The experience and expression of social cognition changes for stroke survivors

This thesis is comprised of four parts: A literature review, a research paper, a reflective critique of the research process and a service evaluation. A systematic literature review was undertaken concerning longer term stroke survivors accounts of social and emotional challenges after stroke. This resulted in 12 studies which were then explored. All 12 studies used qualitative approaches and sought to gain direct accounts from stroke survivors concerning these issues. The studies collated accounts from stroke survivors about their social and emotional experiences through particular study lenses of social support, social participation, quality of life, quality of friendship, quality of spousal relationship and personal perspectives. The studies were then examined in order to understand their contribution to the literature. Across the studies it was clear that from the stroke survivors viewpoint, rehabilitation service models tended to be focussed on early intervention and lacked a longer term strategy which supported emotional and social adjustment. Five main themes across the studies were identified. These were: Loss & Maintenance of friendships; Losses in Social world and role leading to isolation; Social participation & community integration changes; Pre and post stroke self, continuous/discontinuous self; and Emotional responses. These themes were examined more closely in order to appreciate their thematic meaning for stroke survivors and the contribution the various studies had made to this. Recommendations for future research from these results are discussed. A research study interviewed six stroke survivors (ranging from 1-9 years post stroke) in order to gain their views and experiences about any social cognition changes since their stroke. Open ended qualitative interviews were recorded verbatim and then analysed using Interpretative Phenomenological Analysis. Three superordinate themes emerged from this analysis: My changed sense of self in relation to others; Managing my social behaviour; and My altered states of feeling. Each of these superordinate themes contained a number of sub themes. Stroke survivors’ self-understanding of these issues and their views about the impact this has had on relationships is discussed and recommendations are made. A reflective critique records the personal experiences of the author during the research and thesis process. This describes the challenges and lessons of engaging in the academic and research process for this thesis. A service evaluation describes the establishment and provision of a six month pilot offering an in house psychological service for staff within an acute medical hospital alongside a physiotherapy service. Psychological services were offered as a brief treatment model and also provided consultancy and training to staff at all levels. Over the six months, 53 members of staff were seen for direct psychological consultation/treatment. Data were collected regarding professional group, and frequency of sessions and the 10 effectiveness of the service on staff well-being was measured using the HADS as a measure of individual change. Organisational sickness absence data was gathered as a measure of the pilots cost effectiveness within the organisation. Data were also collected on the types of issues that staff presented with and the category of staff that attended. Results showed that staff anxiety decreased at a highly significant level, and depression at a significant level, but the level of returns of the questionnaires was very low. Staff sickness absence due to stress was compared to the same six months of the previous year and had decreased by 40% resulting in substantial cost savings. Staff sickness across the division dropped from 5.29% to 3.87% over the 6 months. Staff reported sleep problems, low mood and emotional events as the most frequent issues that made them stressed, but loss of confidence in work role and being affected by events at work were also frequently reported; indicating the importance of a service that links in to the organisation. The treating psychologists reported bereavement issues as the most common treatment issue arising from users of the pilot. The evaluation is critically discussed, comparisons are made to published information about the national picture and recommendations are made for future evaluation and research.