Veteran stroke survivors’ lived experiences after being discharged home: a phenomenological study

Abstract

Background Stroke is a leading cause of disability in adults and third cause of death in the United States. Survivors face challenges postdischarge, including risks in self-management (SM) following prescribed regimens. Although SM education can help develop skills to control risk factors for stroke recurrence, little is known about lived experiences of patients adopting SM. Aims To examine Veterans’ lived poststroke experiences after discharge and their experiences in SM goal setting/attainment. Methods Patients within one year of discharge from a Veterans Administration Medical Center in the United States with two risk factors for stroke recurrence were enrolled and received an SM workbook. Eight patients were interviewed (six males, two females; mean age 62: range 45–80). Part I concerned lived experience. Part II described experiences with goal setting and attainment. Data were analyzed inductively, identifying common experiences. Deductive analysis described goal setting and attainment. Transcript reviews identified SM themes and strategies. Results Lived experiences included 1) uncertainty about life, 2) anger and frustration, and 3) healthcare system challenges. Coping skills and setting goals to manage risks were critical for physical and emotional functioning. Conclusions SM coping and goal setting aided recovery and improved life quality among Veterans after stroke. SM interventions assisted in regaining physical and emotional function. Findings may help in design of interventions for survivors, using SM and goal setting and attainment. IMPLICATIONS FOR REHABILITATION Several implications for clinical practice were identified: Providers should acknowledge Veterans’ challenges and struggles after their stroke and help Veterans to re-establish social identity, enhance self-esteem and improve mood. More emphasis should be given to the Veterans’ caregivers’ availability and willingness to help with their loved one’s recovery, work reinstatement status and financial struggles. Recognition of the importance of the social context of recovery after a stroke is important, as nonmedical social interaction is often overlooked. Improvements are needed in the area of providers working with social workers and physical, occupational and mental health therapists to arrange more inpatient and outpatient treatments, including more frequent home visits. Veterans should be strongly encouraged to attend self-management diabetes education classes and smoking cessation and weight-loss programs offered for free within the Veterans Health Administration system. Self-management strategies using goal-setting and attainment concepts may assist individuals with stroke to regain physical and emotional functions, subsequently preventing another stroke.