The emergent role of the link worker: a study in collaboration

Partnership working is integral to New Labour's approach to modernising health and social care services for vulnerable groups such as children with complex needs. This paper draws on an initiative from Cornwall and the Isles of Scilly in which strategic and operational change have been promoted across the health and social care community in order to provide co-ordinated assessment and care for children with complex needs and their families. The introduction of link workers has been central, key contacts for families and professionals alike who are drawn from a wide range of backgrounds. The political imperative for partnership, combined with the commitment and commonality of purpose of front-line staff, has proved sufficient to facilitate inter-professional working without many of the enabling factors that are often regarded as important, such as co-location or parity of status. However, a number of organisational barriers to sustainability remain and the degree to which a strong operational lead can secure the necessary breadth of strategic resource allocation and support remains questionable.     

Establishing a new service role in tuberculosis care: the tuberculosis link worker

Title. Establishing a new service role in tuberculosis care: the tuberculosis link worker Aim. This paper is a report of a study to develop a social outreach model of care, including the role of a link worker in developing collaborative care pathways, for marginalized groups with tuberculosis. Background. Social risk factors such as homelessness and substance misuse are associated with poor treatment outcomes. Models of interprofessional practice to address the health and social care of patients are needed to improve outcomes. Methods. A process evaluation involving a prospective cohort study of 100 patients and interviews with eight agencies involved in their care was conducted in London between January 2003 and April 2005. Outcome measures included a profile of patient need to guide service development; referrals to care providers; goal attainment; social improvement and treatment outcomes; and agencies’ views on the benefits of link working. Findings. The median age of the sample was 32·4 years and 62% were males. Reasons for referral to the link worker included housing need (56%); welfare benefits (42%); immigration (29%) and clinical management issues (28%). One‐third of the patients were referred to other agencies. Goals, as agreed in the care plan, were attained totally or partially for 88% (59/67) of patients and 78% of patients successfully completed treatment. Barriers to attaining goals included service criteria which excluded some groups of patients and, in some cases, a patient’s inability to follow a course of action. Conclusion. Link workers can mitigate some of the social risk factors that complicate the treatment of tuberculosis by enabling integrated health and social care.     

The emerging role of the urban-based aboriginal peer support worker: A Western Australian study

PurposeTo explore the self-perceived role of the Aboriginal peer support worker working with families with young children. This study was a component of a larger participatory action research study undertaken in a Western Australian metropolitan setting to develop and evaluate the suitability, feasibility and effectiveness of an Aboriginal peer-led home visiting program.MethodsFocus group interviews were carried out with peer support workers using unstructured and semi-structured interviews within Action Learning Sets. Data were analysed using thematic analysis.ResultsThe overarching theme on the self-perceived role of the Aboriginal peer support worker was Giving Parent Support, with subsidiary themes relating to development and ongoing sustainability of the support.DiscussionThe peer support workers viewed their role as providing parent support through enabling strategies which developed client acceptance and trust, delivered culturally relevant support, advocated for families, developed therapeutic engagement and communication strategies, and created safe home visiting practices. They recognised the importance of linking families with community support such as community child health nurses which was important for improving long term physical and psychosocial health outcomes for children.ConclusionAboriginal Peer Support Workers identified their emerging integral role in the development of this unique culturally acceptable home visitingsupport for Aboriginal parents. Innovative approaches towards client engagement demonstrated their value in developing creative ways of working in partnership with families, community support services and child health nurses across a range of challenging psychosocial environments.     

Evaluation of the multifunctional worker role: a stakeholder analysis

Health care organizations are rethinking how care is delivered because of incentives generated by managed care and a competitive marketplace. An evaluation of a work redesign project that involved the creation of redesigned unlicensed caregiver roles is described. The effect of model implementation on patients, multiple categories of caregivers, and physicians was measured using several different approaches to data collection. In this evaluation, caregivers perceived the institutional culture to be both market-driven and hierarchical. The work redesign, along with significant changes in unit configuration and leadership over the same period, significantly reduced job security and satisfaction with supervision. Quality indicators suggested short-term declines in quality during model implementation with higher levels of quality after implementation issues were resolved. Objective measurement of the outcomes of work redesign initiatives is imperative to assure appropriate adjustments and responses to caregiver concerns.     

The role of the support worker in nursing homes: a consideration of key issues

The aim of this paper is to critically consider the role of the support worker in the nursing home sector and with particular reference to the United Kingdom situation. With the expansion of the nursing home sector, there is an increasing population of support workers in this field. Literature in this paper covers the period between 1989 and 2002, beginning with the build up to the introduction of the National Health Service and Community Care Act (available at: http://www.hmso.gov.uk), which necessitated a major shift between public and private sector employment. The findings of this paper indicate limited research, investigating the role of support workers in general and specifically those working in the nursing home sector. The literature suggests that the majority of the role focuses on direct patient care, however, a lack of role clarification was evident and differences emerged between the views of support workers and Registered Nurses regarding the place of support workers in the care process. In particular, support workers saw their role as similar to that of the Registered Nurse, although Registered Nurse regarded 'basic nursing care' as the key remit of the support worker role. The paper also indicated inadequate preparation and subsequent supervision of support workers. These key findings indicate that role clarification, appropriate preparation and a process of continuing development require careful consideration by managers if the positive contribution of this group of care workers is to be fully realized. Furthermore, while there exists no central source of funding to finance the role preparation and mentorship of support workers, training provision will remain ad hoc. Obtaining core funding would allow for the training and education of support workers to become standard practice, which, in turn, is more likely to lead to improvements in the planning and resourcing of care provision. Equally, further research is needed if the support worker role is to be used effectively and efficiently within the expanding nursing home sector.     

