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The challenges of training, support and assessment of healthcare support workers: a qualitative study of experiences in three English acute hospitals

Sarre, Sophie; Maben, Jill; Aldus, Clare; Schneider, Justine; Wharrad, Heather; Nicholson, Caroline; Arthur, Antony

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Sophie Sarre

Jill Maben

Clare Aldus

Justine Schneider

Professor of E-Learning and Health Informatics

Caroline Nicholson

Antony Arthur


Ever-growing demands on care systems have increased reliance on healthcare support workers. In the UK, their training has been variable, but organisation-wide failures in care have prompted questions about how this crucial section of the workforce should be developed. Their training, support and assessment has become a policy priority.

This paper examines: healthcare support workers’ access to training, support and assessment; perceived gaps in training provision; and barriers and facilitators to implementation of relevant policies in acute care.

Design and settings
We undertook a qualitative study of staff caring for older inpatients at ward, divisional or organisational-level in three acute National Health Service hospitals in England in 2014.

58 staff working with older people (30 healthcare support workers and 24 staff managing or working alongside them) and 4 healthcare support worker training leads.

One-to-one semi-structured interviews included: views and experiences of training and support; translation of training into practice; training, support and assessment policies and difficulties of implementing them. Transcripts were analysed to identify themes.

Induction training was valued, but did not fully prepare healthcare support workers for the realities of the ward. Implementation of hospital policies concerning supervision and formal assessment of competencies varied between and within hospitals, and was subject to availability of appropriate staff and competing demands on staff time. Gaps identified in training provision included: caring for people with cognitive impairment; managing the emotions of patients, families and themselves; and having difficult conversations. Access to ongoing training was affected by: lack of time; infrequent provision; attitudes of ward managers to additional support workforce training, and their need to balance this against patients’ and other staff members’ needs; and the use of e-learning as a default mode of training delivery.

With the current and unprecedented policy focus on training, support and assessment of healthcare support workers, our study suggests improved training would be welcomed by them and their managers. Provision of training, support and assessment could be improved by organisational policy that promotes and protects healthcare support worker training; formalising the provision and availability of on-ward support; and training and IT support provided on a drop-in basis. Challenges in implementation are likely to be faced in all international settings where there is increased reliance on a support workforce. While recent policies in the UK offers scope to overcome some of these challenges there is a risk that some will be exacerbated.


Sarre, S., Maben, J., Aldus, C., Schneider, J., Wharrad, H., Nicholson, C., & Arthur, A. (2018). The challenges of training, support and assessment of healthcare support workers: a qualitative study of experiences in three English acute hospitals. International Journal of Nursing Studies, 79, 145-153.

Journal Article Type Article
Acceptance Date Nov 28, 2017
Online Publication Date Nov 29, 2017
Publication Date Mar 1, 2018
Deposit Date Feb 22, 2019
Publicly Available Date Feb 25, 2019
Journal International Journal of Nursing Studies
Print ISSN 0020-7489
Electronic ISSN 1873-491X
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 79
Pages 145-153
Keywords Acute care; Assessment; Competencies; Healthcare assistants; Healthcare support workers; Non-registered staff; Nursing assistants; Older people; Qualitative data; Staff training and development
Public URL
Publisher URL
Contract Date Feb 25, 2019


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