Search

BACKGROUND: Healthcare is labour intensive, and the importance of a cost-effective and safe health workforce is a critical consideration in the planning of human resources for health. Efforts to constrain costs and manage nurse workloads and staffing norms have seen an increased use of task-shifting or task-sharing as innovations to address strained healthcare staff shortages. The use of hospital-based ward assistants like orderlies has been suggested as a task-shifting initiative that can help nurses and other healthcare professionals to optimise their shift time by spending it on the core clinical care duties that require more technical skills; and also, significantly reduce risks for rationed, delayed or missed care. Characterization, use or non-use, management, and supervision of ward assistants tend to vary globally. This scoping review will map out and document roles and duties, training, regulatory, and clinical governance mechanisms for hospital ward assistants as well as their impact on patients’ care and staffing norms. METHODS: We will conduct a scoping review following the Joanna Briggs Institute (JBI) evidence synthesis guideline. We will conduct searches for relevant literature from PUBMED, CINAHL, PsychINFO, EMBASE, Web of Science, Scopus, and Google Scholar using keywords and synonyms for ward assistants, supportive care assistants, and orderlies. Two reviewers shall independently conduct searches and screen results on relevance, initially by title and abstract, followed by full-text screening based on a pre-defined search strategy and against the inclusion and exclusion criteria following the Participants, Context, and Concepts (PCC) framework. End Note software and a pre-developed form on MS Excel shall be used to aid in screening and data charting. Data charting shall be used to extract relevant information from the eligible full texts namely, bibliographic details, study context, and characteristics, concepts, roles and duties, training content, patient care outcomes, nurses’ experiences, budget implications, and staffing norms related to the utilisation of ward assistants. ANALYSIS: The PRISMA-ScR guidelines shall be used to synthesise, chart, and report evidence on the concepts and roles that characterize ward assistants, their training and management, as well as their impact on patient care in hospital settings across the globe. The findings shall be used to identify research, education, and practice gaps, and implications for human resource management, as well as provide recommendations for future work on task-shifting and task-sharing in healthcare.

Search Strategy for the Scoping review on the role and impact of ward assistants on patient care

The subject of British military medicine during the First World War has long been a fruitful one for historians of gender. From the bodily inspection of recruits and conscripts through the expanding roles of women as medical care providers to the physical and emotional aftermath of conflict experienced by men suffering from war-related wounds and illness, the medical history of the war has shed important light on how the war shaped British masculinities and femininities as cultural, subjective and embodied identities. Much of this literature has, however, focused on the gendered identities of female nurses and sick and wounded servicemen. Increasingly, however, more complex understandings of the ways in which medical caregiving in wartime shaped the gender identities of male caregivers are starting to emerge. This article explores some of these emerging understandings of the masculinity of male medical caregivers, and their relationship to the wider literature around the complex and sometimes contradictory relationship between warfare and medicine. It examines the ways in which the masculine identity of male medical caregivers from the ranks of the Royal Army Medical Corps, namely stretcher bearers and medical orderlies, was perceived and represented both by the men themselves and those they cared for. In doing so it argues that total war played a crucial role in shaping social and cultural perceptions of caregiving as a gendered practice. It also identifies particular tensions between continuity and change in social understandings of medical care as a gendered practice which would continue to shape twentieth-century British society in the war’s aftermath.

The cooperative, invisible non-clinical work of hospital orderlies is often overlooked. It consists foremost of transferring patients between hospital departments. As the overall efficiency of the hospital is highly dependent on the coordination of the work of orderlies, this study investigates the coordination changes in orderlies' work practices in connection to the implementation of a workflow application at the hospital. By applying a mixed methods approach (both qualitative and quantitative studies), this paper calls for attention to the changes in orderlies' coordination activities while moving from a manual and centralized form to a semi-automatic and decentralized approach after the introduction of the workflow application. We highlight a set of cross-boundary (spatial and organizational) information-sharing breakdowns and the challenges of orderlies in maintaining local and global coordination. We also present design recommendations for future design of coordination tools to support orderlies' work practices.

Background The increasing proportion of elderly people with respective care requirements and within the total population stands against aging personnel and staff reduction in the field of health care where employees are exposed to high load factors. Health promotion interventions may be a possibility to improve work situations and behavior. Methods A systematic literature search is conducted in 32 databases limited to English and German publications since 1990. Moreover, internet-searches are performed and the reference lists of identified articles are scanned. The selection of literature was done by two reviewers independently according to inclusion and exclusion criteria. Data extraction and tables of evidence are verified by a second expert just like the assessment of risk of bias by means of the Cochrane Collaboration’s tool. Results We identified eleven intervention studies and two systematic reviews. There were three randomized controlled trials (RCT) and one controlled trial without randomization (CCT) on the improvement of physical health, four RCT and two CCT on the improvement of psychological health and one RCT on both. Study duration ranged from four weeks to two years and the number of participants included from 20 to 345, with a median of 56. Interventions and populations were predominantly heterogeneous. In three studies intervention for the improvement of physical health resulted in less complaints and increased strength and flexibility with statistically significant differences between groups. Regarding psychological health interventions lead to significantly decreased intake of analgesics, better stress management, coping with workload, communication skills and advanced training. Discussion Taking into consideration the small to very small sample sizes, other methodological flaws like a high potential of bias and poor quality of reporting the validity of the results has to be considered as limited. Due to the heterogeneity of health interventions, study populations with differing job specializations and different lengths of study durations and follow-up periods, the comparison of results would not make sense. Conclusions Further research is necessary with larger sample sizes, with a sufficient study duration and follow-up, with a lower risk of bias, by considering of relevant quality criteria and with better reporting in publications., GMS Health Technology Assessment; 7:Doc06; ISSN 1861-8863

L’objectif de cet article est de démontrer en quoi l’intégration de nouveaux préposés aux bénéficiaires dans les CHSLD au Québec peut être analysée comme un processus d’habilitation, c’est-à-dire de construction identitaire des recrues par le groupe de pairs, à travers deux phases spécifiques : les préposés expérimentés jugent rapidement la capacité de la recrue à supporter la lourde charge de travail durant la phase dite d’ « orientation », en sélectionnant les recrues selon ce critère ; puis ils transmettront certaines compétences informelles aux recrues sélectionnées et considérées comme capables de faire partie du groupe de pairs., The aim of this article is to show how the integration of new nursing assistants in nursing homes in Quebec can be analyzed as a process of “enablement” or identity construction of the recruits by peer group through two specific phases: experienced nursing assistants quickly judge the ability of the recruit to support the heavy workload during the phase known as “orientation”, selecting recruits by this criterion; and they will transmit some informal competences to recruits selected and considered able to be part of the peer group.