ISRCTN - ISRCTN10385799: Can health care assistant training improve the relational care of older people?

Plain English Summary

Background and study aims
Elderly people aged 75 years and older account for a large and increasing number of admissions to acute hospitals. There is evidence to suggest that older paper rate the care that they receive in hospital in terms of the kindness, compassion and respectful communication they get from hospital staff. Healthcare assistants (HCAs) provide an increasing amount of direct care to older people, but their training needs are often overlooked. The aim of this study is to test a training programme (intervention) that has been designed to improve the care given by HCAs, comparing it to the usual training currently being offered.

Who can participate?
Acute hospital wards where 50% or more of inpatients are aged 70 years and above. Healthcare assistants employed to provide care in one of the recruited wards. All patients aged 70 years and over discharged from one of the recruited wards during the four weeks before and following the intervention (study) period.

What does the study involve?
Recruited wards are randomly allocated to either the ‘training in relational care’ or ‘training as usual’ group. HCAs from wards randomised to the new training package receive training in relational care. HCAs from wards randomised to ‘training as usual’ receive their usual training. The success of the new training package is assessed at the ward, individual HCA and patient level. It includes measuring patient experience, the quality of interaction between HCAs and patients, and changes in both empathy and attitude of HCAs towards older patients. Ward and HCA level outcomes are measured before the intervention training begins and again after its completion. Patient-level outcomes are measured after discharge from hospital during periods before and after the intervention training.

What are the possible benefits and risks of participating?
No risks to patients are anticipated

Who is leading the study?
The study is led by the University of East Anglia in collaboration with King’s College London and the University of Nottingham.

When is the study starting and how long is it expected to run for?
March 2015 to October 2015

Who is funding the study?
National Institute of Health Research Health Services and Delivery Research programme (UK)

Who is the main contact?
Prof. Antony Arthur
antony.arthur@uea.ac.uk

Trial website

Contact information

Type

Scientific

Primary contact

Prof Antony Arthur

ORCID ID

Contact details

Edith Cavell Building
School of Health Sciences
University of East Anglia
Norwich Research Park
Norwich
NR4 7TJ
United Kingdom
+44 (0)1603 591094
antony.arthur@uea.ac.uk

Additional identifiers

EudraCT number

ClinicalTrials.gov number

Protocol/serial number

HS&DR 12/129/10

Study information

Scientific title

Can Health care Assistant Training improve the relational care of older people? A development and feasibility study of a complex intervention

Acronym

CHAT

Study hypothesis

The study will test whether it is feasible to deliver and measure the effect of healthcare assistant training in the relational care of older people within acute hospitals in England using a cluster RCT.

Ethics approval

Cambridge South Research Ethics Committee, 13/02/2015, ref: 15/EE/0025

Study design

Multicentre pilot cluster randomised controlled trial

Primary study design

Interventional

Secondary study design

Cluster randomised trial

Trial setting

Hospitals

Trial type

Treatment

Patient information sheet

Not available in web format, please use the contact details to request a patient information sheet

Condition

Healthcare of older people

Intervention

1. HCAs in wards randomised to relational care training will receive two one-day training sessions approximately one week apart. Training will be delivered by HCA trainers based at each of the participating hospitals. Day 1 will introduce and begin to explore aspects of relational care for older patients. At the end of Day 1 HCAs will also be asked to undertake brief unstructured individual study prior to Day 2 and further training support in the form of e-learning will also be available by computer and mobile device. Day 2 will build upon Day 1 and explore further aspects of relational care.
2. HCAs in wards not randomised to relational care training will receive 'training as usual', typically restricted to periods of staff induction or focussed on mandatory training requirements such as manual handling.

Intervention type

Behavioural

Phase

Drug names

Primary outcome measure

The primary outcome measure will be at the patient level:
Patient Evaluation of Emotional Care during Hospitalisation inventory (PEECH) . The PEECH contains 23 items and four subscales (levels of security, knowing, personal value, connection)

Secondary outcome measures

Secondary outcome measures will be taken at the level of ward and individual HCAs.
Ward outcomes:
1. Quality of interaction with older patients, measured using the Care Kindness and Compassion Observation Tool. It is used to assess three domains of care:
1.1. General care
1.2. Patient and visitor engagement
1.3. Patient safety. Interactions are rated by an observer
2. HCA outcomes:
2.1. Change in empathy, measured using the Toronto Empathy Questionnaire (TEQ). The TEQ conceptualises empathy as an emotional process and contains 16 items
2.2. Change in attitude towards older people, measured using the age group evaluation and description (AGED) inventory, a measure of the extent to which stereotypes about ageing are held by the respondent

Overall trial start date

01/03/2015

Overall trial end date

01/10/2015

Reason abandoned (if study stopped)

Eligibility

Participant inclusion criteria

1. Ward inclusion criteria: general medicine or care of the elderly/older people wards where the median age of the inpatient population is 70 years or greater
2. Healthcare assistant inclusion criteria: healthcare assistants working either full time or part time within enrolled wards
3. Patient inclusion criteria: patients aged 70 years or over and discharged from an inpatient stay on an enrolled ward during the four-week period prior to the start of the intervention and during the four-week period following the end of the intervention

Participant type

Mixed

Age group

Mixed

Gender

Both

Target number of participants

12 wards, 96 HCAs, 200 patients

Participant exclusion criteria

1. Ward exclusion criteria: specialist dementia wards; medical admissions units
2. Health-care assistants exclusion criteria: healthcare assistants who are employed as bank staff and are not part of the named staff on the ward roster
3. Patients exclusion criteria: patients discharged to another ward or hospital

Recruitment start date

01/03/2015

Recruitment end date

01/10/2015

Locations

Countries of recruitment

United Kingdom

Trial participating centre

The School of Nursing Sciences
Edith Cavell Building
Norwich
NR4 7TJ
United Kingdom

Sponsor information

Organisation

University of East Anglia (UK)

Sponsor type

University/education

Website

Funders

Funder type

Government

Funder name

Health Services and Delivery Research Programme

Alternative name(s)

HS&DR Programme, NIHR Health Services and Delivery Research Programme, NIHR Health Services and Delivery Research (HS&DR) Programme, Health Services and Delivery Research (HS&DR) Programme, HS&DR

Funding Body Type

government organisation

Funding Body Subtype

Federal/National Government

Location