Life after stroke: an ethnomethodological study of emotion work among adult stroke survivors and their carers in rural areas of Nakhon Sawan Province, Thailand
This thesis aims to explore the nature of emotion work within the context of care occurring in adult stroke survivors (18-59) and their carers situated at home in Nakhon Sawan Province, Thailand. It also investigates how their roles were constructed after the stroke event. An ethnomethodological approach facilitated the understanding of the sense-making processes in daily routines. Data collection was comprised of semi-structured interviews and observations which were gathered from a sample of twelve pairs of stroke survivors and carers, 24 participants in all, over a period of three months. Data were analysed by a thematic analysis approach. Stroke survivors’ belief about the cause of stroke and its effects on their attitude towards themselves and carers, and carers’ accounting for their care of stroke survivors emerged as two overarching themes derived from the interview data. The first theme illustrates that stroke survivors described difficult experiences during the first six months post stroke as the turning point of their lives. They searched their life experiences to create their current status within society. A self-evaluation of their health created a positive or negative attitude towards themselves, which affected their emotions in everyday living. In all cases the stroke survivors’ appreciation of carers’ help was significant. For carers, family relationships and expectations influenced their sense of responsibility and expectations. The feeling of gratitude, the morality of Buddhist values and a sense of duty were their underlying reasons for taking the caring role. Carers’ expectations of stroke survivors’ ability to perform routine activities were influential in managing their own feelings and actions in everyday life. The influence of neighbours reinforced carers’ ideas of moral standards of caring for stroke survivors. Emotion management is the third theme. Emotion work is involved in stroke survivors’ and carers’ everyday affairs which helped to keep their current life situations in balance and assist them in continuing to live as normal. Their life experiences and specific feeling rules (the feeling of gratitude and the sense of responsibility) govern the achievement of their emotion work. A differentiation between male and female roles also influenced their emotion work. Stroke survivors and carers presented how emotion work served to maintain their interpersonal relationship and to minimise difficult conditions in ordinary living. A conceptual framework of the process of emotion work is presented to facilitate understanding of how they engage in and accomplish emotion work during caring interactions. Emotion work emerges as a means to show their gratitude to each other and represents one of several ways to fulfil their Buddhist beliefs in the law of karma. They exchange emotion work for the values of caring and gratitude. These findings will be beneficial to stroke survivors and carers for dealing effectively with emotional problems in day-to-day life. Community nurses and other health professionals will gain a deeper knowledge of emotion work in order to assist them in providing holistic care for stroke survivors and carers. The findings will also be of interest to health policy makers to enable them to organise information and home-healthcare activities in future stroke care and health promotion strategies in rural communities in Thailand and elsewhere.