Managing Delegation to Physiotherapy Assistants: Application of a Functional Analysis Model

This paper addresses the need for systematic delegation of tasks to physiotherapy assistants. A model of delegation is presented that encapsulates the issues necessary to manage delegation in a system that is cost-beneficial without loss of quality.It is argued that task analysis is necessary to enable decisions to be made on whether subtasks are knowledge, rule or skill based and thus suitable for delegation. Following application of criteria to allocate tasks to personnel, cost-benefit analysis is used to consider whether the training investment is worth while.It is suggested that the working relationship and communication network between physiotherapist and assistant, with the arrangement of the working environment, will facilitate delegation and ensure that the patient receives appropriate care.     

连云港市养老护理员现状调查及培训对策的研究

目的提升养老护理员的专业水平。方法采用访谈及问卷调查,评估我市不同层次养老机构62名养老护理员的现状及学习需求。探讨医学院校与行业协会、养老机构合作研究,采取讲授、操作示教、信息化网络平台等培训对策。结果调查显示,养老护理员接受相关培训的比例及持证上岗率很低,受访者普遍认为养老护理员非常有必要进行培训学习及接受继续教育。参加养老护理员培训的人数增加,培训效果提高,群众反映良好。结论养老护理员的培训应形式多样、内容丰富、多处设点,并充分利用网络资源以提高培训效果。     

Perspectives on caregiving: A qualitative evaluation of certified nursing assistants

This study sought Certified Nursing Assistants' (CNAs) perspectives on the activities that compose quality care. CNAs provide the majority of hands on care in nursing homes positioning them to have a unique perspective on factors that constitute good quality care. Using semi-structured interviews, 23 CNAs from New York State nursing homes were asked to identify factors they felt were components of good care. Interviews were recorded, transcribed verbatim, and coded using open coding. Three themes emerged: (1) technical aspects of care; (2) care of the environment; and (3) a little bit more. Our results emphasize the complexities of providing care that go beyond items that can be regulated. Assessments of quality care should incorporate the voices of CNAs.     

医院护理辅助人员职业防护知识现状及影响因素调查

目的：了解医院护理辅助人员职业防护知识现状及其影响因素。方法采用自行设计的问卷对北京市某三级甲等综合医院97名护理辅助人员的职业防护知识现状及其相关因素进行调查。结果97名护理辅助人员防护知识总得分为（31．87±0．244）分,得分正确率范围为71．1％～100％。相关性分析显示,工作年限与防护知识呈正相关（r＝0．358,P＜0．05）。接受过院内培训的护理辅助人员其物理和化学防护得分高于未接受培训者,差异有统计学意义（Z值分别为－2．314,－2．000;P＜0．05）。结论护理辅助人员职业标准化亟待建立,护理辅助人员的防护知识还有待提高,应根据护理辅助人员的工作年限进行持续的有侧重点的强化培训。     

养老院护士及护理员对老年人跌倒相关因素认知情况调查研究

目的:了解养老院中护士与护理员对老人跌倒各种因素认识程度,从管理的角度增加相关人员知识的培训,完善相关管理制度,减少老年人跌倒的发生。方法:采用自设调查问卷,对养老院中护士和护理员分别进行问卷调查。结果:其在跌倒的相关因素方面有一定的认识,在疾病因素、护理因素、环境因素、危害因素方面,护士和护理员认知程度有统计学差异(P0.01)。结论:护士、护理员对老人年跌倒相关因素均有一定认识;护理员较护士对老年人跌倒相关知识少,对老年人跌倒的疾病因素、护理因素、环境因素、危害因素等方面认识不足。     

Role, Training and Job Satisfaction of Physiotherapy Assistants

Physiotherapy assistants form approximately 20% of the work force within physiotherapy departments and yet little is known about them.

The purpose of this study was to assess the current role of physiotherapy assistants in one NHS Region via postal questionnaire, identifying tasks performed and levels of responsibility and supervision; assessing the level of satisfaction of physiotherapy assistants; and comparing these findings with a previous study in 1991. A response rate of 85% (424 assistants) was achieved.

The results showed that there is indication of increasing responsibility, independence and specialist skills of physiotherapy assistants since 1991. Training is locally determined and varied. Update of national training initiatives is limited. Overall physiotherapy assistants are satisfied with their jobs (91%). Specific areas of dissatisfaction are pay and career development. Satisfaction is associated with levels of supervision, in-service training and age (p < 0.05).     

Pain in Alzheimer's disease: nursing assistants' and patients' evaluations

AIM: This paper reports on a study examining the level of agreement between the pain perceptions of nursing assistants, older people without dementia and patients with Alzheimer's dementia. It was hypothesized that nursing assistants would overestimate the pain experience of patients with Alzheimer's dementia. BACKGROUND: There is now increasing evidence that, in contrast to other subtypes of dementia, patients with Alzheimer's disease might experience a decrease in pain. It is unfortunate that these latest insights into the complex relationship between subtypes of dementia and pain are not always included in education programmes for nursing assistants. METHOD: Twenty patients with Alzheimer's disease and 17 older people with arthrosis and/or osteoporosis but no dementia and their personal nursing assistants participated in the study. Pain experience was assessed using the Coloured Analogue Scale for the assessment of Pain Intensity and Pain Affect, the Faces Pain Scale, and the Checklist of Non-verbal Pain Indicators. The data were collected in 2002-2003. RESULTS: Before and after walking, the absolute difference in pain evaluation between nursing assistants and older people without dementia was statistically significantly less than the difference in pain evaluation between nursing assistants and patients with Alzheimer's disease on the Coloured Analogue Scale for Pain Intensity (P = 0.007 and P = 0.04, respectively) and on the Coloured Analogue Scale for Pain Affect (P = 0.009 and P = 0.01, respectively). CONCLUSION: Nursing assistants may overestimate the extent of suffering from pain of patients with Alzheimer's disease. They might be very well able to estimate this pain, provided they were educated about new insights into the influence of the various subtypes of dementia on pain.     

