Journal of Clinical Nursing 15, 1418-1425Multidisciplinary perceptions of the role of nurses and healthcare assistants in rehabilitation of older adults in acute health care Aim. This paper describes the perceptions of nurses, healthcare assistants, doctors and therapists of rehabilitation and the role of nurses and healthcare assistants on an acute older adults ward in a London teaching hospital. Background. The role perception, education and training and attitudes towards the older adults have been identified as barriers that have an impact upon the nurses' role within rehabilitation. However, little is known about the role of nurses and healthcare assistants in rehabilitation of older adults in acute health care. Design. Action research study. Method. Twenty-four semi-structured interviews were conducted and audio recorded about healthcare professionals' understanding of rehabilitation, the type of skills needed and their perceptions of the role of nurses and healthcare assistants in rehabilitation. The interview transcripts were analysed using the thematic content analysis. Results. The findings suggest that the therapists relied on nurses and healthcare assistants for therapy carry-over. Healthcare assistants were perceived as the professional group who could deliver therapy carry-over. There was an evidence of role hierarchy as healthcare assistants perceived that they were not actively involved in decision-making or discharge planning. Conclusion. This paper suggests that healthcare assistants and nurses are viewed as the professional group best placed to deliver therapy carry-over. However, whilst there is an acknowledgement of their role, there remains a reluctance to acknowledge healthcare assistants as a professional group and to involve them within decision-making and discharge planning Relevance to clinical practice. Employers must be seen to advocate, support and implement education and training programs for healthcare assistants. However, 1418Ó 2006 Blackwell Publishing Ltd whilst nurses and healthcare assistants have an integral role in rehabilitation, there needs to be more research into the how they are supported by therapy professionals.

Older adults experiences of rehabilitation in acute health care Background:Discharging patients from hospital is a key component of nursing and allied health care professionals roles in health and social care settings. It is noteworthy that despite government legislation and research that stretches back over twenty years in both Europe and North America, discharge planning remains problematic. Discharge planning entails bridging the gap between hospital and home and is regarded as a process that can enable resources to be used more effectively and efficiently. The challenge for health care professionals is to ensure that older adults who are hospitalised continue participating fully within society once discharged from hospital.Objectives: This paper reports on stage two of an action research project to ascertain older adult's perceptions of the rehabilitation profess.Design: Semi-structured post discharge interviews.Setting: A large acute teaching hospital in London serving a diverse social, economical and cultural population.Participants: All older adults discharged from an acute older acute rehabilitation ward to their own homes in the community were eligible to participate. The only exclusion criteria was older adults who were thought to be unable to give consent to participate by the nurse in charge and the researcher. Whilst 92 older adults were eligible to participate in this research study only 20 agreed to be interviewed.2 Method: 20 post discharge semi-structured telephones interviews .The interview transcripts were analysed using thematic content analysis.Results: The findings from this study suggest that nursing and the professions allied to medicine play a limited role in restoring occupations of daily living. In addition older adults expressed dissatisfaction with their current level of function once discharged back into the community. Older adults valued interaction with health professionals but were aware of time constraints that hindered communication.Conclusion: This study suggests that both nurses and allied health care professional are not actively providing rehabilitative services to promote health and wellbeing, which contradicts the focus of active ageing. Furthermore, there was evidence of unmet needs on discharge, weak communication and older adults unable to recall the professions that were involved and the rationale for therapy input. It is suggested that further research is needed to explore the effectiveness of allied health rehabilitation in the acute setting. Furthermore there is evidence of health care professionals failing to evaluate the effectiveness of the discharge once the patient was at home which suggests that professionals are not regarding discharge planning as a linear process..

Mitral valve stenosis can lead to a range of symptoms that affect daily life. As many of the people with this problem are elderly, the difficulties resulting from age can be exacerbated by illness. A pilot descriptive study was designed to examine the differences in anxiety, depression and functional capacity in women with mitral valve stenosis who were aged over 60 years when compared to a similar group of volunteers who did not have any cardiac disease. Measurement was undertaken using the Hospital Anxiety and Depression scale, the SF-36 Health Status questionnaire and the Functional Limitations Profile. Forty women were recruited to the study: 20 women with mitral valve stenosis and 20 volunteers. Each person was asked to complete the three questionnaires on one occasion only. Non-parametric statistics were used for analysis. Patients fared worse than volunteers with significant differences between groups in respect of anxiety (P = 0.03), depression (P = 0.02) and overall function (P < 0.001), but not in physical (P = 0.52) or mental health (P = 0.32). Future research could focus on strategies that would help alleviate anxiety and depression and improve functional capacity in older women with mitral valve stenosis.

The World Health Report [1] has suggested that achieving the correct mix of health personnel is a major challenge for most health care providers. While there is a surplus of research predominately from North America and the United Kingdom the issue to date remains the same, are health care assistants effective? Indeed, a review published by the World Health Organization [2] investigating skill mix in health care suggests that it is an important international subject matter because the findings are often not relevant in different health care systems. Furthermore, many studies are often descriptive and/or have methodological weaknesses.Little research has evaluated the impact of health care assistant's education and training on clinical care. Within the literature, different types and approaches to training and education of health care assistants have been identified [3,4].A database search using AMED

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