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Identity construction and memory after Subarachnoid Haemorrhage: Patients' accounts and relatives' and patients' statements in relation to memory tests
University of Skövde, School of Life Sciences.
2010 (English)Licentiate thesis, comprehensive summary (Other academic)
Abstract [en]

Background: A Subarachnoid haemorrhage (SAH) is a complex pathophysiological event and most patients have, before the onset, felt completely well. Being stricken by a SAH is a dramatic event, often followed by unconsciousness and memory problems. This may influence the adjustment to daily life. Supporting patients and relatives in nursing care therefore requires knowledge concerning patients' experience of the onset of the SAH event, and knowledge concerning patients' memory after a SAH.

Aim: The general aim of this thesis was to study patients' experiences and reconstruction of the onset of, and events surrounding, a SAH and to study patients' and relatives' experience of patients' memory ability, in a long-term perspective.

Specific aims:

(I) The aim of this study was to analyse people's accounts of SAH, and to describe how they initiate and create meaning for the onset and events surrounding the SAH. The specific questions were : (i) What is highlighted in the accounts of SAH? (II) How is the illness reconstructed? (iii) How is meaning created through communicative interaction with others about SAH?

(II) The aim was to describe memory after a SAH from the perspective of relatives and patients in two cohorts. In this study, the researchers also aimed to evaluate the application of relatives' statements as a tool in nursing care and rehabilitation, in order to support the patients. This was achieved by comparing: (i) Relatives' statements with patients' statements and (ii) Relatives' and patients' statements with the patients' memory test results.

Methods: Both an inductive and a deductive approach were used. Nine open interviews were carried out in home settings, 1 year and 7 months (ranging 14-24 months) after the patients' onset and discourse analysis was used to interpret the data (I). Eleven relatives and 11 patients, 11 years and 15 relatives and 15 patients, 6 years after the onset participated in two studies. Interview questions and memory tests were used to collect data. Fischer's exact test was used for the statistical analysis (II).

Findings:Patient with experience of a SAH were able to judge their own memory for what happened when they became ill. Both conscious irrational and rational actions were expressed in relation to experienced sensations. Critical events related to SAH were "existential insights" and "time as waiting and time as structuring meaning". The reconstruction of the illness event may be interpreted as an identity ceating process. The process of meaning-making is both a matter of understanding SAH as a pathological event, and a social and communicative matter, where the SAH is constructed into a meaningful life history, in order to make life complete (I). Memory problems were common according to relatives' and patients' statements and from memory test results. There was correspondence between relatives' and patients' statements regarding the patients' memory in general and long-term memory. Patients judged their own memory ability better than relatives, compared with results on memory tests. Both relatives and patients underestimated older patients' memory ability and underrated younger patients' memory problems, when compared with results on memory tests. Relatives stated that some patients had meta-memory problems (II). The episodic memory seemed to be well preserved, both concerning the onset (I) and in the long-term perspective (II).

Conclusions: The reconstruction of the illness is a tool in nursing for understanding the patient's self-positioning and identity-construction. (I) Relatives' and patients' statements regarding patients' memory can also be used as tools in nursing care. However, the results showed: meta-memory problems (relatives' statements); that patients' judged their own memory ability better than relatives in comparison with results on memory tests. Consequently, memory tests and formalized dialogues, between the patient, the relative and a professional are required in order to prevent complications in the patient's mutual family relationships. However, professionals must assume that patients can judge their own memory (II). Dialogues between the patient, the relative and a professional, with focus on how to manage daily life in patients' home context, due to the patient's experience of the onset of the SAH and possible memory problems after the SAH, will probably improve the mutual family relationship in a positive way (I,II).

