1
|
Tyagi S, Luo N, Tan CS, Tan KB, Tan BY, Menon E, Venketasubramanian N, Loh WC, Fan SH, Yang KLT, Chan ASL, Farwin A, Lukman ZB, Koh GCH. Seeking healthcare services post-stroke: a qualitative descriptive study exploring family caregiver and stroke survivor perspectives in an asian setting. BMC Neurol 2021; 21:429. [PMID: 34740323 PMCID: PMC8569985 DOI: 10.1186/s12883-021-02463-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 10/22/2021] [Indexed: 11/10/2022] Open
Abstract
Aim Exploration of the healthcare journey post-stroke is incomplete without acknowledging the crucial role of family caregivers. With limited literature documenting the role of caregivers in the healthcare journey post-stroke, we aimed to describe the healthcare experiences of family caregivers and stroke survivors across different caregiver identities in Singapore. Methods We conducted a qualitative descriptive study involving semi-structured interviews with transcripts analysed using thematic analysis. 26 stroke survivors and 35 family caregivers purposively sampled from multiple settings. Results Findings were summarized into seeking care and experience of healthcare encounters. Seeking care comprised of the following themes: factors influencing seeking care, decision to seek care and role of caregiver in seeking care. Experience of healthcare encounters comprised of the following themes: service around the patient, service with care and role of caregiver in healthcare encounters. Conclusion Multi-dimensional role of caregivers in healthcare experience emerged as a major finding. Unique to our Asian context, as per the participants’ accounts, family caregivers seemed to be central in healthcare decision-making for stroke survivors, with adult-child caregivers commonly reported being engaged in collaborative decision-making. While spousal caregivers preferred a relational healthcare experience, adult-child caregivers preferred a transactional one. Practical implications include equipping caregivers with skillset to make healthcare decisions, provision of supportive decision-making environment for caregivers and reinforcing communication aspects in the medical, nursing and allied healthcare curriculum to improve healthcare experience. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-021-02463-7.
Collapse
Affiliation(s)
- Shilpa Tyagi
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, 117549, Singapore, Singapore
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, 117549, Singapore, Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, 117549, Singapore, Singapore
| | - Kelvin Bryan Tan
- Policy Research & Economics Office, Ministry of Health, Singapore, Singapore
| | | | - Edward Menon
- St. Andrew's Community Hospital, Singapore, Singapore
| | - N Venketasubramanian
- Raffles Neuroscience Centre, Raffles Hospital, Singapore, Singapore.,Singapore National Stroke Association, Singapore, Singapore
| | - Wei Chin Loh
- St. Andrew's Community Hospital, Singapore, Singapore
| | - Shu Hui Fan
- St. Andrew's Community Hospital, Singapore, Singapore
| | | | - Audrey Swee Ling Chan
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, 117549, Singapore, Singapore
| | - Aysha Farwin
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, 117549, Singapore, Singapore
| | - Zunairah Binti Lukman
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, 117549, Singapore, Singapore
| | - Gerald Choon-Huat Koh
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, 117549, Singapore, Singapore.
| |
Collapse
|
2
|
Tyagi S, Luo N, Tan CS, Tan KB, Tan BY, Menon E, Venketasubramanian N, Loh WC, Fan SH, Yang KLT, Chan ASL, Farwin A, Lukman ZB, Koh GCH. Support system diversity among family caregivers of stroke survivors: a qualitative study exploring Asian perspectives. BMC Geriatr 2021; 21:594. [PMID: 34696724 PMCID: PMC8543837 DOI: 10.1186/s12877-021-02557-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 10/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Caregiving is a global phenomenon which is bound to increase in tandem with the aging population worldwide. Stroke is a condition common in older people that requires complex caregiving necessitating provision of adequate support to the caregivers. Past literature consists of limited accounts of types and organization of support arrangements needed by different caregivers. We aimed to describe the support system of caregivers of stroke survivors in Singapore, highlighting differences across the different caregiver identities (i.e. spouse, adult-child, etc.). METHODS We conducted a qualitative descriptive study in the community setting involving 61 purposively sampled and recruited stroke survivors and caregivers. Semi-structured interviews were conducted, and transcripts were analysed using thematic analysis. RESULTS Our findings were summarized across the following 4 themes: 1) cultural influence and caregiving; 2) caregiver support system with the following sub-themes: 2.1) dyadic caregiver support type, 2.2) extended caregiver support type, 2.3.) distributed caregiver support type and 2.4) empowering caregiver support type; 3) breaks in care of stroke survivor and 4) complex relationship dynamics. We operationalized the caregiver support system as comprising of type, people and activities that enable the caregiver to participate in caregiving activities sustainably. While spouse caregivers preferred dyadic and extended support systems positioning themselves in a more central caregiving role, adult-child caregivers preferred distributed support system involving family members with paid caregivers playing a more central role. CONCLUSIONS Our findings highlight caregiver identity as a surrogate for the differences in the caregiver support systems. Practical implications include imparting relationship-building skills to the stroke survivor-caregiver dyads to sustain dyadic support system and educating clinicians to include differences in caregiving arrangements of stroke survivors in practising family-centred care.
