Development of a Caring Model Incorporating Yoga for Promoting Physical Recovery and Wisdom of People Living with Stroke in Nepal

Abstract

The study of caring incorporating spiritual practices has become subject of increasing scientific interest and inquiries for providing strong humanistic and holistic care to the clients in a hospital setting. Yoga, a spiritual practice has positive effect for stroke rehabilitation. The aim of the study was to develop a caring model integrating yoga for promoting physical recovery and wisdom of people living with stroke. The action research was used to develop the model whereas care, compassion, confidence, communication, courage, and commitment concepts of caring and yoga were used to guide the study. The study was conducted in a University hospital, Nepal. Sixteen nurses working in a neurology unit recruited as key participants whereas four physicians, sixteen stroke clients and their family caregivers were associate participants. Action research was used as a study design comprises of reconnaissance phase and two cycles of the action research. Data were gathered using group discussion and in-depth interview questionnaire along with observation and field note. Content analysis was used to analyze the data. The findings of the initial phase of the study revealed that stroke clients were suffering from multiple physical problems, functional losses, psychological, emotional and spiritual distress along with lack of knowledge and skills about the stroke and caring to self. Likewise, nurses also had insufficient knowledge, attitude and confidence on caring related to stroke in acute stage. Similarly, medical model was used for management of stroke with given more priorities of medical order and routine care. Aformentoned situations indicated that holistic approaches of care were lacking in the setting for management of the stroke clients as a whole being. Thus, there is a need of holistic approaches of care to improve nursing practices and client's health outcomes. To address both issues of the clients and the nurses, a tentetive caring model incorporating yoga was developed. The tentative caring model was finalized through two cycles of action research process. The main theme of the first cycle was transitional phase from reluctance to confidence through direct involvement by the nurses into the nursing practice using the program. The first cycle of the action research focused on changes the perception of the nurses toward the program by helping them to increase knowledge, skills and experiences on caring and yoga practice which made them confidence on caring to the stroke clients in acute stage. The second cycle of the action research phase aimed to initiate and enduring the program by the nurses for its sustainability. During the process of model development, nurses established caring relationship through application of cultural based caring compassion, communication and courage by involving the clients and their family caregivers in the care process. Gradually, all the contents of the program was implemented into the clients in accordance with 6Cs attributes of caring. Collectively, all of the caring actions helped hugely for promoting the physical recovery in terms of activities of daily living and wisdom of people living with acute stroke. The findings revealed that the expected outcomes of the caring model were achieved from nurse's caring behaviors and actions by cultivating caring relationship using integrated caring program with yoga focusing on cultural specific approaches in nursing practice. Finally, the caring model was benefited to the stroke clients and their family members for obtaining culturally congruent holistic care. The findings of the study can be used to any clients in a various sociocultural background.