Promoting psychosocial wellbeing following stroke using narratives and guided self-determination: a feasibility study

Marit Kirkevold, Randi Martinsen, Berit Arnesveen Bronken, Kari Kvigne, Marit Kirkevold, Randi Martinsen, Berit Arnesveen Bronken, Kari Kvigne

Abstract

Background: Extensive studies have documented the complex and comprehensive psychosocial consequences of stroke. Psychosocial difficulties significantly affect long-term functioning and quality of life. Many studies have explored psychosocial interventions to prevent or treat psychosocial problems, but most have found modest effects. This study evaluated, from the perspective of adult stroke survivors, (1) the content, structure and process and (2) experienced usefulness of a dialogue-based psychosocial nursing intervention in primary care aimed at promoting psychosocial health and wellbeing.

Methods: This was part of a feasibility study guided by the UK MRC complex interventions framework. It consisted of dialogue-based encounters with trained health professionals during approximately the first year poststroke. It was tested in two formats; individual or group encounters. Inclusion criteria were: Acute stroke, above 18 y.o., sufficient physical and cognitive functioning to participate. Data were collected immediately before, during and 14 days after the completion of the intervention. Pre- and post-data included medical and demographic data, quality of life, emotional wellbeing, life satisfaction, anxiety and depression. Qualitative interviews focusing on participant experiences were conducted two weeks following the intervention. Log notes taken by the health professionals conducting the intervention and work sheets filled in by participants also comprised data. Data analysis was case-oriented. The structured instruments were analysed regarding completeness of data and indication of changes in outcome variables. The qualitative interviews, log notes and work sheets were analysed using thematic content analysis.

Results: Twenty-five stroke survivors (17 men, 8 women), median age 64 (range 33-89), participated. Physical limitations varied from mild to severe. Seven participants had moderate to severe expressive aphasia. The participants found the content and process of the intervention relevant. Both the individual and group formats were found useful. Patients with aphasia reported that there were too few encounters (eight encounters were originally planned). The participants underscored the benefits of being supported through a difficult time, having a chance to tell and (re)create their story and being supported in their attempts to cope with the situation.

Conclusions: This study provides initial support for the usefulness of the psychosocial intervention and highlights areas requiring further consideration and development.

Trial registration number: ClinicalTrials.gov Identifier: NCT01912014.

Keywords: Complex intervention; Feasibility study; Goal-setting; Multiple case study; Narrative; Nursing intervention development; Patient-centred; Psychosocial wellbeing; Quality of life; Stroke.

Figures

Figure 1
Figure 1
Theoretical structure of intervention.