Collapse
Affiliation(s)
- Shilpa Tyagi
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Kelvin Bryan Tan
- Policy Research & Economics Office, Ministry of Health, Singapore, Singapore
| | | | - Edward Menon
- St. Andrew's Community Hospital, Singapore, Singapore
| | - N Venketasubramanian
- Raffles Neuroscience Centre, Raffles Hospital, Singapore, Singapore.,Singapore National Stroke Association, Singapore, Singapore
| | - Wei Chin Loh
- St. Andrew's Community Hospital, Singapore, Singapore
| | - Shu Hui Fan
- St. Andrew's Community Hospital, Singapore, Singapore
| | | | - Audrey Swee Ling Chan
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Aysha Farwin
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Zunairah Binti Lukman
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Gerald Choon-Huat Koh
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore.
| |
Collapse
|
3
|
Suddick KM, Cross V, Vuoskoski P, Stew G, Galvin KT. Holding space and transitional space: stroke survivors' lived experience of being on an acute stroke unit. A hermeneutic phenomenological study. Scand J Caring Sci 2021; 35:104-114. [PMID: 32065418 PMCID: PMC7984029 DOI: 10.1111/scs.12824] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 12/13/2019] [Accepted: 01/12/2020] [Indexed: 12/01/2022]
Abstract
Despite substantial reorganisation of stroke unit provision in the United Kingdom, limited qualitative research has explored how stroke survivors experience the acute stroke unit. This hermeneutic phenomenological study used accounts from four stroke survivors who experienced one of two acute stroke units. Through detailed analysis, the acute stroke unit emerged as a meaningful space, in two distinct but interconnected forms. As holding space, the unit was understood to offer protection and safe haven, as the stroke survivors looked to cope and respond to the temporal, bodily, biographical disruption and significant vulnerability brought about by stroke and by being in hospital. Holding was fulfilled by different people (including their fellow stroke survivors) and reflected a human response to human need and existential vulnerability. This space, and the practices within it, functioned to hold them intimately but also at a distance from their prestroke lifeworld. As such, the acute stroke unit holding space was intertwined with how it supported, encouraged or provoked transition. In the transitional space of the acute stroke unit, stroke survivors described how they survived the hospital-healthcare space, stroke unit and poststroke space. This paper articulates how transition was meaningfully signified through its absence or presence, as they transformed, relinquished or re-asserted their 'self', and in one case, recovered whilst 'in there'. The findings of this study provide phenomenological insight into stroke survivors' lived experience, the meaningful holding and transitional contribution of the unit, and how these spatial forms were intertwined. These insights are discussed in relation to the existing evidence base and stroke unit provision.
Collapse
Affiliation(s)
| | - Vinette Cross
- School of Health SciencesUniversity of BrightonEastbourneUK
- Centre for Health and Social Care ImprovementSchool of Health and WellbeingUniversity of WolverhamptonWolverhamptonUK
| | - Pirjo Vuoskoski
- School of Health SciencesUniversity of BrightonEastbourneUK
- Present address:
Faculty of Sport and Health SciencesUniversity of JyväskyläJyväskyläFinland
| | - Graham Stew
- School of Health SciencesUniversity of BrightonEastbourneUK
| | | |
Collapse
|
4
|
Guo Y, Zhang Z, Lin B, Mei Y, Liu Q, Zhang L, Wang W, Li Y, Fu Z. The Unmet Needs of Community-Dwelling Stroke Survivors: A Systematic Review of Qualitative Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2140. [PMID: 33671734 PMCID: PMC7926407 DOI: 10.3390/ijerph18042140] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 02/03/2021] [Accepted: 02/05/2021] [Indexed: 12/20/2022]
Abstract
The unmet needs perceived by community-dwelling stroke survivors may truly reflect the needs of patients, which is crucial for pleasant emotional experiences and a better quality of life for community-dwelling survivors not living in institutionalized organizations. The purpose of the study is to identify the scope of unmet needs from the perspectives of stroke patients in the community. A qualitative meta-synthesis was performed according to the Joanna Briggs Institute method. Six electronic databases were searched from inception to February 2020. A total of 24 articles were involved, providing data on 378 stroke survivors. Eight categories were derived from 63 findings, and then summarized into four synthesized findings based on the framework of ICF: (1) unmet needs regarding with the disease-related information; (2) unmet physical recovery and activity/participation needs; (3) unmet needs for social environmental resources; (4) unmet psycho-emotional support needs. We found the framework of ICF mostly complete, but unmet information needs still remain. The needs that are mainly unsatisfied include physical, psychosocial and informational, as well as the practical support from professional or environment resources. The ever-present unmet needs perceived by community-dwelling stroke survivors who do not live in institutions are discoverable and mitigable. Future studies should focus on quantifying unmet needs comprehensively derived from experiential domains, assessing the rationality of the unmet needs expressed by patients' perspectives and developing flexible strategies for long-term and changing needs.
