Person-centred working relationships that focus on the unique goals of the individual are the heart of supported self-management: a qualitative study with stroke survivors

Résumé fourni par la source

The aim of this study was to understand stroke survivors’ experiences of developing working relationships (also known as therapeutic alliance) conducive to self-management during community stroke rehabilitation. Qualitative phenomenological study using semi-structured, one-to-one interviews. Seven people with lived experience of stroke helped shape the research. Purposive sampling recruited 21 stroke survivor participants from community stroke teams and peer support groups in England. Data were analysed using Braun and Clarke’s reflexive thematic analysis. Two themes “person centredness is the heart of supported self-management” and “relationship with myself and others,” relate to an overarching theme “the long and winding journey of self-management.” Seven subthemes describe the core features of alliances that are central to self-management and reveal wider barriers and facilitators of self-management success. Trusting relationships with healthcare professionals that focus on individual, person-centred goals are important for self-management. Negative experiences can impact the journey of self-management causing withdrawal from relationships with professionals. Relationships with family, friends, peers and wider organisations facilitate self-management success. The embodied experience of stroke and its consequences on self-identity are under-explored in the context of self-management. More research is needed to determine whether acceptance of a post-stroke identity may facilitate readiness to self-manage. Stroke survivors desire the right help, from the right person, at the right time which requires consistency, planning and efficient communication across services.Effective listening, a balanced approach to working towards patient-centred goals, and patient education are important aspects of self-management support.Rehabilitation professionals should spend time developing a bond that supports the work of therapy, before focusing on the tasks and goals of rehabilitation.Nursing and allied health rehabilitation professionals need investments in training to confidently and appropriately address alliance ruptures in stroke rehabilitation settings. Stroke survivors desire the right help, from the right person, at the right time which requires consistency, planning and efficient communication across services. Effective listening, a balanced approach to working towards patient-centred goals, and patient education are important aspects of self-management support. Rehabilitation professionals should spend time developing a bond that supports the work of therapy, before focusing on the tasks and goals of rehabilitation. Nursing and allied health rehabilitation professionals need investments in training to confidently and appropriately address alliance ruptures in stroke rehabilitation settings.

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