Burdett Trust for Nursing

Improving Healthcare through Nurse-led initiatives. Registered Charity 1089849

Scholarship Stories: Lisa Kidd

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Burdett Trust

Lisa Kidd and her team

What is your project entitled?

Our project is called TALISSMAN which stands for ‘Tailored Stroke Self-Management’.

What are the key focuses of your project?

The key focus of our project was to develop and test a nurse-led, self-management support
intervention for stroke survivors. There has been a great deal of interest lately in self-management
because of its reported benefits in promoting recovery and patient empowerment in people who
have a long-term condition. It can also help to improve a range of health outcomes such as people’s
quality of life, their physical wellbeing and their emotional wellbeing as well as helping to manage
the ever increasing costs of care. Nurses working in the community are well placed and well skilled
to be able to help their patients self-manage. However, there is a lack of research evidence on
how to develop effective interventions to help nurses to help their patients self-manage and a lack
of information on how best to put these interventions into practice. There is also a lack of research evidence
on how to tailor the provision of support and help towards what people can and are willing to do
for themselves (their abilities and needs), what they as important to their self-management (their
priorities) and how they wish to be supported to self-manage (their preferences).

Our mixed method project, conducted in NHS Scotland, attempted to address these gaps by
undertaking a systematic literature review, as well as semi-structured interviews and focus groups to
understand issues such as: what self-management meant to stroke survivors and how they already
self-managed and, what self-management meant to stroke nurses, what kind of self-management
support they already offered and the challenges of this. We also asked stroke survivors to complete
a questionnaire, the ‘Patient Activation Measure’ (PAM) which was developed by Judith Hibbard
and colleagues in North America. We used this questionnaire to help us understand how ‘activated’
our participants were or in other words how ‘ready to self-manage’ they were. The questionnaire is
designed to give a score which shows on a continuum whether a person is a highly activated self-
manager or inactivated self-manager (i.e. they are not able or perhaps now willing to self-manage).
Primarily we used this opportunity to test out the PAM ahead of using it in the intervention itself as a
way of determining the self-management needs, abilities, priorities and preferences of the participants
and aligning the provision of self-management support to these accordingly.

The information from these stages was then used to help understand how to best develop a tailored,
nurse-led intervention which would help them to help their patients to self-manage effectively and
appropriately and to evaluate its use within practice in one Scottish NHS Board. The intervention
itself consisted of a personally tailored self-management action plan, presented in a booklet-format,
created jointly by nurses and the participant in partnership. Motivational interviewing prompts and the
PAM were both used during the intervention to assess participants’ abilities and confidence to self-
manage and to identify key goals to contextualise and frame their personal self-management plan and
the advice subsequently offered by the nurses.

What funding did you receive from the Burdett Trust?

We received fudning from the Burdett Trust under their Empowerment Programme Grant which is
designed to help empower nurses to lead the way in innovative improvements within their clinical
practice.

How did this funding help your project?

The funding enabled us to gather the evidence required to help develop a nurse-led self-management
support intervention for stroke survivors and to further understand how concepts such
as ‘activation’ and ‘self-management’ are understood and thought about amongst stroke survivors
and stroke nurses. The funding also helped us to understand more about the barriers and facilitators
to stroke survivor’s engagement in self-management and also the integration of self-management
support in nurses’ clinical practice.

What were the final outcomes of the project?

The project findings revealed that the intervention was well received by, and feasible and acceptable
to stroke survivors. The presentation and layout of the tailored self-management action plan was
appealing to stroke survivors and it was easy and straightforward to use. The goal setting process
was perceived as particularly valuable by both stroke survivors and nurses. In particular, it helped to
encourage genuine partnership working, enabled their patients to verbalise their personal aspirations
and priorities, and helped to structure their subsequent visits and self-management discussions. The
PAM was perceived as less useful within the intervention. The nurses commented that participants
would frequently give a ‘socially desirable’ answer placing them at the higher end of the self-
management spectrum that did not fit with their ‘true’ attitudes or behaviours towards engaging in
their self-management and that there was confusion over several of the questions in the way they
were worded. It was also suggested that more severely impaired stroke survivors may have more
specific issues of concern in relation to their self-management than the questionnaire tended to
address. In terms of the integration of the intervention within practice, the nurses perceived that the
intervention was time-consuming, resulted in the need for additional visits and did not fit well into their
current schedules of care delivery. It also seemed that the intervention was viewed by some of the
nurses as an adjunct to the on-going care that they were providing to their patients, rather than being
readily integrated within their care delivery, which may reflect the difficulties in shared understandings
of ‘supported self-management’. It was suggested that the documentation needed to be made
simpler, for example, a one-sided A4 page of check boxes rather than the booklet format in which it
was presented.

The Burdett Trust for Nursing was established in 2002 with the aim of making charitable grants to support the nursing contribution to healthcare. The Trustees target their grants at projects that are nurse-led and that empower nurses to make significant improvements to the patient care environment. The Trustees regularly review their grant-making policies and procedures to ensure that their grants achieve positive outcomes for patients, nursing and healthcare practice.

Find us online: www.btfn.org.uk

Facebook: facebook.com/burdetttrust

Twitter: @burdetttrust

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Author: burdetttrust

Improving Healthcare through Nurse-led initiatives. Registered Charity 1089849

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