COVID-19: a catalyst for bravery

As the impact of another surge in COVID-19 looms, we have an opportunity to take stock of not only the challenges that COVID-19 has thus far presented but where this has brought us to in terms of unexpected or new opportunities, and creative ways of working to facilitate the ongoing delivery of person-centred, long-term support for people with stroke. During the height of the pandemic, many practitioners found themselves having to work differently because the routine delivery of rehabilitation and post-stroke services had been paused or ‘looked different’; swiftly moving to online and virtual consultations and support instead of the usual face-to-face approaches. Much has been written and discussed about digital health during this time and its longer-term place in the post COVID-19 healthcare landscape.  However, the pandemic has also been a conversation starter for the broader changes in the ways care delivery has shifted, not just in terms of service delivery pathways but also in the ways that practitioners work in their day-to-day practice to help people develop the capacity and confidence to manage the impact of their stroke on their own terms.

All of us recognise the challenges of consistently ‘doing’ person-centred care within the confines and limits of our healthcare system. Previous research has highlighted how practitioners largely work in a risk-averse way within a paradigm of ‘efficiency’ which can jar with true person-centredness.^1,2 The pressures of ‘getting people through the system’ coupled with the perceived frustrations about a lack of joined up working between, or bureaucratic processes involved in, accessing and working with, other professionals, agencies and organisations within local communities, can make it even more difficult to deliver person-centred, self-management support.¹ Challenging these prevailing systems and structures in practitioners’ day-to-day practice can be difficult and emotionally and physically exhausting.  Many, understandably, avoid changing the status-quo because of the fear ‘getting something wrong’ or ‘not having all the answers’ or generally feel unsure of where to start with working in a different and unfamiliar way.

Yet, the pandemic has required us to navigate a challenging and unfamiliar landscape, where traditional structures have been flattened and role boundaries blurred, and where practitioners simply haven’t been able to work in ways that we’ve always done. In a sense, it’s forced practitioners to step outside the comfort zone of their day-to-day practice and become used to dealing with the unknown, the unexpected and the (sometimes) uncomfortable, and contributed to a greater acceptance (and self-acceptance) that they won’t always have all the answers. COVID-19 has transformed our idea of ‘community’ and what it means to us, both in a personal and professional sense. Practitioners have found themselves having to work closer than ever with third sector and community partners to deliver post-stroke care and support which can only have helped to strengthen the visibility of third sector and community organisations in the provision of long-term supported self-management and the synergy and connections across health, the third sector and local communities. Perhaps through this, a greater sense has emerged that self-management is something that is supported through meaningful and authentic relationships with stroke survivors and their families but also through better relationships with each other as professional colleagues.

Yes there’s been many hurdles – and likely, more to come – but has COVID-19 been the ‘disruptor’ that’s created the conditions for us to challenge the risk averse nature of the system that many of us have become so used to working in, enabled us to be brave, to feel confident and take positive risks, and most importantly, to be able to consistently put people’s needs ahead of the service when it comes to supporting person-centred self-management? How we maintain the impetus and momentum that COVID-19 has created in driving forward a person-centred agenda of supported self-management remains to be seen.

References:

1. Kidd L, Booth J, Lawrence M & Rowat A (2020) Implementing supported self-management in community-based stroke care: a secondary analysis of nurses’ perspectives Journal of Clinical Medicine 9:4:985 https://doi.org/10.3390/jcm9040985
2. Morris J, Oliver T, Kroll T, Joice S & Williams B (2017) Physical activity participation in community dwelling stroke survivors: synergy and dissonance between motivation and capability: a qualitative study Physiotherapy 103:3:311-321

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