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Bright FAS, Ibell-Roberts C, Wilson BJ. Psychosocial well-being after stroke in Aotearoa New Zealand: a qualitative metasynthesis. Disabil Rehabil 2024; 46:2000-2013. [PMID: 37198959 DOI: 10.1080/09638288.2023.2212178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 05/05/2023] [Indexed: 05/19/2023]
Abstract
PURPOSE Psychosocial well-being is key to living well after stroke, but often significantly affected by stroke. Existing understandings consider well-being comes from positive mood, social relationships, self-identity and engagement in meaningful activities. However, these understandings are socioculturally located and not necessarily universally applicable. This qualitative metasynthesis examined how people experience well-being after a stroke in Aotearoa New Zealand. MATERIAL AND METHODS This metasynthesis was underpinned by He Awa Whiria (Braided Rivers), a model which prompts researchers to uniquely engage with Māori and non-Māori knowledges. A systematic search identified 18 articles exploring experiences of people with stroke in Aotearoa. Articles were analysed using reflexive thematic analysis. RESULTS We constructed three themes which reflect experiences of well-being: connection within a constellation of relationships, being grounded in one's enduring and evolving identities, and being at-home in the present whilst (re)visioning the future. CONCLUSION Well-being is multi-faceted. In Aotearoa, it is inherently collective while also deeply personal. Well-being is collectively achieved through connections with self, others, community and culture, and embedded within personal and collective temporal worlds. These rich understandings of well-being can open up different considerations of how well-being is supported by and within stroke services.
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Affiliation(s)
- Felicity A S Bright
- Centre for Person Centred Research, Auckland University of Technology, Auckland, New Zealand
| | - Claire Ibell-Roberts
- Centre for Person Centred Research, Auckland University of Technology, Auckland, New Zealand
| | - Bobbie-Jo Wilson
- Centre for Person Centred Research, Auckland University of Technology, Auckland, New Zealand
- Department of Physiotherapy, Auckland University of Technology, Auckland, New Zealand
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Ohan JL, Jackson HM, Bett R, Farmer GM, Martini A. Experiences and needs of children and adolescents affected by a parent's acquired brain injury: a systematic review and thematic synthesis. Disabil Rehabil 2024; 46:1034-1044. [PMID: 36861777 DOI: 10.1080/09638288.2023.2179673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Revised: 12/21/2022] [Accepted: 02/06/2023] [Indexed: 03/03/2023]
Abstract
PURPOSE To identify the experiences and needs of dependent children who have a parent with an acquired brain injury (ABI) using a systematic review and thematic synthesis. MATERIALS AND METHODS A systematic search of Medline, Embase, PsycINFO, CINAHL Plus, and Web of Science was conducted. The search included variants of: "children," "parents," "acquired brain injury," and "experiences" or "needs." Eligible articles reported on the experiences/needs of dependent children who have a parent with an ABI, from the child's perspective. Thematic analysis was used to identify themes. RESULTS A total of 4895 unique titles were assessed, and 9 studies met inclusion. Four themes were identified: (1) Sustained Emotional Toll (subthemes: (i) Initial Shock and Distress; (ii) Ongoing Loss and Grief; (iii) Present-Day Stress and Emotions), (2) Responsibilities Change and Children Help Out, (3) Using Coping Strategies (subtheme: Talking Can Help), and (4) Wanting Information about the Injury. CONCLUSION Themes highlighted significant disruption and challenges to children's wellbeing across development, with ongoing and considerable impacts many years after the parent's injury. The nature of the experiences shifted with time since the parent's injury. These children need ongoing support starting shortly after their parent's injury that is grounded in their particular experiences.IMPLICATIONS FOR REHABILITATIONWhen a parent has an acquired brain injury (ABI), dependent children and adolescents face emotional upheaval, significant stressors, increased responsibilities, and lack of information about their parent's injury that persist even many years after injury.The nature of these experiences and therefore their needs change based on the acute versus later stages of the parent's injury.Children often do not ask questions or tell others how they feel, which means that they need support that asks about, and listens and responds to their needs.Support for children needs to start soon after the parent's injury, be grounded in the lived experiences of this group, consider their parent's recovery stage, and be embedded as part of service provision rather than rely on children or families to make service contact.
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Affiliation(s)
- Jeneva L Ohan
- School of Psychological Science, The University of Western Australia, Crawley, Western Australia
| | - Hayley M Jackson
- School of Psychological Science, The University of Western Australia, Crawley, Western Australia
- Brightwater Research Centre, Brightwater Care Group, Perth, Western Australia
| | - Robyn Bett
- Brightwater Research Centre, Brightwater Care Group, Perth, Western Australia
| | - Glenda M Farmer
- School of Psychological Science, The University of Western Australia, Crawley, Western Australia
| | - Angelita Martini
- Brightwater Research Centre, Brightwater Care Group, Perth, Western Australia
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Liao ZY, Haycock-Stuart E, Kean S. Biographical continuation: recovery of stroke survivors and their family caregivers in Taiwan. Prim Health Care Res Dev 2024; 25:e2. [PMID: 38179717 PMCID: PMC10790715 DOI: 10.1017/s1463423623000610] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 07/28/2023] [Accepted: 10/23/2023] [Indexed: 01/06/2024] Open
Abstract
AIM To explore the experiences pertaining to long-term care services from the perspectives of dyads of stroke survivors and their family caregivers in indigenous and non-indigenous communities. BACKGROUND Stroke occurrence is a life-changing event associated with quality of life for stroke survivors and their families, especially those who provide primary support. Indigenous people are more likely to experience a stroke at a younger age and have a higher likelihood of hospitalisation and death due to health disparities. Few studies have investigated family dyads or indigenous populations to understand their experiences of coping with changed body-self and to contextualise their reintegration into communities post-stroke. METHODS Ethnographic fieldwork over nine months in 2018-2019 with indigenous, urban-based, and non-indigenous populations, resulting in 48 observations and 24 interviews with 12 dyads in three geo-administrative communities. FINDINGS The post-stroke recovery trajectory is illuminated, delineating the dyads' life transitions from biographical disruption to biographical continuation. The trajectory is shaped by seven states involving four mindsets and three status passages. The four mindsets are sense of loss and worry, sense of interdependence, sense of independence, and wellbeing state. The status passages identified in this study are acceptance, alteration, and identification. A community-based and family-centred long-term care system, aligning with medical healthcare and community resources, underpinned each dyad's biographical continuation by: (1) providing rehabilitation that afforded time and space for recovery adaptation; (2) acknowledging the individuality of family caregivers and helping to alleviate their multitasking; and (3) reintegrating stroke survivors into their communities. Key to determining the quality of recovery for the indigenous participants was their reintegration into their native community and regaining of identity. Therefore, integrating post-stroke care into various care contexts and incorporating indigenous-specific needs into policymaking can support dyads in adapting to their communities.
