Attitudes of healthcare professionals towards self-management for patients with stroke

Abstract

Self-management approaches towards stroke rehabilitation are gaining more attention due to emerging evidence of their impact on patient outcomes. This mixed methods study explored the attitudes of healthcare professionals (HCPs) towards stroke selfmanagement. The Bridges Stroke Self-Management Programme (Bridges SSMP) training was delivered to 51 HCPs in New Zealand. Questionnaires were completed by consenting participants (n=43) prior to administration of the Bridges SSMP training. In-depth, semi-structured interviews were conducted with three participants. The General Inductive Approach was used for thematic analysis of the qualitative data. The resulting overarching theme was "integrating the self-management concept into practice", which encompasses organisational, contextual and individual factors that HCPs feel are challenges when applying self-management. Two contributors to this theme -"education" and "facilitating empowerment" -emerged as barriers or enablers, respectively, to putting self-management into practice. Questionnaire data showed HCPs were confident in their capability of self-management concepts yet did not frequently use them in practice. Healthcare professionals were mostly positive about the concept of self-management but challenges and barriers were evident when applying this to practice. Hence, they may require a deeper understanding of the principles of self-management and become more familiar with the process by applying the principles of self-management in their own lives.Taylor, A., Monsanto, X., Kilgour, H., Smith, C., & Hale, L. (2019). Attitudes of healthcare professionals towards selfmanagement for patients with stroke.

Exploring self-management within hospital-based stroke care: current and future opportunities

“…Stroke self-management support has previously been explored in the context of the multidisciplinary team in the community [17,29] and this study extended that work to explore the perspectives of clinicians working in multidisciplinary teams across hospital-based care. The findings suggest that support for self-management across the care continuum was impacted by an inconsistent understanding of self-management within and across teams, and differing expectations and beliefs about readiness for self-management support.…”

“…However, there was limited discussion of the other core skills including decision making, problem solving and forming partnerships with clinicians, suggesting that role and emotional self-management behaviours were considered less often [3]. For individuals to receive comprehensive support in developing self-management skills and behaviours, clinicians first need a strong foundational knowledge of all self-management principles [29]. Day hospital clinicians were the only participant group to address all elements of self-management in their practice, perhaps due to working with clients who had returned home and were better able to clearly articulate their needs [17].…”

“…The second theme identified various beliefs about readiness for self-management, with clinicians suggesting that this varied significantly between individuals. It has previously been demonstrated that clients and clinicians alike report differing ideas regarding the best time to commence [29,[33][34][35] and that a standardised approach is considered to be ineffective due to the individualised nature of self-management [33]. Some individuals may demonstrate readiness to engage in self-management soon after stroke and evidence demonstrates that self-management support at this stage is feasible [14,15].…”

“…Perhaps aware of this, clinicians in this study highlighted the value of promoting self-management, usually in the form of education, prior to discharge. Whilst this strategy for developing self-management is beneficial, education alone is not sufficient to promote self-efficacy and support behavioural change [29]. Parke and colleagues [3] describe a process that includes the acquisition of selfmanagement skills followed by the independent incorporation of these skills into selfmanagement behaviours, thereby building individuals' self-efficacy.…”

Implementing and evaluating the Bridges stroke self-management programme into a New Zealand district health board stroke service: A case study

“…Due to shiftwork, many nurses could not attend the workshops, and an abbreviated 2-hr workshop was designed and delivered to ward nurses in line with previous Bridges training (Mäkelä et al, 2014). Prior to training, attendees experiences and perceptions about self-management support were explored; these findings have been reported previously (Taylor et al, 2019).…”