Getting to the heart of the matter: an ethnography of emotions and emotion regulation in cardiac rehabilitation

ABSTRACT

Considering the detrimental impact of emotional suffering on patient recovery (e.g. increased mortality rates), a key component in rehabilitation settings should be the promotion of psychosocial health. Research has shown cardiac rehabilitation (CR) to decrease anxiety and depression, enhance emotional well-being and reduce the deleterious effects of negative emotions on prognosis. Nevertheless, limited attention has been given to heart disease as a lived experience and the presence of the patient’s voice in CR is negligible. Using an ethnographic approach, the aim of the current research was to provide a penetrative insight into the social and psychological environment of a CR setting in the United Kingdom. Three main methods were used to collect data over a 12-month period, including participant observation (225 h), informal and formal interviews, and a reflexive diary. Thematic analysis was used to generate patterns (themes) in the data. Following thematic development, ethnographic creative non-fiction was adopted to fashion non-fictional stories grounded in real events and patients’ lived experiences. Three composite narratives illustrated the emotional intensity of recovering from a cardiac event and highlighted the value of CR to aid patients with reskilling and emotional support. In discussing our data, we emphasise the potential value of emotional intelligent care provision, and the creation of an environment that encourages emotional disclosure. We conclude with a discussion of the value of narrative medicine as a pedagogical tool for CR staff and patients.

KEYWORDS:

• Cardiac rehabilitation
• emotion regulation
• emotions
• referral
• narrative

Acknowledgments

We would like to thank all the staff, volunteers and patients for their time participating in this study, and for sharing their stories.

Disclosure statement

In accordance with Taylor & Francis policy and my ethical obligation as a researcher, I, Samantha J Meredith, am reporting that I am an employee of the NHS cardiac rehabilitation service, a company that may be affected by the research reported in the enclosed paper. I have disclosed those interests fully to Taylor & Francis, and I have in place an approved plan for managing any potential conflicts arising from that involvement. Christopher R D Wagstaff declares that he has no conflict of interest. Matt Dicks declares that he has no conflict of interest.

Additional information

Notes on contributors

Samantha J. Meredith

Samantha J. Meredith is a PhD student in the Department of Sport and Exercise Science at the University of Portsmouth, and a clinical exercise practitioner working for Hampshire Hospitals Foundation Trust. Her current interests lie in the use of representative research designs to explore emotions, and self-regulation in the uptake of health behaviours.

Christopher R. D. Wagstaff

Christopher R. D. Wagstaff is the psychology pathway lead and course leader in the Department of Sport and Exercise Sciences at the University of Portsmouth. His current interests lie in the integration of psychological and sociological approaches to advancing knowledge in organisational psychology in sport.

Matt Dicks

Matt Dicks is a lecturer in the Department of Sport and Exercise Sciences at the University of Portsmouth. His current interests lie in skill acquisition in sport, interpersonal perceptual expertise, and the visual control of movement.