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. Here, we want 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?
As we are training healthcare assistants we do not anticipate any risks to patients.
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 under their Health Services and Delivery Research programme (NIHR 12/129/10) (UK)
Who is the main contact?
Professor Antony Arthur
Prof Antony Arthur
Edith Cavell Building
School of Health Sciences
University of East Anglia
Norwich Research Park
Can Health care Assistant Training improve the relational care of older people? A development and feasibility study of a complex intervention
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.
Cambridge South Research Ethics Committee, 13/02/2015, ref: 15/EE/0025
Multicentre pilot cluster randomised controlled trial
Primary study design
Secondary study design
Randomised controlled trial
Patient information sheet
Not available in web format, please use the contact details below to request a patient information sheet.
Healthcare of older people
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.
Primary outcome measures
The primary outcome measure will be at the patient level:
We will use the 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.
1. To measure quality of interaction with older patients we will use 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. To measure change in empathy we will use the Toronto Empathy Questionnaire (TEQ). The TEQ conceptualises empathy as an emotional process and contains 16 items.
2.2. To measure change in attitude towards older people we will use 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
Overall trial end date
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
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
Recruitment end date
Countries of recruitment
Trial participating centre
The School of Nursing Sciences
Edith Cavell Building
University of East Anglia (UK)
c/o Mrs Susan Steel
Research and Enterprise Services
University of East Anglia
Norwich Research Park
UK National Institute for Health Research under their Health Services and Delivery programme (NIHR HS&DR 12/129/10).
Funding Body Type
Funding Body Subtype
Results and Publications
Publication and dissemination plan
Publication of results in NIHR report.
Intention to publish date
Participant level data
Not expected to be available
Results - basic reporting
2015 protocol in: http://www.ncbi.nlm.nih.gov/pubmed/26646251