Enriching relational knowing on stroke units through appreciative action research

Authors: Gordon, C., Ellis-Hill, C., Dewar, B. and Watkins, C.

Conference: Collaborative Action Research Network Conference

Dates: 25-27 October 2018


Background: Improvements in stroke care in the UK are supported through national monitoring of processes and outcomes where the focus for services is often physical observable improvement. However this approach do not account for the context of care or the quality of patient, relative and staff experiences. Patients and relatives , have asked for more of a focus on personal subjective recovery and stroke unit healthcare staff report feel increasingly disenfranchised Method: CG collaborated with two specialist stroke units in district hospitals in England. Using Appreciative Action Research, participants identified and developed approaches that support meaningful experiences for all.

Participants: (i) Current in-patients on stroke units (n=17) (ii) Relatives (n=7) (iii) Stroke unit staff (n=65) Data were generated over 20 months through 16 semi-structured interviews, observations of usual stroke unit care (213 hours) and 10 discussion groups. Co-analysis of the data with participants developed themes around their most valued care experiences. Further in-depth analysis was conducted by the authors to confirm themes.

Findings: All participants described similar valued experiences of forming a human connection with each other. Human connection strengthened a sense of community between all participants, leading to co-created moments of well-being during the busyness of ward life.

The processes that supported connecting with each other included: 1. Sensitising to experiences a. Getting to know me, not why I’m here b. Noticing what matters through appreciative eyes 2. Sharing and reflecting a. Co-creating stories about the person b. Sharing experiences together c. Reflecting on what is meaningful 3. Trying out ways to connect a. Being open and curious to others’ perspectives b. Being opportunistic and not over-formalising c. Having the freedom to act The majority of staff participants reported improved well-being, and connecting with their colleagues more, which then appeared to support their relationships with patients and relatives.

Source: Manual