Collapse
Affiliation(s)
| | - Zhenxiang Zhang
- School of Nursing and Health, Zhengzhou University, Zhengzhou 450001, China; (Y.G.); (B.L.); (Y.M.); (Q.L.); (L.Z.); (W.W.); (Y.L.); (Z.F.)
| | | | | | | | | | | | | | | |
Collapse
|
5
|
Sørensen KE, Dreyer P, Rasmussen M, Simonsen CZ, Andersen G. Experiences and needs of patients on the endovascular therapy pathway after acute ischaemic stroke: Being helpless and next to yourself. Nurs Open 2020; 7:299-306. [PMID: 31871714 PMCID: PMC6917975 DOI: 10.1002/nop2.391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 08/08/2019] [Accepted: 09/08/2019] [Indexed: 11/08/2022] Open
Abstract
Aims To explore the experiences and needs of patients on the endovascular therapy pathway. Design A qualitative design using a phenomenological-hermeneutic approach. Methods Semi-structured interviews and participant observations were carried out. Data were collected from April 2016-January 2017. Data were analysed using Ricoeur's theory of interpretation, capturing meaning and ensuring comprehensive understanding. The Consolidated Criteria for Reporting Qualitative Research checklist was used as a guideline. Results The findings of this study show that the impact of stroke goes far beyond physical disability. During the structural analysis, four themes were identified: (1) Acute admission to a stroke unit - an overwhelming and blurred experience. (2) Being helpless and next to yourself. (3) The important care when you worry about dying. (4) Poststroke feelings of loneliness and uncertainty.
Collapse
Affiliation(s)
| | - Pia Dreyer
- Department of Anaesthesiology and Intensive CareAarhus University HospitalAarhus NDenmark
| | - Mads Rasmussen
- Department of Anaesthesiology and Intensive CareAarhus University HospitalAarhus NDenmark
| | | | - Grethe Andersen
- Department of NeurologyAarhus University HospitalAarhus NDenmark
| |
Collapse
|
6
|
Hole E, Stubbs B, Roskell C, Soundy A. The patient's experience of the psychosocial process that influences identity following stroke rehabilitation: a metaethnography. ScientificWorldJournal 2014; 2014:349151. [PMID: 24616623 PMCID: PMC3927748 DOI: 10.1155/2014/349151] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 10/19/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND PURPOSE Patient experience is increasingly being recognised as a key health outcome due to its positive correlation with quality of life and treatment compliance. The aim of this study was to create a model of how patient's experiences of rehabilitation after stroke influence their outcome. METHODS A metaethnography of qualitative articles published since 2000 was undertaken. A systematic search of four databases using the keywords was competed. Original studies were included if at least 50% of their data from results was focused on stroke survivors experiences and if they reflected an overarching experience of stroke rehabilitation. Relevant papers were appraised for quality using the COREQ tool. Pata analysis as undertaken using traditional processes of extracting, interpreting, translating, and synthesizing the included studies. RESULTS Thirteen studies were included. Two themes (1) evolution of identity and (2) psychosocial constructs that influence experience were identified. A model of recovery was generated. CONCLUSION The synthesis model conceptualizes how the recovery of stroke survivors' sense of identity changes during rehabilitation illustrating changes and evolution over time. Positive experiences are shaped by key psychosocial concepts such as hope, social support, and rely on good self-efficacy which is influenced by both clinical staff and external support.
