Discussion: Alternative Research Design – Nursing Paper Essays

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ORIGINAL ARTICLE
Implementing an interprofessional model of self-management support across a community workforce: A mixed-methods evaluation study Stefan Tino Kulnik a,b, Heide Pöstgesa,b, Lucinda Brimicombea,b, John Hammonda, and Fiona Jonesa,b
aFaculty of Health, Social Care and Education, Kingston University and St. George’s, University of London, London, UK; bBridges Self-Management Limited, London, UK
ABSTRACT The importance of implementing self-management support (SMS) is now widely accepted, but questions remain as to how. In 2015, we facilitated the implementation of an interprofessional model of SMS (Bridges Self-Management) for people with complex multiple long-term conditions through community rehabilitation and social care services in one Southeast England locality. Over 90 professionals and support workers from this workforce received interprofessional training to integrate SMS into their care and rehabilitation interactions. This gave an opportunity to explore how SMS can be implemented in practice. We conducted a mixed-methods study with unequal weighting (qualitative emphasis), con- current timing, and embedded design. Staff provided written feedback and case reflections, participated in group discussions, and completed a survey of self-management beliefs and attitudes. We recruited a convenience sample of 10 service users and conducted qualitative interviews and standardised ques- tionnaires. Findings showed that staff appreciated and benefited from the interprofessional learning environment. Staff reported changes in their interactions with service users and colleagues and had gained knowledge and confidence to support individuals to self-manage. Data also highlighted the need to facilitate SMS practice at the level of service organisation. Service user data illustrated the impact of interactions with staff, and how SMS had increased service users’ confidence and encouraged different skills to manage life with their conditions. This project has shown how multi-agency commu- nity teams can benefit from interprofessional training to enhance SMS for people living with long-term conditions, build a shared understanding of SMS, and integrate effective SMS strategies into everyday practices. Discussion: Alternative Research Design
ARTICLE HISTORY Received 23 January 2016 Revised 19 August 2016 Accepted 5 October 2016
KEYWORDS Community rehabilitation; interprofessional education; long-term conditions; mixed-methods; self- management support; social care
Introduction
Self-management support (SMS) is now considered a neces- sary component of health and social care provision, in order to adapt systems to increasing numbers of people who are living with one or more long-term conditions (Eaton, Roberts, & Turner, 2015). The concept of SMS is based on the under- standing that a person living with a long-term condition is at the centre of managing life with the condition, not healthcare services (Boger et al., 2015; Demain et al., 2015; Lorig & Holman, 2003). The principles of SMS focus on the ways in which individuals can work in partnership with health and social care professionals, predicting potential challenges and managing their health. This runs contrary to a traditional focus on episodic service provision in response to acute illness or crisis. Interventions to promote SMS can deliver promising clinical outcomes and more appropriate health and social care use (Coulter et al., 2015; de Silva, 2011; Hibbard & Greene, 2013). While the case for SMS has been made, questions remain as to the best ways of implementing effective SMS on a large scale. Discussion: Alternative Research Design
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In 2015, we facilitated the implementation of an interprofes- sional model of SMS (Bridges Self-Management) for people with different long-term conditions who are clients of community
rehabilitation and social care services in one locality in the South East of England. The organisation of these services broadly reflects current service provision in the United Kingdom (Allen & Glasby, 2009). Briefly, this workforce includes teams that provide rehabi- litation and social support to individuals with predominantly physical health concerns, in order to enable integration and parti- cipation in the local community. The workforce typically com- prises health professionals (nurses, occupational therapists, speech and language therapists, physiotherapists, and social workers) and support workers. The nature of the work consists of individual one-to-one support in the community and background case work. This workforce shares a client base of people with varying long- term conditions who may present with different individual impairments and activity limitations. For example, individuals may be referred for temporary community support after discharge from hospital; or for re-evaluation of community support systems and a period of community rehabilitation following deterioration in their long-term conditions.
For this project, we drew on two main perspectives. Firstly, we took an interprofessional approach to workforce education and practice, which has constituted a strong influence in the development and implementation of Bridges Self-Management since inception. Interprofessional education (IPE) is defined as
CONTACT Stefan Tino Kulnik [email protected] Faculty of Health, Social Care and Education, Kingston University and St. George’s, University of London, Cranmer Terrace, London, SW17 0RE, UK.
JOURNAL OF INTERPROFESSIONAL CARE 2017, VOL. 31, NO. 1, 75–84 http://dx.doi.org/10.1080/13561820.2016.1246432
© 2017 Taylor & Francis