Starting early: integration of self-management support into an acute stroke service

Abstract

Self-management support following stroke is rare, despite emerging evidence for impact on patient outcomes. The promotion of a common approach to self-management support across a stroke pathway requires collaboration between professionals. To date, the feasibility of selfmanagement support in acute stroke settings has not been evaluated.The Bridges stroke self-management package (SMP) is based on self-efficacy principles. It is delivered by professionals and supported by a patient-held workbook. The aim of this project was to introduce the Bridges stroke SMP to the multidisciplinary staff of a London hyperacute and acute stroke unit.The 'Plan Do Study Act' (PDSA) cycle guided iterative stages of project development, with normalisation process theory helping to embed the intervention into existing ways of working. Questionnaires explored attitudes, beliefs and experiences of the staff who were integrating selfmanagement support into ways of working in the acute stroke setting.Self-management support training was delivered to a total of 46 multidisciplinary stroke staff. Of the staff who attended the follow-up training, 66% had implemented Bridges self-management support with patients since initial training, and 100% felt their practice had changed.Questionnaire findings demonstrated that staff attitudes and beliefs had changed following training, particularly regarding ownership and type of rehabilitation goals set, and prioritisation of self-management support within acute stroke care.Staff initiated an audit of washing and dressing practices pre-and post-training. This was designed to evaluate the number of occasions when techniques were used by staff to facilitate patients' independence and self-management. They found that the number of occasions featuring optimum practice went from 54% at baseline to 63% at three months post-training.This project demonstrated the feasibility of integrating self-management support into an acute stroke setting. Further work is required to evaluate sustainability of the Bridges stroke SMP, to understand the barriers and opportunities involved in engaging all professional groups in integrated self-management support in acute stroke settings, and to assess patient reported outcomes.

Adapting the Bridges stroke self-management programme for use in Australia

“…More than half of the health professionals who attended the Australian Bridges workshops worked with people who were less than six months post stroke. The Bridges SSMP has recently been adapted for use in acute stroke services in the UK, to support the early introduction of strategies to empower the stroke survivor to be as independent as possible and to encourage them to participate in decision making about their initial care (Makela et al, 2014). While most focus group participants were more than six months post stroke, the usefulness of the workbook in the early stages was also highlighted, with some participants feeling that it was 'too late' now for them to receive this information.…”

“…Key components of the Bridges SSMP training are illustrated in Figure 1. Previous studies have demonstrated preliminary proof of concept and feasibility of this programme for people living in the community post stroke (Jones et al, 2009;Jones et al, 2013;Jones et al, 2016;McKenna et al, 2015a) and in acute stroke care settings (Makela et al, 2014).…”

Implementing an integrated approach to self-management support in an acute major trauma therapy team: an improvement project

“…Additionally, we used three further methods to explore contextual and personal issues which aided and/or hampered a self-management approach in acute trauma: (1) AHP case reflections describing accounts and experiences of integrating self-management support with a patient and families; (2) Peer review to observe clinical interactions and record against a self- management fidelity checklist used in previous research20 and (3) summary of discussions about perceived barriers and facilitators to self-management support during intervention delivery (training package).…”

“…The Bridges SMP is an evidence-based educational intervention that has been tested and developed in different rehabilitation settings since 2008 13 17–20. Earlier work focused on implementation in community stroke settings but in 2013, Bridges SMP was successfully integrated into the working practices of a multidisciplinary acute stroke ward19 and in 2015 into a multidisciplinary traumatic brain injury pathway 13 21.…”

Exploring the Caring Incorporating Yoga Program in Promoting Physical Recovery of Stroke Patients in Acute Phase

“…In contrast, stroke patients also develop extreme levels of negative emotions [10] along with high level of functional dependency [11,12]. They have poor knowledge and understanding about the reality of stroke life [13], lack skill in selfcare to overcome the challenges caused by stroke [14], and have poor adjustment to the sense of new life [15], with high caregiving burden in acute phase of disease and until 3-6 months post stroke [16]. In addition, poorly managed stroke in acute stage lead to higher possibility of living with unresolved physical problems and uncertainty that deeply changes the client's life in long term [17].…”