Undertaking special observation of patients with neurological conditions: evaluation of a training programme for HCAs

Abstract

This paper reports on a study carried out at an acute neurosciences hospital trust. The aim was to evaluate the effectiveness of a training programme for healthcare assistants undertaking special observation of patients. Some patients being cared for at the hospital have neurological complaints that are accompanied by confusion and agitation and they require close observation, in order to preserve their own and others' safety. The literature review revealed an abundance of literature related to special observation in mental health care. However, there is very little research related to the care of patients with neurological conditions. Some 20 experienced, female, healthcare assistants took part in the training programme. At the start of the study, their attitudes to undertaking special observation were negative. The training programme included topics such as communication, management of extreme agitation, de-escalation strategies and diversional activities. Participants' confidence levels concerning assessment for suitable activities, using distraction techniques, de-escalation and restraint methods increased on completion of the programme. It is concluded that caring for confused patients in acute hospital settings may sometimes be a passive, non-therapeutic type activity. Increasing the range of patient activities available and encouraging meaningful interactions with carers and patients will improve the caring experience for all concerned.

An observational study of older patient specialling in acute hospital settings

“…The specialling role is often unpopular, due to staff anxiety about managing challenging behaviours in older adults, such as agitation during a delirium episode, while endeavouring to provide person‐centred care (Flynn, Prescott, & Jinks, 2016). However, confidence and job satisfaction levels in undertaking specialling duties can improve when senior staff provide the special with an orientation to the ward policies and procedures, provide them with training in communication skills when caring for people with a cognitive impairment, give information on reasons for confusion and agitation in these patients and provide clear advice on management of extreme agitation, de‐escalation strategies and diversional activities (Ayton et al, 2017; Bateman, Anderson, Bird, & Hungerford, 2016; Flynn et al., 2016). Patient outcomes such as reduced hospital stay, improved pain management and fewer falls have been reported when specials are supported by appropriate training and when they are recruited from a pool of existing hospital staff who are familiar with the ward routines, policies and procedures (Bateman et al., 2016).…”