Older Stroke Patients’ Negotiations Within the Hierarchic Medical Context

Abstract

A stroke can affect a person's whole being and make him or her feel helpless and insecure. In this study, the authors aimed to analyze from a gender perspective how elderly women and men responded to treatment and care after stroke in the acute care setting. They used a strategic selection procedure in this qualitative follow-up interview study, in which 7 women and 5 men aged 75 to 83 participated. Personal interviews were performed, tape-recorded, transcribed verbatim, and analyzed in accordance with grounded theory. In the hierarchic medical context, the participants used four kinds of negotiations. These negotiations were either resistant (striving for autonomy and criticizing the care) or adjustive (following the rules and building alliances) to the hierarchic structure. The authors discuss how the concepts of power from above versus power from below can be applied in the hierarchic medical context.

Elderly peoples’ experience of nursing care after a stroke: from a gender perspective

“…This has implications for men and women both as patients and nurses, and can lead to different attitudes in situations when patients do not take part. These findings are both confirmed and contradicted by Löfmark and Hammarström (2005). Their study confirmed that patients lack participation in care, but they also found that both older women and men negotiated their care with healthcare staff.…”

Elderly peoples’ experience of nursing care after a stroke: from a gender perspective

“…This has implications for men and women both as patients and nurses, and can lead to different attitudes in situations when patients do not take part. These findings are both confirmed and contradicted by Löfmark and Hammarström (2005). Their study confirmed that patients lack participation in care, but they also found that both older women and men negotiated their care with healthcare staff.…”

A systematic review of the qualitative literature on older individuals’ experiences of care and well‐being during physical rehabilitation for acquired brain injury

“…Participants felt restricted and trapped during their inpatient rehabilitation and hospitalization in a clinical setting, further highlighting their concerns of losing their independence (Loft et al, 2017 ; Tholin & Forsberg, 2014 ). Older individuals undergoing rehabilitation are overwhelmed with sentiments of passivity, docility, subordination and dependency in their struggle to (re)define their identity and regain a sense of autonomy (Löfmark & Hammarström, 2005 ; Olofsson et al, 2005 ).…”

“…Furthermore, Löfmark and Hammarström's ( 2005 ) study purport that older individuals’ interactions with staff in part aims to negotiate the opportunity of regaining their autonomy in a traditional gendered context. Women chose to negotiate with nurse assistants, as they felt being in a subordinate position in the medical context.…”

“…Women chose to negotiate with nurse assistants, as they felt being in a subordinate position in the medical context. In contrast, men perceived themselves to be equal with nurses and physiotherapists, hence making efforts to negotiate a type of alliance with them (Löfmark & Hammarström, 2005 ).…”

“…The above institutional and organizational hindrances adversely impact older individuals’ ability to set rehabilitation goals and take part in planning their care (Krishnan et al, 2019 ; Loft et al, 2017 ; Tholin & Forsberg, 2014 ). Furthermore, goal setting in rehabilitation is also negatively impacted by the medical model's approaches to care for older individuals and its dominance in the organization of care and rehabilitation (Löfmark & Hammarström, 2005 ; Loft et al, 2017 ; Tholin & Forsberg, 2014 ). On the contrary, older individuals’ rehabilitation based on constructive relations, positive communication and person‐centred care, increases older individuals’ satisfaction and encourages them to move forward with their recovery (Galvin et al, 2009 ; Mangset et al, 2008 ; Morris et al, 2007 ).…”

Elderly peoples’ experience of nursing care after a stroke: from a gender perspective

“…This has implications for men and women both as patients and nurses, and can lead to different attitudes in situations when patients do not take part. These findings are both confirmed and contradicted by Löfmark and Hammarström (2005). Their study confirmed that patients lack participation in care, but they also found that both older women and men negotiated their care with healthcare staff.…”

A systematic review of the qualitative literature on older individuals’ experiences of care and well‐being during physical rehabilitation for acquired brain injury

