Implementing Supported Self-Management in Community-Based Stroke Care: A Secondary Analysis of Nurses’ Perspectives

Abstract

The provision of supported self-management (SSM) is recommended in contemporary guidelines to address the longer-term needs and outcomes of stroke survivors and their families, yet its implementation across stroke pathways has been inconsistent. This paper presents a secondary analysis of qualitative data, which aims to identify and offer insight into the challenges of implementing SSM from the perspectives of community stroke nurses (n = 14). The findings revealed that the implementation of SSM in stroke is influenced by factors operating at multiple levels of the healthcare system. Contextual challenges arise because of different understandings and interpretations of what SSM is, what it comprises and professionals’ perceptions of their roles in its implementation in practice. A professionally controlled, one-size-fits-all model of SSM continues to be reinforced within organizations, offering few opportunities for nurses to deliver contextually tailored and person-centred SSM. In conclusion, there are many professional concerns and organizational tensions that need to be addressed across multiple layers of the healthcare system to achieve the consistent implementation of contextually tailored and person-centred SSM following a stroke. Attempts to address these challenges will help to narrow the gap between policy and practice of implementing SSM, ensuring that stroke survivors and families benefit from SSM in the longer-term.

Effects of Chronic Care Model‐based interventions on self‐management, quality of life and patient satisfaction in patients with ischemic stroke: A single‐blinded randomized controlled trial

“…It is noted that most stroke patients have at least one modifiable risk factor, such as diabetes, smoking, obesity, physical inactivity, and an unhealthy diet that is often poorly managed during the follow-up process (Bridgwood et al, 2018). Self-management support is a significant strategy in the prevention of recurrent stroke (Kidd et al, 2020). As a result of a meta-analysis study, it was found that self-management interventions were effective in improving overall risk factor control in stroke patients (Sakakibara et al, 2017).…”

Supported self-management in community stroke rehabilitation: what is it and how does it work? A protocol for a realist evaluation study

“…30 The implementation of supported self-management may also be influenced by different perspectives on, and interpretations of, supported self-management in stroke. 26 Thus, although evidence suggests supported self-management in stroke is effective, to optimise and meaningfully tailor its delivery to stroke survivors' needs in the community, we need to learn more about how supported self-management works and how it is delivered in different settings of community rehabilitation. The proposed realist evaluation study aims to address this gap.…”

“…Several well-defined supported self-management interventions in stroke exist, for example, Bridges25 in the UK and Take Charge in New Zealand 18 24. However, our previous research and anecdotal evidence suggests that the diffusion and delivery of supported self-management in practice requires organisational culture change within the healthcare system, rather than the simple implementation of a discrete and well-defined intervention with specific evaluation outcomes 20 25 26. Supported self-management approaches have often been delivered according to a set of principles or ideas that fit with, or are in some way influenced by, the system or organisational context.…”

“…It is plausible that supported self-management in stroke may work in different ways, or not at all, because of factors inherent in the geographical or organisational contexts or models of rehabilitation delivery in which it is being implemented 30. The implementation of supported self-management may also be influenced by different perspectives on, and interpretations of, supported self-management in stroke 26. Thus, although evidence suggests supported self-management in stroke is effective, to optimise and meaningfully tailor its delivery to stroke survivors’ needs in the community, we need to learn more about how supported self-management works and how it is delivered in different settings of community rehabilitation.…”

Factors related to daily use of the paretic upper limb in patients with chronic hemiparetic stroke–A retrospective cross-sectional study

“…On the other hand, approaches to proceed a self-management or home-based rehabilitation has a certain effect not only to maintain chronic health condition, but also to improve body function [ 3 , 4 ]. It is suggested that tailored counselling or with tailored supervised training as well as nurses’ intervention improves participation and arm function [ 5 , 6 ].…”