Holistic Care and Assessment in Primary Care: The Healthcare Support Worker Role

The developing role of the Healthcare Support Worker (HCSW) is now

widely recognised and considered a fundamental part of the NHS
Modernisation Agenda (Wanless, 2003; Wag, 2005; WAG, 2010), in
order to increase flexibility and capacity and improve efficiency and
effectiveness by making best use of staff resources and skills (Spilsbury
et al, 2011). Assessing and caring for people holistically has now
become part of the appropriately trained HCSW’s role in general
practice. Appropriate delegation and understanding one’s own
accountability are critical to taking on this developing role. The Code of
Conduct for HCSW in Wales (WAG, 2011) and the All Wales Guidelines
for Delegation (WAG, 2010) clearly set out the standards that are to be
achieved in order that high quality, safe and effective care is delivered
by HCSWs.

The term ‘holistic’ refers to a philosophy of nursing

practice that considers all aspects of patient care,
considering the physical, emotional, social, economic
and spiritual needs of patient/clients/service users. According to (WAG, 2010) failure to or inconsistent
Within primary care all members of the nursing team will approaches to delegation can have a negative
make an holistic assessment. Gathering of information impact on the quality of care and the culture of the
and the formulation of judgements regarding a person’s work environment. Delegation is not new and is
health, situation, needs and wishes which should guide practiced every day in a range of work
further action (DOH, 2000). It is the first stage in the environments. Delegation is often undertaken as a
nursing process. sub-conscious function. Its purpose is to ensure:
Service users receive timely and appropriate care.
Staff resources are utilised effectively, work is
shared fairly. HCSW feel valued and motivated,
‘The gathering of information and the formulation of which can achieve team success. It can also be
judgments regarding a person's health, situation, needs positive to make sure the HCSW is trained and
& wishes, which should guide further action.’ (DoH, thinking and working more holistically for the best
2000) The holistic nurse/HCSW is an instrument of care possible for the patient.
healing and a facilitator in the healing process. Holistic
nurses/HCSW honour each individual's subjective
experience about health, health beliefs, and values. (RCN, 2010) state that all health care teams
include a range of registered professionals, health
care assistants (HCAs), assistant practitioners
(APs) and students. It is vital that each member of
the team is clear about their level of accountability
It’s about collecting appropriate information or data and that the registered staff are confident when
about a person, his/her carer and family. This could delegating tasks to their colleagues. That every
be :- objective .. Involving blood pressure or member of the team is trained appropriate before
subjective.. based on a professional’s feelings, values providing holistic care to the patient.
& beliefs.

Setting the Direction (WAG, 2010) is a

community based strategy that
To ‘undertake and document a comprehensive advocates a paradigm shift from hospital
systematic and accurate nursing assessment of to community based care in Wales.
the physical, psychological, social and spiritual Holistic care and assessment involving
needs of the patients, clients and communities.’ HCSW’s in the primary care setting, will
(DoH, 2000) The nurse/HCSW needs to be able • Observe enhance the patient experience by
to provide a nursing diagnoses to identify the • Touch working in partnership with patients and
patient’s needs. To ensure that the services • Listen families to identify and address their
meet the needs of the patient and to avoid risks • Smell holistic health and social care needs,
to independence. To also develop goals and • Use equipment to record vital signs:- whilst encouraging and supporting
outcomes and to develop care plans. temperature, blood pressure, pulse, independence (WAG, 2005).
respirations
• Assessment Tools

• All patients and clients have a right to • Breathing effort • Pulse

receive information about their condition. • Skin colour • Temperature
• You must always respect a patient’s • Size of patient • Sweating
autonomy. • Swelling • Clamminess
• No-one has the right to give consent on • Distress • Pain
behalf of another competent adult. • Rashes • Sensation
• You must treat information about patient’s • General body language • Swelling
and clients as confidential and use it only for • Sputum
the purpose for which it was given. • Urine faeces
• You should seek patient and client wishes
regarding the sharing of information with
their family and others. (NMC, 2008)

• Coherence • Patient hygiene standards should be

• Family • Communication ability assessed.
• Carers • Noise of breathing • Urinary tract infections maybe
• Healthcare Assistants • History of events evident
• Student Nurses • Ask questions in the correct way • A smell of ketones could indicate a
• Qualified Nurses (be diplomatic, specific, phrase patient who is starved or a patient
• Nurse Specialist's questions to provide yes or no with diabetic ketoacidosis
• Doctors answers if the patient is unable • Sputum
to speak clearly. • Wounds
References
Department of Health (2000) Nurse, midwives and health visitors (training) Amendment
Rules approved order 2000. Stationary office. London NMC (2008) Code of Professional
Conduct: standards for conduct performance and ethics.
http://www.rcn.org.uk/__data/assets/pdf_file/0008/361907/Accountability_HCA_leaflet_A5_
final.pdf. Welsh Assembly Government (2005) Making the Connections Designed for Life:
Creating World Class Health and Social Care for Wales in the 21st Century. Cardiff, Welsh
Assembly Government. Wanless D (2003) Securing our Future Health: Taking a Long-
Term View. The Final Report. London: Department of Health. Welsh Assembly Government
(2010) Setting the Direction: Primary and Community Strategic Delivery Programme.
Cardiff, Welsh Assembly Government. Welsh Assembly Government (2011) Code of
Conduct for Healthcare Support Workers in Wales. Cardiff, Welsh Assembly Government.
Spilsbury, K., Adamson, J., Atkin, K., Bartlett, C., Bloor, K., Borglin, G, Carr-Hill, R.,
McGaughan, D., McKenna, H., Stuttard, L, Wakefield, A (2011) Evaluation of the
Development and Impact of Assistant Paractitioners Supporting the Work of Ward-Based
Registered Nurses in Acute NHS (Hospital) Trusts in England. Final Report. NIHR Service Student number 09050418