‘The hard work starts now’: a glimpse into the lives of carers of community-dwelling stroke survivors

Co-creating Digital Stories With UK-Based Stroke Survivors With the Aim of Synthesizing Collective Lessons From Individual Experiences of Interacting With Healthcare Professionals

Background

Stroke survivor narratives can provide valuable insight into experiences of healthcare and beyond. There is need to further understand collective lessons from stroke survivor narratives, yet prior studies utilizing digital storytelling tend to not synthesize lessons from individual experiences. This study aims to develop a novel method to co-create digital stories with stroke survivors that will aim to synthesize and portray important collective lessons from individual stroke survivors' experiences of interacting with healthcare professionals.

Methods

This study follows-up a qualitative study conducted with 30 stroke survivors exploring factors that help or hinder survivors to positively reconfigure their identity post-stroke. Five co-creation workshops were conducted with a subset of UK-based stroke survivors from this previous study. Participants were invited to join through: online workshops, an online bulletin board, and as an advisor. A four-stage workshop framework was developed through the integration of UK Design Council's Double Diamond method, digital storytelling strategies and the Behavior Change Wheel (BCW) framework for developing behavioral change interventions.

Findings

Six online workshop participants (three male, three female; aged 33–63; time since stroke 2–16 years) co-created digital stories that share six collective lessons aimed at increasing empathy and encouraging behavior change in healthcare professionals (HCPs) working with stroke survivors. Online bulletin board participants (n = 1) and advisors (n = 5) supported the co-creation process. Collective lessons identified were: (1) Stroke has a variety of symptoms that must all be considered; (2) Stroke can affect anyone of any age and not just the elderly; (3) Assumptions should not be made about a survivor's lifestyle or habits; (4) It is important to acknowledge the person behind the stroke and ensure that they are communicated with and listened to; (5) Stroke survivors can often feel unprepared for the reality of life after stroke; (6) Adapting to life after stroke is a long-term process requiring long-term support.

Conclusion

Stroke survivor stories highlighted preconceptions, attitudes and behaviors embedded within healthcare that negatively impacted their experiences and recovery. The novel methodology employed in this study enabled these stories to be synthesized into collective lessons to bring about improvements in these behaviors in future.

The Unmet Needs of Stroke Survivors and Stroke Caregivers: A Systematic Narrative Review

INTRODUCTION

Facilitating stroke survivors and their caregivers to lead a fulfilling life after stroke requires service providers to think about their different needs. Poor post stroke care may lead to unmet needs in stroke survivors and stroke caregivers. This may compromise them in leading their lives optimally after stroke.

OBJECTIVES & METHODOLOGY

This systematic narrative review examines articles published from 1990 to 2017, generated from Ovid, MEDLINE, CINAHL, and PubMed. The search was also supplemented by an examination of reference lists for related articles via Scopus. We included 105 articles.

FINDINGS

We found that the type of unmet needs in stroke survivors and the contributing factors were substantially different from their caregivers. The unmet needs in stroke survivors ranged from health-related needs to re-integration into the community; while the unmet needs in stroke caregivers ranged from information needs to support in caring for the stroke survivors and caring for themselves. Additionally, the unmet needs in both groups were associated with different factors.

CONCLUSION

More research is required to understand the unmet needs of stroke survivors and stroke caregivers to improve the overall post-stroke care services.

Caring for a stroke patient: The burden and experiences of primary caregivers in Uganda - A qualitative study

Aim

We assessed the burden and experiences of caregivers looking after stroke patients in Kampala, Uganda.

Design

We conducted a qualitative cross‐sectional study between May 2018–July 2018 among primary caregivers of stroke patients.

Methods

The primary caregiver was defined as the person spending most of the time providing daily care for the stroke patient for at least four months. Purposive sampling was used to consecutively recruit the primary caregivers. In‐depth interviews were conducted, and audiotape recorded, and observations were also made. Data were managed using NVIVO 12.0 following thematic approach.

