As stroke and neuro rehab staff, we aim to do the best for people with a long-term neuro condition who come to us for rehabilitation. We know that we do not have all the answers and sometimes it’s about listening and letting people talk. Listening is part of the journey for all of us. However, while we wish to get it right, sometimes we worry about getting it wrong. We feel that by asking questions too early in our working relationships with people who come to the service, we will touch on raw, sensitive subjects inadvertently causing distress when our aim is the opposite.
To support us in our quest to empower all involved, we have been lucky to be part of a regional project working with Bridges Self-Management. The questions we are asking is how do make rehabilitation more effective and get it right more of the time? How do we ensure that we start in the best way when someone comes to us for neuro rehabilitation? Would hope that our work with Bridges will help us to answer these questions and better support patients, carers and staff.
We started working on this project in August 2018. So, are we moving in the right direction? We have always used an assessment document which asks why somebody is coming into the service for neuro rehabilitation. However, we are beginning to re-focus these discussions using different initial conversations. We have started to use a ‘Getting to know me’ questionnaire, so from the start we have conversations about what’s important for the people we work with. The questionnaire covers the person’s knowledge of their condition, daily routines, expectations and ideas about how to move forward.
We now focus on what people talk about, being led by their words. This gives a shared understanding of the person’s vision with timeframes guided by their own experiences. The conversations we collectively have ensure we have unambiguous, shared, achievable goals. We focus on people’s confidence, how they feel about manging their own conditions and what actions/information they will find helpful to support them. We work through how people can take small steps and try things in safe ways to help learning and achieving aims; unlocking answers with using different questions.
It is a learning curve for all of us. Staff have voiced concerns about opening up conversations when we do not have the answers, but what makes us stronger together is learning from each other. We talk and listen more – we learn to listen more carefully and together lose our fears.
Charlie Dorer is the Clinical Manager for the Integrated Neurological Rehabilitation and Stroke Early Supported Discharge Teams in Cambridgeshire and Peterborough NHS Foundation Trust, UK.
As part of my role I have been fortunate to be seconded to work with the Bridges team to continue to work on supporting and sustaining self –management across the stroke and neurological rehabilitation pathway for Cambridgeshire and Peterborough patients. This has been funded by Health Education England.