Abstract The purpose of the study was to describe the experiences of home-dwelling stroke patients and their relatives about coping and to identify possible similarities and differences in these experiences. The research data were collected by interviewing 18 stroke patients and 20 relatives. The data were analysed using the phenomenological method. Based on the data, the stroke patients were divided into six groups with different coping strategies: flexible coping, realistic adjustment, recollection of losses, aspiration to work, denial of illness and submission to problems. Persons showing flexible coping live a full life. Meaningful activities and interpersonal relations promote coping, while problems due to the illness impair it. Persons showing realistic adjustment have modified their life styles to suit their resources. Coping is promoted by satisfaction with life and impaired by incidental periods of lack of energy. Persons who prefer to recollect losses draw energy from their past lives. Coping is promoted by interpersonal rehabilitation and impaired by a lack of meaningful activities. Persons showing aspiration to work seek for meaningful activities similar to salaried employment. Coping is promoted by humour and impaired by a lack of activity. Persons showing denial of illness attribute their problems to causes other than the disorder in brain circulation. Coping is promoted by stability of life and impaired by a fear of changes. Persons showing submission to problems tend to dwell on the losses due to their illness. Coping is promoted by contacts with children and impaired by depression. The relatives showed five coping strategies: re-orientation, confidence, escape, persistence and abandonment. Persons showing re-orientation had modified their strategies to be compatible with their life situation. Coping is promoted by hobbies and social relations and impaired by a lack of connections between rehabilitation and home life. Persons showing confidence see both good and bad points in their life situation. The need to re-consider one's life values is good, while the need to give up plans for the future is bad. People who escape tend to live either in the past or in the future. Coping is promoted by the learning of new roles and impaired by living on the patient's condition. Persistence is shown by people who only modify their strategies when forced to do so. Coping is promoted by planning of the future and impaired by disappointments at the medical and nursing personnel and the rehabilitation system. People who show abandonment are dissatisfied with their life situation. They have few chances to alter the situation and often have poor health. The patients' and relatives' experiences showed both similarities and differences. The patients and relatives had similar experiences of their own situation, treatment and rehabilitation, interpersonal relations and expectations, but the patients had more fears about their life situation than the relatives, while the relatives felt more responsibility for the coping at home. The patients' experiences generally focused on themselves, while the relatives' experiences were more abstract and encompassing. The patients and relatives who coped poorly felt that their whole life was filled by the illness, while for those who coped well it was only one experience among the others. The coping strategies of a patient and a relative who lived in the same household were mutually interdependent, and should therefore be viewed together. The findings may help us to understand the everyday home life of stroke patients and their relatives. They can be utilised while developing the nursing practice and rehabilitation.

The aim of this study was to assess the acute and post-acute services for ischaemic stroke patients in the Cape Metro Health District in relation to the South African ischaemic stroke guideline. Part A: Protocol - The protocol outlines the purpose of the study and highlights the importance of conducting this study by analysing the literature on stroke care in both high and low and middle-income countries. The literature also highlights the gaps in stroke care in South Africa which justify the need for this study. The protocol also outlines the methods of data collection and analysis as well as the ethical considerations. Part B: Literature Review - This expands on the literature on the different components of both acute and post-acute stroke care in both high and low and middle-income countries. It also elaborates on stroke in South Africa and why it is important to conduct this study. Part C: South African Medical Journal manuscript - The manuscript summarises the whole study and includes the literature on stroke care, justification of the study and how the data was collected and analysed. The manuscript also includes the results obtained and sections on the discussion and conclusions.

Syftet med studien var att beskriva hur anhöriga upplevde att deras dagliga liv påverkades av att vara anhörigvårdare till en strokedrabbad person och vilken effekt riktade sjuksköterskeinterventioner hade för anhörigvårdarna. Studien genomfördes som en litteraturstudie. Databaser som användes var PubMed, Cinahl och Scopus. Resultatet visade att många anhörigvårdare upplevde oro och stress i olika situationer och detta skapade begränsningar i deras dagliga liv. Anhörigvårdarnas psykiska och fysiska hälsa påverkades av att vårda sin anhörig. Relationen mellan anhörigvårdaren och den strokedrabbade upplevdes förändrad efter stroke både till det positiva och det negativa. Anhörigvårdare som fick ett stöd- och utbildningsprogram från sjuksköterskan fick en ökad livskvalité och bättre kunskap kring stroke. Även då praktisk träning kombinerades med stöd- och utbildningsprogram ökade livskvalitén. De anhörigvårdare som fick ett anpassat utskrivningsprogram och sedan fick uppföljning kunde bättre prioritera de dagliga aktiviteterna men deras livskvalité blev inte bättre. Slutsats: Anhörigas dagliga liv påverkades av att vara anhörigvårdare till en strokedrabbad person till både det positiva och negativa. När sjuksköterskeinterventioner gavs ökade anhörigvårdarnas livskvalité, välbefinnande och de gav vård av bättre kvalitet.

Magister Scientiae (Physiotherapy) - MSc(Physio) / Stroke is the second leading cause of disability worldwide. Up to 60% of the survivors remain severely disabled. These people experience various challenges in such areas as self-care, mobility, accessing medical and rehabilitation services, transportation and finance. These affect them psychologically, physically and socially predisposing them to complications. Hospital based stroke records report on critical cases, which are not a true reflection of after effects of stroke in a community setting. The impact of stroke on patients and spouses cannot be underestimated considering that it is often sudden, giving no chance to patients or spouse to adjust to the predicament. The aim of this study was, therefore, to explore the challenges stroke patients and their spouses experienced during the rehabilitation process, from diagnosis through to treatment and discharge. The study was based on a qualitative approach, utilising an exploratory design. Data was collected using semi-structured in-depth interviews and focus group discussions. All interviews were tape recorded and transcribed verbatim. A thematic content analysis was used to analyse data. Ethical approval was sought from the University of the Western Cape and the College of Medicine Research Ethics Committee, University of Malawi. Permission was obtained from the General Manager of Malawi Against Physical Disabilities. The results indicates a range of challenges including dependence on spouse for basic self-care activities and activities of daily living, stress due to fear of dependence on their spouses, loss of opportunity for regular interaction with friends and family, limited facilities and accessibility to rehabilitation. Spouses are also burdened by of caregiving responsibilities. In conclusion, this study highlights that the consequences of stroke affect both patients and spouses in the areas of health, finance and social. There is need for rehabilitation professionals to give equal attention to the challenges experienced by spouses when managing stroke patients. The study recommends that accessibility to rehabilitation should be improved by increasing patients’ space at the centre, construction of more centres and expand CBR services to cover all districts in the country.

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