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Affiliation(s)
- Zih-Yong Liao
- National Center for Geriatrics and Welfare Research, National Health Research Institutes, Yunlin63247, Taiwan
| | - Elaine Haycock-Stuart
- Nursing Studies, School of Health in Social Science, The University of Edinburgh, EdinburghEH8 9AG, UK
| | - Susanne Kean
- Nursing Studies, School of Health in Social Science, The University of Edinburgh, EdinburghEH8 9AG, UK
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Apiribu F, Duma SE, Ncama BP. Men's experience of perpetrating intimate partner violence following disclosure of HIV status by their seropositive female intimate partners: a qualitative study. Ann Med 2022; 54:1126-1139. [PMID: 35511257 PMCID: PMC9090398 DOI: 10.1080/07853890.2022.2062444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Gender-Based (GB) intimate partner violence is a social and public health issue globally. Several risks of violence related to male sexual partners' perpetration of intimate partner violence (IPV) following the disclosure of their female intimate partners' HIV + status have been reported. No research has been conducted on male sexual partner's perspectives of perpetrating IPV following their female intimate partners' disclosure of human immunodeficiency virus (HIV) seropositive status as a risk factor for the perpetration of IPV in Ghana. OBJECTIVE The objective of this study is to explore and describe male sexual partners' views or perspectives of perpetrating IPV following their female intimate partners' disclosure of being HIV positive in Ghana. METHODS Interpretive phenomenological approach was used to collect and analyse data from a purposive sample of 18 Male participants whose female intimate relations informed them of being HIV + in Ghana. The sample population was taken from Ghana because such research has been reported elsewhere but none has been done in Ghana. A semi-structured interview guide was used to collect the data. The interview guide covered topics such as background information, participants' reaction to HIV positive disclosure, lived experiences of participants, and Participants' understanding of different forms of IPV. RESULTS The findings of this study reveal five main themes that emerged from the interviews which include views on the perpetration of emotional, psychological, and verbal abuse; views on the perpetration of sexual deprivation; views on the perpetration of social isolation; views on the perpetration of financial abuse and views on escalated perpetration of physical abuse. CONCLUSION From the data, HIV positive status disclosure served as a risk factor for different forms of GB IPV against HIV positive women in Ghana, thus making this group more vulnerable and exposed to more GB IPV. Strategies to prevent the perpetration of IPV against women newly diagnosed as HIV positive are needed. We recommend screening all newly diagnosed HIV-positive women for abuse as an additional prevention strategy for IPV associated with disclosure of positive HIV status. KEY MESSAGESHIV positive status disclosure serves as a risk for the perpetration of IPV.Men are predisposed to violence upon hearing that their female heterosexual intimate partners are HIV positive.HIV infection information is distressful to receive from an intimate partner.
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Affiliation(s)
- Felix Apiribu
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.,Department of Nursing, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Sinegugu Evidence Duma
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Busisiwe Purity Ncama
- School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Healthcare Professionals’ Experiences with Rehabilitation Practices for Patients with Cognitive Impairment after Stroke in North Norway: A Qualitative Study. Rehabil Res Pract 2022; 2022:8089862. [PMID: 36124079 PMCID: PMC9482544 DOI: 10.1155/2022/8089862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 08/31/2022] [Indexed: 11/17/2022] Open
Abstract
Methods A focus group interview with clinicians, coordinators, and leaders involved in stroke survivors' rehabilitation trajectories was conducted. The group consisted of a strategic selection of participants with diverse professional backgrounds from specialist and primary healthcare services. The transcribed material was analyzed thematically using systematic text condensation based on an inductive, interpretive approach. Results We found that patients with mild and moderate cognitive impairment after stroke were characterized as a neglected group in rehabilitation services and that neglect was related to both structural and professional issues. First, neglect seemed partly related to the availability of existing healthcare services, which mainly followed up on physical challenges after stroke. Second, cognitive rehabilitation seemed to be less prioritized than other health services, and the established interdisciplinary municipality teams did not seem prepared to follow-up on cognitive issues. Finally, at a professional level, the study reveals the need for building competence in cognitive rehabilitation and having services available in the long run. Conclusion The study demonstrates the need to increase knowledge concerning cognitive rehabilitation and how rehabilitation trajectories and services should be organized to fulfil stroke survivors' and carers' long-term needs.
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Casey AM, Nolan M, Nixon E. 'You Lose Confidence in Being a Human Being, Never Mind Being a Parent': The Lived Experience of Mothers With Spinal Cord Injury. QUALITATIVE HEALTH RESEARCH 2022; 32:1657-1671. [PMID: 35848715 DOI: 10.1177/10497323221115584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Little research to date has explored the experiences of parenting among mothers with Spinal Cord Injury (SCI). The aim of the study was to explore the lived experiences of mothers with SCI. Semi-structured interviews were conducted with eight mothers and an interpretive phenomenological analysis was carried out. Two super-ordinate themes were identified. The first theme, entitled: 'A sit-down mummy: The visibility of differences as a mother with SCI' highlighted how mothers faced challenges when undertaking practical parenting tasks, thus making them feel less than their non-injured peers, and how they navigated the visible and physical intrusion of the wheelchairs in their relationships with their children. The second theme, entitled: 'What kind of mother? Being a good enough parent' reflected mothers' heightened sense of guilt with respect to unmet expectations of the self as mother, and the contrasting positive experiences of availing of support and finding new ways to connect with their children. Clinical implications, methodological considerations and future directions are discussed.
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Affiliation(s)
- Anne-Marie Casey
- School of Psychology, 8809Trinity College Dublin, Dublin, Ireland
| | - Maeve Nolan
- Psychology Department, 82903National Rehabilitation Hospital, Dublin, Ireland
| | - Elizabeth Nixon
- School of Psychology, 8809Trinity College Dublin, Dublin, Ireland
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Gawulayo S, Erasmus CJ, Rhoda AJ. Family functioning and stroke: Family members' perspectives. Afr J Disabil 2021; 10:801. [PMID: 34858798 PMCID: PMC8603059 DOI: 10.4102/ajod.v10i0.801] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 09/10/2021] [Indexed: 11/20/2022] Open
Abstract
Background Stroke survivors often experience permanent or temporal physical and psychological stroke impairments. As a result, stroke survivors are often discharged to recover in their home environments and are cared for mostly by family members. Additionally, caregiving roles are often assumed without any formal training or preparation whatsoever. This can transform the family’s functional patterns due to adjustments that are made to accommodate the caregiving needs. Objectives To explore the experiences and influence of stroke on families and on family functioning. Method Explorative descriptive qualitative research design through the use of in-depth interviews were employed as the means of data collection. The sample size was eight (8) family members and was guided by the saturation point. Data was thematically analysed. Results Four themes emerged from the analysis: 1) reduced interactions with family members due to communication barriers, 2) the influence of stroke on family relationships, 3) emotional engagement in caring for a family member with a stroke and 4) financial implications of stroke on family functioning. This study found that stroke can influence the family functioning negatively as family members may be forced to change their functional patterns. However, some family members reported positive experiences, they developed a supportive structure to accommodate the new life of the stroke survivor. Conclusion Using the McMaster’s model of family functioning, this study found that stroke is a threat to the six dimensions of family functioning: 1) problem-solving, 2) communication, 3) roles, 4) affective responsiveness, 5) affective involvement, and 6) behaviour control.
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Affiliation(s)
- Sibulelo Gawulayo
- Department of Social Work, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - Charlene J Erasmus
- Centre for Interdisciplinary Studies on Children, Families and Society, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - Anthea J Rhoda
- Department of Physiotherapy, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
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Martinsen R, Kitzmüller G, Mangset M, Kvigne K, Evju AS, Bronken BA, Bragstad LK, Hjelle EG, Sveen U, Kirkevold M. Nurses' and occupational therapists' experiences of conducting a home-based psychosocial intervention following stroke: a qualitative process evaluation. BMC Health Serv Res 2021; 21:791. [PMID: 34376188 PMCID: PMC8356405 DOI: 10.1186/s12913-021-06857-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 07/30/2021] [Indexed: 11/24/2022] Open
Abstract
Background Persons with stroke are susceptible to psychosocial problems, and express disappointment at how health care professionals fail to meet their psychosocial needs following discharge to home. The responsibility of nurses and occupational therapists in stroke rehabilitation is to assist the persons and their families during the recovery and adjustment process. A home-based dialogical intervention aiming to enhance psychosocial support was therefore developed and tested in a randomized controlled trial. This study is a part of the process evaluation conducted alongside the trial. The aim was to explore the nurses’ and occupational therapists’ experiences of conducting the intervention. Methods Eighteen nurses and four occupational therapists participated in six focus groups to explore their experiences when providing the intervention. The themes discussed in the focus groups were the aspects that facilitated the delivering of the intervention and the challenges they encountered during the study period. The interviews were analysed using qualitative content analysis. Results The analysis generated two themes. The theme Developing a supportive relationship to facilitate the adjustment process following stroke had two subthemes: Getting personally involved and Handling challenges. This theme reveals how the nurses and occupational therapists experienced their relationship with the persons with stroke and potential threats which challenged them while conducting the intervention. The theme Developing professional skills in providing psychosocial support had two subthemes: Becoming confident in conducting dialogues and Integrating psychosocial topics. This theme reveals the aspects that the nurses and occupational therapists perceived as facilitating the development of their professional skills in conducting the dialogues. Conclusion Delivering the psychosocial intervention was perceived as deeply meaningful and increased the nurses’ and occupational therapists’ understanding of how to support stroke survivors to live with the consequences of stroke. However, balancing the professional and the personal relationship was challenging. A basic educational programme, training, supervision and having dedicated time were crucial elements to instil confidence in professionals conducting theme-based dialogues to promote post-stroke psychosocial well-being. Individual clinical experience and knowledge of stroke care were considering important to enable professionals to integrate psychosocial rehabilitation into community health care. Trial registration ClinicalTrials.gov, NCT 02338869, registered 10/04/2014.
