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Interested in finding out more about Bridges?

 

PRACTITIONERS click here for detailed FAQ's or click here for the evidence supporting the programme

 

COMMISSIONERS and TRAINING MANAGERS please click here

 

PATIENTS/CARERS click here

 

RESEARCHERS/COLLABORATORS/GENERAL ENQUIRIES please register your interest here...

 

 

Bridges Open Workshops

 

We run open workshops for individual practitioners working in neurological and general rehabilitation, or perhaps you work with stroke survivors in the voluntary or third sector.   

 

Click here for more information about our open workshops

 

 

 

 

Case Reflection Analysis

Background

As part of the Bridges stroke self-management training, practitioners are required to complete in-depth case reflections of how they have used the Bridges programme with a stroke survivor. Dr Jones and colleagues recently undertook a qualitative research study to analyse the responses in these case reflections, and explore how practitioners perceive their experiences of using the Bridges stroke self-management programme in practice.

These case studies are used by trainees to reflect on their practice in follow up workshops. However, they also serve to inform future Bridges research, and help develop and improve the Bridges training programme. They can also contribute to an understanding of how Bridges works at different times within the stroke pathway.

Methods

Case reflections from 60 practitioners were sampled and used in the study. All practitioners had attended workshops during 2009 and 2010. The case reflections were analysed using a thematic content analysis.

Results

The most prominent themes from the analysis were timing, congruence with goal setting, belief in the concept of self-management, balance of power and the subtleties and sensitivities of using the SSMP. The case reflections highlight a personal awareness of the complexities of supporting self-management after stroke, and show participants reflecting on how they influence the development of self-management skills in stroke survivors, through their communication and interaction.

Timing
Practitioners talked about ‘waiting for the right time’ to use Bridges with stroke survivors, and many were unsure about using it in the acute setting as they felt patients had not yet had time to ‘accept’ their stroke.

Congruence with goal setting
Practitioners felt that using the Bridges approach constituted a change in goal-setting practices for them. Some were concerned about patients setting unrealistic goals, and reported internal tensions about how the principle aligned with their usual practice. However, practitioners felt Bridges provided a structure for goal setting, and felt they found out more about individuals’ specific aspirations leading to more meaningful goals being set.

Belief in the concept of self-management
People felt that beliefs and attitudes of participants towards the Bridges self-management programme were critical to how much they would use it in their practice.

Balance of power
Some practitioners felt there was a tension between relinquishing control of goal setting, and giving advice and guidance to stroke survivors, and found it hard to resist the temptation to direct the individual to specific goals.

Subtleties and sensitivities of using the SSMP
Some practitioners were concerned about the fact that not all individuals want to, or can, self-manage, and there was a lot of reflection on using the programme in a more subtle way – perhaps using some of the principles without using the whole workbook.

Conclusion
Case reflections proved to be a useful tool for encouraging self-reflection on learning and practice in professionals. The paradox between the professional as the ‘expert’ and supporting self-management through a more collaborative therapeutic relationship needs further exploration.

Please refer to the journal article published about this study for more in depth information:

Jones F, Livingstone E, Hawkes, L. (2012) ‘Getting the balance between encouragement and taking over’- Reflections on using a new stroke self-management programme. Physiotherapy Research International.

Early online viewing of this article is available at http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1471-2865

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