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Self-Concept, Disposition, and Resilienceof Poststroke Filipino Elderly withResidual ParalysisAllan B. de Guzman a , Eleanor Lourdes C. Tan b , Ernestine Faye S.Tan b , Justin Ryan L. Tan b , Mervyn C. Tan b , Daris Mae M. Tancianob & Matthew L. Tang Lee Say ba College of Nursing, College of Education, The Graduate Schooland Research Cluster on Cultural, Educational and Social Issues,University of Santo Tomas , Santo Tomas , Philippinesb College of Nursing, University of Santo Tomas , Santo Tomas ,PhilippinesPublished online: 27 Mar 2012.
To cite this article: Allan B. de Guzman , Eleanor Lourdes C. Tan , Ernestine Faye S. Tan , JustinRyan L. Tan , Mervyn C. Tan , Daris Mae M. Tanciano & Matthew L. Tang Lee Say (2012) Self-Concept,Disposition, and Resilience of Poststroke Filipino Elderly with Residual Paralysis, EducationalGerontology, 38:6, 429-442, DOI: 10.1080/03601277.2011.559861
To link to this article: http://dx.doi.org/10.1080/03601277.2011.559861
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Self-Concept, Disposition, and Resilience of PoststrokeFilipino Elderly with Residual Paralysis
Allan B. de Guzman
College of Nursing, College of Education, The Graduate School andResearch Cluster on Cultural, Educational and Social Issues,
University of Santo Tomas, Santo Tomas, Philippines
Eleanor Lourdes C. Tan, Ernestine Faye S. Tan, Justin Ryan L. Tan, Mervyn C. Tan,
Daris Mae M. Tanciano, and Matthew L. Tang Lee Say
College of Nursing, University of Santo Tomas, Santo Tomas, Philippines
The interplay among self-concept, disposition, and resilience mirrors how the condition affects the
emotional status of poststroke Filipino elderly with residual paralysis. Despite healthcare profes-
sionals’ understanding of these clients’ physical conditions, little is known regarding these clients’
emotional health status related to stroke. Therefore, the central aim of this phenomenological study is
to describe the self-concept, disposition, and resilience of poststroke Filipino elderly with residual
paralysis through the lens of mask-painting. A total of nine poststroke Filipino elderly with residual
paralysis were chosen for this qualitative study, and a three-part research instrument was used to
gather data: robotfoto, semistructured interview, and mask-painting activity. Field texts were struc-
turally analyzed via a dendrogram, and themes were validated via persuasiveness and coherence
(Miles & Huberman, 1994) and a member-checking procedure during data explicitation. The study
revealed a hyperbola model typifying the lived experiences of the respondents relative to the three
variables. The respondents’ self-concept surfaced two themes: relationality and corporeality. Dispo-
sition was described as both phylogenetic and ontogenetic, and resilience was shown to arise from
both conviction and condition. These six themes collectively describe residual paralysis as a hyper-
bolic experience. On the whole, poststroke Filipino elderly with residual paralysis demonstrate major
changes in these three variables poststroke. In these situations, Filipino elderly commonly based their
self-concept on their relationships with others, their disposition on their innate feelings, and their
resilience on the measures they have taken to accept and to cope with the chronic effects of stroke.
According to the World Health Organization (2007), an estimated 15 million people suffer from
stroke, and 5 million are left permanently disabled yearly. In industrialized countries, stroke is
the most important single cause of severe disability and the third most common cause of death
after coronary heart disease and cancer (Garbusinski, van der Sande, Bartholome, Dramaix,
Gaye et al., 2005). Apparently, the management of residual paralysis due to stroke, especially
Address correspondence to Allan B. de Guzman, Research Cluster on Cultural, Educational and Social Issues,
University of Santo Tomas, Santo Tomas, Philippines. E-mail: [email protected]
Educational Gerontology, 38: 429–442, 2012
Copyright # Taylor & Francis Group, LLC
ISSN: 0360-1277 print / 1521-0472 online
DOI: 10.1080/03601277.2011.559861
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the psychological aspect, is not often prioritized in developing countries such as the Philippines.
Despite technology advancement and availability of facilities, 60% of those who suffer from a
stroke die or become dependent (World Health Organization, 2007).