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Affiliation(s)
- Randi Martinsen
- Department of Health and Nursing Sciences, Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, P.B. 400, 2418, Elverum, Norway.
| | - Gabriele Kitzmüller
- Department of Health and Care Sciences, Faculty of Health Sciences, UIT The Arctic University of Norway, Tromsø, Norway
| | - Margrete Mangset
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway
| | - Kari Kvigne
- Department of Health and Nursing Sciences, Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, P.B. 400, 2418, Elverum, Norway
| | - Anne Svelstad Evju
- Department of Health and Care Sciences, Faculty of Health Sciences, UIT The Arctic University of Norway, Tromsø, Norway
| | - Berit Arnesveen Bronken
- Department of Health and Nursing Sciences, Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, P.B. 400, 2418, Elverum, Norway
| | - Line Kildal Bragstad
- Department of Geriatric Medicine, Oslo University Hospital, Oslo, Norway.,Department of Nursing Science and Research Center for habilitation and rehabilitation services and models (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ellen Gabrielsen Hjelle
- Department of Nursing Science and Research Center for habilitation and rehabilitation services and models (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Unni Sveen
- Department of Geriatric Medicine and Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Marit Kirkevold
- Department of Nursing Science and Research Center for habilitation and rehabilitation services and models (CHARM), Faculty of Medicine, University of Oslo, Oslo, Norway
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The experience of close personal relationships after stroke: scoping review and thematic analysis of qualitative literature. BRAIN IMPAIR 2021. [DOI: 10.1017/brimp.2021.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Background and Purpose:
Psychosocial difficulties, including changed relationships are among the most pervasive and concerning issues following stroke. This study aimed to collate and thematically analyse qualitative literature describing the experience of close personal relationships from the perspective of stroke survivors.
Method:
Using a scoping review methodology, four databases (CINAHL/EBSCO, MEDLINE/Pubmed, Embase, Psychinfo) were systematically searched, yielding 3100 citations. Following exclusion of duplicates and screening against inclusion criteria at title/abstract and full text levels, 53 articles were included in the review. Data were charted and thematically analysed.
Results:
While research has increased since 2000, longitudinal designs are few. Four overarching themes and 12 subthemes were identified. ‘Social disruption’ described changing social worlds, lost social opportunities and shrinking networks. ‘Changed relationships’ included changed family and spousal relationships and changed parenting relationships. The third theme ‘relationships help’ highlighted positive aspects including belonging, support and a life worth living. The final theme was ‘coping with an altered social world’ and described adjustment and emotional responses.
Conclusions:
Relationships are an important aspect of life post stroke but are subject to changes and challenges. This article brings together a breadth of qualitative data to describe lived experiences. Further research, in particular, longitudinal research is required.
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Low MA, Power E, McGrath M. Sexuality after stroke: Exploring knowledge, attitudes, comfort and behaviours of rehabilitation professionals. Ann Phys Rehabil Med 2021; 65:101547. [PMID: 34091059 DOI: 10.1016/j.rehab.2021.101547] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 01/19/2021] [Accepted: 03/31/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sexual dysfunction after stroke is common and is associated with poor health and quality of life outcomes. Clinical guidelines for stroke typically recommend that all stroke survivors have access to support relating to sexuality during rehabilitation. However, the extent to which rehabilitation professionals are prepared to address sexuality after stroke is unclear. OBJECTIVE To investigate the knowledge, comfort, approach, attitudes, and practices of rehabilitation professionals toward supporting stroke survivors with their sexuality concerns. METHODS Cross-sectional analytic survey design. Data were collected by using an electronic questionnaire that contained the Knowledge, Comfort, Approaches, and Attitudes towards Sexuality Scale (KCAASS) and sexuality-related practice questions. Participants were recruited from Australia, New Zealand, the United States, Canada, United Kingdom, Ireland, Singapore, and South Africa. Multiple regression was used to explore KCAASS scores and sexuality-related practices. RESULTS A total of 958 multi-disciplinary, stroke rehabilitation professionals participated in the study. Only 23% (n = 216) of health professionals' reported directly initiating sexuality discussions with stroke survivors. On regression analysis, professionals' practices, perception of their role in sexuality rehabilitation, sexuality training, education, age and sex predicted their knowledge of sexuality after stroke (r² = 0.44; p<0.001). Sexuality training, religious affiliation and provision of sexuality-rehabilitation services predicted comfort (r² = 0.21; p<0.001). Professionals' age and provision of sexuality-rehabilitation services predicted approach-related comfort (r² = 0.2; p<0.001). Professionals' perception of health professionals' role in sexuality rehabilitation, religious affiliation and geographical location predicted professionals' attitudes toward sexuality (r² = 0.11; p<0.001). Open-ended responses indicated that participants perceived a need to improve their competency in providing sexuality rehabilitation. The timing of training predicted knowledge (t = 3.99; p<0.001), comfort (t = 3.47; p<0.001) and the provision of sexuality-rehabilitation services (t = 3.68; p<0.001). CONCLUSION Findings confirm that sexuality is neglected in stroke rehabilitation and point to the need for a considered approach to the timing and nature of education.
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Affiliation(s)
- Michelle Anne Low
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Emma Power
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia; Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Margaret McGrath
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
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Laratta S, Giannotti L, Tonin P, Calabrò RS, Cerasa A. Marital Stability and Quality of Couple Relationships after Acquired Brain Injury: A Two-Year Follow-Up Clinical Study. Healthcare (Basel) 2021; 9:healthcare9030283. [PMID: 33806697 PMCID: PMC7998919 DOI: 10.3390/healthcare9030283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 02/27/2021] [Accepted: 03/01/2021] [Indexed: 11/16/2022] Open
Abstract
Couple relationships after acquired brain injury (ABI) could be vulnerable to emotional distress. Previous evidence has demonstrated significant marital dissatisfaction in the first period after a traumatic event, while long-term evaluations are lacking. In this study, we evaluated the impact of a series of demographic and clinical factors on marital stability after two years from the injury. Thirty-five patients (29% female) with mild/moderate ABI (57% vascular, 43% traumatic) and their partners were enrolled. The couples completed a series of psychological questionnaires assessing marital adjustment (Dyadic Adjustment Scale, DAS) and family functioning (Family Relationship Index, FRI) at discharge from the intensive rehabilitation unit and after 2 years. Demographics (i.e., educational level, job employment and religion commitment) and clinical variables (i.e., the Barthel index, aetiology and brain lesion localization) were considered as predictive factors. Regression analyses revealed that the DAS and FRI values are differently influenced by demographic and clinical factors in patients and caregivers. Indeed, the highest educational level corresponds to better DAS and FRI values for patients. In the spouses, the variability of the DAS values was explained by aetiology (the spouses of traumatic ABI patients had worse DAS values), whereas the variability in the FRI values was explained by religious commitment (spending much time on religious activities was associated with better FRI values). Our data suggest that some clinical and demographic variables might be important for protecting against marital dissatisfaction after an ABI.
