Living with stroke during the first year after onset: an instrumental case study exploring the processes that influence adjustment

Abstract

Purpose

The purpose of the study was to explore the experiences of an individual navigating life in the first year after stroke, with attention to the influence of health professionals on adjustment.

Method

In-depth interviews were completed at regular intervals with an individual in rural Australia. This longitudinal approach supported the exploration of views over time. Interview transcripts were coded and analysed using strategies consistent with constructivist grounded theory methods. Findings are presented as an instrumental case study.

Results

The experience of stroke was one of adjustment to a new reality and of an altered and evolving concept of self: captured within the themes of fragmentation, loss, and reconstruction. Self-efficacy emerged as a driver in the adjustment process. Interactions with health professionals influenced adjustment and impacted on conceptualisations of self and self-efficacy.

Conclusions

Adjustment to stroke necessitated a reconceptualization of self. Relationships and interactions with others emerged as potential facilitators. For health professionals working with people after stroke, knowledge of the adjustment process and attention to practices that affirm personhood and enhance self-efficacy have the potential to facilitate long term outcomes. Processes linked to adjustment are represented visually to guide conceptual understandings and facilitative actions.

IMPLICATIONS FOR REHABILITATION

• All interactions with health professionals, including casual or ad hoc interactions, have the potential to influence adjustment after stroke.

• Health professionals who interact in ways that recognise personhood may have an especially positive influence on processes linked to adjustment.

• Giving time to listen to personal narratives and reflections may assist with sense-making and support the process of reconceptualising self after stroke.

• Through bidirectional sharing of experience and ideas, health professionals can facilitate the experience of self-efficacy.

Keywords:

• Stroke
• brain injury
• adjustment
• working alliance
• therapeutic relationship
• self-efficacy
• self-concept

Acknowledgement

The authors sincerely thank the participant who gave his time and so generously shared his experiences and reflections.

Disclosure statement

No potential conflict of interest was reported by the author(s).