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Abstract

This research aims to measure the process of rehabilitation from the individual perspective by adapting Dementia Care Mapping (Kitwood and Bredin 1992) and applying it to the area of stroke rehabilitation, which is referred to as Stroke Care Mapping (SCM). SCM was carried out on a rehabilitation ward with 8 participants who had suffered a stroke. Mapping took place during the course of a typical day from 9.00am to 4.00pm. Results showed that individuals spent some 42% of their time on their own without any accompanying activity. There were also some 35 examples of Personal Detractions, which represent specific incidences where care is not person-centred.

Conversations between staff members and these participants on the ward, in the dining room and in therapy sessions were recorded onto a cassette in a variety of contexts. The audio tapes were analysed using Discourse Analysis to shed more light on the actual process of care. The results showed that on the ward and in the dining room participants spent a great deal of time in silence. Types of interactions between staff/patient comprised mainly of simple explanations and questions which require a yes/no response. However, interactions with the therapists were more likely to be reassuring and sociable than with nurses with a greater emphasis on explanation, teaching and encouragement.

The results of the SCM and Discourse Analysis were used to form the basis of a person-centred training programme for staff and SCM was used as a before (SCM 1) and after measure (SCM 2). During SCM 2, six out of the original 8 participants were mapped (2 participants had been discharged). Comparison of SCM before and after the training showed an elimination of Personal Detractions in SCM 2 and participants only spent 34% of the time on their own with no accompanying activity. The amount of conversations between nurses and between patients increased for participants in SCM 2 and these interactions received a higher overall care value than during SCM 1. The Care Values between SCM 1 and SCM 2 only showed a slight positive increase for the majority of participants. A number of positive changes were made on the ward as a result of the SCM, such as the increased use of group work with individuals from the ward.

These findings suggest the amended version of Dementia Care Mapping has some potential in the area of stroke rehabilitation to offer an insight into the experiences of patients on a stroke ward. Discourse Analysis of taped conversations provided in-depth qualitative information about the process of care but its use as an adjunct to the SCM tool is limited because of the time consuming nature of transcribing the conversations. Increased use of the SCM method, over the course of the research, led to the development of a number of improvements on the ward, the most significant of which includes the mapping of activity directed towards a person’s rehabilitation goals.

Recommendations for the future include further use of SCM and the collection of comparative data from other rehabilitation settings. SCM has potential in rehabilitation not only to measure the quality of care from the perspective of the person with a stroke but also as a potential agent of organisational and cultural change.

Publication Type:	Thesis (Doctoral)
Subjects:	B Philosophy. Psychology. Religion > BF Psychology R Medicine > R Medicine (General)
Departments:	School of Health & Psychological Sciences > Psychology School of Health & Psychological Sciences > School of Health & Psychological Sciences Doctoral Theses Doctoral Theses

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