Collapse
Affiliation(s)
- E. Hole
- Department of Physiotherapy, University of Birmingham, 52 Pritchatts Road, Edgbaston, Birmingham B15 2TT, UK
| | - B. Stubbs
- School of Health and Social Care, University of Greenwich, London SE10 9LS, UK
| | - C. Roskell
- Department of Physiotherapy, University of Birmingham, 52 Pritchatts Road, Edgbaston, Birmingham B15 2TT, UK
| | - A. Soundy
- Department of Physiotherapy, University of Birmingham, 52 Pritchatts Road, Edgbaston, Birmingham B15 2TT, UK
| |
Collapse
|
7
|
Roscigno CI. Challenging nurses' cultural competence of disability to improve interpersonal interactions. J Neurosci Nurs 2013; 45:21-37. [PMID: 23291869 PMCID: PMC3609418 DOI: 10.1097/jnn.0b013e318275b23b] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Worldwide, at least 6.9 billion people have an impairment-producing health condition. Insensitive encounters with healthcare providers (HCPs) can result in negative appraisals, fear, and avoidance, but little is known about what things are commonly perceived as insensitive. A review of published narratives describing negative encounters with HCPs was conducted. Narrative analysis was used to compare, contrast, and synthesize six themes describing the common negative encounters: (a) ignoring or minimizing their knowledge, (b) detached interpersonal interactions, (c) placing a negative skew on their life quality, (d) lack of HCP knowledge related to their complete needs, (e) assuming they should be asexual and childless, and (f) an inherent power differential. The medical model of disability is perceived by individuals with impairment-producing health conditions to inform negative encounters perceived as insensitive. This preliminary knowledge is important so we can address educational needs, plan future research questions, and establish clinical practice improvements.
Collapse
Affiliation(s)
- Cecelia I Roscigno
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| |
Collapse
|
8
|
Gallacher K, Morrison D, Jani B, Macdonald S, May CR, Montori VM, Erwin PJ, Batty GD, Eton DT, Langhorne P, Mair FS. Uncovering treatment burden as a key concept for stroke care: a systematic review of qualitative research. PLoS Med 2013; 10:e1001473. [PMID: 23824703 PMCID: PMC3692487 DOI: 10.1371/journal.pmed.1001473] [Citation(s) in RCA: 126] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 05/09/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Patients with chronic disease may experience complicated management plans requiring significant personal investment. This has been termed 'treatment burden' and has been associated with unfavourable outcomes. The aim of this systematic review is to examine the qualitative literature on treatment burden in stroke from the patient perspective. METHODS AND FINDINGS The search strategy centred on: stroke, treatment burden, patient experience, and qualitative methods. We searched: Scopus, CINAHL, Embase, Medline, and PsycINFO. We tracked references, footnotes, and citations. Restrictions included: English language, date of publication January 2000 until February 2013. Two reviewers independently carried out the following: paper screening, data extraction, and data analysis. Data were analysed using framework synthesis, as informed by Normalization Process Theory. Sixty-nine papers were included. Treatment burden includes: (1) making sense of stroke management and planning care, (2) interacting with others, (3) enacting management strategies, and (4) reflecting on management. Health care is fragmented, with poor communication between patient and health care providers. Patients report inadequate information provision. Inpatient care is unsatisfactory, with a perceived lack of empathy from professionals and a shortage of stimulating activities on the ward. Discharge services are poorly coordinated, and accessing health and social care in the community is difficult. The study has potential limitations because it was restricted to studies published in English only and data from low-income countries were scarce. CONCLUSIONS Stroke management is extremely demanding for patients, and treatment burden is influenced by micro and macro organisation of health services. Knowledge deficits mean patients are ill equipped to organise their care and develop coping strategies, making adherence less likely. There is a need to transform the approach to care provision so that services are configured to prioritise patient needs rather than those of health care systems.
Collapse
Affiliation(s)
- Katie Gallacher
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Deborah Morrison
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Bhautesh Jani
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Sara Macdonald
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, United Kingdom
| | - Carl R. May
- Faculty of Health Sciences, University of Southampton, United Kingdom
| | - Victor M. Montori
- Knowledge and Encounter Research Unit, Mayo Clinic, Rochester, United States of America
| | - Patricia J. Erwin
- Knowledge and Encounter Research Unit, Mayo Clinic, Rochester, United States of America
| | - G. David Batty
- Department of Epidemiology and Public Health, University College London, United Kingdom
- Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, United Kingdom
| | - David T. Eton
- Knowledge and Encounter Research Unit, Mayo Clinic, Rochester, United States of America
| | - Peter Langhorne
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom
| | - Frances S. Mair
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, United Kingdom
- * E-mail:
| |
Collapse
|