Abstract
This six-year qualitative study examines morning routines of persons with chronic disabilities. The focus of year six was on nighttime habits impacting morning routines. Semistructured interviews were conducted and analyzed using cross-case analysis and grounded theory. Results show night habits are used to manage pain, stiffness, or fatigue the next morning and to manage timeliness. It is critical for OTs to understand morning routines and how nighttime habits impact these routines.
Primary Author and Speaker: MaryEllen Thompson
The purpose of this study is to examine the morning routines of persons with chronic disabilities. Study has been conducted over six years. The focus of the current year’s data collection was on night time habits that impact morning routines. Focus evolved from findings in previous years’ data analysis. Review of literature foundlittle research available on morning routines of adults with chronic disabilities and most research on nighttime routines related to insomnia and sleep hygiene. As most occupational therapists will address ADLs and IADLs completed as part of a morning routine, it is critically important they have a thorough understanding of what a morning routine involves and related night time habits.
Qualitative design using cross case analysis and grounded theory was used for purposes of data collection and analysis. Criteria for selecting participants was the existence of chronic disability involving either physical or mental health or both. Students in a master’s level research contribution class recruited a participant known to them to be 18 years or older and having a chronic disability. A total of 36 participants with chronic disabilities and 10 without chronic disabilities have been interviewed and results analyzed over the six year period.
Semi-structure interviews using participant-generated photographs were conducted by student researchers after specific training in this type of data collection. This year’s interviews included specific prompts regarding night time habits. Students transcribed their participant’s interview and coded data using in vivo analysis and making marginal remarks for reflection. The team (consisting of primary researcher and student researchers) reviewed all interviews and coding. Follow up questions were relayed to participants as needed. Content of each case was examined across cases for similarities and differences with secondary coding developed. Interviews and coding were further examined for fit with previous themes and possible emergence of new themes.
Previous themes found in data included: ADLs; IADLs; Objects (common and medical); Temporal Context; Physical Environment; Motivations; and Pleasurable Additions. Analysis of current results showed that within the theme of Temporality, preparation at night was primarily for purposes of managing pain, stiffness and/or fatigue the next morning. Other subthemes within night time temporality included: Gathering and placement of objects; Medication management; managing the need for an extended routine; and Seasonal changes. Persons who needed to get to work or school could not afford extended time for their morning routines, so added to their night time habits accordingly. Review of previous themes in light of the new data resulting in the reconfiguring of themes to include: Activities (Medical, Basic Care, Common); Objects (common and medical); Temporal Context, Physical Environment; and Meaningfulness.
Morning routines show similar components regardless of disability. However, adults with chronic disabilities often need more time and objects than others. Night time habits are incorporated to help manage this extended need for time (showering, dressing at night, gathering needed objects) and/or to manage aspects of their disability that cause them to need more time (pain and/or stiffness). It is vital for occupational therapists to understand components of morning routines as well as how night time habits impact those routines when working with clients with chronic conditions. Additionally, acute care clients with newly acquired disabilities may need assistance in developing new habits and routines that will allow them to resume their everyday life.
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