Journal article review: van Nes F et al (2009)
‘One body, three hands and two minds: A case study
of the intertwined occupations of an older couple following stroke'
- reviewed by Professor Chris Mayers, Research Fellow, York St John
This study was undertaken in the Netherlands.
It demonstrates so clearly how mental health can be enhanced,
following a major life trauma, if an individual’s occupations and
co-occupations are enabled.
Our chosen occupations are often undertaken as
co-occupations with other people. The primary author was therefore
interested in ‘exploring occupations from a couple’s
perspective … to contribute to the theoretical understanding of
occupation and co-occupation’. There is the assumption that
the impact of change in one partner’s occupations may well affect
the other partner’s occupations. Furthermore ‘the relationship
of occupation to health and well being is relevant for both
partners in a couple’.
The case study resulted in the construction of
two personal narratives, that of Wil, an 80 year old female, who
had had a stroke, and Henk, her 84 year old husband of 50 years;
and also one joint narrative. This qualitative research approach
was certainly appropriate in order to obtain in-depth data from the
interviews about the occupations of this couple who lived
independently at home. Ten in-depth interviews were undertaken,
seven individual and three joint over a period of 7 months, 3 years
following Wil’s stroke. Wil can walk short distances but has no
function in her right arm and hand. Wil and Henk are members of the
Dutch Association for Stroke Patients. They heard about the study
at a regular meeting of this group. They met the selection criteria
and therefore volunteered to take part, giving written consent.
Strict confidentiality was maintained.
The narratives demonstrate the one entity of
the couple ‘conceptualized as one body, three hands and two
minds, in their everyday occupations; in timing, co-ordinating,
balancing, orchestrating and assisting’. The narratives
explore each of their lives before Wil’s stroke and since. The
article clearly explains the process of the narrative analysis.
The personal narratives tell the story of
occupational change and the joint narrative tells the story of
their current occupational life. The themes that emerged were:
- From having his own engaging occupation to
the time-consuming occupation of providing support
- From challenging occupations over ‘Nothing
Land’ to occupations for training and filling days
- One body: timing, coordinating and
- Three hands: orchestrating, assisting
- Two minds
The narratives are very sensitively analysed
and recorded. There was obviously a strong and positive
relationship between the researcher and the interviewees as well as
the one between Wil and Henk.
The content of the narratives were discussed
with the couple as a way of member-checking and providing
trustworthiness. Validity of the findings was optimised by data
triangulation, the use of reflexivity with a research diary, by
peer review and the member-checking process. However, as this study
was then translated into English it was not possible to
member-check the translation of the narratives with the couple.
The primary author indicates that the findings
of this study suggest that the co-occupations may well have had the
function of regaining or restoring the personal identity of Wil.
This is so important in the maintenance of mental health. Wil and
Henk’s experience of ‘we-ness’ as one mutual identity emerges
Reference: van Nes F, Runge
U, Jonsson H (2009) One body, three hands and two minds: A case
study of the intertwined occupations of an older couple following
stroke, Journal of Occupational Science, 16 (3), 194-2