Healthcare assistants’ experiences of facilitated reflective learning in the hospital setting

The Care Certificate was developed to support healthcare assistants (HCAs) in providing care with compassion following the Francis report (2013) which found instances of poor care in one National Health Service (NHS) Trust. The Report recommended that HCAs develop the skills of reflection for learning. Previously, the practice of reflection was the preserve of the professional. This study is the first to explore the effects of facilitated reflective learning (the process of learning from one’s experiences through the facilitation of a more experienced professional) for hospital based (non-professional) HCAs. 

A constructivist case study approach was undertaken involving semi-structured interviews with twenty-five HCAs who attended facilitated reflective groups as part of their Care Certificate course. Their data were supplemented with documentary analysis and interviews with seven nurse-educators. Findings indicate that the work environment in the case Trust focused on physical labour and was more suited to the non-reflective learning of standards and tasks, which Francis (2013) warned could contribute to non-compassionate care. The groups provided a supportive environment which facilitated the development of softer skills associated with emotional labour thereby emancipating the HCAs. The facilitated reflective group sessions for HCAs helped transform their approach to practice from task-focused to care-focused. These findings are especially pertinent with the national HCA workforce currently providing around 60% of direct patient care. It is recommended that Trusts, educationalists and policymakers consider utilising facilitated reflective learning groups for their HCA workforce, especially in Trusts where staff are resorting to task based care due to nursing shortages and high dependency/turnover of patients. The case Trust mirrored such circumstances. This study confirms that the provision of facilitated reflective learning groups for HCAs provides a more supportive, empowering learning environment in which HCAs are enabled to be more caring and compassionate.