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Examining what impacts on Healthcare Assistants’ wellbeing and their retention

Research Project Title

Wellbeing of lone working Healthcare Assistants (HCAs) delivering palliative care in the community and its impact on staff retention.

KeyWords

Palliative care, mixed-methods research, healthcare assistant, home care services, wellbeing, workforce

Challenge

Health Care Assistants (HCAs) have an important role caring for patients dying at home and supporting their family caregivers. HCAs often visit patients’ homes on their own, most frequently during the out of hours period. The complexity of this role, combined with how experienced and well-prepared for the role HCAs are, was reported to have an impact on their wellbeing. Staff turnover is high, which is difficult for the organisation managing care in the community and may impact the capacity of services to deliver high quality person-centred care to patients and families.

Research Project aims and methods

It is important to understand the level of self-reported wellbeing of lone workers and if they have an intention to leave the job. To gain this knowledge we designed a mixed-method sequential explanatory online study.

Phase 1: An online survey of community lone worker HCAs employed in UK organisations to scope the psychological wellbeing among this group and to assess and compare the psychological wellbeing and intention to leave among lone working HCAs in relation to their employment and demographic characteristics (e.g., gender, age, marital status, education level, care experience etc.).

Phase 2: Online interviews with community lone worker HCAs who completed the Phase 1 to explore in depth issues identified from the survey.

Quantitative data was transferred to SPSS, cleaned and subject to analysis using descriptive and inferential statistics. Free text answers were analysed alongside interview data using thematic analysis.

This research will provide a profile of the level of wellbeing of lone working HCAs in the UK and help their employing organisations understand the current situation regarding their intention to leave and the possible causes. The research team hope it will help to uncover approaches and actions that may be useful for retaining community lone workers and provide evidence for developing interventions and enhancing appropriate support and wellbeing strategies.

Public, patient and personal involvement (PPI)

A research advisory group has been established to assist in guiding the researchers throughout the research process. Members include current community HCAs, a nurse who previously worked as a HCA, a member of the public, and managers.

A member of the public and a nurse supporting a previous project (‘Lone working practices, support, and educational needs of Healthcare Assistants providing 24/7 palliative care in the community across the UK’) agreed to remain involved via the research advisory group. They have been involved in the early discussion shaping the research question and reviewed this research proposal. Further members joined the research advisory group after the funding application was submitted and have played an active role in developing the survey questions and interview guide, data analysis and dissemination activities.

Key Findings and next steps

  1. Higher wellbeing of healthcare assistants is linked to lower intention to leave their role (r (216) = -0.25, p <.001)
    • The majority of participants reported moderate to high levels of wellbeing. The levels of wellbeing observed in this study were similar or higher than those reported in the general UK population[1, 2]. However, 22.9 % of respondents had low levels of psychological wellbeing indicative of possible or probable depression based on the benchmark cut-off from other studies[2, 3].
    • 45% reported low intention to leave, 47% of respondents showed little intent either to stay or leave their job with only 8% of respondents reported high intention to leave.

 

  1. Over 80% of the survey participants believed their work impacted the lives of the people they worked with. Based on qualitative data, job satisfaction and the perception of finding role meaningful emerge as main factors for retaining individuals in their positions.

 

  1. Factors impacting on psychological wellbeing and intention to leave are complex and wide-ranging and can be divided into 3 levels: societal, organisational, individual (Figure 1.). Most commonly reported factors influencing wellbeing and intention to leave are:
    • job satisfaction and finding the role meaningful (individual)
    • workplace support (organisational)
    • lone working practices (organisational – this includes unpredictability of the role, driving at night over long distances into unknown areas, work-related duties outside of the shift times and others).
    • feeling recognised and valued (organisational and societal)

Figure 1. Factors impacting on psychological wellbeing and intention to leave of HCAs.

