Building a Grounded Theory of Resilience Among Survivors of Chronic Ischemic Stroke

Abstract

Abstract Stroke is disruptive with elusive recovery and adjustment. Beyond traditional aspects of stroke rehabilitation, literature suggests adjustment to stroke should also include intervention with focus on resilience. A gap exists between conceptualization, theoretical models, and strategies for supporting resilience in persons with chronic ischemic stroke. This three-manuscript dissertation research comprised a scoping literature review, a pilot study, and a phenomenological case study. We employed a convergent mixed methods design in which we implemented and studied outcomes of an adaptive mindfulness intervention. We implemented eight focus groups with eight adults and four individual interviews over 13 months. The Brief Resilience Scale and Stroke Specific Quality of Life were used to measure resilience and quality of life pre- and postintervention. We used advanced theory construction techniques (Hage, 1972; Walker & Avant, 2019), grounded theory methods of coding, Wilcoxon signed-rank tests, and descriptive statistics to develop a grounded theory of resilience in chronic stroke. The model of psychological resilience in chronic stroke was developed from the antecedents, attributes, and consequences of resilience. Core categories associated with the bounded case were Antecedents to Poststroke Resilience, The Obstacle Is the Way, and Embodied Mindfulness. Overall, results showed resilience scores increased from a mean of 3.22 ± 1.01 to 3.45 ± 1.09, whereas quality of life scores rose from a mean of 169.50 ± 29.93 to 182.88 ± 39.35. The energy subscale with quality of life demonstrated a statistically significant increase (p = .034). The selective code, Sand Mandala (the essence of resilience, growth, and thriving after stroke) symbolizes a participant’s insight to drop the notion of returning to pre stroke state and developing acceptance by mindfulness, impermanence, holism, healing transformation, and community. Stroke care often neglects psychosocial factors, despite their significant impact. Stepping back from “door to needle” to “door to lifelong recovery” broadens the view on the continuous impact of stroke. Future research should explore theoretical frameworks, health inequities, and resilience in stroke longitudinally. Nurses, the most ubiquitously dispersed and capable group of healthcare providers in the United States, are prepared to support a life worth living after stroke