References

    1. Andrews FM, Robinson JP. Measures of subjective well-being. In: Robinson JP, Shaver PR, Wrightsman LS, editors. Measures of personality and social psychological attitudes. San Diego, Canada: Academic Press; 1991.
    1. Antonovsky A. Unravelling the mystery of health. How people manage stress and stay well. San Francisco: Jossey-Bass; 1987.
    1. Barker-Collo SL. Depression and anxiety 3 months post stroke: prevalence and correlates. Archives of Clinical Neuropsychology. 2007;22:519–531. doi: 10.1016/j.acn.2007.03.002.
    1. Bhogal SK, Teasell R, Foley N, Speechley M. Lesion location and poststroke depression: systematic review of the methodological limitations in the literature. Stroke. 2004;35:794–802. doi: 10.1161/01.STR.0000117237.98749.26.
    1. Bronken BA, Kirkevold M, Martinsen R, Kvigne K. The Aphasic Storyteller: Coconstructing Stories to Promote Psychosocial Well-Being after Stroke. Qualitative Health Research. 2012;22(10):1303–1316. doi: 10.1177/1049732312450366.
    1. Bronken BA, Kirkevold M, Martinsen R, Wyller TB, Kvigne K. Nursing Research Practice. 2012b. Psychosocial well-being in persons with aphasia participating in a nursing intervention after stroke; p. 568242.
    1. Burton C, Gibbon B. Expanding the role of the stroke nurse: a pragmatic clinical trial. Journal of Advanced Nursing. 2005;52(6):640–650. doi: 10.1111/j.1365-2648.2005.03639.x.
    1. Cantril H. The pattern of human concerns. New Jersey: Rutgers University Press; 1965.
    1. Craig P, Dieppe P, MacIntyre S, Mitchie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ (Clinical research ed.) 2008;337:a1655. doi: 10.1136/bmj.a1655.
    1. Donnellan D, Hevey D, Hickey A, O’Neill D. Defining and quantifying coping strategies after stroke: a review. Journal of Neurology, Neurosurgery and Psychiatry. 2006;77:1208–1218. doi: 10.1136/jnnp.2005.085670.
    1. Ellis G, Mant J, Langhorne P, Dennis M, Winner S: Stroke liaison workers for stroke patients and carers: an individual patient data meta-analysis.Cochrane Database of Systematic Reviews 2010, (Issue 5):Art. No.: CD005066. DOI:10.1002/14651858.CD005066.pub2
    1. Eriksson M, Lindström B. Validity of Antonovsky’s sense of coherence scale: a systematic review. Journal of Epidemiology and Community Health. 2005;59:460–466. doi: 10.1136/jech.2003.018085.
    1. Eriksson M, Lindström B. Antonovsky’s sense of coherence scale and the relation with health: a systematic review. Journal of Epidemiology and Community Health. 2006;60:376–381. doi: 10.1136/jech.2005.041616.
    1. Ferro JM, Caeiro L, Santos C. Poststroke emotional and behavior impairment: a narrative review. Cerebrovascular Diseases. 2009;27(suppl 1):197–203. doi: 10.1159/000200460.
    1. Forbes A. Clinical intervention research in nursing. International Journal of Nursing Studies. 2009;46:557–568. doi: 10.1016/j.ijnurstu.2008.08.012.
    1. Forster A, Brown L, Smith J, House A, Knapp P, Wright JJ, Young J: Information provision for stroke patients and their caregivers.Cochrane Database of Systematic Reviews 2012, (Issue 11):Art. No.: CD001919. DOI:10.1002/14651858.CD001919.pub3
    1. Frank AW. The wounded storyteller: body, illness and ethics. Chicago IL: University Press; 1995.
    1. Frank A. Just Listening: Narrative and Deep Illness. Families, Systems & Health. 1998;16(3):197–212. doi: 10.1037/h0089849.
    1. Graneheim UH, Lundman B. Qualitative content analysis in nursing research: concepts, procedures and measures to achieve trustworthiness. Nurse Education Today. 2004;24:105–112. doi: 10.1016/j.nedt.2003.10.001.
    1. Hackett ML, Anderson CS, House A, Halteh C: Interventions for preventing depression after stroke.Cochrane Database of Systematic Reviews 2008, (Issue 3):Art. No.: CD003689. DOI: 10.1002/14651858.CD003689.pub3
    1. Hackett ML, Anderson CS, House A, Xia J: Interventions for treating depression after stroke.Cochrane Database of Systematic Reviews 2008, (Issue 4):Art. No.: CD003437. DOI: 10.1002/14651858.CD003437.pub3
    1. Hilari K, Byng S, Lamping DL, Smith SC. 'Stroke and Aphasia Quality of Life Scale-39 (Saqol-39): Evaluation of Acceptability, Reliability, and Validity'. Stroke. 2003;34:1944–1950. doi: 10.1161/01.STR.0000081987.46660.ED.
