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Understanding Life After Stroke
Uppsala University, Medicinska vetenskapsområdet, Faculty of Medicine, Department of Public Health and Caring Sciences.
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Stroke is an acute, neurological dysfunction of vascular origin with sudden occurrence and it influences physical, cognitive and psychological functions. Initial treatment aims at eliminating or reducing the brain damage. Soon, however, the influence of the stroke on the entire life of stroke survivors has to be considered.

This thesis explores the meaning of life after stroke to 19 elderly stroke survivors during the first year post stroke. Survivors were interviewed twice and the interviews were analysed through qualitative methods.

Study I was about four survivors who delayed hospital arrival far beyond time limits for trombolytic treatment. The survivors had a strong need for control of body, autonomy and integrity and they demanded to be encountered in consultations as a person by a person. To make them search for emergency evaluation in time might demand an emergency care treating them according to these needs.

In Study II the voice of an aphasic survivor was heard. Because of the damaged language his rehabilitation unilaterally focussed on language training and his need for comprehensive support and planning for the future was not observed. Implementation of a qualitative research method for text analysis adapted to practical use in dialogues with aphasic persons might ensure these survivors an adequate rehabilitation.

Study III showed how time models in narratives helped stroke survivors to overcome uncertainty and recreate narrative coherence in their lives. Professionals can support survivors through revealing and reinforcing the meaning of these models.

Study IV found that the meaning of rehabilitation to stroke survivors was social reintegration. Many probably did not socially reintegrate because their own strategies and subjectively experienced disabilities were unacknowledged in their rehabilitation. Through integrating illness-as-lived perspectives with biomedical perspectives, subjective dysfunctions and rehabilitation strategies of survivors could be acknowledged in stroke rehabilitation.

Place, publisher, year, edition, pages
Uppsala: Universitetsbiblioteket , 2008. , 80 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 376
National Category
Clinical Science
Identifiers
URN: urn:nbn:se:uu:diva-9278ISBN: 978-91-554-7280-1 (print)OAI: oai:DiVA.org:uu-9278DiVA: diva2:172520
Public defence
2008-10-10, Rudbecksalen, Rudbecklaboratoriet, Dag Hammarskölds väg 20, Uppsala, 09:15
Opponent
Supervisors
Available from: 2008-09-18 Created: 2008-09-18Bibliographically approved
List of papers
1. Stroke patients' delay of emergency treatment
Open this publication in new window or tab >>Stroke patients' delay of emergency treatment
2010 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 24, no 2, 307-311 p.Article in journal (Refereed) Published
Abstract [en]

Treatment of stroke victims with fibrinolysis should take place within a time limit of 3 hours. In spite of comprehensive endeavours to reduce hospital arrival time, too many patients still delay arrival beyond this time limit. This qualitative case study explored the meaning of acute stroke and treatment to four patients with more than 24-hour delayed arrival. The setting of the study was the catchment area of a university hospital. Semi-structured interviews were analysed through the empirical psychological, phenomenological method. An essence was found which was constituted by four themes. The essence of stroke symptoms and treatment was: 'Threatened control of bodily function, autonomy and integrity'. When the patients fell ill they acted as if nothing had happened. They treated their body like a defective device. In encounters with physicians they demanded to be met as a person by a person; otherwise they rejected both the physician and her or his prescriptions. They did not involve their near ones in decision-making. The conclusions were the following: Health care information about how to act in cases of early stroke symptoms may need to imbue people with an understanding of how early treatment of neurological symptoms and preserved control of life are intimately connected. Furthermore emergency care of acute stroke patients might need to take place in an organisation where patients are sure to be met by physicians as a person by a person.

Keyword
cerebrovascular accident, stroke, emergency treatment, delay of treatment, patient centredness
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-97531 (URN)10.1111/j.1471-6712.2009.00721.x (DOI)000277713500014 ()20233357 (PubMedID)
Available from: 2008-09-18 Created: 2008-09-18 Last updated: 2010-12-13Bibliographically approved
2. Understanding the meaning of rehabilitation to an aphasic patient through phenomenological analysis - a case study 
Open this publication in new window or tab >>Understanding the meaning of rehabilitation to an aphasic patient through phenomenological analysis - a case study 
Show others...
2007 (English)In: International Journal of Qualitative Studies on Health and Well-Being, ISSN 1748-2623, Vol. 2, no 2, 93-100 p.Article in journal (Refereed) Published
Abstract [en]

Stroke patients with aphasia commonly suffer from distress related to their language deficit. They are often unable to express what they experience during their rehabilitation. Hence, the aim of this study was to reveal the meaning of rehabilitation to an aphasic person. With an approach based on the philosophy of Husserl and Merleau-Ponty, two open-ended interviews were analysed through the Empirical Phenomenological Psychological (EPP) method. The essential structure of the meaning of rehabilitation to the informant was that he lived as being responsible in a dichotomised situation. The informant had to adapt his behaviour, thereby destroying his chances of normal interactions; he was supposed to train in a goal-oriented way and believe in recuperation, but at the same time, he had to prepare himself and his next of kin for a failure. The defined impairment of aphasia misled both the informant and health care professionals to focus only language therapy, hence leaving the informant unsupported in other important aspects of the rehabilitation.

