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.
Highlights
Stroke is recognized as an acute event followed by long-term treatments and support that facilitate rehabilitation and prevent further stroke
A few of the nurses spoke about the presence or absence of legislative and local policies, guidelines and local or national initiatives designed to support the implementation of supported self-management (SSM) or nurses’ roles within SSM at the time of the study
Across Europe, there are calls for greater provision for, and further research on, frameworks to support the consistent implementation of longer-term care and integration of SSM into stroke pathways and service provision [14]
Summary
Stroke is recognized as an acute event followed by long-term treatments and support that facilitate rehabilitation and prevent further stroke. In the United Kingdom (UK), strokes cost the economy £26 billion each year; much of which is the direct cost to stroke survivors and their families [1]. There are currently up to 1.2 million stroke survivors living in the UK [1]. This figure is predicted to rise to 1.5 million by the year 2025 [1]. Many stroke survivors experience significant and complex physical, cognitive and emotional stroke-related impairments, and multimorbidities that require longer-term management, and meaningful and effective support in primary and community care settings [1,2,3]. The identification and management of the long-term consequences of stroke is a priority issue in the UK and a global priority for stroke researchers [4,5]
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