    1. Hilari K, Lamping DL, Smith SC, Northcott S, Lamb A, Marshall J. 'Psychometric Properties of the Stroke and Aphasia Quality of Life Scale (Saqol-39) in a Generic Stroke Population'. Clinical rehabilitation. 2009;23:544–557. doi: 10.1177/0269215508101729.
    1. Kagan A, Winckel J, Shumway MA. Supported Conversation for Adults with Aphasia. Toronto: Aphasia Center; 1996.
    1. Kirkevold M. The role of nursing in the rehabilitation of stroke survivors. Advances in Nursing Science. 2010;33(1):27–40. doi: 10.1097/ANS.0b013e3181cd837f.
    1. Kirkevold M, Bronken BA, Martinsen R, Kvigne K. Promoting psychosocial well-being following a stroke: developing a theoretically and empirically sound complex intervention. International Journal of Nursing Studies. 2012;49(4):386–397. doi: 10.1016/j.ijnurstu.2011.10.006.
    1. Knapp P, Young J, House A, Forster A. Non-drug strategies to resolve psychosocial difficulties after stroke. Age and Ageing. 2000;29:23–30. doi: 10.1093/ageing/29.1.23.
    1. Kouwenhoven SE, Kirkevold M, Engedal K, Kim HS. Depression in acute stroke: prevalence, dominant symptoms and associated factors. A systematic literature review. Disability and Rehabilitation. 2011;33(7):539–556. doi: 10.3109/09638288.2010.505997.
    1. Kraus W. The narrative negotiation of identity and belonging. In: Bamberg M, editor. Narratives – state of the art. Amsterdam/Philadelphia: John Benjamins Publ; 2007. pp. 123–132.
    1. Martinsen R, Kirkevold M, Bronken BA, Kvigne K. Work-aged stroke survivors’ psychosocial challenges narrated during and after participating in a dialogue-based psychosocial intervention: a feasibility study. BMC Nursing. 2013;12:22. doi: 10.1186/1472-6955-12-22.
    1. McAdams DP. The Person. An Introduction to the science of personality psychology. 5th Hoboken. NJ: Ed. J. Wiley & Sons; 2009.
    1. Næss S. Livskvalitet som psykisk velvære. [Quality of life as psychological wellbeing] Tidskr Nor Lægeforen [Journal of Norwegian Medical Association] 2001;121:1940–1944.
    1. Parr S. Living with severe aphasia – the experience of communication impairment after stroke. Pavillion: Joseph Rowntree Foundation; 2004.
    1. Polkinghorne D. Narrative knowing and the human sciences. Albany: State University of NewYork Press; 1988.
    1. Redfern J, McKevitt C, Wolfe CDA. Development of complex interventions in stroke care. A systematic review. Stroke. 2006;37:2410–2419. doi: 10.1161/01.STR.0000237097.00342.a9.
    1. Shadden B, Hagstrom F. The role of narrative in the life participation approach to aphasia. Topics in Language Disorders. 2007;27(4):324–338. doi: 10.1097/01.TLD.0000299887.24241.39.
    1. Stake RE. Multiple case study analysis. New York: The Guilford Press; 2006.
    1. Tambs K, editor. Choice of Questions in Short FormQuestionnairs of Established Psychometric Instruments. Proposed Procedure and Some Examples. Oslo, Norway: University of Oslo; 2004.
    1. Taylor S. Narrative as construction and discursive resource. In: Bamberg M, editor. Narratives – state of the art. Amsterdam/Philadelphia: John Benjamins Publ; 2007. pp. 113–122.
    1. Teoh V, Sims J, Milgrom J. Psychosocial predictors of quality of life in a sample of community-dwelling stroke survivors: a longitudinal study. Topics in stroke rehabilitation. 2009;16(2):157–166. doi: 10.1310/tsr1602-157.
    1. Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32 item checklist for interviews and focus groups. International Journal for Quality in Health Care. 2007;19(6):349–357. doi: 10.1093/intqhc/mzm042.
    1. Watkins CL, Auton MF, Deans CF, Dickinson HA, Jack CIA, Lightbody CE, Sutton CJ, van den Broek MD, Leathley MJ. Motivational Interviewing Early After Acute Stroke (RCT) Stroke. 2007;38:1004–1009. doi: 10.1161/01.STR.0000258114.28006.d7.
    1. Whyte EM, Mulsant BH. Post Stroke Depression: Epidemiology, Pathophysiology, and Biological Treatment. Biological Psychiatry. 2002;52:253–264. doi: 10.1016/S0006-3223(02)01424-5.
    1. Zoffmann V. Guided Self-Determination. A life skills approach developed in difficult Type 1 diabetes. 2004.
Pre-publication history
    1. The pre-publication history for this paper can be accessed here:

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel