A person-centred approach to communicating risk.
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Biomedical subjects
Publications and source records attributed to Andy Alaszewski.
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PURPOSE: This pilot study aimed to explore with stroke survivors, carers and professionals, the impact of stroke and the process of recovery and rehabilitation. One theme that emerged in interviews with professionals was their use of the bereavement model in relation to recovery from stroke. The purpose of this paper is to explore the ways in which professionals use the bereavement model to explain and manage the rehabilitation of stroke survivors. METHOD: A person-centred study using qualitative research methods, semi structured interviews and self report diaries to explore with stroke survivors and carers the impact of stroke on their lives. Twenty-five interviews with stroke survivors, 23 individual or with carers and seven in two focus groups. Evidence from four self- report diaries provided more detailed examples of the everyday experiences of the survivors. A set of parallel interviews involving 17 professionals involved in the care and support of such individuals, nine individual and one group interview involving a community rehabilitation team. RESULTS: The bereavement model can be identified in the literature aimed at professionals, and was evident in some professional accounts of stroke but was absent from survivors' and carers' accounts of stroke. In over half the interviews, professionals made reference to the bereavement model to explain a process of loss and readjustment. While survivors in their accounts of life after a stroke did acknowledge the ways in which stroke disrupted every-day life and resulted in losses and disabilities, their perception of such losses and disruption was shaped by the context of their every-day life. Most survivors sought to actively manage their recovery by setting goals. They wanted professional support in achieving their goals. The bereavement model appeared to be used by professionals in situations where there was a conflict over goals and professionals felt that survivors had become 'stuck' and their goals unrealistic. CONCLUSIONS: Following stroke, people try to make sense of what has happened and normalize their lives by setting themselves goals to progress towards recovery. It is important that professionals communicate effectively so that their interventions are grounded in and support the survivors' goals and strategies.
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Carers complain they are sometimes excluded from decision making and are seen as lacking in knowledge. Detailed discussion in advance makes a discharge more likely to be successful. Carers of children with learning disabilities have particular communication and support needs.
The inquiry into the services provided by the paediatric cardiac surgical team at Bristol Royal Infirmary between 1984 and 1995 marks a watershed in the development of health and social care services in the UK. There was an organisational failure of foresight based on a series of systemic and communication failures which contributed to oversight of an 'incubating' hazard which ultimately led to disaster. The recommendations of the Bristol inquiry have provided a major stimulus to the modernisation programme and especially of governance in health and social care which aims to restore public confidence and create 'high-trust' organisations. While it is premature to evaluate the impact of the changes, there is little evidence at present to indicate that they will improve the quality of professional decision making and the safety of users or enhance user and public confidence in the NHS and other public services.