The overall rate of stroke remains high due to the aging population (American Heart Associ-
ation, 2007). Stroke generally affects elderly, as the incidence of degenerative blood vessels and
hypertension—the two leading causes of stroke, increases with age. For every 10 years after the
age of 55, the risk of stroke doubles; and two-thirds of all strokes occur in people over 65 years
old (Nickens, 2009). People over 65 also have a seven-fold greater risk of dying from stroke than
the general population (National Institute of Neurological Disorders and Stroke, 2010). Notably,
when the baby boomers move into the over-65 age group, stroke will take on greater significance
in the healthcare field (National Institute of Neurological Disorders and Stroke, 2010).
Vital to rehabilitation programs are emotional and external supports or aids (Michel &
Mateer, 2009). However, healthcare professionals tend to focus more on the improvement of
poststroke clients’ physical functions rather than their emotional status. In a holistic manage-
ment, the emotional wellness of these clients should be given much importance as this directly
affects their coping mechanisms and compliance to treatments. Therefore, it can be considered
that the emotional conditions of these clients are as essential as their physical conditions in
adapting to their illness and disability.
Doolittle (1992) found that although respondents considered improvements in physical abili-
ties essential, recovery was viewed as a return to the life they lived before the stroke. Undoubt-
edly, the self-concept, disposition, and resilience of geriatric poststroke clients are greatly
affected by the disease. This is because the condition changes their functional and physical capa-
cities drastically, affecting their activities of daily living and societal roles.
Self-concept is the dynamic collection of self-representations formed through personal experi-
ences and through interpretation of the environment (Hill & Horn, 1999). As individuals experi-
ence a differing relationship with their bodies, their families, and society, their self-concept is
expected to change (Hill & Horn, 1999). In a study by Hill and Horn (1999), it was also found
that stroke respondents rated their current self-concept as similar or more negative than their
self-concept before stroke, suggesting that stroke indeed has an effect on self-concept.
Another variable, disposition, is defined in this study as the temperamental makeup or the
prevailing mood of the client. This is an important variable to consider since poststroke clients
have a tendency to shift moods easily due to several factors like physiologic changes and psy-
chologic stresses. Following stroke, most clients tend to develop depressive disorders as this is
viewed as a traumatic event (Lincoln, Nicholl, Flannaghan, Leonard, & Van der Gucht, 2003). A
negative disposition poses a negative impact on these clients’ recovery and presents an obstacle
to rehabilitation (Lincoln et al., 2003).
The third variable, resilience, is the ability to bounce back from adversity and move forward
(Dyer & McGuinness, 1996). Understanding the experiences and resilience of clients after a dev-
astating illness will help maximize their independence, improve outcomes, and foster effective
community support (Dyer & McGuinness, 1996).
This paper argues that interplay among self-concept, disposition, and resilience mirrors how
the condition affected the respondents’ emotional status as they struggle with the disability on a
daily basis. It is important for health care professionals to gain insights about these variables,
which, in turn, can facilitate the development of better and holistic care for specific groups of
people with chronic illness.
430 A. B. DE GUZMAN ET AL.
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Previous studies used different ways to represent emotional statuses of clients. Several studies
used doodles to reflect the respondents’ perceptions of their stories (de Guzman, Cucueco,
Cuenco, Cunanan, Dabandan et al., 2009). Some studies used art therapy to let the respondents
express their emotional needs, pains, pleasures, and comforts (Collie, Bottorff, & Long, 2006).
Other studies made use of paintings (Carmi & Mashiah, 1996) and essay-writings. Although
it was found that a high percentage of poststroke clients preferred creative activities (Logan,
Gladman, Drummond, & Radford, 2003), few items in the literature used mask-painting as a lens
to reflect emotional expressions of poststroke clients.
Mask-painting is an artistic representation of the self. It allows an individual to explore and
develop personal and social identities and express experiences, beliefs, and emotions (Zoss,
Smagorinsky, & O’Donnell-Allen, 2007). Respondents put in elements or qualities in the masks
and inscribed them with meanings and visual representations of their emotions and perceived
selves (Zoss et al., 2007). In a study by Zoss et al. (2007) involving mask-paintings for
self-expression, it was found that the respondents used different colors, lines, and shapes to sym-
bolize their emotions and to allot meaning to the masks. In this study, mask-painting is preferred
over other activities. This is not only because it does not require fine motor skills that would be
difficult to exercise for clients with residual paralysis, but it also exercises the clients’ muscle
activity and gross motor skills.
Although the physical conditions of poststroke clients are well-understood by health care pro-
fessionals in terms of management and prognosis, little is known regarding these clients’
emotional health status related to stroke, especially about the three variables. This concludes that
further exploration is needed for better health management and care. Thus, the central aim of this
study is to describe the self-concept, disposition, and resilience of poststroke Filipino elderly
with residual paralysis through the lens of mask-painting.
