The Lanarkshire Managed Clinical Network for Stroke made effective use of ‘patient narratives’ within a Project called ETHoS. This Project set out to create a care environment that would enhance the rehabilitation process and minimise the stress suffered by patients and carers following the sudden onset of stroke. It therefore had a strong quality improvement focus and the approach taken made extensive use of inter-professional education and dialogue.
The narratives were used in part as a tool to encourage active listening in members of the multi-disciplinary stroke care team. This was an important feature of the staff training component of ETHoS.
The main reason for promoting active listening is that it can aid understanding. The care team had the privilege of sharing three patients’ journeys and developed a greater sense of what it really means to experience such a life-changing episode. This in turn prompted reflection on individual practice, resulting in a more compassionate approach to care. Empathy was also developed between the various healthcare professionals working with the patient, resulting in a stronger sense of teamwork. Although not easy to quantify using traditional metrics, these changes were remarked upon by patients, carers and staff.
The storytellers were also invited back to the acute setting to discuss their experiences. Here they returned not as patients, but as people. Once a ‘patient’ has been discharged, there’s usually no further follow-up by the acute care team. The return visits allowed staff to see the progress made by people they had cared for during the early stages of recovery and to gain a more rounded picture of the ongoing rehabilitation process and the part they play in it. Reviewing the narratives with participants and staff present to express their feelings added an important dimension to the overall experience.
By listening ‘deeply’ and gaining a better understanding of the experiences of patients, carers and other members of the multi-disciplinary care team, it was also possible to identify the following improvements:
The patient narratives in particular pointed out several areas for service improvement, mostly concerning the timing and content of staff communications with patients and carers.
Since completing the Project, single page extracts from the narratives have been used, unaltered, as the forward to the ETHoS Project Report and the Lanarkshire Stroke Managed Clinical Network 2007 Annual Report. The narratives also featured strongly within the ETHoS Approach, presented at the NHSScotland event in July 2007, generating strong emotions and intense discussion, and resulting in a highly successful evaluation.
On an ongoing basis, the narratives form a valuable resource that can be revisited by staff and offered to new staff as part of the induction process.
By acknowledging the grief associated with illness and recognising the inner spiritual strength and resilience within humanity, we can support people more fully.
Bob Devenny, ETHoS Project