Lucinda Brimicombe
11 Nov 2016 0 comments
Topic: Self-management

Starting self-management support early in the acute setting: happier staff, happier patients, reduced length of stay?

Imagine that you have spent months in hospital following numerous plastic surgeries.  One Friday morning the surgeon comes to your bedside and says that you are fit to return home.  However, there’s one problem; you haven’t been out of bed for weeks, and now you feel that you can’t get out of bed.  You see at one point, getting out of bed to use the toilet felt painful, so the nursing staff brought you a bed pan to use and you’ve continued to use the bed pan ever since.  You didn’t think to question it.  Nobody else questioned it.  Now you have been told that you can go home but you feel anxious as you cannot see how you will cope.

This is a real scenario recounted by an Occupational Therapist during a recent Bridges follow-up workshop.  She was asked to review this patient before discharge from hospital.  She was shocked to find him bed bound as there was no physical reason for him to have become so dependent in a short amount of time.  The Occupational Therapist spent time with him and discovered that he had lost confidence in his capabilities and consequently he was not doing anything for himself.  Together they figured out a way for him to use the commode instead of the bed pan over the coming weekend.

By Monday morning, he was successfully using the bed pan and furthermore, he had planned how he could use the toilet on the ward.  Together they trialed his plan and every time the Occupational Therapist returned over the next week, she discovered him doing more for himself.  He returned home 10 days after the surgeon had declared him medically fit for discharge.  This scenario reminds us all about the importance of self-management support early in the acute setting; it enables people, it could stop them from becoming too dependent on staff and services, and it may even reduce length of stay.

Some healthcare practitioners see self-management support as something that happens after discharge from hospital, to be provided by community services and the third sector.  However, we believe that self-management support can and should be started early in a patients’ healthcare journey.  When a multidisciplinary team works in a way to support the self-management skills of patients and families, it can help them to prepare for a more successful discharge from hospital, reduce the length of stay and improve patient satisfaction.  In this scenario, if the multidisciplinary team had worked together from day one to help the patient to help himself, he could have returned home as soon as he was declared medically fit.

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When a multidisciplinary team works in a way to support the self-management skills of patients and families, it can help them to prepare for a more successful discharge from hospital, reduce the length of stay and improve patient satisfaction.

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We have previously written about the notion of ‘every interaction counts’ when supporting self-management in an acute healthcare setting [1].  A common misconception is that self-management support can take more time in the acute setting, something that acute practitioners on busy wards do not have.  However, our work shows that it can be integrated into the working practices of acute practitioners without it taking more time, by considering how their every interaction is supporting the patient (or not) to feel more in control of their health and their life.  This requires an investment of time to train whole teams and importantly, to support them to sustain self-management support strategies in the longer term [2].

We have explored the barriers and facilitators to integrating Bridges self-management support into the working practices of acute stoke teams [3], a brain injury pathway and an acute major trauma setting.  Whilst there are considerable challenges to training acute medical, nursing, allied health and support staff at the same time, we believe that whole team training is essential to change a teams’ ethos to one that supports more person-centred ways of working.  We also know that bringing teams together during multidisciplinary training can improve team-working and communication.   To quote one senior nurse working in an acute neurosciences setting, who is involved in our Health Foundation Spreading Improvement project:

“The benefits of self-management for a team is that it helps us to see patients as an individual, as part of a family and a community.  It’s too easy to see patients as an injury in a bed and not to engage with them as people, so the better able we are to engage with them; with their history, their background and their future; the more satisfaction we get from our jobs.”

 

References

  1. Jones F & Brimicombe L (2014) Every interaction counts: The 'Bridges' approach to stroke self-management.  International Journal of Therapy and Rehabilitation, 21(4), pp. 158-159
  2. Ahmad, N., Ellins, J., Krelle, H., & Lawrie, M. (2014). Person-centred care: from ideas to action. The Health Foundation: London.  Retrieved from http://www.health.org.uk/publication/person-centred-care-ideas-action
  3. Makela P, Gawned S, Jones F. (2014 ) Starting early: integration of self-management support into an acute stroke service. BMJ Qual Improv Report 2014;3: doi:10.1136/bmjquality.u202037.w1759