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.

Uncovering Treatment Burden as a Key Concept for Stroke Care: A Systematic Review of Qualitative Research

“…Settings of studies: community (n=34) [7],[52],[55]–[58],[60],[61],[63],[69],[71],[73],[75],[80],[83],[85]–[88],[90]–[94],[96],[99]–[101],[106],[110],[115]–[117],[119]; outpatient (n=5) [54],[62],[65],[74],[118]; care homes (n=3) [111]–[113]; hospital (n=6) [59],[68],[72],[81],[104],[107]; stroke units (n=8) [64],[66],[67],[76],[78],[79],[89],[95]; stroke medical centre (n=1) [108]; and mixed setting such as hospital and community (n=12) [53],[70],[77],[82],[84],[97],[98],[102],[103],[105],[109],[114]. Gender of participants: males and females (n=56) [7],[52],[53],[55]–[57],…”

“…During the management of their stroke, patients are required to comprehend a large amount of information [52],[62],[65],[73],[79],[95],[106]. This is an aspect of treatment burden that commonly arises in the literature.…”

“…Even before diagnosis has been achieved, patients assess symptoms and make decisions about seeking help [65],[92]. They subsequently learn about their diagnosis of stroke, investigations, acute interventions, medications, and risk factor modification [52],[62],[95],[106].…”

A trustful relationship—the importance for relatives to actively participate in the meeting with the physician

“…The healthcare organization is characterized by power and dependency relationships between relatives and physicians; relationships that are asymmetrical (Johanson, Sätterlund Larsson, Säljö, & Svärdsudd, 1998; Löfmark & Hammarström, 2005). This asymmetry may affect the result of the meeting because of the rules governing acceptable communication, meaning the level of participation of relatives in the meeting with the physician is determined by the conditions provided by the healthcare organization and the physician (Säljö, 2000; Vygotsky, 1987).…”

“…The physician's position of power, for instance to determine the conditions of the meeting (e.g., agenda, setting, and time), may entail that the relatives and patients are not given the opportunity to express their insights or interests. The physician's dominant position can negatively impact the meeting with the relative and the patient (Aronsson & Larsson, 1987; Löfmark & Hammarström, 2005). …”