By Liz Charalambous @lizcharalambou
Volunteers provide an extra something special to patient care. They provide a complementary service which supports both patients and staff members. You could say that volunteers embody the principles underpinned by Atul Gawande in his excellent book Being Mortal, “how we seek to spend our time may depend on how much time we perceive ourselves to have” [1]. They themselves also benefit, often describing that after a volunteering shift they go home feeling satisfied for having helped others.
Recruiting volunteers to a hospital setting
Many opportunities exist to recruit volunteers into hospital settings nationally and internationally, including through the NHS England and Helpforce. A major stakeholder is the ‘step up to serve’ campaign, funded by the Pears Foundation, which uses the #iwill campaign to inform young people about volunteering in a range of areas, including hospitals. A key goal of the #iwill campaign is to enable organisations to understand and recognise high quality youth social action.
Working as a youth volunteer project manager
The Nottingham Hospitals Charity developed my role as a youth volunteer project manager at Nottingham University Hospitals Trust to recruit young volunteers. Funded by the Pears Foundation, the project is part of a national network across the country. We work with young people to develop new roles, embed youth volunteering, and monitor impact. One role which has attracted support and interest is that of ‘Fitness Friends’, known in some trusts as ‘mobility volunteers’.
Fitness friends: improving mobility in the hospital setting
This role trains volunteers to support patients with movement and exercise prescribed by the physiotherapists and other health professionals with the aims to maximise function, promote independence, and enable appropriate or timely discharge. It also dovetails with the principles of the phenomenally successful de-conditioning and #EndPJparalysis campaigns.
The Fitness Friends debate
Many clinicians have expressed a keen interest in this developing role, yet there are reservations from others who take a more risk averse approach and worry that young volunteers encouraging mobility and movement could present a falls or safety risk. The time is ripe to open up the debate around this role. In the spirit of wishing to improve patient care and outcomes, this is an opportunity for us to challenge our own perceptions and understandings of safe, effective care.
Arguments against Fitness Friends
Hospitals are quite rightly uneasy that the Fitness Friends role may be a risk to patient safety, and as such may adopt a risk averse approach to care in attempt to manage falls. The limited evidence available on this role highlights concerns over volunteer training, safety and liability [3] (There are also concerns over the potential for volunteers to replace the role of paid workforce). A systematic review of the use of volunteers to help older medical patients mobilise in hospital [4] identifies a lack of scientific evidence for the use of volunteers in mobilising older medical inpatients.
Arguments for Fitness Friends
There is now increasing evidence to support the role of mobility volunteers. The Hospital Elder Life Program (HELP) [5] which originated in America has recently published evidence on the benefits of volunteer involvement in delirium prevention. Roles include support with mobility. A systematic review [6] which included volunteer support in identifying feasible physical activity programs for long term care home residents, found that such roles required minimal investment in staff and equipment, and demonstrated positive outcomes. It also represents an effective way to improve the physical, psychological, and social health of residents. Furthermore, quality improvement initiatives suggest that volunteers can be employed in this role. It appears that staff and patients are satisfied with this approach, with indications that this is an area for further development and evaluation. Indeed, University Hospital Southampton NHS Foundation Trust reports trust wide success with their mobility volunteers operating in clinical areas.
While there is a need for more evidence to support this role, the future looks promising as the idea gains interest. With appropriate training and support, there is a distinct advantage to including young volunteers in this role.
In summary, I once again laud Gawande who said “our most cruel failure in how we treat the sick and the aged is the failure to recognize that they have priorities beyond merely being safe and living longer”. Bearing in mind many of our patients may not have much more time to spend with their loved ones, isn’t it time we rallied thoughts and actions across the world and work together to consider better ways to support our patients to be mobile and to deliver on their priorities?
Yes, we have a duty to keep our patients safe, but with that comes the responsibility to open up the debate to understand how we can support these priorities.
After all, enabling patients to enjoy being more active is the best way to protect and promote their health!
Thanks to Honorary Associate Professor Ann Gates @exerciseworks for helping me with the manuscript.
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Liz Charalambous (@lizcharalambou) RN BSc (Hons) MSc. Email: liz.charalambous@nuh.nhs.uk
References
[1] Gawande, A. (2014) Being Mortal: Medicine and What Matters in the End, New York: Metropolitan Books.
[2] GOV.UK (2016) Promotional material: Start active, stay active: infographics on physical activity, Physical activity benefits infographic for adults and older people, available at https://www.gov.uk/government/publications/start-active-stay-active-infographics-on-physical-activity#history [accessed 22ndFebruary 2019]
[3] Babine, R.L., Hyrkäs, K.E., Mckenzie, C.G., Wierman, H.R. (2018) Mobilizing older adults: A multi-site, exploratory and observational study on patients enrolled in the Hospital Elder Life Program (HELP). Geriatr Nurs. 2018 Nov 6. pii: S0197-4572(18)30288-X. doi: 10.1016/j.gerinurse.2018.10.005. [Epub ahead of print] available at https://www.ncbi.nlm.nih.gov/pubmed/30413275 [accessed 22nd Febraury 2019].
[4] Baczynska, A.M., Lim, S.E.R., Sayer, A.A., and Roberts, H.C. (2016) The use of volunteers to help older medical patients mobilise in hospital: a systematic review. Journal of Clinical Nursing, 25, 3102–3112, doi: 10.1111/jocn.13317
[5] Hshieh , TT., Yang, T., Gartaganis, S.L., Yue, J., and Inouye, S.K. (2018) Hospital Elder Life Program: Systematic Review and Meta-analysis of Effectiveness. Am J Geriatr Psychiatry, 26(10):1015-1033. Available at https://www.ncbi.nlm.nih.gov/pubmed/30076080 [accessed 22nd February 2019].
[6] Shakeel, S., Malik, A., and Heckman, G. (2015) Identifying Feasible Physical Activity Programs for Long-Term Care Homes in the Ontario Context. Canadian Geriatrics Journal, volume 18, issue 2, June 2015