Title: Supporting the person experiencing a stroke through fostering relationship-centred care on a stroke unit.
Funder: Health Education England

Abstract: Background Compassionate, dignified, relationship-focused care is under strain in the modern NHS. Recently stroke services have improved the organisation and efficiency of hospital-based stroke care with the reduction of length of stay. Staff are focusing on tasks and processes that are not always informed by caring relationships. This can leave them feeling disenfranchised as they are unable to fulfil their caring roles. Providing relationship-centred stroke care has become more challenging.Aims: To explore and describe the processes involved and outcomes of implementing a relationship-centred rather than task-focused care approach in a stroke ward setting involving a) the person with stroke, their relatives and/or informal carers, b) the stroke ward health care team, and c) hospital managers. Objectives: 1) To facilitate stroke survivors and their families in sharing their experiences of relationship-centred care (RCC) on a stroke unit; 2) To enable stroke survivors, their families and the stroke multidisciplinary team to identify facilitators and barriers of RCC; 3) To determine the influence of hospital managers and the organisational culture on RRC in a stroke unit; 4) To implement and evaluate the processes which support the clinical team, in collaboration with stroke survivors, their relatives and hospital managers, to change practice in order to redress the balance allowing staff to focus on RCC; 5) To define the principles and insights behind RCC, and the specific elements and processes to support consistent RCC in other stroke unit settings and develop these into a tool-kit. Plan of Investigation An Appreciative Inquiry (AI) action research approach will be used. AI has a positive approach, specifically focusing on what works well, and how this can be built on to inform other aspects of practice. It is a research method with stroke survivors, relatives, health-care staff and managers (together referred to as 'participants') being co-collaborators. Therefore it is a supportive, respectful process that will involve understanding experiences of giving and receiving care (Dewar 2010, Reed 2010). This AI action research will have 5 stages: Discovery Phase. To explore participants' experiences of care where relationships are central to the caring process. This will be achieved by (a) semi-structured interviews, (b) focus groups, and (c) observations of care. Vision Phase.The participants will review that data from the Discovery Phase and explore what process or support enabled them to have positive RCC experiences. They will together agree a vision of how they wish to deliver and experience improved RCC. Design Phase. The participants co-design the social architecture (norms, values, systems) to support their ideal RCC. Through leadership all the participants develop a commitment to change. Delivery Phase. The new practices are implemented and evaluated. Health-care staff develop the skills to continually develop and monitor practice improvements. The new care practices will be evaluated through a range of methods depending on the type of new interventions implemented. For example (a) Focus groups, (b) Semi structured interviews, (c) Observations of staff-stroke survivor interactions, and (d) Analysis of care plans to see if these new care practices were documented. Transferability. A tool kit' of potential improvements with descriptions of processes and principles that can support RCC will be developed and tested in another stroke unit. Summary of potential benefits: 1. An understanding of what is relationship-centred stroke care, with a description of its barriers and facilitators at all levels in a hospital's organisational structure; 2. A tool-kit to support consistent RCC in another stroke setting. To test out' the principles developed and increase transferability. 3. Provide insight into and recommendations for the translation of national NHS care quality policy (i.e. dignified, compassionate, RCC) into real clinical practice.

Lay abstract: Objective: Hospitals can become process and taskorientated with human relationships in caring diminished. We will determine the necessary processes for, and outcome of, relationship-focused rather than task-focused care in stroke units. Design: Using Appreciative Inquiry Action Research; people with stroke and their relatives, stroke unit staff and hospital managers will describe positive caring relationships and replicate those which are working well while analysing facilitators and barriers to change. Outcomes: Understanding of a) processes needed to develop/maintain relationships supporting excellent hospital stroke care b) the nature/quality of these relationships. Benefits: A toolkit to support relationship-focused care in stroke units.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: STROKE