Results

Twenty‐five caregivers were included in the analysis with a mean age of 39.3, SD 10.7. Four themes were identified from the qualitative analysis on caregivers’ experiences of looking after stroke patients: taking on new responsibilities, factors that protected caregivers from breaking down, limited resources and experiences with patient outcomes. Our findings highlight the need for interventions to support stroke patients and their caregivers.

Association between incongruence about survivor function and outcomes among stroke survivors and family caregivers

BACKGROUND

Stroke survivors and family caregivers often have incongruent appraisals of survivor cognitive, physical, and psychosocial function. Partner incongruence contributes to poor outcomes for survivors and caregivers.

OBJECTIVES

This study explored whether partner incongruence: (1) differs by function domain; (2) increases or decreases over time, and; (3) is associated with self-rated health, distress, stress, and depressive symptoms.

METHODS

Structured surveys were administered to 32 survivors and caregivers at approximately 3 (enrollment) and 7 months (follow-up) post-stroke. Paired t-tests were used to examine partners' ratings of survivor function at enrollment and follow-up, and changes in incongruence over time. Partial correlations were used to examine the association between incongruence at enrollment and outcomes at follow-up.

RESULTS

Survivors consistently rated their own memory and thinking as significantly better than caregivers rated their memory and thinking. At follow-up, survivors rated their own communication as significantly better than caregivers rated their communication. Incongruence about survivor memory and thinking was associated with survivor distress, as well as caregiver distress, stress, and depressive symptoms. Incongruence about survivor ADLs was associated with caregiver stress and depressive symptoms. Incongruence about survivor social participation was associated with caregiver distress.

CONCLUSIONS

Findings from this study suggest that survivors and caregivers often have incongruent appraisals of survivor function, that incongruence does not improve naturally over time, and that incongruence may be detrimental for survivor and caregiver outcomes. Further research should be directed at the mitigation of incongruence and strategies to improve outcomes for both survivors and family caregivers.

Caring Interaction with stroke survivors' family members-Family members' and nurses' perspectives

AIMS AND OBJECTIVES

To examine emotional support given by nurses to family members in the acute phase after a working-aged patient's stroke based on nurses' and family members' experiences.

BACKGROUND

The number of patients with stroke is increasing globally. There is a lack of knowledge about the emotional support of family members during the acute phase of working-aged stroke victims. To be able to provide high-quality nursing care during this phase, we need information about emotional support from family members' and nurses' perspective.

METHOD

Using a Glaserian grounded theory approach, the study was conducted using open interviews with family members and group interviews with nurses. Data were collected between 2012-2013.

RESULTS

In this study, emotional support is identified as Caring Interaction. The changed life situation and diverse feelings aroused by the stroke are the starting point of providing emotional support to family members. It is important that the nurses notice family members' need for support at the right time, use their intuition and respond appropriately.

CONCLUSIONS

The patient's family members are important when providing holistic nursing care for the whole family. As well as providing emotional support, high-quality nursing interventions enhance the care of family members. This study provides an explanation of the interaction process between family members and nurses. It helps family members and nurses to better understand each other. Although the data were collected 5 years ago, it is assumed that the interaction between family members and nurses has not changed during these years remarkably.

RELEVANCE TO CLINICAL PRACTICE

According to the experiences of family members and nurses who participated in this research, emotional support manifests in Caring Interaction. Being aware of body language and behaviour of family members, nurses can better interact with them.

Quality of life, anxiety, depression and burden among stroke caregivers: A longitudinal, observational multicentre study

AIM

To longitudinally describe stroke caregivers' quality of life, anxiety, depression and burden and to identify predictors of stroke caregivers' quality of life, anxiety, depression and burden.

BACKGROUND

Caregivers have a key role in stroke survivor care and the first year of caregiving is the most challenging. To give tailored interventions, it is important to capture changes and identify predictors of caregiver quality of life, anxiety, depression and burden during the first year.

DESIGN

A 12-month longitudinal study. Data were collected between June 2013-May 2016.

METHODS

Changes in stroke caregiver quality of life, anxiety and depression and burden and their predictors were identified using linear mixed-effects models.