METHOD
Design
Geared to describe the essences and the essential structures of various regions of phenomena
(Mohanty, 1997), this study used phenomenology as its design. Phenomenology is the study
of human experience and of the ways things present themselves to us through such experience
(Sokolowski, 2000). This design was used to unveil the appearances of the self-concept, dispo-
sition and resilience of a select group of elderly. This ‘‘appearance’’ pertains to any existent
impinging on consciousness, anything cognized, irrespective of any judgment as to whether it
be real or illusory (Sion, 2009).
Study Site and Selection
This study took place in the Missionaries of Charity, Tondo, Philippines, a home for the aged
established by a religious order founded by Mother Teresa of Calcutta. Nine respondents were
selected based on the following inclusion criteria: (a) above 60 years old; (b) poststroke with
residual paralysis; (c) able answer questions coherently. Of the selection, the majority of respon-
dents were male (66.7%) and Roman Catholics (88.9%). All were aged 60–70. Most of the
POSTSTROKE FILIPINO ELDERLY 431
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respondents have three siblings (44.4%), no children (55.6%), are single (44.4%), living alone
(55.6%), and who have never been visited by any relative (66.7%) in their 1–2 years of stay
in the institution (66.7%). Most of them finished high school (44.4%) and worked full time
(77.8%) as a nonprofessional (55.6%) earning less than P5,000 (US $116.20) a month
(66.7%). Alcohol (66.7%) and smoking (77.8%) were the most common vices. Most of respon-
dents eat a balanced diet (66.7%) and have medical assistance (55.6%). Most respondents had
their first stroke when they were 40–50 years old (55.6%), 2009–2011 (66.7%) or two years
since the time of the study. The most common therapies that respondents have undergone were
transcutaneous electrical nerve stimulation or TENS (44.4%), physical therapy (33.3%), and
massage (33.3%). Hypertension (55.6%), diabetes (33.3%) and arthritis (33.3%) were their other
common diseases.
Data Measures
This study made use of a three-part research instrument. First, the robotfoto, a Dutch term mean-
ing a picture or a cartographic sketch (Kelchtermans & Ballet, 2002), was used to obtain the
respondents’ baseline profile. The second part, the series of semistructured interviews that lasted
for three hours, explored the respondents’ experiences, unveiling their self-concept, disposition,
and resilience in life. The last part of the instrument was mask-painting. According to Atkins
et al. (2003), masks are ways of seeing an inner truth. Masks are tools used to explore hidden
or unexpressed feelings, qualities, or roles (Gallo-Lopez & Schaefer, 2005). Using these, the
variables were understood, and interview findings were strengthened.
Data Collection
A request letter was sent to the institution asking permission to conduct the study on their
geriatric residents. With the permission of the sisters from the institution and the participants’
consents, interviews were conducted in the institution. The policies prohibited recording
devices, so the respondents’ responses were transcribed verbatim. Each interview lasted
approximately one hour and was scheduled once a week for three weeks. Follow-up questions
were also asked to elicit more detailed responses.
Ethical Considerations
Proper ethical approvals were sought and granted before conducting the study. The question-
naires used were preapproved by a senior researcher-professor of the university’s research insti-
tute to avoid unintended emotional harm to the respondent during the interview. The study was
performed observing the principle of beneficence, confidentiality, and respect for human dig-
nity using the Belmont Report of 1979 (Campbell & Cecil, 1979). Before data gathering, writ-
ten informed consents were solicited from the respondents. In accordance to the institution
policies, interviews were conducted without recording devices. The authors were careful in
translating the interviews to keep their original meanings. Contact details of the researchers
were given to the participants for clarifications.
432 A. B. DE GUZMAN ET AL.
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Mode of Analysis
Prior to data analysis, the three flows of activity presented by Miles and Huberman (1994) were
observed: data reduction, data display, and conclusion drawing. Data reduction refers to the pro-
cess of selecting, focusing, or simplifying pertinent data reflecting the essence of the variables.
Data display is an organized, compressed assembly of information (Miles & Huberman 1994). In
this study, a dendrogram, a data analytical tool, was used to display the significant responses,
anchors, or phenomenal referents in an organized way for data analysis. The last activity, con-
clusion drawing, is where the authors came up with themes from the specific words. A theme is
an entity that brings meaning and identity to an experience and its variant manifestations (de
Santis & Ugarizza, 2000). In phenomenology, there is only one essence, and the careful analysis
and interpretation of themes will reveal the unified essence of the three variables.
