Stroke Survivors’ Transition Home during the COVID-19 Pandemic: A Focused Ethnography

Abstract

Stroke is the leading cause of disability in the United States and the fifth leading cause of death, with rural stroke survivors having poorer health outcomes than urban survivors. The majority of stroke survivors are discharged back to their community following treatment of acute stroke. The COVID-19 pandemic initially led to decreased stroke hospitalizations, but obtaining post-stroke care was more difficult for survivors. There is a gap in the literature regarding the experiences of stroke survivors, especially during the COVID-19 pandemic. Fully understanding the facilitators and barriers survivors face can help healthcare providers individualize their care and encourage behaviors that will lead to a better health status. The purpose of this focused ethnographic study was to explore the beliefs and behaviors of stroke survivors transitioning home to their community in the southeastern part of the United States during the COVID-19 pandemic. Stroke survivors who were returning to their community after treatment were recruited from two hospitals located in a mid-sized city in the southeastern United States. Both hospitals routinely provided care to stroke survivors from the urban area as well as the surrounding rural community. Because of challenges recruiting participants returning home to a rural community, participants from both rural (n = 6) and urban (n = 8) communities were recruited. Semi-structured interviews, participant observations, and a mapping activity were utilized to collect data, and data were analyzed using a constant comparative analysis method. Based on data analysis, four main themes were revealed regarding the stroke experience, facing challenges, the role of faith and support, and getting back to 4 normal. The survivors’ cultural identity, cultural empowerment, relationships and expectations all shaped their beliefs and behaviors regarding their health and stroke experience. The findings of this study illustrated survivors’ barriers and facilitators to attaining optimal health during their recovery journey. The stroke experience was described as shocking, and while survivors had challenges, they reported good support networks to help them recover. The COVID-19 pandemic was largely considered to be a nuisance to the survivors, but not one they thought would affect their recovery. Strengths of the study included the researcher’s prolonged engagement with the stroke survivor population as a nurse as well as her experience residing in the rural community. Study limitations included not being able to focus solely on participants in a rural community, not having a participant observation on all participants (observed 7 out of 14 participants), and not being able to follow-up with survivors through the end of their stroke recovery journey. The study demonstrated a critical need for nurses to implement more tailored stroke education, including individualized risk factor assessment as well as training on symptom recognition. Public health policy campaigns on recognizing strokes and the urgency to seek emergent treatment at symptom onset are also needed. Finally, more research is needed to better understand rural stroke survivors’ beliefs and behaviors throughout their transition home and recovery period, especially in situations that involve strained resources.