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The impact of using self management techniques within the Lewin Stroke and Rehabilitation Unit

The impact of using self management techniques within the Lewin Stroke and Rehabilitation Unit at Addenbrooke’s Hospital

Background

When introducing self-management, massive benefits accrue from getting those who will use the new techniques to design the system to deliver it.

What we did

In the Lewin Stroke & Rehabilitation Unit at Addenbrooke’s Hospital, Assistant Practitioners (Rehabilitation) [AP(R)s] have been trained in agenda setting and goal setting for their patients. The training schedule included the AP(R)s designing and testing their own agenda and goal setting forms, which they refined based on their own experience of using them (PDSA).  The course ended on 30 March 2012, since which the AP(R)s have been using their new skills to encourage self-management among patients in the Unit. Some patients are completing the forms themselves, but in other cases (depending on the extent of disability or level of literacy) the AP(R)s are completing them, based on their conversations with the patients.

To iron out any problems that might arise, to build confidence and to embed good practice, AP(R)s have been supported and coached ‘at the bedside’ by Petrea Fagan.

Assistant Practitioners (Stroke) (APRs), working mainly with stroke patients in Addenbrooke’s Hospital, Cambridge, received tailored training to use self-management techniques with their patients. These included exploring concepts and understanding of self management support, collaborative agenda setting tools, action planning and facilitation of problem solving approaches. Patients were asked on a regular basis ‘what is important to you, what is your priority and what would you like to achieve?’ This information was used to support healthcare professionals to define treatment goals in partnership with the patient. These were then translated into action plans for the sessions the patient had with the APRs. In addition patients were encouraged to reflect on how confident they were to achieve their action plans, to identify potential barriers and to consider ways of overcoming them.

Impact

The focus on collaboration and understanding the patient’s perspective ensured that the rehabilitation team were fully aware of what was important to the patient in addition to therapeutically understanding what was important for the patient. This resulted in a powerful integration of both elements within the rehabilitation programme and supported patients to be more activated and also to start developing skills that would be important when returning to the community and integrating into daily life.

APRs were able to learn and develop new skills which increased their job satisfaction, perceived efficacy and cohesion within the team. The majority of healthcare professionals also gave very positive feedback regarding the process and the information content that was discovered.  Many patients reported the immense value in working towards a goal that they had set for themselves (with support) within their own context, rather than working on goals set for them. We believe, but haven’t yet proved, that recovery is quicker among patients that are self-managing their rehabilitation. Further work is underway to evaluate this model and indentify best practice when working with patients with significant difficulties with speech and understanding.

Patients were complimentary about the agenda setting and goal setting processes.  They have commented:

  • how their motivation to recover has increased;
  • how much quicker they feel they are progressing than before they were introduced to self-management;
  • the benefits of having forms to help to structure their thought processes;
  • how everyone who works with them understands their goals;