An exploration of stroke survivors' acute stroke unit experience

Introduction
Since the substantive re-organisation of stroke unit services in the United Kingdom only a small number of studies have explored what being on an acute stroke unit is like for stroke survivors. Even then, studies have tended to focus on individual elements of stroke unit provision or within a broader stroke care context. This study aimed to explore the subjective experience of being on an acute stroke unit in all its meaningful, qualitative character.

Method
A hermeneutic phenomenological methodology ensured that in-depth analysis of experiential interview accounts from four stroke survivors who had experienced one of two acute stroke units within the same healthcare Trust, could be explored in detail. Towards the end of the analysis, the understanding being developed led to the creation of geographical maps to represent the complex, holistic nature of the stroke survivors’ experience.

Results
The acute stroke unit emerged as a meaningful place in two differentiated and interconnected forms: holding space and transitional space. Holding was understood to provide distance, safety, protection, time and emotional support; was meaningfully related to need and existential vulnerability; was practiced by nurses as well as others (including their fellow stroke survivors) and was not just the foreground but could also be the impetus for transition. Transition reflected how these four individuals varied in how they responded to the challenges and vulnerabilities they faced after the stroke whilst they were on the stroke unit and because of being in hospital. These transitions were mostly internally orientated within themselves, and could be absent, occur quickly and/or in combination, and reflected a range of protective, necessitous or potentially driven transitions.

Conclusion
This study aims to contribute to the dialogue about the meaningful components of acute stroke unit care and give voice to those with direct experience. The findings point towards how holding and transition were meaningful for four stroke survivors. It provides understanding of the ways these four individuals practiced as well as transitioned in a range of ways on the acute stroke unit. The findings propose the invisible but meaningful contribution of holding and transition in acute stroke unit care. Holding that went beyond caring and helping; and transition that reflected more than recovery-orientated change. These findings are an offering from which to consider the relevance of qualitative research, the acute stroke unit experience and how these insights could contribute to further research and stroke unit practice.