Background - Much of the work carried out in hospice settings by paid staff would be impossible without the support of volunteers. Effective working between paid staff and volunteers is needed to prevent problems in their working relationships. Researchers have called for improvements in communication, clearer roles and boundaries, and increasing team building between paid staff and volunteers in palliative care settings. Despite repeated recommendations, there has often been a lack of proactive research, including participatory approaches, to drive positive change.
Aim - The overarching aim of the thesis was to gain insight into hospice volunteering, identify strengths and challenges to the working relationship between paid staff and volunteers, and improve any identified barriers to effective collaboration in hospice practice as necessary.
Literature review - A meta-ethnographic review of qualitative research exploring the experiences of paid staff and volunteers working together in palliative care was conducted. Following analysis of 14 articles identified from four databases (CINAHL, PsycINFO, Medline, and AMED), five storylines were constructed: 1) “we [paid staff] are the cake and they [volunteers] are the cream”: understanding the volunteer role – separate, but part of a whole; 2) “…we [volunteers] don’t know what’s wrong with people but sometimes we need to know”: access to information and importance of trust; 3) “everybody looks out for each other”: access to paid staff and their support; 4) “...we [volunteers] don’t meddle in the medical”: boundaries; 5) "it's the small things that the staff does for me that makes me feel good about my work": sense of value and significance. Ongoing issues in working relationships between paid staff and volunteers were identified, which informed my methodological choice of participatory research.
Methods - Participatory action research, underpinned by critical and solidarity theories, was conducted with paid staff and volunteers in a UK hospice. The study was in three main phases: Phase one: An exploration of the hospice's context through semi-structured interviews with paid staff and volunteers, and a review of relevant documentation. Phase two: Iterative participatory action research cycles, directed by a participatory action research group. The aim was to plan, act, observe, and reflect on current practice and the impact of suggested changes collaboratively. Phase three: A deliberative panel, consisting of members of the wider hospice team to refine the findings of the participatory action research through facilitated discussions.
Data from the three phases were analysed using reflective thematic analysis, involving iterative reflection, action, and collaboration to refine the findings.
Findings - Five semi-structured interviews were conducted with paid staff (n=2) and volunteers (n=3), and documentation was reviewed. The participatory action research group initially included eleven group members (paid staff (n=3) and volunteers(n=8)), with a core group of six group members (paid staff (n=2) and volunteers(n=4)). The deliberative group included two participants (paid staff (n=2)). Five overarching themes were created from the participatory action research: 1) hierarchy and power ‘we are not asking for the world’ (volunteers do not sit in traditional hierarchical models); 2) belonging ‘they must have put a face to the name’ (knowing others and being known builds belonging); 3) being together ‘let’s get mixing’ (neutral shared spaces support feelings of being one team); 4) adding value ‘what value do we really place on our volunteers?’ (different perspectives on ways volunteers add value); 5) information and knowledge sharing ‘it’s getting the balance’ (preventing misunderstanding and being ‘on the back foot’).
Discussion and Conclusion - Volunteers should be involved and integrated into hospice power and hierarchical structures. Hospices need to create meaningful opportunities for paid staff and volunteers to mix. Silos between teams can negatively impact the working relationships within hospices. Hospices must find new ways of building a sense of mutual belonging for paid staff and volunteers. Volunteers need to be known, involved, and visible within hospice teams to build strong relationships, promote belonging, and clarify their roles in the hospice context.
