The Lived Experience of HCA’s Delivering Enhanced Supervision to

Patients With Dementia on an Acute NHS Hospital Ward

Joanne Beaumont – Occupational Therapy Student UEA
Research and development team James Paget University Hospital

INTRODUCTION R ES U LT S CONCLUSION

THEMES - T h r e e m a i n t h e m e s i d e n ti fi e d Perception of enhanced supervision

Today it is estimated that one in four patients will have Dementia
(Alzheimer’s UK,2021) Improving safety and quality of care for
patients with dementia in acute hospitals is an urgent priority for the
NHS. (NHS, 2021)
Patients with Dementia are some of the most vulnerable and
challenging patients on hospital wards. Hospitalization can be very
confusing and distressing for them and often results in a longer length
of stay,
The staff responsible for supporting patients on enhanced supervision
(ES) on the wards, who provide the most hands on care are Healthcare
Assistants (HCAs) .
STUDY AIMS
1.To describe the lived experience of the HCAs when delivering
enhanced supervision care to patients with Dementia on the wards.
This study aimed to understand the lived experience of HCAs
supporting patients with dementia and to establish if there was
The challenges on performance when conducting enhanced A common theme is how the HCAs felt when supporting patients with
more support that could be given to help them in their role. The
supervision. dementia, about how they were regarded by other members of staff and by
analysis of the data gathered in the questionnaires and the
other patients on the ward.
interview highlight that they enjoyed supporting patients with
Perception of enhanced supervision
dementia, but that they felt that more training would benefit them
“I think at times you feel guilty because you are not doing your normal job
in giving their support and improving the care they give. It was also
as such”
Training of HCAs in dementia care. evident that pressures were placed upon them with workload and
routine factors.
“It is awful, because it puts you in a really really awkward spot, because
all the other patients just see you sitting there and that you’re not doing
A study into Dementia-friendly interventions to improve the care of
anything, you are just sitting with a patient.”
The challenges on performance when people living with dementia admitted to hospitals by Handley et Al
(2017) concluded that strategies such as dementia awareness
conducting enhanced supervision training alone will not improve dementia care or outcomes for
patients with dementia.
A common theme from the HCAs are factors which make enhanced
By investing in the education of the HCAs and in ensuring good
supervision challenging, these included:
routines are place, it would improve the self efficacy of the HCAs,
positively influencing the motivation and effectiveness of the care
• Length of time on enhanced supervision
team.
HCAs reported that the length of time that they spent on enhanced
supervision was not set and that some reported to of spent entire 12.5
hour shifts on supervision. HCAs get frustrated at not being able to rotate.

2.To establish the confidence of HCAs in their care of patients under

enhanced supervision
3.To identify any areas in which further training could be of benefit to
the HCAs, which in turn will benefit the patients and the trust
METHOD
This was a mixed method study conducted in two stages which
consisted of questionnaires and an interview. By using mixed methods
a more holistic, comprehensive picture of the phenomenon could be
obtained.
Stage 1 Questionnaire
A questionnaire consisting of open, closed and Likert scale questions.
The data collected from the closed and Likert questions provided
descriptive quantitative statistical data as well as the open questions
providing qualitative data.
Stage 2 – Interview
A semi structured interview audio recorded and transcribed providing
qualitative data.
Data from the questionnaires and the interview was analysed to
identify common themes using Interpretative phenomenological
Analysis (IPA). IPA is concerned with the detailed examination of the
human lived experience of the phenomenon being studied.
“Should have forms which staff can document change overs so they don’t
get stuck for hours”
“So if anything should be improved it would be making sure something is
put in place so that you do have to swap”
•Pressures of staffing and work load
Many of the HCAs reported that when there was a shortage of staff it put
pressure on them effecting their performance to deliver the level of care
required
“I’ve been in situations where we have had 2 HCAs and 3 one to ones in
one bay”
“ I can’t manage it all and that’s when it is harder to be patient”
“ I do not enjoy feeling helpless when jobs need doing and I am on
enhanced supervision”
Influence of Professional Identity –
Occupational Therapist (student)
Occupational therapy Is concerned with the key elements of
occupational performance and identity: how individuals identify
themselves, their roles and relationships. It aims to enable and
empower people to be competent and confident in their lives.
Training of HCA’s in Dementia care (Duncan, 2006)
The HCAs reported the need and desire for more training on: To aid in understanding the factors and influences on an individual’s
occupational performance and identity, occupational therapists use
• Understanding the impact of dementia on an individual conceptual models as a framework (Kielhofer, 1993) Throughout
• Good dementia care techniques this project The Model of Human Occupation (MOHO) was used in
• How to deal with verbal and physical aggression the development of questions and the interpretation of the data.
“and aggression as well, that is something I have never been trained in,
how to manage someone who is being really aggressive”
• Activities to engage patients with dementia
• How to encourage oral intake
• The rights and obligations of staff when trying to stop a patient
from leaving the ward or being physically aggressive towards
them or other patients
“I had a patient that ran out of the ward, and I ran after her and thought
well what can I do? How can I physically stop her… and you don’t know
what it is you can actually do.”

References
Alzheimers.org.uk. 2021. Counting the Cost, Caring for people with dementia on Hospital Wards [online] Available at: <https://www.alzheimers.org.uk/sites/default/files/2018-05/Counting_the_cost_report.pdf> [Accessed 24 January 2021]. Alzheimer’s research UK. 2021. Hospitals | Dementia Statistics Hub. [online] Available at: <https://www.dementiastatistics.org/statistics/hospitals/>
[Accessed 23 January 2021]. Duncan, E. and Hagedorn, R., 2006. Foundations for practice in occupational therapy. Edinburgh: Elsevier Churchill Livingstone. Handley, M., Bunn, F. and Goodman, C., 2017. Dementia-friendly interventions to improve the care of people living with dementia admitted to hospitals: a realist review. BMJ Open. Kielhofner, G., 1993. A model of human
occupation. Baltimore: Williams & Wilkins. NHS England., 2021. NHS England » Dementia. [online] England.nhs.uk. Available at: <https://www.england.nhs.uk/mental-health/dementia> [Accessed 22 January 2021].