FINDINGS
Through in-depth interview and mask-painting, this phenomenological study attempted to deter-
mine the essence of self-concept, disposition, and resilience of a select group of poststroke
Filipino elderly with residual paralysis. From the cool and warm analyses of the rich verbaliza-
tions of the respondents, two divergent but fascinating themes describing self-concept, dispo-
sition, and resilience emerged. In the selfconcept aspect, the two themes that emerged were
relationality and corporeality. Explicitation of their articulations showed their disposition’s
phylogenetic and ontogenetic nature. Subsequently, the respondents’ resilience arises from their
conviction and condition.
The mask expressions painted by the respondents (Figure 1) showed a variety of represen-
tations extending from gestures (smiling, gnarling, frowning); emotions (love, sadness, crying,
happiness); physical attributes (beautiful face, dark complexion, rosy cheeks, pink lips); suf-
fering (tears, blood, sweat, darkness); natural environment (tree, sky, sun, clouds, rain); reli-
gion (cross, heaven, hell, earth); symbols of colors (maroon, red, blue, white, orange,
green, violet, yellow, black, rainbows, radiant colors) to nationalism (Philippine flag, Chinese
masks).
These representations embody the respondents’ individual and collective portrait of their
self-concept, disposition, and resilience in relation to their present condition. Interestingly, the
study emerged a hyperbola model that typifies the self-concept, disposition, and resilience of
poststroke Filipino elderly with residual paralysis. As shown, the self-concept consists of cor-
poreality and relationality describing the right and left foci of the hyperbola, respectively; dis-
position as phylogenetic and ontogenetic represent the right and left asymptotes of the
hyperbola. Resilience, characterized by condition and conviction, comprises the directrix. These
six themes form the structure of the hyperbola model entitled Residual Paralysis as a Hyperbolic
Experience (Figure 2).
Self-concept as Corporeality
Corporeality is the quality of being physical and material in nature. It refers to an indivi-
dual’s perception of self through his physical attributes. In this study, self-concept was
POSTSTROKE FILIPINO ELDERLY 433
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examined based on the respondents’ self-image. The respondents recounted their attributes
pre- and poststroke.
Prestroke, most respondents had positive views regarding their self-concept, specifically in
their features, physique, and qualities that distinguished them from others.
As to features, the respondents named parts of their body that contribute to their positive
self-concept. One of the respondents narrated, ‘‘During my adolescence, I had a beautiful face.
FIGURE 1 Mask representations and their respective metaphors. (Color figure available online.)
FIGURE 2 Residual Paralysis as a Hyperbolic Experience.
434 A. B. DE GUZMAN ET AL.
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That’s why I had a lot of suitors.’’ Another respondent stated, ‘‘I looked handsome because of
my long hair.’’
As to physique, having a fit body made the respondents proud. Some of their statements were
as follows: ‘‘I was proud of my big, healthy body, and my good posture when I was young.
That’s why I liked my body back then.’’ and ‘‘I used to be sexy when I was in college.’’
On qualities, some mentioned that their talents increased their self-confidence. One of the
respondents verbalized, ‘‘I used to be the vocalist and the drummer of a band.’’
Self-Concept as Relationality
Relationality explains how people connect, interact, and find meaning with the bonds they
build with others. These are one’s social encounters affecting the formation of one’s self-
concept.
In this study, the respondents’ ability to form lived relations with other people despite their
condition contributed to the essence of their self-concept. The respondents associated their rela-
tionships with other people to the development of their well-being. Evidently, most of their
responses focused on family relationships, and that seemed to contribute greatly to their
self-concept. One of the respondents articulated, ‘‘I’m a loving brother to my siblings. I love
genuinely. I don’t hide anything, and I don’t make promises I can’t keep.’’ Another respondent
verbalized, ‘‘I am a loving and respectful son, and I still love my mom even though she abused
me.’’ Another admitted, ‘‘I have siblings and children, but my husband is gone. I am willing to
give anything for them. It is very important to be a good mother because it is hard to control your
children once they start to rebel.’’ These statements conveyed that certain principles and values
have been developed as the clients performed their respective familial roles.
Relationships with friends also had significant roles in the respondents’ self-esteem needs.
Negative points of view were commonly verbalized by those who have not been visited by their
friends. One respondent stated, ‘‘I used to have a lot of friends but they abandoned me when I
needed them the most. Most of them don’t even know me anymore.’’ Another respondent boldly
said, ‘‘They don’t visit me anymore, but it’s ok. Sometimes I miss them, but I also have plenty
of friends here.’’
