Observe, Coach, Assist, and Report: An Emerging Framework for Integrating Unregulated Healthcare Providers into Interdisciplinary Healthcare Teams

Abstract

Background: Unregulated healthcare providers known as personal support workers (PSWs) provide the majority of home care services in Ontario, Canada. However, there is little direction to guide their activities as members of interdisciplinary healthcare teams. The purpose of this study was to explore and describe the role of PSWs in interdisciplinary evidence-based stroke care.

The role of unregulated care providers in Canada—A scoping review

“…The scoping review demonstrates a perceived lack of respect for the role of UCPs by other healthcare providers and a lack of authority for decision‐making in patient care. This theme was consistent across Canada, with studies from British Columbia (Reimer‐Kirkham, Sawatzky, Roberts, Cochrane, & Stajduhar, ), Alberta (Dahlke & Baumbusch, ; White, Jackson, Besner, & Norris, ), Ontario (Giosa et al., ; Heckman et al., ; Kaasalainen et al., ; Kontos, Miller, & Mitchell, ; McGilton, Guruge, Librado, Bloch, & Boscart, ; Tayab & Narushima, ; Wagner et al., ; Zeytinoglu et al., ) and New Brunswick (McCloskey, Donovan, Stewart, & Donovan, ; Rheaume, ) reporting minimal UCP contribution to interprofessional care teams and highlighting important challenges. Such challenges included vertical power hierarchies within the teams (Heckman et al., ; McGilton et al., ), isolation from teams or lack of communication and collaboration between UCPs and other members of the team (Dahlke & Baumbusch, ; Heckman et al., ; Tayab & Narushima, ), lack of role clarity and perceived differences in knowledge among team members (Heckman et al., ; Reimer‐Kirkham et al., ) and a limited role in documentation in patient charts (Kontos et al., ; McCloskey et al., ; White et al., ).…”

“…Additional tasks and activities performed by UCPs beyond ADL and IADL support include assisting with hearing aids (Slaughter, Hopper, Ickert, & Erin, ), performing visual assistance tasks (Gibson, Brooks, DeMatteo, & King, ), physical exercises or range of motion of exercises (Johnson & Noel, ) and providing emotional support to patients (Berta et al., ; Giosa, Holyoke, Bender, Tudge, & Gifford, ; Kortes‐Miller et al., ; Waskiewich, Funk, & Stajduhar, ). According to Guay et al.…”

The evolving role of the personal support worker in home care in O ntario, C anada

“…With the ageing of the population, care needs of individuals living with chronic conditions and complex comorbidities is expected to triple between 2010 and 2050 (Prince, Prina, & Guerchet, ). Related to this trend is growing pressure to expand provision of healthcare services in home‐care settings (De Vliegher, Aertgeerts, Declercq, & Moons, ; Giosa, Holyoke, Bender, Tudge, & Gifford, ). To address these increasing demands while containing healthcare costs, some care activities previously provided by regulated health professionals (RHPs) including nurses and physiotherapists are being delegated to unregulated care providers such as personal support workers (PSWs) (Denton, Brookman, Zeytinoglu, Plenderlieth, & Barken, ; Health Professions Regulatory Advisory Council [HPRAC], ; Zeytinoglu, Denton, Brookman, & Plenderleith, ).…”

The role of unregulated care providers in home care: A scoping review

“…In this scoping review, a body of research was identified that focused on the expanding role of UCPs in home care, specifically, the nature and extent of what patient care activities are being provided by UCPs. While significantly less research exists evaluating the impact of this role expansion, work is being done to demonstrate the possibilities of expanded UCP roles in home care and key facilitators for implementation (Giosa et al., ; Guay et al., ; Pierratos et al., ; Royackers et al., ; Stanmore & Waterman, ). Addressing home care safety issues in response to the growing demand of home care services will require co‐ordination and collaboration among patients, health care professionals, policy and decision makers, and health system leaders.…”

“…As UCP roles expand, the risk for compromised care quality increases unless adequate teaching, appropriate delegation and supervision can be provided. This is particularly relevant for nurses as they often act in the role of UCP supervisors in home care settings (Giosa et al., ; Pringle, ; Royackers et al., ). While UCPs, like all health care providers, have a duty of care and are accountable to the law and their employer, individuals delegating care are responsible for assessing the competence of the UCP, ongoing clinical decision making and monitoring the skills and competencies of the UCP to ensure quality care (Pringle, ; Vaughan et al., ).…”