Stroke Training Carers Issues

1. Stroke Training & Carers Issues Lynsey Duncan Stroke Training Co-ordinator I have been asked to speak today about the stroke training programmes available in Grampian and to highlight some of the issues that have been identified when including carers during some of the sessions. I am Lynsey, the stroke training co-ordinator for NHS Grampian. I am employed by Chest, Heart & Stroke Scotland but work as a partnership to meet the stroke training needs of health and social care staff across Grampian. The training programmes that I plan and deliver are part of a national programme of stroke training. CHSS have 4 other stroke training co-ordinator�s in Lothian, Fife, what was Argyll & Clyde and Dumfries & Galloway. We meet regularly to ensure that the content of the training is similar across Scotland, while meeting the local needs of our own areas. Stroke training programmes have been available in Grampian since September 2005.I have been asked to speak today about the stroke training programmes available in Grampian and to highlight some of the issues that have been identified when including carers during some of the sessions. I am Lynsey, the stroke training co-ordinator for NHS Grampian. I am employed by Chest, Heart & Stroke Scotland but work as a partnership to meet the stroke training needs of health and social care staff across Grampian. The training programmes that I plan and deliver are part of a national programme of stroke training. CHSS have 4 other stroke training co-ordinator�s in Lothian, Fife, what was Argyll & Clyde and Dumfries & Galloway. We meet regularly to ensure that the content of the training is similar across Scotland, while meeting the local needs of our own areas. Stroke training programmes have been available in Grampian since September 2005.

2. Stroke Training in Grampian Multi-disciplinary Meet the different needs of health & social care staff Delivered at different locations Aim to facilitate learning and/or build on knowledge & skills in stroke care Flexible Therapy Stroke Team The core stroke training programmes are multi-disciplinary to encourage team-building and sharing of knowledge. I will discuss on the next slide what I mean by �core�. The programmes are delivered at different levels to try and meet the varying needs of staff from novice to expert! Again I will explain this better on the next slide. The programmes run in different areas across Grampian, e.g. Aberdeen, Keith, Elgin & Fraserburgh have all had stroke training brought to them. The aim of the programmes are to facilitate knowledge and skills in stroke care or build on existing knowledge and skills at different levels. The different sessions on the programmes are delivered by trainers with the relevant experience in that field and the FTST are involved with training on all the programmes. The core stroke training programmes are multi-disciplinary to encourage team-building and sharing of knowledge. I will discuss on the next slide what I mean by �core�. The programmes are delivered at different levels to try and meet the varying needs of staff from novice to expert! Again I will explain this better on the next slide. The programmes run in different areas across Grampian, e.g. Aberdeen, Keith, Elgin & Fraserburgh have all had stroke training brought to them. The aim of the programmes are to facilitate knowledge and skills in stroke care or build on existing knowledge and skills at different levels. The different sessions on the programmes are delivered by trainers with the relevant experience in that field and the FTST are involved with training on all the programmes.

3. The training programmes... Core: Introductory Course in Stroke Care (part 1) Intermediate Course in Stroke Care (part 2) Advanced Study Days (Secondary prevention in stroke care & Post-stroke - what�s out there?) The programmes you see on this slide are the core programmes available in Grampian and title and content are similar to those available through CHSS across Scotland. The Intro and Inter are run over three days, 2 consecutive days and a one day follow-up. The Introductory Course is aimed at health care staff who have minimal/no experience in stroke care or who have not received training in stroke for some time. It is titled part 1 as the Intermediate Course is a follow on from this level. The Intro course has very recently been involved in a project through NES and CHSS to look at incorporating the Stroke Core Competencies into this first level. The report has just been issued and we will be looking to make changes/adjustments as recommended in the report , by the end of the year. The Intermediate Course branches out from this core level and looks at other skills/topics essential to looking after someone after a stroke e.g spirituality after stroke and sexuality and sexual health after stroke. You have a training leaflet on your chairs and this will outline the content of each of these courses for you. The advanced days are a single study day which explore one topic in relation to stroke care in detail. You can see on the slide the two advanced days that have been held so far. There are another 2 planned in 2008.The programmes you see on this slide are the core programmes available in Grampian and title and content are similar to those available through CHSS across Scotland. The Intro and Inter are run over three days, 2 consecutive days and a one day follow-up. The Introductory Course is aimed at health care staff who have minimal/no experience in stroke care or who have not received training in stroke for some time. It is titled part 1 as the Intermediate Course is a follow on from this level. The Intro course has very recently been involved in a project through NES and CHSS to look at incorporating the Stroke Core Competencies into this first level. The report has just been issued and we will be looking to make changes/adjustments as recommended in the report , by the end of the year. The Intermediate Course branches out from this core level and looks at other skills/topics essential to looking after someone after a stroke e.g spirituality after stroke and sexuality and sexual health after stroke. You have a training leaflet on your chairs and this will outline the content of each of these courses for you. The advanced days are a single study day which explore one topic in relation to stroke care in detail. You can see on the slide the two advanced days that have been held so far. There are another 2 planned in 2008.

