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Understanding Patient Learning in a Stroke Rehabilitation Setting: An Ethnographic Exploration

Davenport, (Henrietta) Sally; (2023) Understanding Patient Learning in a Stroke Rehabilitation Setting: An Ethnographic Exploration. Doctoral thesis (Ph.D), UCL (University College London). Green open access

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Abstract

Background and purpose: Learning is fundamental to recovery following stroke but little is known about how stroke survivors learn in the rehabilitation setting, how learning contexts are communicated and what impact they have on engagement with rehabilitation. This research used ethnographic methods to explore learning and being a learner in rehabilitation. / Methods: Study 1: A meta-ethnography to synthesise research on patients’ perceptions of education and teaching on engagement with, and adherence to, independent therapy-based practice. Study 2: An ethnography with observation and shared conversations to explore learning within a neurorehabilitation setting in the early to late subacute stages post stroke. / Findings: Study 1: Synthesis from 18 papers resulted in three interrelated themes focussing on the person as learner, the therapist as teacher, and the guidance received. Teaching and learning in the prescription of independent therapy-based exercises were found to be interdependent. Practice that considers one without the other may have a negative impact on outcomes. Study 2: Observation over 53 days and serial conversations with 14 stroke survivors showed that recovery involved a complex process of new learning. Stroke survivors looked for alignment between the teaching they received and what they expected and wanted to learn. Coherence between teaching and learning positively impacted rehabilitation engagement and emotional well-being. / Conclusion: This study has improved understanding of learning from the perspective of stroke survivors and advanced the theory of learning in neurorehabilitation. Findings suggest that engagement with learning activities such as rehabilitation-based practice may be compromised when there is a mismatch between patients’ learning expectations and clinicians’ planned content. An openly inviting, visible and unifying rehabilitation curriculum that aligns expectations and delivery may enhance engagement. The concept of a rehabilitation curriculum is new and requires further exploration and development to determine its value within practice.

Type: Thesis (Doctoral)
Qualification: Ph.D
Title: Understanding Patient Learning in a Stroke Rehabilitation Setting: An Ethnographic Exploration
Open access status: An open access version is available from UCL Discovery
Language: English
Additional information: Copyright © The Author 2023. Original content in this thesis is licensed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0) Licence (https://creativecommons.org/licenses/by-nc/4.0/). Any third-party copyright material present remains the property of its respective owner(s) and is licensed under its existing terms. Access may initially be restricted at the author’s request.
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Population Health Sciences > UCL GOS Institute of Child Health > Infection, Immunity and Inflammation Dept
URI: https://discovery.ucl.ac.uk/id/eprint/10175644
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