“Specialling” and “Sitters”: What does communication between registered nurses and unregulated workers reveal about care?

• Published in: Collegian (Royal College of Nursing, Australia) Australia), 2021-10, Vol.28 (5), p.482-488
• Main Authors: Graham, Frederick, Eaton, Emma, Jeffrey, Carol, Secher-Jorgensen, Heidi, Henderson, Amanda
• Format: Article
• Language: English
• Subjects: agitation; delirium; dementia; hospital; non-pharmacological; Specials
• ISSN: 1322-7696
• DOI: 10.1016/j.colegn.2020.12.004

Specialling involves unregulated care workers who, while supervised by registered nurses (RNs), constantly sit with patients at risk of harm. To describe information exchanges between nurses who “special” people with cognitive impairment experiencing behavioural and psychological symptoms and whether psychosocial strategies are explicitly communicated. Sequential mixed methods study using online survey (quantitative and qualitative) followed by a group discussion. All Assistants in Nursing (AINs) who worked as “specials’ in a large Australian metropolitan hospital were approached to undertake an online survey about specialling that included multichoice questions and free-text responses. Analysis involved univariate statistics and content analysis. Subsequent discussion with a convenience sample of AINs explored content revealed in survey responses. Of 186 possible AINs, 139 (74.7%) undertook the survey and 14(7.5%) participated in the group discussion. Only 27% reported receiving start-of-shift handovers from an RN, and just 9.4% gave an end-of-shift handover to their RN. Some AINs reported receiving hourly over-the-shift communication with their RNs while others reported receiving none. Mostly, AINs received information about physical tasks, not psychosocial care. Psychosocial information about patients was communicated considerably less than physical care, suggesting planned non-pharmacological strategies for behavioural and psychological symptoms were either absent or deprioritised. Although exemplary work interactions existed, there were also inadequate interactions regarding care provision highlighting a lack of RN oversight for those nominally under their supervision. This examination of AINs’ self-reports, suggests that important psychosocial information is not communicated in specialling, possibly preventing resolution of patient symptoms and perpetuating risks.