Occupational transaction after stroke constructed as threat and balance

Older adults who have had a stroke may experience anxiety, depression and difficulties participating in meaningful occupations while also experiencing excitement, discovery and satisfaction in creating a new occupational balance. The aim of this qualitative study was to explore how older adults experienced the changes in their everyday occupations after a stroke. Five women and three men who had experienced a mild to moderate stroke participated in focus group discussions. Systematic text condensation was applied. The participants’ experiences revealed how the stroke was perceived as an ‘occupational threat’ that produced feelings of social exclusion which were experienced as occupational exclusion, deprivation, marginalisation and imbalance. However, at the same time, the participants reconstructed occupational balance by performing occupations in new ways. The participants’ experiences provided insight into how they perceived their occupations as threatened after their stroke, while at the same time endeavoring to reconstruct occupational balance. These findings indicate that everyday life after stroke is a time of transaction where people are actively involved in creating control, occupational balance and being socially include

Implementation fidelity in a complex intervention promoting psychosocial well-being following stroke: an explanatory sequential mixed methods study

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Nurses’ and occupational therapists’ experiences of conducting a home-based psychosocial intervention following stroke: a qualitative process evaluation

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.publishedVersio

Perceived study-induced influence on the control group in a randomized controlled trial evaluating a complex intervention to promote psychosocial well-being after stroke: a process evaluation

Background A commonly applied control condition in trials evaluating complex interventions in rehabilitation research is “usual care.” The main challenge is to ensure that the control group receives genuine usual care as delivered in everyday clinical practice. The assessment interviews and dialogues with the data collectors may influence the control group participants’ reflections on their condition and adjustments. This represents a threat to the internal validity of the trial. Thus, the aim of this study was to explore the perceived study-induced influence of assessment interviews on the adjustment of the members of a control group in a randomized clinical trial. The aim of the trial was to test a dialogue-based psychosocial intervention aiming at promoting the psychosocial well-being and adjustment of stroke survivors. Methods Fifteen participants in the control group of a multicenter stroke rehabilitation trial participated in narrative semi-structured interviews. Ricoeur’s interpretation theory guided the analysis. Results The perceived study-induced influence of the assessment interviews on the adjustment process of members of the control group varied considerably. The results demonstrated that the assessment interviews facilitated some participants’ feelings of control and their ability to cope. Other participants’ statements indicate that they relied on their existing personal capacity to cope and adjust and that the assessment interviews did not make any difference either on their coping ability or on their process of adjustment. Five themes were identified that described the perceived study-induced influence of the assessment interviews in the control group. The themes illustrated that the assessments served as a safety net, enhanced awareness and understanding, encouraged seeking support, allowed the opportunity to vent disappointment, or did not make any difference either way. Conclusions RCT assessment interviews may influence the adjustment process and represent a serious problem in measuring interventions over time in trials of complex interventions in rehabilitation research. To uphold rigor and stringency, the usual care control conditions should be thoroughly assessed and described. Informing participants only about the treatment they were allocated to receive might counteract the potential to dilute the difference between the two arms of the trial

Promoting psychosocial well-being following stroke: study protocol for a randomized, controlled trial

Source at https://doi.org/10.1186/s40359-018-0223-6.Background: Stroke is a major public health threat globally. Psychosocial well-being may be affected following stroke. Depressive symptoms, anxiety, general psychological distress and social isolation are prevalent. Approximately one third report depressive symptoms and 20% report anxiety during the first months or years after the stroke. Psychosocial difficulties may impact significantly on long-term functioning and quality of life, reduce the effects of rehabilitation services and lead to higher mortality rates. The aim of the study is to evaluate the effect of a previously developed and feasibility tested dialogue-based psychosocial intervention aimed at promoting psychosocial well-being and coping following stroke among stroke survivors with and without aphasia. Methods: The study will be conducted as a multicenter, randomized, single blind controlled trial with one intervention and one control arm. It will include a total of 330 stroke survivors randomly allocated into either an intervention group (dialogue-based intervention to promote psychosocial well-being) or a control group (usual care). Participants in the intervention group will receive eight individual sessions of supported dialogues in their homes during the first six months following an acute stroke. The primary outcome measure will be psychosocial well-being measured by the General Health Questionnaire (GHQ). Secondary outcome measures will be quality of life (SAQoL), sense of coherence (SOC), and depression (Yale). Process evaluation will be conducted in a longitudinal mixed methods study by individual qualitative interviews with 15–20 participants in the intervention and control groups, focus group interviews with the intervention personnel and data collectors, and a comprehensive analysis of implementation fidelity. Discussion: The intervention described in this study protocol is based on thorough development and feasibility work, guided by the UK medical research council framework for developing and testing complex interventions. It combines classical effectiveness evaluation with a thorough process evaluation. The results from this study may inform the development of further trials aimed at promoting psychosocial well-being following stroke as well as inform the psychosocial follow up of stroke patients living at home. Trial registration: NCT02338869; registered 10/04/2014 (On-going trial).</p

