Workplace stress in a national health dementia unit: the experiences of health care assistants

Background: Exposure to workplace stress for healthcare assistants (HCAs) who care for inpatient dementia patients has health implications that pose potential significant social and economic costs. HCAs are part of the frontline workers who have regular contact with dementia patients within the inpatient facilities but are less likely to be recognised, supported, and have the least access to training. The work environment in the NHS has worsened since the UK financial austerity period (2008-2019). However, there is a paucity of contemporary studies relating to HCAs' wellbeing in the care of dementia patients. Aims: This study explores the HCAs' experiences of workplace stress in caring for inpatient dementia patients, and their coping strategies, and considers ways to ensure a healthier work environment. The contemporary viewpoints of HCAs following ten years or so of recent financial austerity in the provision of dementia care are little understood. Method: 15 HCAs were recruited from an NHS Trust in eastern England from a staff base of approximately 35 regular support staff on a dementia unit in a regional hospital. Semi-structured interviews provided a qualitative evaluation of their stressful experiences. Interviews were audio-taped and transcribed for thematic analysis. A follow-up focus group of 6 HCAs enabled corroboration but also provided an opportunity to explore how HCAs coped. Data analysis also identified the conflict in the team's work relationships, so post hoc interviews with ten nurses were also convened to understand the issues better. The study design received ethics and research governance approvals from the university, an NHS ethics committee and the Trust in which the study was located. Results: Key stressors from the individual interviews experienced by HCAs were high demands of dementia care and factors in the work environment. The latter was directly or indirectly related to staff shortage, including poor shift rotas, poor team leadership, difficult interrelationships within the team, lack of support, and lack of autonomy and input into ward developments (i.e., change). The focus group corroborated these themes. In addition, HCAs poorly articulated coping strategies and appeared to entail a pragmatic acceptance of challenges within a difficult job and trying to maintain a work-home balance. Nurses interviewed agreed that team inter-relations were poor but blamed the HCAs. Discussion: Locating the findings within the Job Demands-Resources model of work stress indicated high Demands and poor Resources far outweighed the Resources, indicative of high strain, recognised as a high-risk factor for burnout and staff attrition. Suggestions are made for intervention at the primary (organisational) and secondary (individual) levels regarding improved resources and personal stress management. It was evident that increased demands and resource deficits had been left either unrecognised or to fester. Conclusions: Findings have implications for staff retention and recruitment, which can only worsen the situation, potentially impacting patient care and staff well-being. Stress management interventions and practice developments are urgently required, with management provision of better support for HCA (and nurses) in this challenging period. Though a local study, the impact of financial austerity seems likely to be recognised in similar dementia settings elsewhere. Findings, therefore, are probably transferable to other mental health Trusts.