Towards a new Foothold in Life: A Phenomenological-Hermeneutic Study of patients’ lived experiences during the trajectory of Cardiac Rehabilitation: PhD dissertation.

The purpose of this thesis was to investigate how patients suffering from a minor heart attack experience their life situation and the cardiac rehabilitation programme which they followed in a hospital setting. In order to get a thorough understanding and to provide new knowledge about patients’ experiences when suffering from a minor heart attack and later participating in a cardiac rehabilitation programme, the present study was carried through on a phenomenological-hermeneutic basis. 11 patients with respectively unstable angina pectoris (UAP) or non-ST elevation-myocardial infarction (NSTEMI) were followed during an eight week long group-based rehabilitation programme via field observations. At the end of the group-based programme focus group interviews were carried out, which were followed up by individual interviews one or two months later. The data material, consisting of field notes and transcribed interviews, was analyzed and interpreted with inspiration from Paul Ricouer’s phenomenological-hermeneutic theory of interpretation. The findings of the thesis are based on three papers. The first looks into the patients’ experience of their life situation in connection with suffering from a minor heart attack. The other two papers show how the patients experience the exercise-based cardiac rehabilitation and what the rehabilitation activities mean to these patients. The findings are further interpreted and discussed in this thesis. The findings point out that the patients undergo a comprehensive transition, where they are forced onto an existential journey where they have to learn to cope with a life as being chronically ill. Mentally, physically and socially their lives have been changed forever, featuring loss of joy and meaningfulness. During the rehabilitation programme the patients support each other in realizing the seriousness of their disease and its importance for their everyday lives. Furthermore it is shown that not only the professionals but also fellow patients and more experienced heart patients support the patients in order to find new hope and gain courage to get on in life with the disease. The patients achieve positive physical experiences in exercise-based rehabilitation because it brings them renewed strength and good sense of well-being. This motivates the patients to continue in an everyday with physical activity. Additionally it is shown that the rehabilitation programme supports the patients in being able to live in accordance with both the recommendations about lifestyle and renewed personal values. Thus patients are supported in finding a new foothold in life based on what is meaningful to them. At the same time the study shows that there are structural obstacles in relation to fully participating in the rehabilitation programme, that there is a need for further involvement of relatives, and that the programme is too short. In the concluding part of the discussion, in this thesis, it is shown that the cardiac rehabilitation empowers the patients to cope with the existentially challenging situation that they find themselves in. It can be concluded that through the rehabilitation programme professionals, fellow patients and more experienced heart patients provide the patients with hope and courage to get on in life. Therefore it is important that as many as possible are included in the rehabilitation. The patients need to be able to participate in the entire programme and to get support from professionals for more than eight weeks. Also the relatives should be given more information. Moreover patients should be assured to have a possibility of being together with fellow patients and listen more to experienced heart patients, maybe over a longer period of time. The findings emphasize that cardiac rehabilitation programmes should be attentive of the demanding personal development that patients go through. If the patients are given support, they may become more capable of making the choices that are based on their own ideas of what provides good health and gives them meaning. This may bring the patients forward to being capable of taking upon themselves the responsibility to lead a life that is in good keeping with their possibilities and values. It should be considered if the heart rehabilitation at the hospital is to be followed up by new initiatives that support the patients further in living with the disease.