gms | German Medical Science

Background: The provision of supported self-management (SSM) is recommended in European-wide policy and guidelines for addressing the longer-term needs and outcomes of stroke survivors and their families. Its implementation across longer-term stroke pathways, however, has been inconsistent.

Aim: The aim of this research was to explore nurses’ perceptions of the challenges associated with implementing SSM in stroke care.

Method: A secondary analysis of qualitative data from the TALISSMAN project [1] was undertaken. Challenges were thematically categorised into ‘external infrastructure’, ‘organisation’, ‘professionals’, and ‘intervention’, according to Lau et al’s framework [2].

Results/findings: Different understandings and interpretations of what SSM is and consists of and nurses’ perceptions of their roles in its delivery and implementation makes implementation of SSM difficult. There is confusion over where SSM sits in the longer-term stroke pathway. The complexity of the healthcare system in which SSM is to be embedded limits the extent to which nurses can deliver on a person-centred agenda of SSM in stroke. A professionally-driven, one-size-fits-all model of SSM continues to be reinforced by the system, offering little opportunity for practitioners to operate outside the scope of this and little incentives to tailor care towards individualised need.

Discussion and conclusions: The implementation of SSM in stroke is influenced by factors operating at multiple levels of the healthcare system. Attempts to address these challenges will help to narrow the gap between the policy on, and implementation of, SSM in stroke, ensuring that stroke survivors and families benefit from SSM in the longer-term across Europe.