- Title
- Investigating boredom during inpatient stroke rehabilitation
- Creator
- Kenah, Katrina
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2024
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Many people who have a stroke may spend weeks to months in inpatient rehabilitation to (re)learn skills and regain function affected by their stroke. Functional recovery is driven by neuroplasticity – the ability of intact nervous system to change its structure, functions and connections in response to experience or the environment – which is heightened in these initial weeks and months after a stroke. Evidence from animal models of stroke indicates that functional recovery can be optimised when relearning of skills is undertaken in an environment which provides both an opportunity for repetitive task-specific practice and which is stimulating (an “enriched environment”). Despite this, research conducted within inpatient rehabilitation units reveals that outside of scheduled therapy sessions, many stroke survivors report to be bored and spend large portions of their day inactive and alone in their rooms. Our understanding of the effect of experiencing boredom during inpatient rehabilitation remains limited. However, boredom has been established to affect mood, and limit engagement and learning outcomes in educational settings, and so may similarly compromise wellbeing, learning opportunities and functional recovery post-stroke. This thesis takes an exploratory approach to, for the first time, investigate boredom in stroke survivors during inpatient rehabilitation. The thesis is comprised of a chapter presenting a framework for understanding boredom during inpatient rehabilitation and three published studies: 1) a scoping review that summarised the current literature on boredom and factors that may contribute to boredom during stroke rehabilitation, 2) an observational study that measured the prevalence of boredom, tested the effect of enriching the rehabilitation environment on boredom levels, and explored other factors that may contribute to boredom, and 3) a qualitative study that investigated stroke survivors’ experiences of boredom and the meaning they ascribe to activities undertaken during non-therapy time. Findings highlight that boredom is a significant issue for many stroke survivors during inpatient rehabilitation. Boredom was conceptualised to arise when activities lacked meaning or were unable to maintain their attention. Boredom might then be sustained as a result of physical or cognitive impairments or beliefs of the stroke survivor, together with features of the rehabilitation environment, that together limited perceived control and the ability of stroke survivors to act to resolve underlying meaning or attention deficits. Attempts to create a more stimulating rehabilitation unit environment via application of an enriched environment, that is one that provided increased opportunities to participate in physical, cognitive or social activity during non-therapy time, did not result in a statistically significant reduction in stroke survivor boredom levels. Boredom was found to be associated with depression and lower levels of social interaction post-stroke. Analysis of stroke survivors’ experiences within the rehabilitation unit environment further highlighted the importance of social relationships and connection with other patients, family and staff in warding off boredom. Experiences and preferences for occupying non-therapy time were varied. For some, inactivity during non-therapy time denoted needed rest, which was deemed to be therapeutic for their recovery. However, for others, there was “nothing to do” and non-therapy time was considered to be “wasted time” due to a perceived lack of opportunity to participate in activities to support their recovery post-stroke. Features of the rehabilitation environment perceived to contribute to boredom included: social isolation, busy staff, paternalistic staff attitudes, and working practices and the culture of the rehabilitation unit. Stroke survivors with a strong sense of control and internal motivation were less likely to complain of boredom. The findings from this thesis begin to elucidate the theoretical underpinnings of boredom during inpatient rehabilitation and inform how current rehabilitation environments and work practices could be optimised to create affirming environments that enhance stroke survivor autonomy, social connection and participation in meaningful activity. Furthermore, the learnings from these initial attempts to understand and quantify boredom provide important future direction for measuring boredom when evaluating a stroke survivor’s experience of inpatient rehabilitation. Reducing boredom to optimise a stroke survivor’s time use and learning opportunities within inpatient rehabilitation is likely important to ensure they achieve the best functional recovery and quality of life possible after stroke.
- Subject
- boredom; stroke; rehabilitation; meaningful activities; engagement; autonomy; healthcare environments; thesis by publication
- Identifier
- http://hdl.handle.net/1959.13/1505864
- Identifier
- uon:55762
- Rights
- Copyright 2024 Katrina Kenah
- Language
- eng
- Full Text
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 7 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 403 KB | Adobe Acrobat PDF | View Details Download |