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Journal article review: van Nes F et al (2009)

Professor Chris Mayers‘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 University

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 balancing
  • 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 clearly.

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