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A Narrative Study of Women’s Early Symptom Experience of Ischemic Stroke

Beal, Claudia C. PhD, RN; Stuifbergen, Alexa PhD, RN, FAAN; Volker, Deborah PhD, RN

The Journal of Cardiovascular Nursing: May/June 2012 - Volume 27 - Issue 3 - p 240–252
doi: 10.1097/JCN.0b013e31821bf83c

Background and Research Objective: Delayed arrival at the emergency department after the onset of ischemic stroke symptoms is an important reason for low tissue plasminogen activator administration rates. There is evidence that women arrive at the hospital later than do men, but little is known about women’s experiences in the period between symptom onset and hospital arrival. The purpose of this naturalistic investigation using narrative methodology was to gain understanding of women’s early symptom experience of ischemic stroke.

Subjects and Methods: The sample consisted of 9 women aged 24 to 86 years with an ischemic stroke within 1 year of diagnosis. Data were collected using in-depth interviews in which participants were asked to tell the story of their stroke from the moment they noticed the symptoms until they arrived at the hospital. Data were analyzed using sequential methods of narrative analysis.

Results and Conclusions: The participants experienced stroke onset as the inability to carry out their accustomed activities in usual ways and as a process occurring over time rather than a discrete event. There was a tendency to objectify the body. Two participants considered stroke as a possible cause for their symptoms, and the other women attributed symptoms to everyday bodily experiences and/or other health conditions. Most participants did not perceive themselves at risk for stroke, although all but 1 woman had risk factors. For some women, stroke onset was different from their previous ideas about this event, and this was especially the case if a woman had prodromal symptoms. Decision making during early stroke flowed from women’s evaluation of symptoms and the meaning of symptoms, and meaning was informed by a woman’s life situation. The findings from this study may yield variables for future studies of cognitive, emotional, and behavioral predictors of hospital arrival time. There is a need for research on women’s prodromal symptoms.

Claudia C. Beal, PhD, RN Assistant Professor, Louise Herrington School of Nursing, Baylor University, Dallas, Texas.

Alexa Stuifbergen, PhD, RN, FAAN Laura Lee Blanton Chair in Nursing and James R. Dougherty Jr Centennial Professor in Nursing, University of Texas at Austin School of Nursing.

Deborah Volker, PhD, RN Associate Professor, University of Texas at Austin School of Nursing.

The authors have no funding or conflicts of interest to disclose.

Correspondence Claudia C. Beal, PhD, RN, 5108 Lake Jackson Dr, Waco, TX 76710 (

© 2012 Lippincott Williams & Wilkins, Inc.