Identity and sense of self: the significance of personhood in rehabilitation

Recovery from conditions leading to illness/disability is often defined in terms of physical improvement; however, people themselves describe their own recovery as more than this alone: it is a returning to the life they led before their illness. These two approaches highlight a potential mismatch between the way we as health care professionals perceive our world (the observable) and the way the people we are caring for perceive their world (often hidden from us). In this presentation I will explore how we can access the subjective world of those who use our services by exploring the role of life narratives within rehabilitation. I will share ideas from research linked to life changes, sense of self, and agency which we can use to inform our practice and support people in their recovery and rehabilitation

Fostering Hope Through Palliative Rehabilitation

Cancer patients’ need for rehabilitation is growing, as more and more people live with the long-term consequences of disease and its treatment due to early detection and improved treatment regimens. There are a number of people living with incurable cancer who have symptoms that need to be managed for many years, paralleling long-term conditions. Beyond clinical management, a sense of hope is vital in enhancing their quality of life

How do you exercise with epilepsy? Insights into the barriers and adaptations to successfully exercise with epilepsy.

Exercise has been shown to be a physiological and psychological benefit for people with epilepsy (PWE). However, barriers prevent many PWE from exercising safely and confidently. This research explored current perceived barriers to exercise and adaptation techniques used by PWE in order to maintain physical activity levels. Three focus groups (2-3 participants per group) and three semi-structured interviews were conducted (11 participants total). Constructive grounded theory was used to frame the study and analyse the findings, presenting new insight into the motivation, perceived barriers, and adaptation techniques used to exercise. The main motivator to maintain physical activity levels was the benefit of exercise on physical and mental health. This was shown in an increase in mood, higher social interaction, and perceived improvement in overall physical health as a result of exercise. Current barriers to exercise included a fear of injury, lack of social support, and exercise-induced seizures (e.g., through overheating and/or high exercise intensity level). Adaptation techniques used were self-monitoring through the use of technology, reducing exercise frequency and intensity level, and exercising at certain times of the day. The importance of social support was shown to provide increased confidence and positive encouragement to exercise, contrasting with family and friends worrying for his/her safety and medical professionals requesting termination of some physical activities. These findings provide new insight into current adaptation techniques that are used and developed by PWE to overcome common barriers to exercise. These new additions to the literature can lead to further development of such techniques as well as examine current medical professionals' knowledge of the benefits of exercise for PWE

Autoethnography in occupational science: me, we or they?

Studies of engagement in occupation have involved small group of individuals (Carin-Levy and Jones, 2007), ‘they’ or the occupational scientist/therapist themselves, (Taylor, 2008), ‘me’. My PhD research into “creative writing as an occupation” proposes an integrated approach combining autoethnography with collaborative group exploration of narratives to gain the perspective of the ‘we’. The exploration of an occupation by those who participate in it, including one who has a perspective as an occupational therapist will contribute to a deep understanding of the range of personal and sociocultural meanings (Creek, 2010) and will seek to frame the findings in occupational terms. This approach steps into a wider debate about ‘Heartful’ autoethnography, where evocative narratives ‘create the effect of reality’ (Ellis, 1999, p. 669) versus analytic autoethnography, where the researcher, a member of the research group has the specific aim of developing theoretical understanding (Anderson, 2006). Ellis and Bochner (2006) challenge the need for this analytical shift arguing that theorising or generalizing from autoethnography by using traditional analysis negates the way stories work. Through framing questions in occupational terms the narrative stories gathered will both speak for themselves and highlight occupational experience in a way that is immediately relatable to practising therapists. Anderson, L. 2006. Analytic Autoethnography. Journal of Contemporary Ethnography, 35(4), 373-395. Carin-Levy, G. and Jones, D., 2007. Psychosocial Aspects of Scuba Diving for People with Physical Disabilities: an occupational science perspective. Canadian Journal of Occupational Therapy, 74(1), 6-14. Creek, J., 2010. The Core Concepts of Occupational Therapy: a dynamic framework for practice. London: Jessica Kingsley Publishers. Ellis, C. 1999. Heartful Autoethnography. Qualitative Health Research. 9(5), 669-683. Ellis, C.S. and Bochner, A.P. 2006. Analyzing Analytic Autoethnography: an autopsy. Journal of Contemporary Ethnography, 35(4), 429-449. Taylor, J. 2008. An autoethnographic exploration of an occupation: doing a PhD. British Journal of Occupational Therapy, 71(5), 176-184

Exploring positive adjustment in people with spinal cord injury.

