Recognition of the health assistant as a delegated clinical role and their inclusion in models of care: a systematic review and meta-synthesis of qualitative evidence

Aim Assistants have been utilised worldwide in healthcare as a means to ensure the provision of adequate and efficient healthcare in the midst of increased pressures on health services for many years. This review aimed to synthesise available qualitative evidence regarding the appropriateness of strategies used to establish the health assistant role as a recognised delegated clinical role and to promote their inclusion in models of care. This review focused on how to make strategies appropriate for health assistants and professionals. Health assistants were defined as those who provide assistance and support to health professionals by whom they are directly or indirectly supervised in all healthcare and health education sectors. Methods A systematic review with meta-synthesis of qualitative studies using meta-aggregation was conducted. Types of participants considered included assistants in healthcare, including nursing and allied health assistants. The phenomena of interest was the appropriateness of strategies used to establish the assistant role as a recognised delegated clinical role and/or to promote their inclusion in models of care. Qualitative research studies including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research and feminist research were considered for inclusion. Electronic searches of multiple databases including MEDLINE, AMED, CINAHL and EMBASE, limited to the English language were conducted during the period of 14 April to 13 May 2011. In addition, grey literature was also searched for, as well as a hand search of relevant journals. Assessment of methodological quality of papers prior to inclusion in the review was performed using a standardised critical appraisal instrument from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI QARI). Data were extracted using the standardised data extraction tool from JBI QARI. Data synthesis using the JBI QARI approach of meta-synthesis by meta-aggregation was performed. Results Ten studies met the inclusion criteria. From the 10 included studies, 66 findings were identified that were organised into 11 categories by similarity of meaning. Categories were then aggregated into four synthesised findings: assistants and professionals may have good or difficult inter-professional relationships, which is dependent on a variety of factors, and can thus inform appropriate strategies to include assistants in models of care; professionals and assistants perceive the assistant role and the need for practice change in different ways, whereas the role itself and tasks performed may be influenced by a number of different factors; despite assistants feeling different levels of preparedness for training or the need for training, there are effective training programmes with certain characteristics that can result in positive training outcomes; there are concerns amongst health staff regarding responsibility in models of care using assistants, highlighting the need for appropriate supervision and mentoring of assistants. Conclusions Qualitative meta-synthesis was performed providing a unique perspective on the role of health assistants and strategies used to include them in models of care. These synthesised findings can be used to guide practice in healthcare organisations considering strategies for implementing the assistant role, or where assistants are currently utilised.