医院智慧护理信息系统的构建与应用

[目的]基于“互联网+护理”的软硬件一体化解决方案,构建智慧护理信息化平台,并探讨其在临床中的应用效果。[方法]对医院智慧护理信息系统使用前后的不良事件、护理工作耗时、病人护理满意度进行调查比较。[结果]智慧护理信息系统使用后的不良事件发生率、护理工作耗时明显低于使用前(P<0.05),病人护理满意度明显高于使用前(P<0.05)。[结论]医院智慧护理信息系统应用于临床工作中能优化工作流程,提高护理工作效率,简化工作方式,降低不良事件发生率,改善护患关系,推动医院护理信息化的建设和发展。     

Health care assistants' role,function and development: results of a national survey

Intensive care has developed as a speciality since the 1950s; during this time there have been major technological advances in health care provision leading to a rapid expansion of all areas of critical care. The ongoing problem of recruiting appropriately qualified nurses has affected staffing levels in many units and continues to be a national problem. For many, the answer lies in employing health care assistants to support the work of registered nurses. A key aim of the British Association of Critical Care Nurses is to promote the art and science of critical care nursing by providing representation for its members, by responding to political and professional change and by producing and publishing position statements. A primary component of the work surrounding the development of this second position statement was the gathering of contemporary information in relation to the role of health care assistants within critical care units throughout the UK, through a survey of 645 critical care units within the UK. At present the impact upon the role of the critical care nurse is not fully understood, with research in this area suggesting that although there is a role for the health care assistant in the critical care environment, this should only be undertaken with a full analysis of this impact upon the work of the registered nurse.     

Position statement on the role of health care assistants who are involved in direct patient care activities within critical care areas

Intensive care has developed as a speciality since the 1950s, and during this time, there have been major technological advances in health care provision, leading to a rapid expansion of all areas of critical care. The ongoing problem in recruiting qualified nurses in general has affected, and continues to be a problem for, all aspects of critical care areas. During the past decade, nursing practice has evolved, as qualified nurses have expanded their own scope of practice to develop a more responsive approach to the complex care needs of the critically ill patient. The aim of this paper is to present the British Association of Critical Care Nurses (BACCN) position statement on the role of health care assistants involved in direct patient care activities, and to address some of the key work used to inform the development of the position statement.     

The Future of Emergency Medicine

Background

The specialty of emergency medicine (EM) continues to experience a significant workforce shortage in the face of increasing demand for emergency care.

Summary

In July 2009, representatives of the leading EM organizations met in Dallas for the Future of Emergency Medicine Summit. Attendees at the Future of Emergency Medicine Summit agreed on the following: 1) Emergency medical care is an essential community service that should be available to all; 2) An insufficient emergency physician workforce also represents a potential threat to patient safety; 3) Accreditation Council for Graduate Medical Education/American Osteopathic Association (AOA)-accredited EM residency training and American Board of Medical Specialties/AOA EM board certification is the recognized standard for physician providers currently entering a career in emergency care; 4) Physician supply shortages in all fields contribute to—and will continue to contribute to—a situation in which providers with other levels of training may be a necessary part of the workforce for the foreseeable future; 5) A maldistribution of EM residency-trained physicians persists, with few pursuing practice in small hospital or rural settings; 6) Assuring that the public receives high quality emergency care while continuing to produce highly skilled EM specialists through EM training programs is the challenge for EM's future; 7) It is important that all providers of emergency care receive continuing postgraduate education.     

无陪护医院医疗护理员培训体验的质性研究*

目的: 了解医疗护理员接受培训的体验,为构建培训层级管理体系提供参考。方法: 采用质性研究中的现象学研究方法,选取无陪护医院完成培训的11名医疗护理员进行深度访谈,应用Claizzi七步分析法对资料进行分析、整理、归纳出主题。结果: 从被访人的内心感受、亲身经历提炼出2个主题6个方面内容。主题1为认知与情感的双重体验,包括4个方面,分别为职业认同感和自我肯定、学习的潜能与乐趣、护理安全意识提升、知识与技能的获取。主题2为培训项目整体印象,包括2个方面,分别为培训内容实用性强、期待培训形式更加多样化。结论: 护理员培训是提升医疗护理员队伍整体素质的必要手段,是无陪护医院落实护理服务,满足患者健康护理需求的保障。     

Physician assistants in English primary care teams: A survey

Ensuring that health care teams have a mix of skilled professionals to meet patient need, safely and effectively, is a priority in all health services. The United Kingdom, like a number of other countries, have been exploring the contribution physician assistants, who are well established in the United States of America, can make to health care teams including primary care. This study investigated the employment of physician assistants in English primary care and their contribution through an electronic, self report, survey. Sixteen physician assistants responded, who were working in a variety of types of general practice teams. A range of activities were reported but the greatest proportion of their time was described as seeing patients in booked surgery appointments for same day/urgent appointments. The scope of the survey was limited and questions remain as to patient and professional responses to a new professional group within English primary care.