None listed
Conditions
Brief summary
In New Zealand 6,000 people have a stroke each year resulting in about 32,000 people currently living with disability caused by stroke. Although most people receive rehabilitation and support whilst in hospital little long term rehabilitation is provided for survivors of stroke nationally. Self -management programmes have been shown to be beneficial and effective in reducing hospital re-admissions. Jones and colleagues developed, in the UK, an individualised stroke self-management programme for people with stroke, the Bridges Stroke Self-Management programme (Bridges). Bridges is a self management approach that is delivered to patients by any health professional trained in its approach in tertiary, secondary and primary health care settings. Professionals are trained to support people with stroke throughout their “stroke journey” to develop their self- management skills using strategies such as reflection, self-discovery, goal setting and shared decision making. Bridges is not a structured didactic programme but is a philosophical approach integral to empowering the stroke survivor and facilitating self- management principles in rehabilitation. In a previous project we contextualised the Bridges approach (in particular the accompanying workbook) to New Zealand and evaluated its feasibility in a NZ context. In this project, we wish is to integrate and evaluate Bridges into stroke care (acute to community) in the South Canterbury District Health Board (SCDHB) as a whole multidisciplinary team approach over a 12 month period. We will use a case study design. We will implement Bridges informed by the Normalisation Process Theory (NPT) using 'Plan Do Study Act’ (PDSA) cycles. We will evaluate, from the perspectives of staff, patients and DHB management the implementation and potential benefits via qualitative evaluation. We hope this project will inform implementation of Bridges into other health services.
Interventions
Bridges is a self-management approach for people with stroke that is delivered to patients by any health professional trained in this approach. Thus Bridges is a model of care and practice delivered by multi-disciplinary teams in tertiary, secondary and primary health care settings.
The Bridges approach is taught in two stages, with a full day (7 hours) initial workshop and half day (5 hours) follow-up workshop approximately six months later. In the workshops practitioners learn methods of commu
Bridges is a self-management approach for people with stroke that is delivered to patients by any health professional trained in this approach. Thus Bridges is a model of care and practice delivered by multi-disciplinary teams in tertiary, secondary and primary health care settings. The Bridges approach is taught in two stages, with a full day (7 hours) initial workshop and half day (5 hours) follow-up workshop approximately six months later. In the workshops practitioners learn methods of communicating, key principles of self-management, reflecting on progress, goal setting and taking action that they can then use with stroke survivors with the aim of building the stroke survivors’ self-management and self-efficacy skills and minimising dependency on health professional staff. Bridges focuses on practitioners’ daily interactions with patients (what they say and what they do), and these interactions are supported by a patient held stroke workbook in which the patient can reflect on their progress, record aspirations/hopes and write down small targets. Training comprises the following components: 1. Theory, research and practical examples relating to stroke and self-management, 2. Role play and practice using the Bridges stroke workbook and principles, 3. Debate and discussion about integration into practice, using case-based scenarios, and 4. Completion of case reflections on using the Bridges SMP within practice and developing individual and team action plans. in the second workshop reflect on their practice of Bridges to date and discuss with peers and the facilitator. revisit theory and research. Discuss use of Bridges with more complex cases and how they can sustain this approach going forwards. The two Bridges training workshops will be delivered by two certified Bridges Trainers to all South Canterbury District Health Board (SCDHB) (New Zealand) staff involved in the stroke service as per Bridges specifications and in liaison with Fiona Jones (the developer of Bridges). Trained SCDHB staff will then implement the Bridges approach with all appropriate patients with stroke that they work with post-training. Researchers, using fidelity checklists will observe a random selection of health practitioners in practice using the Bridges approach on two occasions. This trial evaluates the implementation of this approach into a stroke pathway from both staff and patient perspectives, focussing on 1. Identify context-specific delivery factors, facilitators and barriers to implementation of Bridges into a small DHB; 2. Evaluate the potential benefits of Bridges to patients, health professionals and the DHB; and 3. Explore the attitudes and beliefs held about self-management support in this context.
Sponsors
University of Otago
Study design
Allocation
Non-randomised trial
Intervention model
Other
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
There are two types of participants: 1. All patients with a stroke diagnosis admitted to service for 12 month period following the initial Bridges training workshop - Received the Bridges approach - Over the age of 18 years - Able to provided own consent 2. All staff from the SCDHB acute and community care stroke team will be targeted for Bridges training. This team includes physiotherapists, occupational therapists, social workers, speech language therapists, nurses, senior medical officer, dieticians, and clinical nurse specialists. all staff attending the Bridges training workshop will be eligible for recruitment.
Exclusion criteria
Patients with stroke: - Not a stroke diagnosis, e.g. a TIA - Did not receive the Bridges approach - Under 18 years of age - Inability to provide informed consent Staff participants: - Did not receive the Bridges training
Outcome results
None listed