Notably, the participants’ spiritual relationship made a great impact on how they view them-
selves. The roles they assumed in their relationship with God were one of the defining character-
istics that contributed to their self-concept. These were roles clearly manifested by their
responses: ‘‘I am God-fearing and observant of the teachings of God,’’ ‘‘I take pride in being
an adaptable and prayerful person.’’
The poststroke phase focused on the respondents’ view of their body after experiencing
stroke with residual paralysis. Residual paralysis can limit an individual’s physical activities
and affect how the elderly view themselves. Most of the respondents did not dwell on their
body’s functional limitations. As one respondent verbalized, ‘‘I may not be able to move my
right hand, but I still got my left hand and I continue to use it everyday.’’
Health was also a factor in determining the respondents’ self-image poststroke. Most respon-
dents viewed themselves as healthy despite experiencing stroke. Some of their statements were
as follows: ‘‘I am healthy and looking forward to a long life.’’ and ‘‘I am strong and healthy
though I have difficulty moving my extremities.’’
POSTSTROKE FILIPINO ELDERLY 435
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Disposition as Phylogenetic
Disposition is defined as one’s mood or temperament. In this study, disposition is described as
both phylogenetic and ontogenetic. While ontogenetic is defined in this study as inherent or
self-originating, phylogenetic is defined as something that is caused by a sequence of events
involved in a part of one’s life. Disposition, being phylogenetic in this study, simply means that
the moods or temperaments shown by the respondents originate from the situations or events
happening in their lives. This is related to the respondents’ prestroke state where their moods
were greatly affected by external rather than internal factors.
During their prestroke phase, all of the respondents described their moods in relation to other
people or to situations they encounter. Many of them mentioned that they were kind to others,
and all of them mentioned that they were cheerful. One respondent stated, ‘‘Before I had a
stroke, I would often think of others first—think first how I should react to them. I would base
my mood to what I should do. If I should get angry, then I would. If I should be happy, then I
would be. It depends on the situation.’’ Another respondent said, ‘‘I am usually cheerful, but it
depends on the situation. If I should be happy then I would be, if I were in the right place, at the
right time and in the right situation.’’ Regarding their temper, the majority of respondents ver-
balized that they were not easily angered, but that their anger depended on the situation. One
respondent said, ‘‘I only get mad when I have to, or when the situation calls for it. If there is
nothing to be angry about, then generally, I am not easily angered.’’
The majority of the respondents mentioned that prestroke being with other people made them
happy; prestroke they also used to feel comfortable in social gatherings or in public places. One
respondent said, ‘‘I would prefer it if I were to speak in a public gathering or if I could meet new
people. Being around people makes me happy, especially if I can make them laugh or feel
comfortable.’’ Another stated, ‘‘If I were to speak in a public gathering, I would first assess
the situation. I will base my actions on my observations. If everything looked fine, then it would
be ok. I can easily make friends anyway, and I’d like to.’’ When asked what they would have done
in their prestroke phase given the chance to meet new people, the majority of respondents said that
they would interact and make friends with others; however, they would initially assess the person
before initiating a conversation. One respondent said, ‘‘I will first observe him or her and assess if
he or she is trustworthy. If he were, then I would make friends with him. I would even initiate it.’’
When asked about what they would do if they accidentally spilled a stranger’s food, the
majority of respondents mentioned that they would apologize. One respondent said, ‘‘Given
the situation, I would apologize, because in that case, saying sorry is the right thing to do.’’
Disposition as Ontogenetic
Disposition is viewed as ontogenetic in the light of the respondents’ post-stroke experiences.
Ontogenetic, in this study, is defined as something inherent, self-originating, or self-developed.
Disposition, being described as ontogenetic in this study, means that the respondents’ behaviors
and personalities are shown because these are who they really are.
After stroke, most respondents verbalized being more optimistic, as evidenced by their
answers to the question, ‘‘Do you view a half-filled glass of water as half-full or half-empty?’’
To this question, the majority of respondents answered that they viewed the glass as half-full.
436 A. B. DE GUZMAN ET AL.
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The majority of respondents verbalized that they exhibit warm attitudes toward others, but
their moods were often ‘‘lonely’’ or ‘‘sad.’’ One respondent said, ‘‘I am kinder and quieter now-
adays, but I feel lonely most of the time.’’ However, despite admitting to being lonely, all of
them still compared their moods or feelings with the positive meaning of the colors they have
given. One articulated, ‘‘I like the color red most, because it signifies love and warmth to
others.’’ Another mentioned, ‘‘I like the color white to describe my mood since it gives one
a sense of peace.’’