“…Participants felt restricted and trapped during their inpatient rehabilitation and hospitalization in a clinical setting, further highlighting their concerns of losing their independence (Loft et al, 2017 ; Tholin & Forsberg, 2014 ). Older individuals undergoing rehabilitation are overwhelmed with sentiments of passivity, docility, subordination and dependency in their struggle to (re)define their identity and regain a sense of autonomy (Löfmark & Hammarström, 2005 ; Olofsson et al, 2005 ).…”

“…Furthermore, Löfmark and Hammarström's ( 2005 ) study purport that older individuals’ interactions with staff in part aims to negotiate the opportunity of regaining their autonomy in a traditional gendered context. Women chose to negotiate with nurse assistants, as they felt being in a subordinate position in the medical context.…”

“…Women chose to negotiate with nurse assistants, as they felt being in a subordinate position in the medical context. In contrast, men perceived themselves to be equal with nurses and physiotherapists, hence making efforts to negotiate a type of alliance with them (Löfmark & Hammarström, 2005 ).…”

“…The above institutional and organizational hindrances adversely impact older individuals’ ability to set rehabilitation goals and take part in planning their care (Krishnan et al, 2019 ; Loft et al, 2017 ; Tholin & Forsberg, 2014 ). Furthermore, goal setting in rehabilitation is also negatively impacted by the medical model's approaches to care for older individuals and its dominance in the organization of care and rehabilitation (Löfmark & Hammarström, 2005 ; Loft et al, 2017 ; Tholin & Forsberg, 2014 ). On the contrary, older individuals’ rehabilitation based on constructive relations, positive communication and person‐centred care, increases older individuals’ satisfaction and encourages them to move forward with their recovery (Galvin et al, 2009 ; Mangset et al, 2008 ; Morris et al, 2007 ).…”

Elderly peoples’ experience of nursing care after a stroke: from a gender perspective

“…This has implications for men and women both as patients and nurses, and can lead to different attitudes in situations when patients do not take part. These findings are both confirmed and contradicted by Löfmark and Hammarström (2005). Their study confirmed that patients lack participation in care, but they also found that both older women and men negotiated their care with healthcare staff.…”

A systematic review of the qualitative literature on older individuals’ experiences of care and well‐being during physical rehabilitation for acquired brain injury

“…Participants felt restricted and trapped during their inpatient rehabilitation and hospitalization in a clinical setting, further highlighting their concerns of losing their independence (Loft et al, 2017 ; Tholin & Forsberg, 2014 ). Older individuals undergoing rehabilitation are overwhelmed with sentiments of passivity, docility, subordination and dependency in their struggle to (re)define their identity and regain a sense of autonomy (Löfmark & Hammarström, 2005 ; Olofsson et al, 2005 ).…”

“…Furthermore, Löfmark and Hammarström's ( 2005 ) study purport that older individuals’ interactions with staff in part aims to negotiate the opportunity of regaining their autonomy in a traditional gendered context. Women chose to negotiate with nurse assistants, as they felt being in a subordinate position in the medical context.…”

“…Women chose to negotiate with nurse assistants, as they felt being in a subordinate position in the medical context. In contrast, men perceived themselves to be equal with nurses and physiotherapists, hence making efforts to negotiate a type of alliance with them (Löfmark & Hammarström, 2005 ).…”

“…The above institutional and organizational hindrances adversely impact older individuals’ ability to set rehabilitation goals and take part in planning their care (Krishnan et al, 2019 ; Loft et al, 2017 ; Tholin & Forsberg, 2014 ). Furthermore, goal setting in rehabilitation is also negatively impacted by the medical model's approaches to care for older individuals and its dominance in the organization of care and rehabilitation (Löfmark & Hammarström, 2005 ; Loft et al, 2017 ; Tholin & Forsberg, 2014 ). On the contrary, older individuals’ rehabilitation based on constructive relations, positive communication and person‐centred care, increases older individuals’ satisfaction and encourages them to move forward with their recovery (Galvin et al, 2009 ; Mangset et al, 2008 ; Morris et al, 2007 ).…”