The study deepening how the long-term recovery trajectory after stroke is about ongoing embodied, practical and socially situated negotiations. The study demonstrates that the recovery trajectory is a long term process of learning where the stroke survivor, as an embodied agent, gradually modifies new bodily habits, re-position participation and transforming of the self. Health personnel are usually available in the acute and early rehabilitation period. The three phenomenons under ongoing change; "body", "participation" and "self" are at this point just about being moved toward a renewed and a more coherent relationship in the stroke survivor long-lasting everyday life situated recovery trajectory. Available rehabilitation services at the municipal level supporting stroke survivors and relatives practical, social and interpersonal long-term challenges in everyday life can be important for minimizing their struggles and for promoting the experience progress, wellbeing and faith in the future.
The results of this study contribute to knowledge about user involvement from service users' perspective, and highlight the difficulties experienced in achieving self-determination and recognition during rehabilitation.
This study explores stroke survivors' experience of being part of an institutional rehabilitation context and what it means for the immediate experience of discharge home. The aim is to develop a deeper understanding of how the dynamic phenomenon body, participation in everyday life and sense of self interrelates and changes through stroke survivors' movement in and between the two contexts and what this phenomenon means for stroke survivors' process of change and well-being in the early rehabilitation trajectory. Repeated, retrospective, in-depth interviews were conducted with nine persons living with moderate impairment after stroke and their closest relatives. Phenomenological and critical psychological concepts are used for analysing the data. Stroke survivors' experience indicates that their time as in-patients is important for their safety in the early juncture. Being part of an institutional rehabilitation context mobilizes stroke survivors' to optimize focus, energy and hope of physical recovery. At the same time it appears to postpone feelings of uncertainty and grief as well as reflection on their situation. However, immediately after homecoming a critical passage in the stroke survivors' rehabilitation trajectory appears because the perception of body, participation in everyday life and the sense of self undergo profound changes. This study stresses the importance of broadening the scope of professional initiative and paying attention to the post-rehabilitation context of everyday life during the in-patient stay.
The influence of professional values in the occupational therapists' local cultures was a substantial factor in the implementation processes. In addition personal values and clinical experiences influenced professional decision-making. Furthermore, the study reinforced current knowledge of the importance of culture and leadership in implementation of research-based clinical guidelines.
This study investigated the facilitation of evidence-based practice with the use of everyday life occupations and client-centred practice within occupational therapy in three settings of stroke rehabilitation. Method: The study was based on a phenomenological hermeneutical research approach, and inspired by participatory action research methods. Participant observations, focus group discussions and individual interviews took place over a period of 20 months. Text interpretation, developed by Ricoeur, was used in data analysis. Findings: The key role of the facilitator in the implementation of evidence-based practice as a change process was stressed. During the implementation, it was crucial that the therapists as a group had the opportunity to discuss local practice knowledge, and to appraise the knowledge use critically, in order to develop their practice knowledge and new skills adapted to local contexts. The implementation resulted in various new working routines. Learning processes became part of developing the occupational therapists' professional identities, expressed in more professional confidence. Collaboration in the organisation of the implementation process was significant. Conclusion: The main findings indicated that the use of participatory action research methods and theory of situated learning interacting with the Promoting Action on Research Implementation in Health Services framework provided useful perspectives and structures for the investigation of the implementation of evidence-based occupational therapy.
This paper proposes a perspective of learning in the context of neurorehabilitation. Central concepts from Lave and Wenger's theory of situated learning are presented as a promising theoretical perspective to grasp the problems typically encountered by professionals and a strategy to analyse the effectiveness of rehabilitation strategies aimed at everyday activities. Empirical data from field studies and focus group interviews describing rehabilitating efforts were analysed and discussed using central concepts from the 'theory of situated learning'. We found that professionals are challenged when including patients with severe brain injury as 'participants' in the 'rehabilitation practice community'. Systematic use of the proposed learning concepts may support rehabilitation professionals to facilitate and challenge patient participation and learning during rehabilitation. Two interrelated levels of pedagogical challenges exist: (1) supporting the gain of the patient or compensation for changed learning abilities and (2) supporting the patient in learning or compensating for lost abilities.
On top of what students learned through the initiative, all of this was to the benefit of the university college, the occupational therapy program, and the practice fields and citizens. The results point toward a continuation of the educational initiative.
The aim of the study is to gain insight into the user's perspective on user involvement in mental health rehabilitation. The study was designed as a field study lasting 15 months in two supported housing schemes. An ethnographic approach by James Spradley was employed, involving participant observation, informal conversations, and individual-and group-interview. A phenomenological-hermeneutic approach inspired by Paul Ricoeur's theory on text interpretation was used, including theories of situated learning. The results of the study show that the users experienced their involvement in rehabilitation to be associated with learning processes in interaction with residents as well as professionals. Learning took place via legitimate peripheral participation, via support from and negotiations with professionals and support from peer residents. Both opportunities for and limitations for learning were experienced. The transferability of knowledge and skills to life in a community was questioned, as limited access to participation was experienced.
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