Integrating g self management across the Stroke

Transcription

1 Integrating g self management across the Stroke Pathway Tess Baird, Clinical Lead Neuro Team, Royal London Hospital, Barts Health.

2 Aims of the session. Introduce Royal London & Tower Hamlets Stroke Pathway. Key evidence relating to a pathway approach to self management. Challenges and opportunities across the stroke pathway for delivering self management approach.

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4 Royal London Stroke Pathway Hyper Acute Stroke Unit Acute Stroke Unit Rehab Stroke Unit Community Stroke Team

5 Rehabilitation ti treatment t t approach. It is important for there to be a consistent approach to rehabilitation and to maximise the carry-over outside of formal therapy by giving patients opportunities for informal practice. Also an agreed consistent approach for each problem faced by a patient, ensuring the patient is given the same advice and taught the same technique to ameliorate or overcome it. (RCP Guidelines 2012)

6 Self efficacy recommendations RCP Stroke Guidelines (2012) A All patients should be offered training in selfmanagement skills, to include active problem- solving and individual id goal setting. B Any patient whose motivation and engagement in rehabilitation seems reduced should ldbe assessed dfor changes in self-identity, lfid self-esteem and self-efficacy

7 WISE (Kennedy 2007) WISE The whole system informing self engagement g model. The models vision i is that t informed patients t who receive support and guidance from trained practioners working in balance with a healthcare system set up to be responsive to patients needs.

8 Patient Professional Structure Improve Change Improve information professional access to Strategyt responses services Work with Promote Use patient patients to develop flexibility in professional & professional Method information that is response through patient contacts to discuss relevant accessible centred approach & access options & and uses lay & traditional negotiation of self encourage self referral. evidence base. management plan.

9 What impacts on self management? Jones, Riazi &, Norris (2012)

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11 Staff workshops What did our service users think of Bridges? Local workshops to look at the challenges and opportunities in each stage of the pathway. Engagement into service development and research looking at the challenges in using Bridges. Bridges Buddies

12 HASU staff focus group Challenges (Norris 2012) Opportunities (Coyle 2012) Time Medically unstable Pathway approach. Medical model environment Using Bandura s sources of self efficacy typical Readiness to participate. i t therapy interventions Starting something that were reviewed for couldn t be continued. acceptability on the HASU.

13 HASU Focus Group Sources of self efficacy Mastery Practical application on HASU Service Users prioritise the focus of the rehab session. Setting challenges within the session. Task related self rating scales pre and post task. Rehearsal e ea of tasks s to encourage a problem solving approach. Independent practice Risk taking.

14 HASU Focus Group Vicarious Experiences Befriending Group activities Physiological feedback Verbal persuasion Encouraging services users to notice changes in how their body feels when doing a task. Biofeedback Encouraging words where appropriate. p

15 ASU Focus Group Challenges Medical model environment. Readiness to participate. Staffing levels l Starting something that couldn t be continued. Engaging nursing & medical staff. Opportunities Philosophy during rehab sessions Preparation for transition to community MDM format Groups Self efficacy model during MDT case discussions. Works well with MUS

16 RSU Focus Group Challenges High levels of disability of the client group.. Engaging family members with the carers workbook. Opportunities Philosophy during rehab sessions. Bridges Workbook. Carers Workbook. MDM. Groups. Self efficacy model during MDT case discussions.

17 CST Focus Group Challenges Encouraging RSW to lead on long term goal setting. Integrating Stroke Specific Social Worker to training Opportunities Philosophy during rehab sessions Bridges & Carers Workbook. Self efficacy model during MDT case discussions. RSW s involved in Bridges goal setting. Discharge report is goal focused with confidence ratings included

18 Long term support in Tower Hamlets Stroke Association Befriending Service Ability Bow Annual Stroke Service Users Events Stroke reference group

19 Inspired by UKSF Information provision across the Stroke Pathway (Baird 2011) Use of distress thermometer in CST (Julienne 2012) Who controls the goals? Service users guiding g the development of long term goal setting with RSW in CST. (Coster 2012) Self Management on a HASU. (Coyle 2012) Challenges of using Bridges on the HASU. (Norris 2012) Bengali Bridges. (Norris 2012)

20 Where eenext? Maintaining i i the philosophy h Health beliefs questionnaires. Extension of Barts Health Stroke Pathway.

21 Key message The whole systems approach requires a multi level strategy where changes at different levels are linked to maximise the effect. (Kennedy 2007)

22 References Barlow et al (2002) Self management for people with chronic conditions a review. Pat Educ Couns 48: Bury et al (2005) A rapid review of the current state of knowledge regarding lay led self management of chronic illness. London, NICE. Jones et al (2012) Self management after stroke: time for some more questions? Disability & Rehabilitation DOI / Kennedy, Rodgers & Bower (2007) Support for Self Care for patients with chronic disease. BMJ 10,11,33511 National Primary Care Research & development Centre. The WISE approach to self management Norris & Kilbride (2013) From dictatorship to democracy: stroke therapist talking about self management. Disability & Rehabilitation DOI / Royal College of Physicians Guidelines for Stroke (2012) Royal College of Physicians, London.