In conclusion, the results of this project offer valuable insights into the self-reported psychological wellbeing and intention to leave among lone working HCAs providing hospice care at home. By shedding light on these important aspects, our study contributes to a better understanding of the challenges faced by this workforce.
Furthermore, our findings serve as a foundation for the development of targeted interventions aimed at enhancing support, implementing wellbeing strategies, and improving retention rates among lone working HCAs.
Moving forward, it is imperative that policymakers, healthcare organizations, and stakeholders utilise this evidence to implement effective interventions and policies that support the wellbeing and retention of HCAs in the hospice sector.

Timeline

Survey: May-June 2023
Survey data analysis: June-July 2023
Interviews: July-August 2023
Full data analysis: September-October 2023
Outputs for dissemination expected from October 2023

Research Team

Timeline

Survey: May-June 2023
Survey data analysis: June-July 2023
Interviews: July-August 2023
Full data analysis: September-October 2023
Outputs for dissemination expected from October 2023

Ms Katarzyna A. Patynowska, Research Nurse, Marie Curie
Ms Raquel Fantoni, Research Manager, Marie Curie
Dr Felicity Hasson, Senior Lecturer, Ulster University
Dr Tracey McConnell, Senior Research Fellow, Marie Curie

Ms Katarzyna A. Patynowska, Research Nurse, Marie Curie

Ms Raquel Fantoni, Research Manager, Marie Curie

Dr Felicity Hasson, Senior Lecturer, Ulster University

  • Dr Anne Finucane, Senior Research Fellow, Marie Curie 

Dr Tracey McConnell, Senior Research Fellow, Marie Curie

Research Project Lead: Ms Katarzyna A. Patynowska, Research Nurse, Marie Curie

Dr Felicity Hasson, Senior Lecturer, Ulster University

Ms Raquel Fantoni, Research Manager, Marie Curie

Dr Emma Maun , Research Manager, Marie Curie (maternity cover)

Dr Anne Finucane, Senior Research Fellow, Marie Curie 

Dr Tracey McConnell, Senior Research Fellow, Marie Curie

Collaborators

Mr Peter Donnelly, Voices4Care, All Ireland Institute of Hospice and Palliative Care
Ms Colette McAtamney, Registered Nurse, previously Healthcare Assistant, Marie Curie
Mr Jonathan Clemo, Associate Director Strategic Partnerships & Services, Marie Curie
Ms Epiphany Leone, Wellbeing Lead, Marie Curie
Ms Gill Walpole, Healthcare Assistant, Marie Curie
Ms Natasha Wynne, Senior Policy Manager, Marie Curie

Funding

The project is funded by Marie Curie Small Research Grants Scheme 2022
Grant Reference: MCSGS-22-801

Research project outputs and impact

Marie Curie Research Conference 2024

Oral presentation (selected abstract)

Wellbeing of lone working Healthcare Assistants and its impact on staff retention in hospice care at home services

EAPC Research Congress 2024

Oral presentation (selected abstract)

Wellbeing of lone working Healthcare Assistants and its impact on staff retention in hospice-at-home services

Painting by Dáire Lawlor, Northern Ireland based artist depicting multifaceted role of MC Healthcare Assistant. This art has been commissioned by the researcher Kasia Patynowska and funded by MC Small Research Grant

MCSGS-22-801.

Related prior work

Patynowska KA, McConnell T, McAtamney C, Hasson F. ‘That just doesn’t feel right at times’–lone working practices, support and educational needs of newly employed Healthcare Assistants providing 24/7 palliative care in the community: A qualitative interview study. Palliative Medicine. 2023 Jun 19:02692163231175990.

Fee A, Hasson F, Slater P, Payne S, McConnell T, Finlay DA, McIlfatrick S. Out-of-hours community palliative care: a national survey of hospice providers. International Journal of Palliative Nursing. 2023 Mar 2;29(3):137-43.

Fee A, Muldrew D, Slater P, Payne S, McIlfatrick S, McConnell T, Finlay DA, Hasson F. The roles, responsibilities and practices of healthcare assistants in out-of-hours community palliative care: A systematic scoping review. Palliative medicine. 2020 Sep;34(8):976-88.

For Further Information Contact:

Kasia.Patynowska@mariecurie.org.uk
+447514929000
Twitter handle @KPatynowska