RESULTS

The caregivers (N = 244) were 53 years old and mostly female. Caregiver quality of life did not change significantly over the 12 months, anxiety and depression decreased up to 9 months and caregiver burden decreased from baseline to 3 months, then increased up to 9 months. Higher caregiver quality of life was predicted by caregiver younger age, higher education, living with a stroke survivor, survivor older age and higher physical functioning; higher anxiety and depression were predicted by older caregiver age and younger survivor age; higher burden was predicted by caregiver male gender, the caregiver not living with survivor and survivor lower physical functioning.

CONCLUSION

The first 9 months of caregiving are particularly problematic for caregivers. The trajectories of the above variables and their predictors may be useful for policy makers, clinicians, investigators and educators to give better care to stroke caregivers and their survivors.

Stroke survivors' and informal caregivers' experiences of primary care and community healthcare services - A systematic review and meta-ethnography

Objective

To describe and explain stroke survivors and informal caregivers’ experiences of primary care and community healthcare services. To offer potential solutions for how negative experiences could be addressed by healthcare services.

Design

Systematic review and meta-ethnography.

Data sources

Medline, CINAHL, Embase and PsycINFO databases (literature searched until May 2015, published studies ranged from 1996 to 2015).

Eligibility criteria

Primary qualitative studies focused on adult community-dwelling stroke survivors’ and/or informal caregivers’ experiences of primary care and/or community healthcare services.

Data synthesis

A set of common second order constructs (original authors’ interpretations of participants’ experiences) were identified across the studies and used to develop a novel integrative account of the data (third order constructs). Study quality was assessed using the Critical Appraisal Skills Programme checklist. Relevance was assessed using Dixon-Woods’ criteria.

Results

51 studies (including 168 stroke survivors and 328 caregivers) were synthesised. We developed three inter-dependent third order constructs: (1) marginalisation of stroke survivors and caregivers by healthcare services, (2) passivity versus proactivity in the relationship between health services and the patient/caregiver dyad, and (3) fluidity of stroke related needs for both patient and caregiver. Issues of continuity of care, limitations in access to services and inadequate information provision drove perceptions of marginalisation and passivity of services for both patients and caregivers. Fluidity was apparent through changing information needs and psychological adaptation to living with long-term consequences of stroke.

Limitations

Potential limitations of qualitative research such as limited generalisability and inability to provide firm answers are offset by the consistency of the findings across a range of countries and healthcare systems.

Conclusions

Stroke survivors and caregivers feel abandoned because they have become marginalised by services and they do not have the knowledge or skills to re-engage. This can be addressed by: (1) increasing stroke specific health literacy by targeted and timely information provision, and (2) improving continuity of care between specialist and generalist services.

Systematic review registration number

PROSPERO 2015:CRD42015026602

Incongruence between stroke survivor and spouse perceptions of survivor functioning and effects on spouse mental health: a mixed-methods pilot study

OBJECTIVES

This pilot study investigated stroke survivors' and caregiving spouses' individual perspectives on survivor cognitive and physical functioning and the extent to which incongruence between partners' perceptions affects spouse depressive symptoms and overall mental health.

METHOD

Mixed-methods, with quantitative survey data from 35 couples and qualitative interview data from a subsample of 13 couples being collected and analyzed using paired t-tests, multiple regression with survivor-spouse discrepancy scores as predictors of spouse depressive symptoms, and interpretive-description techniques.

RESULTS

Quantitative data indicated that spouses rated survivor cognitive functioning as significantly worse than survivors rated their own and that survivor-spouse discrepancy scores for physical functioning were significantly associated with spouse depressive symptoms. Qualitative data enhanced understanding about the nuances of partner incongruence and the ramifications of partner incongruence for spouse mental health.

CONCLUSION

Partner incongruence has an impact on spouse depressive symptoms and overall mental health. Interventions targeted at survivor-spouse dyads and focused on improving communication between partners about survivor abilities may be effective for improving the mental health of spousal caregivers.

