ABSTRACT

The intent of this study is to gain insight into and a deeper understanding of living with a history of a heart attack for males at least two years after the event. A heart attack is a sudden, dramatic and sometimes fatal event; we suspect that it is a profound experience which affects the very core of the individual's being. But how is the heart attack and particularly life after the event experienced? What is it like to live with a history of a myocardial infarction (heart attack)?

In order to address this question, I used a human science approach which aims, through description and interpretation, to illuminate the participants' experiences and to reveal their meaning. The descriptive interpretive work of the study is based on conversations with seven men who had heart attacks and all of whom subsequently returned to work. Each person begins his story with the event and progresses through time to the present.

The stories of the seven interviewees are presented in the form of re-constructed narratives. In each person 5 story we can detect a certain pattern of meaning, a thematic concern. These same patterns were shared to some extent among the various narratives; but they did not occupy, in the same manner, centre stage.

The inquiry, however, moves beyond the individual since the quest S to identify and explicate aspects of life after a heart attack which are possible shared human experiences. These possible human experi-nces I refer to as "the experiential characteristics which emerge

from descriptions focusing respectively on corporeality, sociality, temporality, and spatiality. The experiential characteristics reveal that the body emerges as a separately experienced entity as it impedes choices and action; that the other has the potential for assisting the post-MI patient to re-engage his world or for distancing him from it; that the past lives in the present; that to live authentically the post-MI patient has to create a world where he can feel secure and in control.

Finally, this inquiry raises the question of how to access the individual's experience, a question which is focal to nursing practice.

TABLE OF CONTENTS

1. ThE WAY TO ThE QUESTION 1

Introduction 1

My Interest in the Study 4

2 WHAT Do WE KNOW ABOUT LIVING WITh A HEART ATTACK? 10

Introduction 10

Relevant Research Studies 10

The Coronary-Prone Behaviour Pattern 11

The Heart Attack 15

Psychological Aspects of Recovery 17

Illness Behaviour 20

Descriptions from the Literature 23

3 A HUMAN SCIENCE APPROACH 29

Introduction 29

The Meaning of Lived Experience 30

Researching the Lived Experience: Description/Interpretation 38

The Conversations 40

Finding Participants 42

The Stories 42

Interpreting the Stories 45

Writing 45

Organization 47

4. ECONSTRUCTED NARRATIVES ABOUT LIFE AFTER A HEART

ATTACK 48

Introduction 48

Dirk Mulder 48

Orest Radowski 61

Raymond Singh 74

Randall Woytowich 92

Mark Shaw 109

Brent Hamilton 120

Kenneth Martin 134

5 CORPOREALITY: ThE BODY LOSES ITS TRANSPARENCY 151

Introduction 151

Separation of the Mind and the Body 152

Listening to the Body 159

The Objectification of the Body 165

6 SOCIALITY: A BEING TOGEThER WHILE BEING APART 172

Introduction 172

A Reorientation to the Other 173

Discovering Those Who Care 173

Seeing and Relating to the Other

in a Different Way 175

Living his Commitment to his Family 178

The Other Creates Distance--Being Seen as an "It't 180

The Look as an Obstacle to Engaging his World 180

The Look Distances the Self from the Other 183

Responses to the "Look" 186

7 TEMPORALITY: TIME IS LIVED IN EVENTS 192

Introduction 192

Taking Stock 193

The Past Lives in the Present 200

Living With the Awareness of What Comes First 206

8 SPATIALITY: CREATING A WORLD FOR ONESELF 209

Introduction 209

A Change in Place, a Change in Pace, a Change in Meaning 211

Living in a More Authentic Way 223

9. REFLECTIONS: POSSIBILITIES FOR PRACTICE AND RESEARCH 228

Introduction 228

Implications for Health Care Practitioners 228

Reflections on the Mode of Research and Its Place

in Nursing Research 234

The Mode of Research in this Study 234

Limitations 238

Fundamental Patterns of Knowing in Nursing 239

BIBLIOGRAPHY 243

APPENDIX A INFORMED CONSENT FORM 252

APPENDIX B INTERVIEW SCHEDULE 255

APPENDIX C EXAMPLES OF QUESTIONS FOR GUIDING

ThE CONVERSATIONS 257

© Max van Manen, 2002
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