4. Other training... Care Home Staff Study Days Social Service Staff Study Days Student Nurse Awareness Sessions Volunteer Session Shetland Isles Other training that is available across Grampian are listed above. Both the care home and social service staff study days are run over one single day and are titled �Working with Stroke�, again run in different locations in Grampian (Aberdeen & Elgin) I have been involved with running stroke awareness sessions for student nurses and have more plans to provide further training in the future. I was asked to run a session on the emotional impact of stroke for volunteer staff at Raeden Court and this was well received. With permission from the MCN, I delivered a 2 day Introductory Course in the Shetland Isles in may of this year. This was very successful, and they may request an Intermediate Course in the future.Other training that is available across Grampian are listed above. Both the care home and social service staff study days are run over one single day and are titled �Working with Stroke�, again run in different locations in Grampian (Aberdeen & Elgin) I have been involved with running stroke awareness sessions for student nurses and have more plans to provide further training in the future. I was asked to run a session on the emotional impact of stroke for volunteer staff at Raeden Court and this was well received. With permission from the MCN, I delivered a 2 day Introductory Course in the Shetland Isles in may of this year. This was very successful, and they may request an Intermediate Course in the future.

5. Evaluation Forms �I found the whole course really good, educational, interesting & stimulating. It made me more reflective about my current practice.� �very interesting course which has been very beneficial to my work area, thank you� �all staff working within stroke services should have the opportunity of attending this course� The training programmes are well received by staff as you can see from some of the quotes above, taken from the end-of-course evaluation forms.The training programmes are well received by staff as you can see from some of the quotes above, taken from the end-of-course evaluation forms.

6. Future Plans Advanced Topics (Communication workshop 21st Nov 07 & Tone and Postural Management 29th May 08) Community Nurses Study Day (Long Term Conditions - update and refresher 27th Feb 08) in Aberdeenshire Orkney Isles Accreditation There is one advanced day still to run this year in Nov, which will be a communication workshop. There are 2 planned for 2008, and the 1st topic will be tone and postural management. I have planned a shire based day for community nurses as uptake of training from this group has been slow. It has been recognised in other areas in Scotland by CHSS that community nurses prefer to attend a day which covers more than one condition. For this reason, this day has been planned as a trial to judge uptake and success and will include other long term conditions other than stroke. Orkney Isles have approached me to request a 2 day Intro. Awaiting funding to be passed. As a group of trainers from CHSS we have investigated accreditation for the Intro and Inter courses from Napier Uni.. They have had a look over the course content and would be happy to explore this with us however we are waiting till the changes from the Core competency report have been made.There is one advanced day still to run this year in Nov, which will be a communication workshop. There are 2 planned for 2008, and the 1st topic will be tone and postural management. I have planned a shire based day for community nurses as uptake of training from this group has been slow. It has been recognised in other areas in Scotland by CHSS that community nurses prefer to attend a day which covers more than one condition. For this reason, this day has been planned as a trial to judge uptake and success and will include other long term conditions other than stroke. Orkney Isles have approached me to request a 2 day Intro. Awaiting funding to be passed. As a group of trainers from CHSS we have investigated accreditation for the Intro and Inter courses from Napier Uni.. They have had a look over the course content and would be happy to explore this with us however we are waiting till the changes from the Core competency report have been made.

7. Carers Issues Intermediate Course in Stroke Care (part 2) - Caring for carers - Impact of stroke - a carers perspective I have also been asked to mention some of the issues that have been highlighted by carers during the Intermediate Courses. There are 2 sessions around carers included in this course. Caring for carers is delivered by the managers of the carers centre in Aberdeen/Elgin and includes information on the carers act and what the centres can offer. Very useful session for healthcare staff that are not aware of this resource or familiar with their work. The second session is the one we will discuss today, impact of stroke - a carers perspective. This session includes a question and answer session with someone who is a cares for a loved one after stroke. The carers are identified through the CHSS Stroke nurses and are approached firstly by them before I make contact with them. The session lasts for half an hour and I start it off by giving a bit of background info which I retrieve from a questionnaire that I send to them prior to the session. Any topic that they do not wish to address with the group are highlighted on this questionnaire so I can divert questions away from these.I have also been asked to mention some of the issues that have been highlighted by carers during the Intermediate Courses. There are 2 sessions around carers included in this course. Caring for carers is delivered by the managers of the carers centre in Aberdeen/Elgin and includes information on the carers act and what the centres can offer. Very useful session for healthcare staff that are not aware of this resource or familiar with their work. The second session is the one we will discuss today, impact of stroke - a carers perspective. This session includes a question and answer session with someone who is a cares for a loved one after stroke. The carers are identified through the CHSS Stroke nurses and are approached firstly by them before I make contact with them. The session lasts for half an hour and I start it off by giving a bit of background info which I retrieve from a questionnaire that I send to them prior to the session. Any topic that they do not wish to address with the group are highlighted on this questionnaire so I can divert questions away from these.