Place, publisher, year, edition, pages
School of Health Sciences , 2010. , 56 p.
Series
Dissertation Series, ISSN 1654-3602 ; 18, 2011
Keyword [en]
SAH, Stroke, Pain, Memory, Decisions, Meaning-making, Identity-construction, memory tests, interviews
National Category
Medical and Health Sciences
Research subject
Medical sciences
Identifiers
URN: urn:nbn:se:his:diva-5619ISBN: 978-91-85835-17-1 OAI: oai:DiVA.org:his-5619DiVA: diva2:511190
Available from: 2012-03-27 Created: 2012-03-20 Last updated: 2013-09-06Bibliographically approved
List of papers
1. Identity construction and meaning-making after subarachnoid haemorrhage
Open this publication in new window or tab >>Identity construction and meaning-making after subarachnoid haemorrhage
2010 (English)In: British Journal of Neuroscience Nursing, ISSN 1747-0307, Vol. 6, no 2, 86-93 p.Article in journal (Refereed) Published
Abstract [en]

Aim: The aim was to analyse people's accounts of subarachnoid haemorrhage (SAH) and to describe how they initiate and create meaning for the onset and events surrounding the SAH.

Background: Being struck by a SAH is a dramatic event, often followed by unconsciousness. There is therefore a special need for a patient to try to create some kind of meaning for the event during recovery and afterwards.

Method: Nine interviews were carried out in home settings and discourse analysis was used to interpret the data.

Findings: People stricken by SAH seem to be able to judge from memory for when they were becoming ill. Critical events related to SAH were existential threats and existential insights; and time as 'waiting' and time as 'structuring meaning'. The reconstruction of the illness event may be interpreted as an identity-creating process.

Conclusion: The reconstruction of the illness is a tool that can be used by nurses and other health professionals to understand a patient's self-positioning and identity-construction.

Place, publisher, year, edition, pages
MA Healthcare Ltd., 2010
Keyword
Subarachnoid haemorrhage, Illness narratives, Pain, Memory, Meaning-making, Identity construction
National Category
Medical and Health Sciences
Research subject
Medical sciences
Identifiers
urn:nbn:se:his:diva-4155 (URN)
Available from: 2010-06-16 Created: 2010-06-16 Last updated: 2013-04-08Bibliographically approved
2. Subarachnoid haemorrhage has long-term effects on social life
Open this publication in new window or tab >>Subarachnoid haemorrhage has long-term effects on social life
2011 (English)In: British Journal of Neuroscience Nursing, ISSN 1747-0307, Vol. 7, no 1, 429-435 p.Article in journal (Refereed) Published
Abstract [en]

Aim: The aim of this study was to describe memory after a subarachnoid haemorrhage (SAH) from the perspective of relatives and patients in two cohorts and also to evaluate the application of relatives' statements as a tool in nursing care and rehabilitation, in order to support the patient. Background: Cognitive sequelae due to SAH are a large disability and may influence the adjustment to daily life. Supporting patients and relatives requires knowledge concerning the patients' memory both from the perspective of patients and relatives. Method: Eleven relatives and 11 patients (Cohort 1), 11 years after the onset of an SAH and 15 relatives and 15 patients (Cohort 2) 6 years after the onset of an SAH, participated in the study. Interview questions and memory tests were used to collect data. Findings: Problems with memory, including meta-memory problems regarding relatives' statements, were common. Relatives and patients stated patients' menory in a similar manner. However, patients' statements concerning their memory corresponded in higher degree with memory test results, in comparison with relatives' statements. Conclusions: Relatives' and patients' statements are useful as tools in nursing care and rehabilitation. However, from results showing meta-memory problems and that patients' statements concerning their memory corresponded better with memory test results (in comparison with relatives' statements), it is vital to offer patients memory tests in order to prevent complications in mutual family relationships.

Place, publisher, year, edition, pages
MA Healthcare Ltd., 2011
Keyword
Subarachnoid haemorrhage, SAH, stroke, memory, memory test, interview questions
National Category
Medical and Health Sciences
Research subject
Medical sciences
Identifiers
urn:nbn:se:his:diva-4609 (URN)
Note

Preliminär publiceringinformation:

Berggren, E., Sidenvall, B., & Larsson, D. (2010). Memory ability after subarachnoid haemorrhage: relatives' and patients' statements in relation to test results. British Journal Of Neuroscience Nursing, 6(8), 383-388.

Available from: 2011-01-21 Created: 2011-01-21 Last updated: 2014-09-09Bibliographically approved

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