An integrated approach for individualised support: carers' views

Purpose

– The purpose of this paper was to capture carers’ views of a service in Bristol funded jointly by the Local Authority and the NHS Clinical Commissioning Group, which offers support to carers in the form of a one-off payment which they can use for anything they choose.

Design/methodology/approach

– A multi-method evaluation of this integrated service was conducted between August 2012 and October 2013 to explore its impact on carers’ health and well-being. This paper presents findings from 40 interviews conducted with carers as part of the evaluation.

Findings

– Many carers have little respite from very stressful situations; the break enabled them to focus on their own needs. Carers’ needs included actual short breaks away with or without those being cared for, as well as items like household equipment or exercise classes.

Research limitations/implications

– The study was centred on an innovation and integrated approach to support carers in one city and provides a snap-shot of the short-term effects. Longer lasting effects are not known.

Social implications

– Most carers found the support beneficial, and in some cases reported a positive effect on their own health and well-being. Effective inter-agency communication and collaboration is essential for the success of the integrated service.

Originality/value

– There is limited research available on the outcomes of integrated approaches to support carers.

Caregiver-Mediated Intervention Can Improve Physical Functional Recovery of Patients With Chronic Stroke

Background and Purpose. Patients with chronic stroke may benefit from continuing rehabilitation training after hospital discharge. This study examined whether caregiver-mediated, home-based intervention (CHI) could improve physical functioning and social participation in these patients. Methods. A single-blind, randomized, controlled 12-week trial conducted with 51 patients from 3 hospitals in Taiwan who had chronic stroke (>6 months; Brunnstrom recovery stages III-V). Patients and their caregivers in the intervention arm (n = 25) were given weekly personalized CHI trainings designed by a physical therapist. Patients in the control arm (n = 26) received visits from the therapist without intervention. All were evaluated for physical recovery through the Stroke Impact Scale, Berg Balance Scale, 10-Meter Walk Test, 6-Minute Walk Test, and Barthel Index at baseline and endpoint. Caregivers were evaluated with the Caregiver Burden Scale. Results were analyzed through Mann-Whitney U test. Results. CHI significantly improved scores of the Stroke Impact Scale: strength (control vs intervention, respectively: 1.4 vs 15.5; P = .002), mobility (–0.5 vs 13.7; P < .001), composite physical (–0.7 vs 11.2; P < .001), and general recovery domain (0.2 vs 17.4; P < .001). CHI also significantly improved free-walking velocity (–1.4 vs 7.5 cm/s; P = .006), 6-minute walk distance (–10.5 vs 15.8 m; P = .003), Berg Balance Scale score (–0.8 vs 4.5; P = .006), and Barthel Index score (0.6 vs 7.2; P = .008). CHI did not significantly increase caregiver burden at endpoint. Conclusion. CHI can improve physical functional recovery and, possibly, social participation in patients with chronic stroke.

The experience of couples when one partner has a stroke at a young age: an interpretative phenomenological analysis

PURPOSE

Stroke is a major cause of disability worldwide and affects a significant number of working age adults each year. The consequences of stroke impact upon both young stroke survivors and their partners and this study aimed to qualitatively explore their joint experience.

METHODS

Eight joint semi-structured interviews were conducted and analysed using IPA.

RESULTS

Three themes were identified: (1) "How's this happened?"--Making sense of the stroke; (2) "Is this what life is going to be like now?"--From partners to carer and "cared for"; (3) "I lost being a man. I was a little boy, being looked after all the time"--From partners to parent and child.

CONCLUSIONS

Stroke at a young age can significantly disrupt couples' life biographies. The findings highlight the need for both partners to adapt to their reciprocal relationship role changes and the importance of addressing the couple as a focus for intervention. Implications for Rehabilitation Stroke at a young age is an abrupt event that impacts upon both partners in a relationship. The findings add insight to some of the issues faced by young stroke survivors and their partners, which can now be considered in tailoring treatment to this specific cohort within the context of services predominated by older adults. The findings highlight significant relationship role changes experienced within couples, which suggests a need for rehabilitation interventions to focus on the adjustment of both partners.