8. Questionnaire... Do you feel you were given adequate support and advice about the impact this (the stroke) would have on you and your family prior to their discharge from hospital? Carer A - no Carer B - no, all I was told was that it would take time Carer C - no I now want to show you the results of 4 questions taken from this questionnaire. These highlight the common issues that come up time and again during these sessions. I have used only 3 carers due to time limits. Every carer I have worked with on this session has stated that they did not feel they were supported enough prior to taking their loved one home.I now want to show you the results of 4 questions taken from this questionnaire. These highlight the common issues that come up time and again during these sessions. I have used only 3 carers due to time limits. Every carer I have worked with on this session has stated that they did not feel they were supported enough prior to taking their loved one home.

9. Questionnaire... Since their discharge from hospital, are there any particular issues that you have found difficult to deal with? Carer A - my biggest worry is who takes care of the carer when they fall ill? Carer B - coping by myself is hard�arm and shoulder has been knotting up leaving�in agony which keeps them up all night, resulting in me having to stay up as well! Carer C - taking medication Obviously, different carers answer different thing under this question as it very much depends on the severity of the stroke and the ability of the carer to cope with it.Obviously, different carers answer different thing under this question as it very much depends on the severity of the stroke and the ability of the carer to cope with it.

10. Questionnaire... How has your life changed since becoming a carer? Carer A - we have to pace ourselves now�I find it takes longer to do various everyday things Carer B - from being a partner to being a parent again�personality has changed Carer C - loneliness Carer A actually gave a lengthy answer to this question and stated that one of their main worries was that they were somewhat older than the person they cared for and so was less able than perhaps they should be. Carer B is referring to the fact that they have had a change in relationship role since the stroke.Carer A actually gave a lengthy answer to this question and stated that one of their main worries was that they were somewhat older than the person they cared for and so was less able than perhaps they should be. Carer B is referring to the fact that they have had a change in relationship role since the stroke.

11. Questionnaire... Do you feel you have had adequate support since they have been discharged from hospital? Carer A - Yes, in most things I am happy to say Carer B - No Carer C - No support Finally this lets you see that most still feel unsupported after discharge. While all speak very highly of the CHSS stroke nurses and their valuable input and visits, some feel that this is not enough.Finally this lets you see that most still feel unsupported after discharge. While all speak very highly of the CHSS stroke nurses and their valuable input and visits, some feel that this is not enough.

12. Common issues Loneliness No support Not ready for the challenge that faces them when their partner gets discharged home from hospital Feeling that the needs of the carer are neglected These are the common issues that have came out of this session (taking into account all the carers and not just carer A-C. All have said that they have felt lonely at times, many losing friendships since taking on the carers role. Many feel unsupported which adds to the feeling of loneliness. All have highlighted that they were not provided with enough info and support prior to taking on this role (? When is the right time, would they identify themselves as �carer� before they actually become one and see the challenges they face?) It is easy for us to speculate in hindsight!!!! This ties into the fact that many feel that their needs are regularly unaccounted for and some have even stated on the questionnaire how grateful they are that we are highlighting their needs by delivering this session during the training programmes! Like everything in life, I see some positive but many negative storied during this session. What can we do to address this��????? Hopefully we will have a chance to discuss this in our workshop groups today!!!!!These are the common issues that have came out of this session (taking into account all the carers and not just carer A-C. All have said that they have felt lonely at times, many losing friendships since taking on the carers role. Many feel unsupported which adds to the feeling of loneliness. All have highlighted that they were not provided with enough info and support prior to taking on this role (? When is the right time, would they identify themselves as �carer� before they actually become one and see the challenges they face?) It is easy for us to speculate in hindsight!!!! This ties into the fact that many feel that their needs are regularly unaccounted for and some have even stated on the questionnaire how grateful they are that we are highlighting their needs by delivering this session during the training programmes! Like everything in life, I see some positive but many negative storied during this session. What can we do to address this��????? Hopefully we will have a chance to discuss this in our workshop groups today!!!!!

13. Any questions????