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Issues in social recovery
Changing roles: Some informants felt resigned to accepting a passive role in interaction with hospital staff, particularly in the early stages of their stroke. This appeared to be mediated by perceptions of the importance of knowledge held by the professionals who were working for them. Informants who had continued to work after retirement expressed particular difficulties in coping with this situation: "I felt stupid. You know. Being taught to chew my food. I mean I know why. [speech therapist] told me why we were doing this, but it didn't really help." All informants reported that their roles and responsibilities were threatened, notably in areas of work, finance, family and social networks. Although perceptions varied between each individual, a pattern was recognized in the data involving the continuous appraisal and re-appraisal of social role: "I had always driven us to [supermarket] on Friday evenings. I couldn't do it anymore. I suppose it's daft but it was what we did together. Not any more. I help put the things away. Well as much as I can. But it's not the same." Re-appraisal did not necessarily imply an acceptance of the new situation, rather than an adjustment of role. Often these adjustments were evaluated in terms of pre-stroke life, and only rarely in terms of a positive step on the road to recovery.
Reflections on previous life
Conclusion And Recommendations
The study described here details the experiences of recovery from stroke into the long-term by tracking patients for at least 12 months. Whilst the descriptions of some experiences relating to the early stages of stroke reinforce those of other researchers, the nature of individual definitions of recovery may require a re-appraisal of existing models of stroke service provision. This study suggests that stroke is an intensely personal experience, involving the rebuilding and restructuring of an individual's world. The real work of rehabilitation described by informants was the translation of learning from the institutional setting to their home environment. The social context of recovery was extremely important where the focus of recovery was enabling participation in the social world through adaptation and the development of coping skills, rather than improvement in discrete physical function alone.
The complex nature of recovery and the range of possible stroke sequel identified in this study highlight the considerable challenge that stroke sufferers and their carers can face. Rehabilitation programs must equip stroke sufferers and their carers with the support, skills and knowledge to shape their future lives in a meaningful and fulfilling way. A recent survey undertaken by a stroke patient advocacy group suggests that there is much to be done in improving the appropriateness and utility of existing service provision (Stroke Association 1994).
Implications for practice
It would appear that any new strategy should include at least three features. The co-ordination of service provision requires an over-arching perspective from stroke onset into the long-term. To be relevant this perspective must be underpinned by an appreciation of patients' experiences of stroke. The expansion of nursing interventions aimed at the development of coping and adaptation skills at home after discharge from in-patient services requires consideration. Lastly, the importance of the social context of recovery after stroke should be recognized. This would require the imaginative integration of hospital and community rehabilitation services, for example through hospital out-reach or community in-reach, to enable them to be able to respond flexibly to patient and caret need.
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