Hard-return:Development And Transformation Process Of Social Participation In Stroke Survivors

PurposesStroke has become the first cause of disability and death in our country,which has been characterized by high morbidity,high mortality,high disability rate and high recurrence rate.The specificity of stroke has a serious impact on the patients' social participation.The aim of this study was to explore the development and transformation process of social participation in stroke survivors,analyze the controllable factors of nursing intervention,and provide theoretical basis for promoting patients to return to society and improving rehabilitation nursing outcomes.MethodsIn the present study,Kathy C.Charmaz' Constructing Grounded Theory was used and stroke patients with social participation experiences in Shanghai were selected by purposeful sampling,theoretical sampling,and snowball sampling.The participants were accessed to mainly by visiting the stroke follow-up clinic,community,and stroke rehabilitation institutions.As to stroke patients who have insufficient social participation,their contact information was obtained when they were interviewed for the first time.Follow-up interviews were conducted after the participants returned home for several months.A total of 36 participants were recruited and 45 interviews were obtained.All interviews were recorded.The transcriptions were completed within 48 hours after each interview.The grounded theory method requires data collection and analysis to be carried out simultaneously.The analysis of data followed the coding strategy(initial coding and focus coding)of Kathy Charmz' Constructing Grounded Theory,and continuous comparison and memorandum were used to assist analysis.Finally,the first draft of the theory was returned to the participants,and the suggestions of the participants were sought for further revision and improvement.ResultsThrough thorough analysis of more than 40 interview data,based on the view of system theory,the development and transformation process of social participation centered on "hard-return" in stroke patients was constructed,which included four stage ingredients(in orbit,off orbit,returning orbit,in orbit again).The core category of "hard-return" was linked with four stage ingredients,summarizing the development and transformation process of social participation in stroke patients.The state of "in orbit" means the harmony and unity of participation ability and participation intention,and represents the disparity,dynamics,and relative stability in the individual social participation.The state of "off orbit" refers to the dramatical changes of individual social participation,that is destroyed stability,which is caused by decreased participation ability and secondarily decreased participation intention."off orbit" was characterized by sudden change,giant change,and overall change."returning orbit" denotes the transition of social participation system from imbalance to rebalance,a step-by-step process and a new balance of participation ability and participation intention."in orbit again" is the result of rebuilt.It is notable that the state of "in orbit again" can be further classified into two sub-condition,"return" and "loss".In addition,through the observation of the patients' long-term social life,patients whose social participation were loss might be divided into two categories.The "breakout" represented a phenomenon where patients were optimistic and adopted a positive coping style.Patients who were negative and adopted a passive coping style for social participation were difficult to break through.Additionally,affected by different factors,"in orbit again" has been frequently inferior to state of "in orbit" before stroke attack,which further confirms the connotation of hard-return.ConclusionThis study described the status of social participation in stroke patients in China,and constructed the development and transformation process of social participation centered on "hard-return".It is suggested that medical professionals and nursing practitioners should take into consideration different process elements and adopt different and targeted intervention in different specific periods,which will facilitate the improvement of the status of social participation and patients' final rehabilitation outcomes.