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Affiliation(s)
| | - Lucia Giannotti
- S. Anna Institute, 88900 Crotone, Italy; (S.L.); (L.G.); (P.T.)
| | - Paolo Tonin
- S. Anna Institute, 88900 Crotone, Italy; (S.L.); (L.G.); (P.T.)
| | | | - Antonio Cerasa
- S. Anna Institute, 88900 Crotone, Italy; (S.L.); (L.G.); (P.T.)
- Institute for Biomedical Research and Innovation, National Research Council (IRIB-CNR), 87050 Mangone, Italy
- Correspondence:
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Harris Walker G, Gonzalez-Guarda R, Yang Q, Shah S, Prvu Bettger J. Socio-ecological perspective on factors influencing acute recovery of younger stroke survivors: A mixed methods study. J Adv Nurs 2021; 77:2860-2874. [PMID: 33650219 DOI: 10.1111/jan.14778] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 01/13/2021] [Accepted: 01/20/2021] [Indexed: 12/13/2022]
Abstract
AIMS Stroke is affecting an increasing number of young and middle-aged adults. Given the substantial diversion from anticipated life trajectories that younger stroke survivors experience as a result of their stroke deficits, their health-related quality of life (HRQOL) is likely to be negatively impacted during the immediate post-acute recovery period. The aim of this study was to generate a comprehensive understanding of the influences on HRQOL and acute recovery during the first three months following stroke for younger adults using a socio-ecological perspective. DESIGN Longitudinal, convergent mixed methods design. METHODS HRQOL survey data, assessed using the Patient Generated Index (N = 31), and qualitative interview data about survivors' recovery experiences (N = 20) were collected. Simple linear regression and effect size results were integrated with themes and sub-themes identified from conventional content analysis using joint data displays. RESULTS Depression and fatigue negatively affected recovery at the individual level. At the family and societal level, family functioning, social support including being married, having insurance, working, adequate income and being unemployed post-stroke all positively impacted recovery. Qualitative findings revealed determination, coping, and accessing healthcare to positively affect recovery though a meta-inference could not be drawn as no quantitative data addressed these concepts. CONCLUSION A variety of factors intersecting across socio-ecological levels were perceived by young stroke survivors to influence acute recovery experiences and outcomes. IMPACT This study identified individual-, family- and societal-level factors in younger adults' environments that may affect the acute stroke recovery experience. Findings underscore the need for research and clinical approaches that consider environmental factors at multiple levels of influence when supporting stroke recovery for younger adults.
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Affiliation(s)
| | | | - Qing Yang
- Duke University School of Nursing, Durham, NC, USA
| | | | - Janet Prvu Bettger
- Duke University School of Nursing, Durham, NC, USA.,Duke University School of Medicine, Durham, NC, USA
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Pituch E, Bindiu AM, Grondin M, Bottari C. Parenting with a physical disability and cognitive impairments: a scoping review of the needs expressed by parents. Disabil Rehabil 2020; 44:3285-3300. [PMID: 33295215 DOI: 10.1080/09638288.2020.1851786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE Parents, whose daily activities are limited by a disability, account for 6.2% of the American population with minor children. Considering the prevailing knowledge gaps concerning parents with a physical disability and cognitive impairments, there is an urgency to instigate an investigation of their unmet needs. In this study, we will examine the scope of literature relating to the specific needs of parents with a physical disability and cognitive impairments in early child rearing occupations. METHODS A scoping review of peer-reviewed literature was conducted by two independent raters in four databases (CINAHL, EMBASE, Medline, PsycINFO). Data were extracted and analyzed numerically and thematically using the International Classification of Functioning, Disability and Health (ICF). RESULTS Twenty-nine studies were included for review representing the needs of 113 parents. Emerging needs related to 15 ICF categories and three corresponding themes: parents' (1) needs when engaging with their young children, (2) personal needs in and outside the home, and (3) needs navigating the health system. CONCLUSIONS The unmet needs of parents with a physical disability and cognitive impairments legitimize the development of clinical services for this population. Future research should focus on developing assessments and interventions specific to parental needs in child rearing occupations.IMPLICATIONS FOR REHABILITATIONAdults with a physical disability and cognitive impairments who parent young children have unmet needs with regards to engaging in child rearing, meeting their personal needs, and navigating the health system.Studies reporting on the impact of impairments on parenting mostly focus on elucidating physical impairments and less so cognitive impairments.Developing a more comprehensive understanding of parental needs will inform further development of targeted assessments and interventions for parents with a physical disability and cognitive impairments.
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Affiliation(s)
- Evelina Pituch
- School of Rehabilitation, Faculty of Medecine, Université de Montréal, Montreal, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Institut universitaire sur la réadaptation en déficience physique de Montréal du CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
| | - Anna Maria Bindiu
- School of Rehabilitation, Faculty of Medecine, Université de Montréal, Montreal, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Institut universitaire sur la réadaptation en déficience physique de Montréal du CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
| | - Myrian Grondin
- Bibliothèque Marguerite-d'Youville, Université de Montréal, Montreal, Canada
| | - Carolina Bottari
- School of Rehabilitation, Faculty of Medecine, Université de Montréal, Montreal, Canada.,Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Institut universitaire sur la réadaptation en déficience physique de Montréal du CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada
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14
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Harris Walker G, Oyesanya TO, Hurley A, Sandhu S, Liu C, Mulla M, Prvu Bettger J. Recovery experiences of younger stroke survivors who are parents: A qualitative content analysis. J Clin Nurs 2020; 30:126-135. [PMID: 33031618 DOI: 10.1111/jocn.15529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 09/14/2020] [Accepted: 09/27/2020] [Indexed: 11/26/2022]
Abstract
AIMS AND OBJECTIVES To explore the experience of parenting for younger stroke survivors (aged 18 to 64 years at the time of the stroke). BACKGROUND Stroke among younger adults increased 43% between 2000 and 2010. The social, emotional and physical functioning of younger adults affects multiple aspects of their lives including parenting. There is limited research on the experience of parenting after stroke. DESIGN This is a qualitative descriptive study. METHODS We conducted individual semi-structured interviews with 10 younger adults who were actively parenting children under the age of 18 years at the time of stroke. Conventional content analysis was used to analyse the data. We report the methods and results using the COREQ checklist. RESULTS Impairments from stroke disrupted participants' identity, relationships and roles as a parent. The degree to which parenting abilities and behaviours were affected by stroke was contingent upon the type and severity of impairments as well as the children's age. Participants also observed emotional and behavioural changes in their children in response to their stroke. Support from family, friends, healthcare providers and children's school/day care was crucial to participants throughout their stroke recovery. Two major themes emerged: (a) finding a new normal; and (b) support for parenting post-stroke. CONCLUSIONS Findings enable a deeper understanding of the distinct parenting challenges younger stroke survivors face and can inform future research on this population. RELEVANCE FOR CLINICAL PRACTICE Study findings highlight the need for continual and tailored follow-up by nurses and other allied healthcare professionals to decrease the difficulty stroke survivors experience when trying to resume their role as parents.
