The onset of a stroke provides a unique set of challenges and complex experiences for the person and carer, which are particularly evident during transition to home. Previous studies from a family or couple’s perspectives underline the role of interdependence between the person post stroke and the partner for recovery and adaptation process. Moreover, longitudinal findings suggest that the path of adaptation continues to present challenges to both. However, the literature is sparse on interrelations of both people post stroke and carers’ needs, how they manage the new situation and its implications over time, as well as how health professionals may support their adaptation to a new life situation after stroke. Additionally, research on adaptation and coping post stroke in the Portuguese context is almost non-existent. Therefore, this thesis explores the topic of adaptation and coping process during transition to home and rehabilitation after stroke. In particular, it asks: 1) How do Portuguese people, who have experienced a stroke and their carers, cope with the demands of stroke and rehabilitation? and 2) How are roles perceived within the triad (person post stroke, carer and health professional) to facilitate the adaptation and coping process during rehabilitation and transition to home? By undertaking a longitudinal and multi-perspective design this thesis contributes to the literature mainly with: 1) a metasynthesis of qualitative research focusing on people post stroke and carers’ views about coping throughout the first year, including 22 studies and a total of 596 participants, and 2) an understanding of how people who have had a stroke and their carers cope after stroke and during rehabilitation in the first six months at home in a Portuguese context, involving 24 participants (8 triads) in a total of 33 interviews. Additionally, service users and other stakeholders (18 members) were included by organising meetings with advisory groups in order to provide comments and advice on recommendations from the thesis findings and the dissemination of results. This thesis provides a new perspective about the support and interrelations within the family. The importance of a balanced and reciprocal support between the person post stroke and carer(s) over time was emphasised, helping both people post stroke and carers to find their own way of managing their new life situation. A unique contribution was achieved from studying a Portuguese context. With time, Portuguese participants seemed to move from a point when future plans were avoided to a time when they changed their view of the future and life goals, which seemed also to be better achieved within the family. Furthermore, new insights resulted from the methodological approach selected. By undertaking a multi-perspective study involving a triad, similarities and differences were found, with a gap between perspectives of both people post stroke/ carers and health professionals giving additional insights to the need of moving rehabilitation away from the predominant functional and paternalistic approach. Findings from the empirical study suggest the importance of gradually increasing the people post stroke and carers’ active engagement in the adaptation and rehabilitation processes in a dyadic perspective. Moreover, it would also suggest the need for gradual change and adjustment of the health professionals’ approach throughout rehabilitation, according to both people post stroke and carers’ needs and expectations.
| Identifer | oai:union.ndltd.org:bl.uk/oai:ethos.bl.uk:719159 |
| Date | January 2017 |
| Creators | Pereira, Carla Mendes |
| Publisher | St George's, University of London |
| Source Sets | Ethos UK |
| Detected Language | English |
| Type | Electronic Thesis or Dissertation |
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