midwives' scope of practice. The training plan consists of two workshop teaching sessions and a training manual.
CONCLUSION: Future implementation is planned to include a post-training evaluation of the skills and competencies required to fully evaluate the comprehensive programme and deliver the RAPID-2 intervention as planned. In addition, the RAPID-2 study protocol includes a qualitative evaluation of facilitators' views of the usefulness of the training programme.
Source: BMC Pregnancy and Childbirth, Aug 2022; 22(1): 662