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Affiliation(s)
| | | | - Alexandria Hurley
- Trinity College of Arts and Sciences, Duke University, Durham, NC, USA
| | - Sahil Sandhu
- Trinity College of Arts and Sciences, Duke University, Durham, NC, USA
| | - Chelsea Liu
- Trinity College of Arts and Sciences, Duke University, Durham, NC, USA
| | - Maaz Mulla
- Trinity College of Arts and Sciences, Duke University, Durham, NC, USA
| | - Janet Prvu Bettger
- School of Nursing, Duke University, Durham, NC, USA.,School of Medicine, Duke University, Durham, NC, USA
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15
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Dibley L, Williams E, Young P. When Family Don't Acknowledge: A Hermeneutic Study of the Experience of Kinship Stigma in Community-Dwelling People With Inflammatory Bowel Disease. QUALITATIVE HEALTH RESEARCH 2020; 30:1196-1211. [PMID: 30845887 DOI: 10.1177/1049732319831795] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Recent evidence suggests that kinship stigma-the experience of being or feeling stigmatized by family members-arises in the stories of people with inflammatory bowel disease (IBD). Adopting Goffman's definition of stigma as "an attribute which is deeply discrediting," we used hermeneutic (interpretive) phenomenology to further explore the meaning of kinship stigma for people with IBD and reveal its significance. In total, 18 unstructured interviews took place in participants' own homes in the United Kingdom, between July 2015 and April 2016. Transcripts were analyzed using a hermeneutic method to reveal three relational themes and one constitutive pattern. Referring to relevant literature, the presence and impact of kinship stigma on people with IBD is revealed. Kinship stigma-experienced as and meaning a lack of acknowledgment-may have wide-ranging implications for health and social care professionals caring for persons with IBD or other chronic illness and their families.
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Affiliation(s)
- Lesley Dibley
- University of Greenwich, London, United Kingdom
- Barts Health NHS Trust, London, United Kingdom
| | - Ellen Williams
- The University of Mississippi Medical Centre, Jackson, Mississippi, USA
- University of North Alabama, Florence, Alabama, USA
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16
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Scholten EWM, Ketelaar M, Visser-Meily JMA, Stolwijk-Swüste J, van Nes IJW, Gobets D, Post MWM. Self-Efficacy Predicts Personal and Family Adjustment Among Persons With Spinal Cord Injury or Acquired Brain Injury and Their Significant Others: A Dyadic Approach. Arch Phys Med Rehabil 2020; 101:1937-1945. [PMID: 32585170 DOI: 10.1016/j.apmr.2020.06.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/15/2020] [Accepted: 06/17/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To investigate whether the combination of self-efficacy levels of individuals with spinal cord injury (SCI) or acquired brain injury (ABI) and their significant others, measured shortly after the start of inpatient rehabilitation, predict their personal and family adjustment 6 months after inpatient discharge. DESIGN Prospective longitudinal study. SETTING Twelve Dutch rehabilitation centers. PARTICIPANTS Volunteer sample consisting of dyads (N=157) of adults with SCI or ABI who were admitted to inpatient rehabilitation and their adult significant others. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Self-efficacy (General Competence Scale) and personal and family adjustment (Hospital Anxiety and Depression Scale and McMaster Family Assessment Device General Functioning). RESULTS In 20 dyads, both individuals with SCI or ABI and their significant others showed low self-efficacy at baseline. In 67 dyads, both showed high self-efficacy. In the low-self-efficacy dyads, 61% of the individuals with SCI or ABI and 50% of the significant others showed symptoms of anxiety 6 months after discharge, vs 23% and 30%, respectively, in the high-self-efficacy dyads. In the low-self-efficacy dyads, 56% of individuals with SCI or ABI and 50% of the significant others reported symptoms of depression, vs 20% and 27%, respectively, in the high-self-efficacy dyads. Problematic family functioning was reported by 53% of the individuals with SCI or ABI and 42% of the significant others in the low-self-efficacy dyads, vs 4% and 12%, respectively, in the high-self-efficacy dyads. Multivariate analysis of variance analyses showed that the combination of levels of self-efficacy of individuals with SCI or ABI and their significant others at the start of inpatient rehabilitation predict personal (V=0.12; F6,302=2.8; P=.010) and family adjustment (V=0.19; F6,252=4.3; P<.001) 6 months after discharge. CONCLUSIONS Low-self-efficacy dyads appear to be more at risk for personal and family adjustment problems after discharge. Screening for self-efficacy may help healthcare professionals to identify and support families at risk for long-term adjustment problems.
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Affiliation(s)
- Eline W M Scholten
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Marjolijn Ketelaar
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Johanna M A Visser-Meily
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands; Department of Rehabilitation, Physical Therapy Science & Sports, UMC Utrecht Brain Center, University Medical Center Utrecht, The Netherlands
| | - Janneke Stolwijk-Swüste
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Ilse J W van Nes
- Department of Rehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - David Gobets
- Rehabilitation Centre, Heliomare, Wijk aan Zee, The Netherlands
| | | | - Marcel W M Post
- Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands; University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Department of Rehabilitation Medicine, Groningen, The Netherlands.
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Hartman L, Jenkinson C, Morley D. Young People's Response to Parental Neurological Disorder: A Structured Review. Adolesc Health Med Ther 2020; 11:39-51. [PMID: 32273785 PMCID: PMC7105371 DOI: 10.2147/ahmt.s237807] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 02/08/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction A significant paucity of literature exists relating to the impact on children of parental neurological disorder, with the exception of multiple sclerosis. The wider literature in this field (parental cancer, depression, alcoholism, HIV/AIDS) exhibits the many potential challenges young people might experience during serious parental illness. Given this, a literature review of parental neurological disorder is long overdue. Methods This review is structured around the World Health Organisation (WHO) classification of neurological disorders. The WHO identifies 10 common neurological disorders; dementia, epilepsy, headache, multiple sclerosis, neuroinfections, neurological disorders associated with malnutrition, pain associated with neurological disorders, Parkinson's disease, stroke, and traumatic brain injury. A comprehensive search of the MEDLINE database was performed using key terms for each of the 10 conditions. Results for each condition were divided in to "negative", "positive and/or neutral" and "other" child responses. Results The search yielded a total of 6247 titles, of which 184 underwent a full-text assessment. Sixty-five met all eligibility criteria and were thus included in the review. A number of negative issues emerged across parental conditions including the prevalence of child mood disorders, parent-child role reversal, children's need for information on the parental condition, the importance of family cohesion, the negative effect of parental psychopathology and differences between male and female children. A limited number of positive outcomes were evident in a minority of parental conditions. Outcomes measured and methodologies employed were highly heterogeneous. Conclusion Children generally respond negatively to parental neurological disorder. Responses varied between neurological disorders, suggesting the need for parental disease-specific guidance and clinical management where required.
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Affiliation(s)
- Lilian Hartman
- Lincoln College, University of Oxford, Oxford OX1 3DR, UK
| | - Crispin Jenkinson
- Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - David Morley
- Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
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18
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Factors which Influence Risk Taking and the Evolution of Social-Identity in Stroke Narratives: A Thematic Synthesis. Behav Sci (Basel) 2020; 10:bs10020046. [PMID: 32023968 PMCID: PMC7071490 DOI: 10.3390/bs10020046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 01/24/2020] [Accepted: 01/25/2020] [Indexed: 11/17/2022] Open
Abstract
Background: The disruption of a stroke can impact an individual’s sense of social identity. A comprehensive review is required to understand the factors and processes that influence changes in social identity following a stroke. Aims: To undertake a review of literature to discover a process of social identity evolution for people with stroke and identify the factors which influence it. Methods: A meta-ethnographic approach to review was undertaken and a subtle realist viewpoint was assumed. Studies were included if they documented experiences and perceptions relating to stroke. Eight electronic databases were searched from January 2009 until January 2019. Quality assessment and synthesis techniques were applied. Findings: Out of the 18 papers included, a total of 251 (141/251, 56% male, 109/251, 43% female, 1/251, 0.4% undisclosed) individuals were included within the synthesis. The evolution of social-identity model was developed and identified with five key stages to represent a process that individuals with stroke can experience. Factors which influence the process were identified and direct implications for clinical practice are given. Conclusion: This review has highlighted the major themes within the evolution of social identity and management strategies for risk taking to achieve a desired future. Further research is required to consider how these findings may be tested in clinical practice.