Most of the respondents also affirmed that they have mood swings. One respondent stated,
‘‘I have noticed that my mood changes a lot these days.’’ However, many verbalized that their
moods do not affect their sense of right or wrong. In fact, the majority of respondents claimed
that they would do the right things when faced with challenging circumstances. One respondent
verbalized, ‘‘If I see theft going on, I would reprimand the thief or call the police.’’
Even though most respondents verbalized being annoyed with selfish, judgmental, and
greedy people, they mentioned that they were not easily agitated. One respondent stated,
‘‘I do not get easily angry, but I do get irritated with persistently attention-seeking people.’’
The majority of the respondents expressed that they try to interact with others in social gather-
ings or occasions. One respondent articulated, ‘‘I will definitely try to make friends with
people.’’ and ‘‘I would smile and greet them. I will be happy to befriend people.’’
Resilience from Conviction
In this study, resilience is viewed as coming from two origins: conviction and condition.
Conviction is the respondent’s strong persuasion or fixed belief that he or she has incurred in
his youth. This is acquired through past events or from experiences that have challenged one’s
ability to ‘‘bounce back’’ or one’s capacity to cope with stress and adversity. All respondents
have had positive behavioral adaptation as indicated in their statements during the interviews.
Regarding failing, one respondent answered, ‘‘Of course I’m sad whenever I fail, but it’s okay.
I’m good in other things. Everyone is different.’’ Another one shared, ‘‘In life, there are winners
and losers. It’s okay to fail. It’s okay to be sad, but one must try again.’’
Even though the majority of respondents claimed that they were sickly as a child, most of
them verbalized that they had an adequate support system. One respondent shared, ‘‘I was sickly
as a child, but my siblings always took care of me.’’ Another one said, ‘‘I was usually sick, but
my mother used to nurse me.’’
Regarding their school experiences, most respondents viewed education as important. When-
ever they failed on exams, most of them said that they tried again. One elderly person shared,
‘‘Education was really important to me. I was studious and I liked reading books. I always got
high grades. Whenever I fail in an exam I used to become really saddened, but I just pray and try
again. I recover from my failures because I study hard whenever there’s another chance.’’
Another said, ‘‘Education was important to me, but back then, I prioritized my friends over
my studies. Whenever I fail, I wouldn’t be sad if I know I can still catch up. Sometimes when
I feel that I’m going to fail, I study very hard, and I still get a passing grade.’’
Religion also plays a big part in respondents’ coping. When asked about the first thing they
do whenever they face a difficulty, one shared, ‘‘I always pray, so I find the solution.’’ Another
respondent said, ‘‘I always resort to God and my faith.’’
POSTSTROKE FILIPINO ELDERLY 437
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Resilience from Condition
Resilience is the ability to cope and bounce back after a life-altering situation. In this study, one of
the main essences of the resilience of the respondents is that it is viewed as a result of a condition.
Resilience related to condition focuses on the respondents’ ability to cope and bounce back after the
life-altering situation—stroke and residual paralysis. Accepting their condition immediately after
having stroke was notably hard for most of our respondents, as evidenced by the following verba-
lizations: ‘‘This is my karma because of the wrong things I’ve done.’’ ‘‘I got sad because I can’t
move my arms and feet.’’ and ‘‘This is the hardest obstacle that I’ve faced because I can’t work.’’
Fortunately, different physical and spiritual steps were taken by the elderly to cope with the
drastic changes brought by stroke. Some respondents stated, ‘‘I exercise everyday even when
I’m just lying on bed.’’ ‘‘I was taught by my friend yoga and so I practice it. I’m also on water
therapy,’’ and ‘‘I go to the hospital for consultations and for regular check-ups.’’ Because it is
within the Filipino culture to find meaning and comfort in faith and spirituality, it is very much
evident that the respondents also expressed their worries and anxieties in prayer. Some of the
verbalizations included the following: ‘‘I tend to pray and just be brave about it,’’ ‘‘Praying
helps me clear my mind.’’ and ‘‘Reflecting by praying brings me peace and clarity.’’
It is interesting to note that all the respondents have accepted their condition. Their coping
mechanisms in both physical and spiritual aspects helped them regain a sense of control in their lives.
Having this made the elderly improve their point of views in life and live each day one step at a time.
