Abstract
This dissertation is a qualitative study involving three registered nurses working in a rehabilitation ward of a District Health Board in New Zealand. The study has two aims. The first aim of this study was to explore the perceptions of healthcare Professionals (HCPs) using Bridges Self-Management Programme (SMP). The second aim of this study was to evaluate the appropriateness, usefulness, and practicality of using video-based self-assessment as a learning instrument, self-review and/or audit tool of clinicians' performance in applying Bridges SMP principles in a patient encounter. The background context for this study reflects the growing recognition of self-management support as a tool to support health consumers with long term conditions towards promoting active participation and involvement in their treatment and condition. Currently, health care professionals (HCPs) are not adequately skilled to provide self-management support. A half-day Bridges SMP training was provided in a rehabilitation ward to train nurses in applying self-management principles in clinical setting.
This study explored the use of video-recording and self-assessment to promote learning, encourage self-review, and facilitate audit in applying the Bridges SMP principles. Video recording a patient encounter with self-assessments offers an effective method for clinicians to observe, evaluate, enhance expertise and improve outcomes by viewing videotaped experiences Using a qualitative descriptive approach, purposive sampling was undertaken, and participants undertook video recording of a patient encounter within a clinical assessment. A self-assessment was then undertaken by participants in a private room whilst watching the video recording. Finally, data were collected using individual semi-structured interviews which were recorded and transcribed. Inductive thematic analysis considering broad thematic patterning was used to analyse these data which generated three major themes, eleven subthemes, and seventeen categories. The first theme Putting into Practice, which comprises of two subthemes: Patient Benefits and Health Care Professional Gains, explored the application of Bridges SMP principles during the patient encounter. The second theme The Process of Video recording and Self-assessment, is comprised of two sub themes Video Recording and Self-Assessment. The third theme Perceptions About the Exercise, is informed by two subthemes: Video-Recording and Self-Assessment Exercise as a Tool and Implementing the Video-recording and Self-assessment Exercise, examined participants' perceptions regarding the video recording and self-assessment exercise. Whilst these three themes are illustrated within each category and subtheme, it is acknowledged that these are interrelated.
It was concluded that applying Bridges SMP principles in clinical practice was found beneficial for patients and HCPs alike. Self-management principles allow patients to establish goals, facilitate reflection, and increase confidence and motivation in self-managing their condition. Furthermore, it promotes better interaction between HCPs and patients. The process of video-recording and self-assessment was found to be a useful and rewarding process in terms of learning, reflection, and self-improvement. However, the process initially induced anxiety for participants and could be found daunting by HCPs if used as an audit tool.