Holisme og reduksjonisme i sykepleiefaget : en kristisk analyse

Problemstilling: Gjør et holistisk eller et reduksjonistisk perspektiv noen forskjell for selve utøvelsen av sykepleie? Formål: 1) Klargjøre begrepene holisme og reduksjonisme og identifisere om de har ulike konsekvenser for 2) kliniske vurderinger 3) aktiviteter og praktiske metoder Teoretisk forankring: To forskjellige holistiske retninger er presentert av D.C. Phillips som vitenskapsteoretiske begreper. Disse holistiske retningenes betydning som ontologiske tilnærminger når det gjelder forholdet mellom helhet og deler er utledet. De to holistiske retninger danner sammen med filosofiske avklaringer av begrepene reduksjonisme, mekanisme og dualisme, fundament for analysen av sykepleielitteratur. Barbara Stevens Barnums' presentasjon av fire forskjellige tenkningsmønstre (dialektisk, logistisk, problematisk og operasjonell metode), er rammeverk for analysen av kliniske vurderinger. Analysen knyttet til aktiviteter og praktiske metoder, er fundert på to såkalt holistiske sykepleiemetoder, shiatzu akupress og terapeutisk berøring. Metode: En teoretisk studie med en kritisk, dialektisk tilnærming. Resultater: To forskjellige holistiske retninger er identifisert i sykepleielitteratur. Det har ikke vært mulig å identifisere forskjellige konsekvenser av de ulike holistiske retninger for kliniske vurderinger, eller for aktiviteter og praktiske metoder. I Callista Roys' og Martha Rogers' såkalte holistiske sykepleieteorier er det identifisert elementer av ideer som kan assosieres med såvel holisme som reduksjonisme. Teorienes beskrivelse av sykepleierens kliniske vurderinger og aktiviteter og praktiske metoder, kan ikke betraktes som avledet av noen av de holistiske retninger. Konklusjon: Begrepene holisme og reduksjonisme er i sykepleielitteratur upresist definert, og krever ytterligere klargjøring. 1) De reelle forskjeller mellom de ulike holistiske retninger som ontologiske tilnærminger synes uklare. 2) Det er ikke mulig å identifisere forskjellige konsekvenser av de ulike holistiske retninger for kliniske vurderinger. Det er mulig å identifisere ideer innen den dialektiske og den logistiske metode som dels er forenlige med og dels er motstridende til de holistiske retninger. 3) Det er ikke mulig å identifisere noen forbindelseslinjer mellom de ulike holistiske retninger og aktiviteter og praktiske metoder. Denne studien av sykepleielitteratur gir ikke holdepunkter for at forskjellige konsekvenser av de ulike holistiske retninger kan utledes for sykepleierens utøvelse

Occupational transaction after stroke constructed as threat and balance

Older adults who have had a stroke may experience anxiety, depression and difficulties participating in meaningful occupations while also experiencing excitement, discovery and satisfaction in creating a new occupational balance. The aim of this qualitative study was to explore how older adults experienced the changes in their everyday occupations after a stroke. Five women and three men who had experienced a mild to moderate stroke participated in focus group discussions. Systematic text condensation was applied. The participants’ experiences revealed how the stroke was perceived as an ‘occupational threat’ that produced feelings of social exclusion which were experienced as occupational exclusion, deprivation, marginalisation and imbalance. However, at the same time, the participants reconstructed occupational balance by performing occupations in new ways. The participants’ experiences provided insight into how they perceived their occupations as threatened after their stroke, while at the same time endeavoring to reconstruct occupational balance. These findings indicate that everyday life after stroke is a time of transaction where people are actively involved in creating control, occupational balance and being socially include

When Nursing Care and Clinical Trials Coincide : A Qualitative Study of the Views of Nordic Oncology and Hematology Nurses on Ethical Work Challenges

This study investigated the kinds of ethical challenges experienced by nurses in oncology and hematology when nursing care and research overlap in clinical trials, and how the nurses handle such challenges. Individual interviews with 39 nurses from Sweden, Denmark, and Finland indicated that all nurses were positive about research, considering it essential for developing the best care. Ethical challenges exist, however; the most difficult were associated with the end-of-life patients, no longer responsive to standard therapy, who eagerly volunteer for cutting-edge drug trials in the hope of gaining therapeutic benefit. Many nurses lacked systematic strategies for addressing such challenges but found support from their nursing colleagues and relied on the research protocols to guide them

Cognitive and emotional symptoms in patients with first-ever mild stroke: The syndrome of hidden impairments

Objective: To evaluate the prevalence of cognitive and emotional impairments one year after first-ever mild stroke in younger patients Design: Prospective, observational, cohort study. Subjects: A consecutive sample of 117 previously cognitively healthy patients aged 18–70 years with mild stroke (National Institutes of Health Stroke Scale score ≤ 3) were included in 2 hospitals in Norway during a 2-year period. Methods: At 12-month follow-up, patients were assessed using validated instruments for essential cognitive domains, fatigue, depression, anxiety, apathy and pathological laughter and crying. Results: In total, 78 patients (67%) had difficulty with one or a combination of the cognitive domains psychomotor speed, attention, executive and visuospatial function, and memory. Furthermore, 50 patients (43%) had impairment in either one or a combination of the emotional measures for anxiety, depressive symptoms, fatigue, apathy or emotional lability. A total of 32 patients (28%) had both cognitive and emotional impairments. Only 21 patients (18%) scored within the reference range in all the cognitive and emotional tools. Conclusion: Hidden impairments are common after first-ever mild stroke in younger patients. Stroke physicians should screen for hidden impairments using appropriate tools