Background: Psychosocial well-being is important for living well after stroke, however, people with stroke and clinicians agree that it is not adequately addressed in services. It remains an unmet need after stroke, contributing to the burden of stroke. Clinicians have previously suggested their ability to address well-being is limited by their work environment.
Aims:
(1) To explore how clinicians support well-being, and
(2) To understand how practice is influenced by the context in which clinicians work.
Methods: Informed by an Institutional Ethnography methodology, we interviewed 35 healthcare professionals working across the continuum of care throughout New Zealand. Data were analysed using an applied tensions analysis framework.
Findings: In-patient stroke services are focussed on delivering best physical and impairment-based outcomes for people with stroke during the early phase post-stroke. When combined with time-limited services and significant caseload and discharge pressures, it meant other areas of care were pushed out. While clinicians described providing conditional psychosocial support in-the-moment, holistic well-being was generally viewed as an aspect of care and recovery that could be deferred and addressed later by other services. Instead, providing the ‘best chance’ of physical improvement and working at ‘top of scope’ were prioritised. Many clinicians felt they had limited agency to resist the dominant pace of care despite knowing this had consequences for people with stroke. Clinicians expressed frustration at the pace of care, although often inadvertently reproduced this pace.
Discussion: The pace of services shapes the goals of the service and the types of care and aspects of stroke that are prioritised. This influences what people consider is a good outcome, and what it means to recover and live well after stroke. Given the high rates of psychosocial distress post-stroke, it is imperative that we critically consider the unintended consequences of dominant approaches to care.