Healthcare assistants’ experiences on forensic mental health wards
| DOI | https://doi.org/10.1108/JFP-07-2017-0028 |
| Pages | 179-190 |
| Date | 13 August 2018 |
| Published date | 13 August 2018 |
| Author | Stacey Boardman,Jane Clarbour,Kelly Rayner |
Healthcare assistants’experiences
on forensic mental health wards
Stacey Boardman, Jane Clarbour and Kelly Rayner
Abstract
Purpose –In forensic mental health wards, patients spend more time with healthcare assistants (HCAs) than
qualified nurses. Despite this, there is no universally utilised standardised HCA training. The purpose of this
paper is to assess the HCAs’experiences in the HCA role in order to better understand how to build on the
HCA role to ensure safe practice, and enhance staff well-being.
Design/methodology/approach –HCAs working on low and medium secure NHS forensic mental health
units were recruited through purposive methods. HCAs engaged in a semi-structured interview,
with questions surrounding their support needs, clinical decision making and perception of risks in the
role. Template analysis was used, applying an a priori template based on the existing literature to
interview transcripts.
Findings –The participants described the HCA experience to be defined by two master themes:
“HCA factors”and “organisational factors”. HCAs valued a holistic patient view which prized patients’
experiences. The participants described a lack of role clarity which may be defined through ward
expectations and professional experience.
Originality/value –HCAs seek a holistic view of the patient; however, some overlooked patient offences in
order to do their job. Future research should address how looking past offences impacts security and HCAs’
well-being long term.
Keywords Forensic, Mental health, Decision making, Support, Secure services, Healthcare assistant
Paper type Research paper
Introduction
The role of a healthcare assistant (HCA) is to more generally assist patients according to their
care plan so that patients may carry out their daily activities. More specifically, their actual job role
will be stated within their job description. Strauss et al’s (1963) theory of “negotiated order”
suggests that HCAs exercise autonomy in their role that may extend that originally intended by
their job descriptions. The moment-by-moment decision making and interactions with patients
and other staff may result in HCAs having more power than might be intended by their position in
the hierarchy of authority. Typically, HCAs will “prioritise their own delegated workload”under the
support of a qualified nurse (Schneider et al., 2010). The HCA role requires no standardised
pre-recruitment training to ensure workers are competent in patient care. However, patients on
forensic mental health units likely spend more time with unqualified HCAs than qualified nurses
(Adams et al., 2000; Sharac et al., 2010; Whittington and McLaughlin, 2000). Despite this
anomaly, there is a paucity of research investigating what it is like for HCAs to work in forensic
settings. A lack of research addressing the experiences of HCAs in a forensic inpatient
environment means the effects of role demands are unknown. This raises questions regarding
the well-being of staff and the safety of patients (McKenna et al., 2004).
Workingin forensic mental health canexpose staff to traumatic eventssuch as aggression, violence
and self-harm,impacting on thewell-being of HCAs (Patonand Violanti, 1996). Tounderstand how
HCAs adapt to stressful and traumatic events, one must consider their personal and physical
resources and competencies (Antonovsky, 1990). This refers to both individual staff and to the
organisational capacity to use resources and adapt to staff demands (Violanti et al., 2008).
Received 31 July 2017
Revised 7 December 2017
11 December 2017
Accepted 14 December 2017
The authors’sincere thanks goes
to Dr Simon Reid Milligan for his
support in facilitating data
collection.
Stacey Boardman is an
Assistant Psychologist at
Partnerships in Care, Stockton
Hall Hospital, York, UK.
Jane Clarbour is a Senior
Lecturer at the Department of
Psychology, University of York,
York, UK.
Kelly Rayner is a Consultant
Clinical Psychologist at Tees,
Esk and Wear Valleys NHS
Foundation Trust,
Harrogate, UK.
DOI 10.1108/JFP-07-2017-0028 VOL. 20 NO. 3 2018, pp. 179-190, © Emerald Publishing Limited, ISSN 2050-8794
j
JOURNAL OF FORENSIC PRACTICE
j
PAG E 17 9
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