Keyword
Stroke, aphasia, case study, phenomenology, rehabilitation
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-97532 (URN)10.1080/17482620701296358 (DOI)
Available from: 2008-09-18 Created: 2008-09-18 Last updated: 2010-06-02Bibliographically approved
3. To cope with uncertainty: stroke patients' use of temporal models in narratives
Open this publication in new window or tab >>To cope with uncertainty: stroke patients' use of temporal models in narratives
2006 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 20, no 4, 367-374 p.Article in journal (Refereed) Published
Abstract [en]

Stroke victims have to cope with a disrupted autobiography and anxiety because of an uncertain future. Professionals share this uncertainty. The patients reveal their experiences in narratives, and when they try to regain coherence and confidence in life, they use narratives in the reconstructions. Because they have a temporal problem, time might be an important issue in these narratives. The aim of this study was to elucidate the use of time models in stroke patients' narratives. Nineteen stroke patients, who had recently been discharged to their homes after the stroke, accepted to participate in the study. Their age span was between 56 and 89 years. They had lived active urban lives before the stroke, and poststroke only three had more serious physical impairment, and none was demented. They were asked to talk about their present life and their conceptions of future life. The interviews were audio-taped and transcribed verbatim and narratives that referred to temporal aspects were thematically analysed with reference to narrative time models. The stroke accident had caused an autobiographical disruption and a temporal split because of a new awareness of human temporality and an uncertainty of the future. Confronted with these problems of time, the stroke victims constructed narratives based on the time models: time cycles and dissolution of time limits, exchange of time and exclusion from time. Hence, the time models worked as tools when the stroke victims re-established coherence in their present and future life. Stroke patients handled an uncertain future by using temporal models in their narratives. Professionals can support stroke patients by reinforcing these models.

Keyword
Anxiety, Discourse of medicine, Narrative, Stroke, Temporality, Time models
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-97533 (URN)10.1111/j.1471-6712.2006.00415.x (DOI)000243152000002 ()17116145 (PubMedID)
Available from: 2008-09-18 Created: 2008-09-18 Last updated: 2011-02-18Bibliographically approved
4. The meaning of rehabilitation for older people who have survived stroke
Open this publication in new window or tab >>The meaning of rehabilitation for older people who have survived stroke
2009 (English)In: Journal of Nursing and Healthcare of Chronic Illness, ISSN 1752-9816, Vol. 1, no 2, 186-195 p.Article in journal (Refereed) Published
Abstract [en]

Aim. To explore the meaning of rehabilitation to older, Swedish stroke survivors, from the time of the acute stroke to the end of the rehabilitation.

Background. Many people who are stroke survivors do not resume social activities even though they have regained physical functions. However, the contents of stroke rehabilitation seems to depend on whether rehabilitation is understood from the disease perspective or the illness perspective contained in the International Classification of Functioning, Disability and Health. This in turn may determine the kind of rehabilitation offered to survivors.

Design. Inductive, qualitative interview study undertaken during 2003.

Method. Nineteen Swedish stroke survivors were interviewed twice, and the interviews were analysed using a Grounded Theory approach.

Findings. To the older survivors, the meaning of rehabilitation was social reintegration. To achieve this they tried to regain lost physical and cognitive functions, relations (including play activities, everyday narratives and self-esteem) and lost certainty. The survivors needed to regain their ability to be not only to perform social activities. However, their rehabilitation ended when its focus turned to impairments found in the illness experiences of the survivors. The survivors developed their own cognitive and behavioural strategies for overcoming these kinds of obstacles to their social reintegration.

Conclusion. Older, Swedish stroke survivors strive for a socially integrated life. Unacknowledged impairments experienced from the illness perspective of the survivors and the survivors’ own rehabilitation strategies should therefore be considered in their rehabilitation.

Relevance to clinical practice. Stroke survivors need support from professionals who can understand and acknowledge the illness perspective of rehabilitation. Professionals should be able to understand how to facilitate the cognitive and behavioural strategies found in survivors’ illness narratives. In order to socially reintegrate, survivors’ rehabilitation should be transferred to the places where they have previously performed play activities together with family and friends.

Keyword
cerebrovascular, geriatrics, qualitative research, rehabilitation, stroke
National Category
Medical and Health Sciences
Research subject
Health Care Research
Identifiers
urn:nbn:se:uu:diva-97534 (URN)10.1111/j.1752-9824.2009.01020.x (DOI)
Available from: 2008-09-18 Created: 2008-09-18 Last updated: 2012-05-11Bibliographically approved

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