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Fleming V, Robb Y. A critical analysis of articles using a Gadamerian based research method. Nurs Inq 2019; 26:e12283. [PMID: 30848870 DOI: 10.1111/nin.12283] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 12/07/2018] [Accepted: 12/12/2018] [Indexed: 11/27/2022]
Abstract
It is over 20 years since Michael Crotty's groundbreaking critique of phenomenological research in nursing. However, rather than entering into the acrimonious discussions that followed, we developed a research method that we believed translated Gadamer's philosophy into the world of empirical research. Fundamental to that work was our differentiation of hermeneutics from phenomenology. The aim of the present paper was to provide a critical analysis of the citations from publication in 2003 until the end of 2017. We identified 402 citations of which 362 were included. One hundred and sixty-three articles mentioned the article in passing, usually in a list of authors who had discussed hermeneutics. Sixteen citations misrepresented the method mainly claiming that we discussed a method for hermeneutic phenomenology (or phenomenological hermeneutics). Of the 117 citations that partially used the method, the main focus was the four steps of data analysis. Sixty studies used our method in totality although they derive from varying philosophical standpoints. Disappointingly, there has been little critique of our Gadamerian research method. For health disciplines to truly make progress in the academic stage, it is vital that we engage in with critique, some of which will come through open and honest reflexive engagement with our topics.
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Affiliation(s)
- Valerie Fleming
- School of Nursing and Allied Health, Liverpool John Moores University, Liverpool, UK
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20
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Wu CY, Skidmore ER, Rodakowski J. Relationship Consensus and Caregiver Burden in Adults with Cognitive Impairments 6 Months Following Stroke. PM R 2019; 11:597-603. [PMID: 30844137 DOI: 10.1002/pmrj.12009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 11/01/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND Caregiver burden is commonly experienced in caregivers of adults with cognitive impairment after stroke. This burden can be associated with caregiver-centered factors, including caregiver-perceived relationship quality. OBJECTIVE To examine the role of caregiver-perceived relationship quality on caregiver burden at 6 months following stroke. DESIGN Prospective observational study. SETTING Community settings. PARTICIPANTS Adults enrolled in two randomized controlled trials after stroke (n = 60) and their caregivers (n = 60). METHODS Three constructs of relationship quality (relationship consensus, cohesion, and satisfaction) were examined as predictors of caregiver burden (the Abbreviated Dyadic Adjustment Scale). A hierarchical logistic regression and a Poisson regression with robust standard errors were used to examine the effect of relationship quality on caregiver burden while controlling for characteristics of stroke survivors and caregivers. MAIN OUTCOME MEASUREMENTS Caregiver burden was measured with the abridged version of the Zarit Burden Interview. RESULTS Poor relationship consensus (odds ratio [OR] = 1.48; 95% confidence interval [CI] = 1.06-2.07; P = .02) increased the odds of high caregiver burden after controlling for characteristics of stroke survivors (age, comorbidity, cognitive fluency) and caregivers (gender, self-reported health). Relationship cohesion (OR = 1.03; 95% CI = .84-1.25; P = .81) and relationship satisfaction (OR = 1.53; 95% CI = .75-3.10; P = .24) did not predict caregiver burden. CONCLUSION Meaningful and agreeable goals and expectations between dyads are essential to reduce caregiver burden after stroke. Collaborative goal-setting between stroke survivors and their caregivers may be a promising intervention strategy to increase relationship consensus and reduce caregiver burden. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Chao-Yi Wu
- Department of Occupational Therapy, University of Pittsburgh, 5055 Forbes Tower, Pittsburgh, PA 15260
| | - Elizabeth R Skidmore
- Department of Occupational Therapy, Clinical and Translational Institute, Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
| | - Juleen Rodakowski
- Department of Occupational Therapy, Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
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Szczygiel N, Santana S. 'Call me if you need': Social support experiences under economic and social change. SOCIAL WORK IN HEALTH CARE 2018; 57:794-810. [PMID: 30118651 DOI: 10.1080/00981389.2018.1508112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Social interactions play an important role in people's life and people's health but their scope and intensity tend to decrease with age, challenging social support dynamics and increasing the risk of social isolation and helplessness. In Portugal, policymakers still seem to rely on traditional social relations in eldercare, while contextual changes and trends are redefining family roles and behaviors and defying the established social support structure. In this work, we aim to examine the scope, structure and experiences of the informal social support network available in the country for stroke patients 6 months after their discharge from the acute care unit in the context of a larger study. The results seem to confirm the importance of family as a source of social support and shed light on different bonding experiences with non-kin social groups, such as neighbors and friends. A coordinated care provision, combining formal and informal support is vital and beneficial for patients, their caregivers and the care system.
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Affiliation(s)
- Nina Szczygiel
- a GOVCOPP - Research Unit on Governance, Competitiveness and Public Policies , University of Aveiro , Aveiro , Portugal
- b Department of Economics, Management, Industrial Engineering and Tourism , University of Aveiro , Aveiro , Portugal
| | - Silvina Santana
- a GOVCOPP - Research Unit on Governance, Competitiveness and Public Policies , University of Aveiro , Aveiro , Portugal
- b Department of Economics, Management, Industrial Engineering and Tourism , University of Aveiro , Aveiro , Portugal
- c IEETA - Institute of Electronics and Informatics Engineering of Aveiro , University of Aveiro , Aveiro , Portugal
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22
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McGrath M, Lever S, McCluskey A, Power E. How is sexuality after stroke experienced by stroke survivors and partners of stroke survivors? A systematic review of qualitative studies. Clin Rehabil 2018; 33:293-303. [DOI: 10.1177/0269215518793483] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: To synthesise how post-stroke sexuality is experienced by stroke survivors and partners of stroke survivors. Methods: MEDLINE, PubMed, SCOPUS, CINAHL and PsycINFO were searched from inception to May 2018 using a combination of relevant Medical Subject Headings and Free Text Terms. Only papers published in English reporting original qualitative research were included. Methodological quality was assessed using the Critical Appraisal Skills Programme Qualitative Research Checklist. All text presented as ‘results’ or ‘findings’ in the included studies was extracted and subjected to a thematic analysis and synthesis which was discussed and agreed by the research team. Results: The initial search yielded 136 unique papers with a further 8 papers identified through reference checking. Following full-text review, 43 papers were included in the final synthesis. Two analytical themes were identified: sexuality is silenced and sexuality is muted and sometimes changed, but not forgotten. These themes were made up of six descriptive themes: struggle to communicate within relationships, health professionals don’t talk about sexuality, sexuality and disability is a taboo topic, changes to pre-stroke relationships, changed relationship with the stroke survivor’s own body and resuming sexual intimacy – adaptation and loss. Conclusion: Stroke has a profound impact on how sexuality is experienced by both stroke survivors and partners of stroke survivors. Despite this, post-stroke sexuality is rarely discussed openly. Stroke survivors and partners value sexuality and may benefit from strategies to support adjustment to post-stroke sexuality.
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Affiliation(s)
- Margaret McGrath
- Discipline of Occupational Therapy, Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, Australia
| | - Sandra Lever
- Ryde Sexuality and Intimacy Clinic, Graythwaite Rehabilitation Centre, Ryde Hospital, NSW, Australia
- The University of Sydney, Susan Wakil School of Nursing and Midwifery, M02- Sydney Nursing School, The University of Sydney, NSW, Australia
| | - Annie McCluskey
- Discipline of Occupational Therapy, Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, Australia
| | - Emma Power
- Discipline of Speech Pathology, Faculty of Health Sciences, The University of Sydney, Lidcombe, NSW, Australia
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Abstract
Background Stroke is a leading cause of disability in the United States, resulting in physical, cognitive, and emotional impairments. One in ten strokes occur in adults younger than 50 years of age and the incidence has increased approximately 44% from 2000 to 2010. Young adult survivors have specific needs related to their developmental stage including childcare responsibilities. Despite the high value placed on parenting by society, parenting is currently not assessed at any stage of stroke rehabilitation. Objective To determine the state of the science on parenting after stroke Methods A literature search of multiple electronic databases was conducted from 1964 to February 2018. Select key words were adapted for use in each database. Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines were followed. Results One thousand two hundred and forty-one articles were identified from electronic databases. After deduplication, abstract/title review, and full-text review, ten studies were included. Nine of the studies were qualitative and one was a retrospective cohort study. Survivors in all but one of the qualitative studies reported limitations in parenting tasks after stroke. Changes in social relationships and participation as a parent in other life domains as a result of stroke were also described by survivors. Conclusion Findings from this systematic review of the perspectives of stroke survivors actively parenting suggest that residual stroke impairments lead to both activity limitations and participation restrictions. However, the literature available on parenting after stroke is limited and there is a significant opportunity to advance this area of stroke research.