This study explored adjustment in people with spinal cord injury; data from four focus groups are presented. Thematic analysis revealed four themes, managing goals and expectations, comparison with others, feeling useful and acceptance, showing participants positively engaged in life, positively interpreted social comparison information and set realistic goals and expectations. These positive strategies show support for adjustment theories, such as the Cognitive Adaptation Theory, the Control Process Theory and Response Shift Theory. These results also provide insight into the adjustment process of a person with spinal cord injury and may be useful in tailoring support during rehabilitation

An exploration of an equine facilitated intervention with young offenders.

This research reports a qualitative study to explore the behavioural responses to, and reported reflections from Young Offenders undertaking an Equine Facilitated Learning (EFL) Intervention in prison in the UK. Learning was facilitated by an instructor and the participants were taught introductory natural horsemanship skills. Establishments holding young adult prisoners are typically characterised by increased disruption to the regime, and with greater incidents of violence, bullying and conflict than in other types of prison. A resulting challenge for those working with young prisoners is the need to respond to increased levels of social isolation, and difficulties in managing impulsivity, problem solving, temper and conduct. It is hoped that this research will provide some initial evidence to contribute to ideas around the nature of learning practical positive skills and knowledge through inter species interactions

What does care farming provide for clients? The views of care farm staff

Care farming in the UK can help the agricultural community to remain viable and facilitate public interaction with the natural environment. It can also be therapeutic because it can address a range of public health and service provision issues by engaging people in farming activities and improving their health, social and educational circumstances. This paper presents the findings from a UK qualitative study exploring what care farming staff feel are the aims and potential outcomes of the experience they provide with their clients. Fifteen care farming staff were interviewed, using a semi-structured interview schedule. In summary the study findings show staff perceived that the care farm offered a homely, supportive environment where people can experience nature and sustainable food production. They perceived the care farm to be a place that provides an inclusive environment conducive to clients’ personal growth; it enables them to connect with themselves, others and nature and to develop autonomy. People can be themselves at the care farm where they have the opportunity to learn about themselves and nature. We consider how the issues care farm staff identified are linked with well-being theory

Challenges and solutions during analysis in a longitudinal narrative case study.

AIM: To describe the challenges faced by those performing complex qualitative analysis during a narrative study and to offer solutions. BACKGROUND: Qualitative research requires rigorous analysis. However, novice researchers often struggle to identify appropriately robust analytical procedures that will move them from their transcripts to their final findings. The lack of clear and detailed accounts in the literature that consider narrative analysis and how to address some of the common challenges researchers face add to this problem. DATA SOURCES: A longitudinal narrative case study exploring the personal and familial changes reported by uninjured family members during the first year of another family member's traumatic brain injury. Review methods This is a methodological paper. DISCUSSION: The challenges of analysis included: conceptualising analysis; demonstrating the relationship between the different analytical layers and the final research findings; interpreting the data in a way that reflected the priorities of a narrative approach; and managing large quantities of data. The solutions explored were: the mapping of analytic intentions; aligning analysis and interpretation with the conceptual framework; and the use of matrices to store and manage quotes, codes and reflections. CONCLUSION: Working with qualitative data can be daunting for novice researchers. Ensuring rigorous, transparent, and auditable data analysis procedures can further constrain the interpretive aspect of analysis. Implications for research/practice The solutions offered in this paper should help novice researchers to manage and work with their data, assisting them to develop the confidence to be more intuitive and creative in their research

Humanising communication between stroke unit practitioners (SUP) and patients with communication impairment (CI) to support therapeutic relationships

Introduction Research into the lived experience of CI describes discomfort, feeling isolated and ignored when interacting with SUP. Negative feelings are also described by SUP and relatives when attempting to communicate with patients with CI. Study Aim: To explore a humanising relationship-centred approach to support the development of positive relationships between patients, relatives and SUP. This abstract will present data specific to patients with CI. Methods A two-phase action research study with two stroke units over 20 months. Phase 1 explored the experiences of positive relationships with SUP, patients and relatives, and collaborated with SUP to develop and evaluate practices that supported relationships. Phase 2 used the practices developed in Phase 1 to explore translation to a second setting. Methods were participant observation, interviews, story-telling and group discussions. Processes of sense-making and immersion crystallisation were used to analyse data with staff as co-analysts. Results Three themes described the processes in clinical practice to support positive relationships: 1. Intentions by SUP or relatives to reach out towards, to try and connect with those with CI, was most meaningful for patients with CI. Successful transaction of information was less important. 2. Relatives and SUP used vicarious storytelling to share and maintain the uniqueness of the patient with CI. 3. Increasing SUP sensitivity to communicating beyond words – drawing on their emotional or tacit response during encounters. Conclusion This study has shown SUP using a humanising relationship-centred focus and wordless narratives support positive, therapeutic relationships. It offers new insights into practice developments beyond conventional supportive communication strategies