Physicians’ perceptions of the role of the dental hygienist in interprofessional collaboration: a pilot study

ABSTRACT

Shifts in healthcare models, and greater numbers of patients seeking care, has encouraged professional organizations to recommend collaborative healthcare teams. In the realm of oral health, the American Dental Hygienists’ Association (ADHA) and the Commission on Dental Accreditation (CODA) have set recommendations that interprofessional collaboration (IPC) be emphasized in the profession. The purpose of this study was to determine physicians’ perceptions of the role of the dental hygienist in IPC. A pilot study utilizing a nonprobability sampling method which included a purposive sample of 30 licensed physicians was conducted. The survey addressed: personal experiences with a dental hygienist, dental hygienists’ roles working in collaboration with physicians, experiences with IPC, benefits of working with dental hygienists, barriers, and demographics. The majority (77.7%) supported the concept that dental hygienists have the necessary education and are important in IPC. Over 77.7% indicated dental hygienists would add value to a medical practice. Time and transfer of data were identified as primary obstacles in working collaboratively with dental hygienists. Findings revealed dental hygienists have the necessary education to be valuable members of IPC teams. Future research is needed to broaden the scope of studies among dental hygienists and other members of IPC teams.     

The role of the support worker in the health-care team

A one-year study on the role of the support worker in the ward health care team is reported. The brief was to investigate a number of districts chosen on the basis of interesting staffing patterns. The study gave a useful indication as to how future research into skill mix might be carried out, and showed that attention must be given by management to the workforce planning problems faced by ward staff.     

Interdisciplinary collaboration: a study in progress

A multidisciplinary, multi-institutional collaborative effort was initiated to address the perspectives of health care literacy in an urban/rural area of west Texas. This article presents the mechanisms utilized in the development and implementation of this collaborative process. Individuals within multiple institutions realized the importance of working together to address health care issues. As a result of this consortium development, an initial endeavor addressing health care literacy and functional health status was initiated. The development of the consortium and the project is presented in this article to provide a model for consortium development applicable to other professions.     

The role of the child primary mental health worker

The purpose of the study was to explore how the child primary mental health worker role, as defined in the Health Advisory Service document, has been interpreted in each of the mental health trusts in England. Studies have indicated there is a deficit in recognition and treatment skills, by primary care workers, of psychological difficulties presented by children and young people, which could be supported by specialist mental health workers. A postal questionnaire was sent to 169 English mental health trusts. There were 98 returns (59%) indicating that 22 child mental health services had established this new role and a further 42 were planning to develop it in the near future. The child primary mental health workers were spending on average 35% of their time in primary care offering consultation and training to health professionals, rather than direct work with children and families. This development was found to be a growing area of advanced practice for nurses. Given the stated intention of the majority of services to develop or retain this role, further evaluation studies will be needed.     

The role of the senior health care worker in critical care

This article identifies that the introduction of the support worker role in the critical care team facilitates flexibility when organizing and managing patient care. Qualified nurses' time can be used more effectively, enhancing the quality of the patient care delivered. Aspects of the qualified nurses' workload in critical care can be shared and delegated successfully to unqualified staff. It is our view that staffing levels in critical care environments need to be reviewed with more flexible working practices to meet the current and future demands of critical care. There is a need for national consensus amongst qualified nurses to clarify and define the role of the support worker and develop a critical care competency framework to standardize training. To ensure proficiency, adequate training and appropriate accountability, support workers require regulation by a nationally recognized body.     

The emergent role of microRNAs in molecular diagnostics of cancer

A technical breakthrough that expands the scope of clinical samples amenable for global microRNA analysis is highlighted in this Commentary.     

The role of the mental health support time recovery worker

Today in the NHS new ways of working that aim to improve care for service users, address staff shortages and increase job satisfaction are continually being created, piloted and introduced in phases. This article examines one such role in the adult mental health arena--the support time recovery worker.     

Community collaboration in disaster: the role of voluntary agencies

Although the United States has been impacted by numerous devastating disasters over the last 10 years, there have been only limited efforts between the governmental and non-profit/voluntary organizations to meet the multiple disaster health and mental health needs of the community. Too often, responding organizations compete to provide services, duplicate efforts, and frequently under-estimate the need for services. Recent efforts have been undertaken by The American Red Cross and other groups to resolve this issue. Governmental and community-based organizations have been invited to participate in planning sessions to pre-identify roles and responsibilities, as well as to exchange key information about the services each group can and does provide. These efforts have lead to an increased awareness of the potential problems and the development of cohesive plans to provide medical and emotional support services to impacted communities. This has led to improved care for those with serious injuries or psychological crisis, while those with less critical problems have been managed appropriately without needing to be immediately referred to overcrowded emergency departments or physician's offices.