Holistic Care and Assessment in Primary Care: The Healthcare Support Worker Role
The developing role of the Healthcare Support Worker (HCSW) is now
widely recognised and considered a fundamental part of the NHS Modernisation Agenda (Wanless, 2003; Wag, 2005; WAG, 2010), in order to increase flexibility and capacity and improve efficiency and effectiveness by making best use of staff resources and skills (Spilsbury et al, 2011). Assessing and caring for people holistically has now become part of the appropriately trained HCSW’s role in general practice. Appropriate delegation and understanding one’s own accountability are critical to taking on this developing role. The Code of Conduct for HCSW in Wales (WAG, 2011) and the All Wales Guidelines for Delegation (WAG, 2010) clearly set out the standards that are to be achieved in order that high quality, safe and effective care is delivered by HCSWs.
The term ‘holistic’ refers to a philosophy of nursing
practice that considers all aspects of patient care, considering the physical, emotional, social, economic and spiritual needs of patient/clients/service users. According to (WAG, 2010) failure to or inconsistent Within primary care all members of the nursing team will approaches to delegation can have a negative make an holistic assessment. Gathering of information impact on the quality of care and the culture of the and the formulation of judgements regarding a person’s work environment. Delegation is not new and is health, situation, needs and wishes which should guide practiced every day in a range of work further action (DOH, 2000). It is the first stage in the environments. Delegation is often undertaken as a nursing process. sub-conscious function. Its purpose is to ensure: Service users receive timely and appropriate care. Staff resources are utilised effectively, work is shared fairly. HCSW feel valued and motivated, ‘The gathering of information and the formulation of which can achieve team success. It can also be judgments regarding a person's health, situation, needs positive to make sure the HCSW is trained and & wishes, which should guide further action.’ (DoH, thinking and working more holistically for the best 2000) The holistic nurse/HCSW is an instrument of care possible for the patient. healing and a facilitator in the healing process. Holistic nurses/HCSW honour each individual's subjective experience about health, health beliefs, and values. (RCN, 2010) state that all health care teams include a range of registered professionals, health care assistants (HCAs), assistant practitioners (APs) and students. It is vital that each member of the team is clear about their level of accountability It’s about collecting appropriate information or data and that the registered staff are confident when about a person, his/her carer and family. This could delegating tasks to their colleagues. That every be :- objective .. Involving blood pressure or member of the team is trained appropriate before subjective.. based on a professional’s feelings, values providing holistic care to the patient. & beliefs.
Setting the Direction (WAG, 2010) is a
community based strategy that To ‘undertake and document a comprehensive advocates a paradigm shift from hospital systematic and accurate nursing assessment of to community based care in Wales. the physical, psychological, social and spiritual Holistic care and assessment involving needs of the patients, clients and communities.’ HCSW’s in the primary care setting, will (DoH, 2000) The nurse/HCSW needs to be able • Observe enhance the patient experience by to provide a nursing diagnoses to identify the • Touch working in partnership with patients and patient’s needs. To ensure that the services • Listen families to identify and address their meet the needs of the patient and to avoid risks • Smell holistic health and social care needs, to independence. To also develop goals and • Use equipment to record vital signs:- whilst encouraging and supporting outcomes and to develop care plans. temperature, blood pressure, pulse, independence (WAG, 2005). respirations • Assessment Tools
• All patients and clients have a right to • Breathing effort • Pulse
receive information about their condition. • Skin colour • Temperature • You must always respect a patient’s • Size of patient • Sweating autonomy. • Swelling • Clamminess • No-one has the right to give consent on • Distress • Pain behalf of another competent adult. • Rashes • Sensation • You must treat information about patient’s • General body language • Swelling and clients as confidential and use it only for • Sputum the purpose for which it was given. • Urine faeces • You should seek patient and client wishes regarding the sharing of information with their family and others. (NMC, 2008)
• Coherence • Patient hygiene standards should be
• Family • Communication ability assessed. • Carers • Noise of breathing • Urinary tract infections maybe • Healthcare Assistants • History of events evident • Student Nurses • Ask questions in the correct way • A smell of ketones could indicate a • Qualified Nurses (be diplomatic, specific, phrase patient who is starved or a patient • Nurse Specialist's questions to provide yes or no with diabetic ketoacidosis • Doctors answers if the patient is unable • Sputum to speak clearly. • Wounds References Department of Health (2000) Nurse, midwives and health visitors (training) Amendment Rules approved order 2000. Stationary office. London NMC (2008) Code of Professional Conduct: standards for conduct performance and ethics. http://www.rcn.org.uk/__data/assets/pdf_file/0008/361907/Accountability_HCA_leaflet_A5_ final.pdf. Welsh Assembly Government (2005) Making the Connections Designed for Life: Creating World Class Health and Social Care for Wales in the 21st Century. Cardiff, Welsh Assembly Government. Wanless D (2003) Securing our Future Health: Taking a Long- Term View. The Final Report. London: Department of Health. Welsh Assembly Government (2010) Setting the Direction: Primary and Community Strategic Delivery Programme. Cardiff, Welsh Assembly Government. Welsh Assembly Government (2011) Code of Conduct for Healthcare Support Workers in Wales. Cardiff, Welsh Assembly Government. Spilsbury, K., Adamson, J., Atkin, K., Bartlett, C., Bloor, K., Borglin, G, Carr-Hill, R., McGaughan, D., McKenna, H., Stuttard, L, Wakefield, A (2011) Evaluation of the Development and Impact of Assistant Paractitioners Supporting the Work of Ward-Based Registered Nurses in Acute NHS (Hospital) Trusts in England. Final Report. NIHR Service Student number 09050418