DISCUSSION
Self-concept
Self-concept as corporeality centeredon respondents’ body images—revolving around their physique,
features, and talents. The individual is responsible in cultivating and restructuring the corporeal in vari-
ous ways, and this will gradually emerge central to one’s identity (Budgeon, 2003). The view of self-
concept is primarily determined by their physical qualities and functions, especially prior to stroke.
Self-concept as relationality focuses on the individuals’ perception of self as they establish and
maintain relationships with families, friends, and God. Being self-conscious and feeling unattractive
are major factors affecting self-concept and social relations (Ch’Ng, French, & McLean, 2008).
Post-stroke patients with loss of functional ability see themselves as abnormal and not as their real
selves (Becker, 1993; Mumma, 1986). Residual paralysis can limit an individual’s physical activities
and affects howpeople view themselves.However, a shift of focus from the limitations of bodily func-
tions to the persistence of social functions allowed them to view the self in amore positive way. Older
persons tend to be less expectant of their bodies and are inclined to establish relationships because of
illness (Davis, 1973). Principles, values, and perception formation determining one’s view of self are
also established upon assumption of different roles. These, in turn, contribute to their self-concept.
Disposition
The physical and psychological consequences of stroke can present significant challenges to an
individual (Hackett, Yapa, Parag, & Anderson, 2005; Ch’Ng, French, & McLean, 2008), with
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psychological difficulties such as depression and anxiety commonly experienced (Hackett et al.,
2005). Loss of functional ability poststroke greatly affects respondents’ self-concept, with stroke
sufferers describing a sense of being abnormal (Becker, 1993; Mumma, 1986). These changes in
self-concepts contribute to the changes in respondents’ disposition (Ch’Ng et al., 2008). Changes
in disposition can also be attributed to the debilitating effects of stroke, particularly the loss of
physical abilities and the inability to perform social roles (Lincoln, Nicholl, Flannaghan, Leo-
nard, & Van der Gucht, 2003).
Dispositions related to stroke could be endogenous—originating from within the patients
themselves—or exogenous—a psychological reaction to an event in one’s life (Gainotti et al.,
1997). Disposition, as phylogenetic or exogenous, is primarily associated with the prestroke phase;
disposition, as ontogenetic or endogenous, is generally linked to the poststroke phase in this study.
Disposition as phylogenetic mainly focuses on the moods and temperaments of the respon-
dents that were greatly influenced by events that happened during the pre-stroke phase of their
lives. Repondents described their disposition as happier, more positive, and more fulfilling
(Lincoln et al., 2003) due to the functions that they can perform, like their social roles (Ch’Ng
et al., 2008). Also, before stroke, patients can freely perform hobbies and activities that can be a
source of achievement and pleasure for them (Ch’Ng et al., 2008). They generally do not impose
limitations on themselves, but the limitations arise from external factors or life situations. This
causes them to act or feel based mainly on situations rather than their own feelings. This concept
of acting or feeling things based on external factors rather than acting from the self or the
impulse illustrates the description of disposition as phylogenetic.
While phylogenetic is defined in this study as something caused by events or situations, onto-
genetic is defined as self-originating. Disposition as ontogenetic simply means that the respon-
dents base their moods and temperaments on who they are and how they were raised. They show
their feelings because these feelings are parts of their personalities rather than caused by situa-
tions. Disposition being ontogenetic is mainly associated to the respondents’ poststroke phase,
where their moods were greatly affected by internal rather than external factors.
Elderly patients were more likely to experience emotional problems poststroke (Jeon &
Dunkle, 2009). One common emotional problem is emotionalism, wherein an individual easily
shifts from one mood to another with minimal provocation (Bowen, Knapp, Hoffman, & Lowe,
2005)—a characteristic experienced by the respondents. Due to the limitations in the activities
that the patients can do in the situation, they tend to focus more on what they feel and what they
can and cannot do rather than on the situation itself. This makes their disposition depend mainly
on their own emotional views and responses to their limitations. Consequently, the poststroke
phase emphasizes disposition as ontogenetic in nature.
In several studies, it is interesting to note that most poststroke patients experience depression
(Lincoln et al., 2003; Bowen et al., 2005; Ch’Ng et al., 2008), anger, suicidal thoughts and a sense
of loss, and periods of despair (Ch’Ng et al., 2008). However, it is interesting to note that while the
respondents describe their moods as such, they exhibit an optimistic view and outcome of their
condition. This is a remarkable characteristic, as optimism is strongly related to feeling good about
oneself, resulting to self-acceptance, personal growth, and autonomy (Grant & Higgins, 2003).