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Affiliation(s)
| | - Janet Prvu Bettger
- a School of Nursing , Duke University , Durham , NC , USA
- b Orthopedic Surgery , Duke University , Durham , NC , USA
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Aadal L, Angel S, Langhorn L, Pedersen BB, Dreyer P. Nursing roles and functions addressing relatives during in-hospital rehabilitation following stroke. Care needs and involvement. Scand J Caring Sci 2017; 32:871-879. [DOI: 10.1111/scs.12518] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 08/08/2017] [Indexed: 12/21/2022]
Affiliation(s)
- Lena Aadal
- Hammel Neurorehabilitation and Reseach Centre; Denmark
| | - Sanne Angel
- Section for Nursing; Institute of Public Health; Aarhus University; Aarhus Denmark
- Department for Health and Social Care; Molde University College; Molde Norway
| | - Leanne Langhorn
- Department of Neurosurgery; Department of Anaesthesiology and Intensive Care; Aarhus University Hospital; Aarhus Denmark
| | | | - Pia Dreyer
- Department of Anaesthesiology and Intensive Care; Aarhus University Hospital; Aarhus Denmark
- Institute of Public Health; Section of Nursing; Aarhus University; Aarhus Denmark
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Sundin K, Pusa S, Jonsson C, Saveman BI, Östlund U. Envisioning the future as expressed within family health conversations by families of persons suffering from stroke. Scand J Caring Sci 2017; 32:707-714. [PMID: 28851069 DOI: 10.1111/scs.12501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 06/05/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND The whole family is affected when a person suffers from stroke, but few studies have focused on families' expectations following the stroke. OBJECTIVE The aim of this study was to illuminate what persons with stroke and their family members talk about in Family Health Conversations (FamHCs) with focus on the future and how nurses leading these conversations apprehended the families' future shown in closing letters based on these conversations. METHOD In this study, seven families with a member ≤65 years who had suffered a stroke participated in FamHC in their homes after the person with stroke had been discharged from the rehabilitation clinic. The FamHC comprised a series of three conversations conducted every other week and a closing letter sent by the nurses to the family to conclude the series. In this study, the third conversations were recorded and they and the closing letters were transcribed and analysed using qualitative content analysis. RESULT The family members including the persons with stroke were found to be able to tell their stories and express their feelings, worries, losses, hopes and wishes for the future within the context of the Family Health Conversations. Support within the family was highlighted as essential to the satisfactory management of future situations. CONCLUSION The persons with stroke and their belonging family members' vision of the future was reflected over in the light of theories about beliefs, possible selves, hope and suffering, and the findings highlight the need for broader use of family conversations to support persons with stroke and their families to manage the future.
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Affiliation(s)
- Karin Sundin
- Department of Nursing, Umeå University, Umeå, Sweden
| | - Susanna Pusa
- Department of Nursing, Umeå University, Umeå, Sweden
| | - Carin Jonsson
- Department of Nursing, Umeå University, Umeå, Sweden
| | | | - Ulrika Östlund
- Centre for Research & Development, Uppsala University/Region Gävleborg, Gävle, Sweden
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Abstract
ABSTRACTIn health and chronic illness, satisfying marriages promote wellbeing and life satisfaction, yet stroke research has focused on either the stroke survivor as the patient or the spouse as a care-giver. Using Pope, Mays and Popay's framework for synthesising qualitative and quantitative methods, we conducted a systematic review and synthesis of 39 peer-reviewed studies to determine what happens to marital relationships after one partner has suffered a stroke. All the articles examined the impact of stroke. Three overarching themes characterise the evolution of marriage after stroke: chaos in the marriage, work to re-establish the marriage and evolution of the marriages. While both the stroke condition itself and the survivors’ need for care undermined the emotional qualities of the relationship for some couples, about two-thirds were able to retain or regain the relationship closeness. As in other chronic illnesses, the relationship closeness and a couple's ability to collaborate contributed to the survivor's recovery and to the satisfaction with life of the stroke survivor and the spouse. Our results underscore the need to consider the quality of, and the qualities of, the relationship between stroke survivors and their spouses. Future research could include a greater focus on qualitative or mixed-methods approaches to explore the interactions between stroke survivors and spouses that impact the wellbeing of both partners.
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Olivier CL, Phillips J, Roy DE. To be or not to be? A caregiver's question: the lived experience of a stroke family during the first 18 months poststroke. Scand J Caring Sci 2017; 32:270-279. [DOI: 10.1111/scs.12458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 02/14/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Cheryl L Olivier
- Department of Osteopathy; Health Care Practice Pathway; Unitec Institute of Technology; Auckland New Zealand
| | - Jill Phillips
- Department of Nursing; Health Care Practice Pathway; Unitec Institute of Technology; Auckland New Zealand
| | - Dianne E Roy
- Department of Nursing; Health Care Practice Pathway; Unitec Institute of Technology; Auckland New Zealand
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Soufi S, Chabrier S, Bertoletti L, Laporte S, Darteyre S. Lived experience of having a child with stroke: A qualitative study. Eur J Paediatr Neurol 2017; 21:542-548. [PMID: 28185801 DOI: 10.1016/j.ejpn.2017.01.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 06/01/2016] [Accepted: 01/16/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To assess the lived experience of parents whose child has suffered a stroke. METHODS A qualitative study model was chosen, comprising in-depth interviews with parents separately or altogether. A semi-structured interview guide was used. Interviews were audio-recorded, transcribed verbatim and analysed using constant comparison and content analysis. Participant checking was performed. Thirteen families of children aged 1 month to 17 years, having suffered ischaemic or haemorrhagic arterial stroke within one to five years, were recruited. Interviews were conducted within home setting. RESULTS After fourteen interviews, data saturation was met and six main narrative themes were identified, underlining a common path of stroke lived experience: brutality of diagnosis, lack of information regarding disease condition, feeling of abandonment after discharge from hospital, focus on functional recovery, late awareness of cognitive disorders, and need for psychological support and family adaptation. CONCLUSION This is the first qualitative study reporting lived experience of childhood stroke caregivers. In line with other qualitative studies exploring the feelings of parents coping with severe neurological conditions of childhood, our results advocate the need for evaluation of family centred health interventions.
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Affiliation(s)
- Syrine Soufi
- Université Claude Bernard, Institut des Sciences et Techniques de la Réadaptation, F-69677 Lyon, France
| | - Stéphane Chabrier
- INSERM, SAINBIOSE, U1059, unité dysfonction vasculaire et hémostase, université Jean-Monnet, CIC 1408, F-42055 Saint-Etienne, France; CHU Saint-Étienne, Centre national de référence de l'AVC de l'enfant - Service de médecine physique et réadaptation pédiatrique, F-42055 Saint-Etienne, France
| | - Laurent Bertoletti
- INSERM, SAINBIOSE, U1059, unité dysfonction vasculaire et hémostase, université Jean-Monnet, CIC 1408, F-42055 Saint-Etienne, France
| | - Silvy Laporte
- INSERM, SAINBIOSE, U1059, unité dysfonction vasculaire et hémostase, université Jean-Monnet, CIC 1408, F-42055 Saint-Etienne, France
| | - Stéphane Darteyre
- INSERM, SAINBIOSE, U1059, unité dysfonction vasculaire et hémostase, université Jean-Monnet, CIC 1408, F-42055 Saint-Etienne, France.
