卒中和阈限:卒中后重新配置身份的叙述及其对以人为中心的卒中护理的影响。

IF 1.3 Q3 REHABILITATION Frontiers in rehabilitation sciences Pub Date : 2024-12-03 eCollection Date: 2024-01-01 DOI:10.3389/fresc.2024.1477414
Joseph Hall, Frederike van Wijck, Thilo Kroll, Helena Bassil-Morozow
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引用次数: 0

摘要

背景:中风复杂的生理、认知和心理后果会破坏幸存者中风前的正常感和认同感。这会对他们的个人和社会生活产生重大影响。关于中风后生活的个人报告提高了我们对这种影响的理解。然而,由于卒中人口不断增加和指南要求不断增加,卒中支持系统需要更深入的见解,以综合叙述为基础,了解如何使卒中幸存者能够积极地重建生活和身份,以提供以人为本的护理。方法:采用Charmaz的建构主义扎根理论(GT)方法进行定性研究。进行了持续60-90分钟的半结构化访谈。这些访谈是在中风后至少12个月进行的。调查结果:来自英国各地的30名参与者接受了采访(14名女性,16名男性;年龄在31 - 86;中风后1-25年)。参与者报告说,这种破坏性中风可能会影响他们的认同感。阈限的概念,描述了两个不同阶段之间的模糊,转变状态,其中个人或群体存在于“之间和之间”的稳定条件,解释了中风后对身份的挑战。参与者报告说,当他们像中风前一样努力构建身份时,他们产生了一种不确定的认同感。这是因为参与者的性格、特点、爱好或未来生活计划,以及社会关系和角色都受到中风的影响。随后,参与者开始了一个重新配置自己身份的过程,这通常是一个长期的过程,包括接受和整合中风对他们生活的影响。因此,当参与者与长期的变化和持续的不确定性作斗争时,他们可能会进入一个无限期的持续阈限期。结论:阈限的概念首次出现在中风个体的叙述中,它传达了中风幸存者旅程的适应性和持久性。中风后的阈限可能会无限期地持续下去,由幸存者的主观个人和社会状况维持。这一新认识证明,迫切需要根据幸存者的独特情况,提供长期康复和支持。需要进一步的工作来了解量身定制的、长期的和以人为本的支持如何鼓励幸存者积极地重新配置他们的身份。
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Stroke and liminality: narratives of reconfiguring identity after stroke and their implications for person-centred stroke care.

Background: The complex physical, cognitive, and psychological consequences of stroke can disrupt a survivor's sense of pre-stroke normality and identity. This can have a substantial impact on their individual and social lives. Individual reports about life after stroke have improved our understanding of this impact. However, stroke support systems, struggling with increased demands due to a growing stroke population and guideline requirements, require deeper insights based on synthesised narratives into what can enable stroke survivors to rebuild their lives and identities positively to provide person-centred care.

Methods: A qualitative study using Charmaz's Constructivist Grounded Theory (GT) method. Semi-structured interviews lasting 60-90 min were conducted. These interviews were held at least 12 months post-stroke.

Findings: Thirty participants were interviewed from across the UK (14 women, 16 men; aged 31-86; 1-25 years post-stroke). Participants reported the disruption stroke could cause to their sense of identity. The concept of liminality, that describes the ambiguous, transformative state between two distinct stages, where an individual or group exists "betwixt and between" stable conditions, explains the challenge to identity post-stroke. Participants reported developing an uncertain sense of identity as they struggled to structure identity in the same way they did before stroke. This is because the participants' characteristics, traits, hobbies, or future life plans, as well as social relationships and roles, were affected by stroke. Subsequently, participants began a process of reconfiguring their identity, an often-long-term process that involved coming to terms with, and integrating, the impact of stroke on their lives. As a result, participants could enter an indefinite period of sustained liminality as they contend with long-term change and continued uncertainty.

Conclusion: The concept of liminality, which emerged from individual stroke narratives for the first time, conveyed the adaptive and enduring nature of a stroke survivor's journey. Post-stroke liminality may continue indefinitely, sustained by a survivor's subjective individual and social situation. This new insight justifies the urgent call for long-term rehabilitation and support that is tailored towards the unique nature of a survivor's circumstances. Further work is required to understand how tailored, long-term and person-centred support can encourage survivors to positively reconfigure their identity.

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