Remarkably, the majority of the respondents still claimed to be happier in socializing with
other people. This is vital to their disposition and coping as social support is important for allevi-
ating depression, for coping better among older adults (Tyler & Hoyt, 2000), and for helping the
individuals accept their conditions (Ch’Ng et al., 2008).
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Resilience
Resilience from conviction revolves around the individual’s fixed belief established from past
and adverse experiences that allowed them to ‘‘bounce back’’ from stress. A key characteristic
of a resilient individual is having a support network. Support networks can include family, close
friends, classmates, teachers, and community groups that may help and encourage them (Barber,
Dudding, & Flynn, 2006). These support networks facilitate individual development and serve
as protection against stress (Wang & Gordon, 1994).
School promotes resilience as it teaches social and problem-solving skills that provide the
individual with opportunities to succeed in meaningful tasks (Barber et al., 2006). This would
be very evident for clients who give importance to education. Individuals must be able to over-
come rejection and try again to make success possible (Ferrari & Sternberg, 1998). Through the
unfortunate circumstances of failing exams, respondents have learned to try again.
It is common for religion to be linked to a deeper search of the meaning of one’s experiences
(Hall, Reich, & Zautra, 2010). Religion gives a positive view of the stressor when a situation
does not seem understandable (Hall et al., 2010). Religion played a big part in the respondents’
resilience as it was their first resort when facing difficult situations.
Resilience from condition centers on the respondents’ resilience after experiencing stroke and
residual paralysis. This focuses on the physical and spiritual measures they have done to cope
with their illness.
The respondents engaged in physical exercises as independently as possible. Those with high
resilience described feelings of independence when being able to rely on themselves (Richardson,
2002). Without independence, the elderly express anxieties about becoming disabled, weak, and
unable to perform self-care (Richardson, 2002).
Respondents’ faith also contributes to their resilience from condition. In the Philippines,
religion remains an important factor in understanding one’s feelings and perceptions toward
sudden and unforeseen events (Bankoff, 2004). The respondents expressed anxiety and frus-
trations through prayers. These have led them to gain control in their lives and to accept their
situation.
CONCLUSION
Coping with the debilitating effects of stroke creates a spectrum of unique and interesting experi-
ences that define a poststroke patient’s self-concept, disposition, and resilience. From a natural-
istic perspective, this study is purported to explore and describe the essence of the said triad in
poststroke Filipino elderly with residual paralysis. Interestingly, two themes arose from each
variable. It has been found that corporeality and relationality depict the respondents’ self-concept
pre- and poststroke, respectively. Disposition, another variable in the study, is found to be
phylogenetic in the prestroke phase and ontogenetic in the poststroke phase. Lastly, resilience
in the prestroke phase was shown to arise from respondents’ conviction, while resilience in
the poststroke phase arose from their condition.
Despite the fact that poststroke clients are well-managed in terms of their physical condition,
there is a paucity of knowledge regarding the management of these clients’ psychological con-
ditions. Few items in the literature have explored these clients’ emotional well-being. Specifically
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are studies about the three variables vital to these clients’ emotional condition: self-concept, dis-
position, and resilience. With the incidence of stroke escalating, it is imperative for nurses to
address the issues regarding the improvement of poststroke management in the care of these cli-
ents. Athough physical well-being of poststroke patients is necessary, their emotional states
should not be overlooked. This is because emotional states affects patients’ attitudes toward
health care, compliance to treatments, and coping mechanisms. Understanding these variables
can, therefore, facilitate the development of a better, holistic care for these clients.
Cognizant of the scarcity of literature on the said variables associated with poststroke Filipino
elderly with residual paralysis, this study has successfully accounted for the essence of the self-
concept, disposition, and resilience of poststroke Filipino elderly with residual paralysis. This was
done in the context of pre- and post-stroke phases of patients’ lives with an interview as the main
tool and mask-painting as the lens. This study has also strengthened previous studies regarding
the importance of understanding the psychological effects of stroke in care management.
This phenomenological inquiry suggests that further investigations be made in terms of under-
standing elderly respondents’ emotional well-being, taking into account the three variables. Future
studies should also investigate how these variables affect patients’ attitudes toward health care, com-
pliance to treatments, and coping mechanisms. Studies on the proper management of these respon-
dents’ conditions in relation to their emotional states may be pursued. Finally, investigations on how
emotional well-being affects the respondents’ physical well-being remain a research imperative.
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