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Arntzen C, Hamran T. Stroke survivors' and relatives' negotiation of relational and activity changes: A qualitative study. Scand J Occup Ther 2015; 23:39-49. [PMID: 26337928 DOI: 10.3109/11038128.2015.1080759] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study explores stroke survivors' and relatives' negotiation of relational and activity change in their interrelated long-term meaning-making processes of everyday life and what it means for the experience of progress and well-being. MATERIAL AND METHODS Repeated retrospective in-depth interviews were conducted with both the stroke survivor and relatives. A Critical Psychological Perspective gives the frame of reference to study more closely what is going on in and across particular contexts in family members' ongoing social practices. RESULTS An asymmetric problematic relationship can develop among the participants in the context of family life. However, the analysis identifies six beneficial relational and activity changes, which contribute to a reciprocal, balanced repositioning, and help the family move in a more positive direction. The repositioning processes facilitate a new transformation of family we-ness, which is important for the participants' experience of process and well-being. The comprehensive family work that has to be done is about managing the imbalance of everyday life, upholding separate activities outside the family sphere and dealing with the fact that peripheral others become more peripheral. CONCLUSION The study addresses some arguments for taking a family-centred perspective in occupational therapy practice, as well as in a stroke rehabilitation service in general.
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Affiliation(s)
- Cathrine Arntzen
- a Department of Health and Care Sciences , The Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway , Norway ;,b Division of Rehabilitation Services , University Hospital of North Norway , Tromsø , Norway
| | - Torunn Hamran
- c Department of Health and Care Sciences , The Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway , Tromsø , Norway
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Female Spouses’ Perceptions of the Sexual Relationship with Stroke-Affected Partners. SEXUALITY AND DISABILITY 2015. [DOI: 10.1007/s11195-015-9404-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
AIM To report a concept analysis of family homeostasis. BACKGROUND As family members are a majority of informal caregivers, negative consequences from caregiving duty create a vicious cycle in the family unit resulting in ongoing health crises and care challenges. DESIGN Concept analysis. DATA SOURCES Forty empirical studies published from 1956-2012 were selected by searching five electronic bibliographical databases and by a manual search conducted from 2012-2013. Search terms included 'family homeostasis', 'homeostasis in family', 'homeostatic care' and 'family equilibrium'. Clinical experiences in nursing practice were used for constructing cases and clinical implications. METHODS Walker and Avant's method guided this analysis. RESULTS Family homeostasis is defined as the capacity and mechanisms by which equilibrium is re-established in the family after a change occurs. Five critical attributes are identified: (1) predetermined setpoint; (2) self-appraised antecedents; (3) interdependence; (4) tendency to stability; and (5) feedback mechanisms. Antecedents include any type of causative change beyond the tolerable limit, while consequences encompass intermediate and long-term outcomes as well as equilibrium itself. CONCLUSION Family homeostasis provides a conceptual rationale of family caregiving. While care recipients remain the primary beneficiaries of healthcare provision, homeostatic mechanisms are required to support the family caregiver's valuable contribution in the caring process to enhance family well-being. Further study should expand the definition and settings of family to reflect healthcare needs of diverse types of families and from the perspectives of different healthcare providers.
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Affiliation(s)
- Heejung Kim
- University of Kansas, School of Nursing, Kansas, USA
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Persson C, Benzein E. Family health conversations: how do they support health? Nurs Res Pract 2014; 2014:547160. [PMID: 24800068 PMCID: PMC3995177 DOI: 10.1155/2014/547160] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Revised: 02/03/2014] [Accepted: 03/06/2014] [Indexed: 11/17/2022] Open
Abstract
Research shows that living with illness can be a distressing experience for the family and may result in suffering and reduced health. To meet families' needs, family systems intervention models are developed and employed in clinical contexts. For successful refinement and implementation it is important to understand how these models work. The aim of this study was therefore to describe the dialogue process and possible working mechanisms of one systems nursing intervention model, the Family Health Conversation model. A descriptive evaluation design was applied and 15 transcribed conversations with five families were analyzed within a hermeneutic tradition. Two types of interrelated dialogue events were identified: narrating and exploring. There was a flow between these events, a movement that was generated by the interaction between the participants. Our theoretically grounded interpretation showed that narrating, listening, and reconsidering in interaction may be understood as supporting family health by offering the families the opportunity to constitute self-identity and identity within the family, increasing the families' understanding of multiple ways of being and acting, to see new possibilities and to develop meaning and hope. Results from this study may hopefully contribute to the successful implementation of family systems interventions in education and clinical praxis.
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Affiliation(s)
- Carina Persson
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Center for Collaborative Palliative Care, Linnaeus University, 391 82 Kalmar, Sweden
| | - Eva Benzein
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Center for Collaborative Palliative Care, Linnaeus University, 391 82 Kalmar, Sweden
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Lo SHS, Chang AM, Chau JPC, Gardner GE. Theory-based self-management programs for promoting recovery in community-dwelling stroke survivors: a systematic review. ACTA ACUST UNITED AC 2013. [DOI: 10.11124/jbisrir-2013-1056] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Martinsen R, Kirkevold M, Bronken BA, Kvigne K. Work-aged stroke survivors' psychosocial challenges narrated during and after participating in a dialogue-based psychosocial intervention: a feasibility study. BMC Nurs 2013; 12:22. [PMID: 24066840 PMCID: PMC3849869 DOI: 10.1186/1472-6955-12-22] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Accepted: 09/24/2013] [Indexed: 11/30/2022] Open
Abstract
Background Studies point to the lack of psychosocial support and rehabilitation services that are adjusted to the work-aged stroke survivors’ specific needs in order to promote psychosocial well-being. The aim of the study was to illuminate the psychosocial challenges work-aged participants (i.e. aged 18–67 years) thematised during and after participating a dialogue-based psychosocial intervention during the first year following a stroke. Methods The study was a feasibility study guided by the UK Medical Research Council Framework for developing and evaluating complex interventions. Qualitative data from in-depth interviews with fourteen stroke-survivors aged 33–66 years, researcher field notes and log notes written during the intervention were analysed applying a hermeneutic-phenomenological approach. Results The stroke and its consequences had a substantial impact on family and work life. Their experiences were summarised in the two themes The threat of becoming marginalised in family life and The threat of becoming marginalised in work life. Conclusion Life as a work-aged stroke survivor was experienced as challenging and created a threat of becoming marginalised in family and work life. The study highlights the need to understand the specific psychosocial challenges and needs facing work-aged stroke survivors’ in order to promote their psychosocial well-being. More research is needed concerning specific life-span challenges amongst work-aged stroke survivors in order to further develop appropriate interventions that helps address this issue.
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Affiliation(s)
- Randi Martinsen
- Faculty of Medicine, Institute of Health and Society, Department of Nursing Science, University of Oslo, Oslo, Norway.
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Younger stroke survivors' experiences of family life in a long-term perspective: a narrative hermeneutic phenomenological study. Nurs Res Pract 2012; 2012:948791. [PMID: 23304485 PMCID: PMC3530179 DOI: 10.1155/2012/948791] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2012] [Accepted: 11/19/2012] [Indexed: 11/24/2022] Open
Abstract
The psychosocial consequences following a stroke are known to be challenging, influencing the stroke survivors' ability to participate in and carry out the taken-for-granted roles and activities in family life. This study explored how living with the consequences of stroke impacted on family life in the late recovery phase, that is, six months or more after stroke onset. Twenty-two stroke survivors aged 20–61 years were interviewed in-depth six months to nine years after stroke onset. The interviews were analyzed applying a narrative, hermeneutic phenomenological approach. The findings revealed challenges that varied with time, from an initial struggle to suffice in and balance the relationships and roles within the family early after the stroke, towards a more resigned attitude later on in the stroke trajectory. The struggles are summarized in two main themes: “struggling to reenter the family” and “screaming for acceptance.” Nonestablished people living with stroke and stroke survivors in parental roles seem to be particularly vulnerable. Being provided with opportunities to narrate their experiences to interested and qualified persons outside the home context might be helpful to prevent psychosocial problems.
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