Cerebrovascular disease (CVD) is a condition that develops as a result of problems with the blood vessels supplying the brain. The most common type of CVD is a stroke, which There are two main types of, Ischaemic and Haemorrhagic (MedicalNewsToday, 2017). Scotland has a high prevalence of the risk factors associated with CVD such as smoking, high blood pressure, poor diet, lack of exercise and alcohol consumption rates above recommended limits (NHS, 2017). There are approximately 4,500 deaths in Scotland every year where CVD is the underlying cause. In the Scottish health survey 2015, 2.6% of both men and women reported that they had experienced a stroke (Scottish Goverment, 2016). Ischaemic strokes are the most common, they occur when a blood clot blocks the flow of blood and oxygen to the brain. These clots form in areas where arteries have been narrowed or blocked over time by fatty deposits. Strokes are common amongst older people as arteries can naturally narrow, however, many things can accelerate the process. Haemorrhagic strokes are less common and occur when a blood vessel within the skull bursts, bleeding into and around the brain, the main cause of hemorrhagic stroke is high blood pressure, which can weaken the arteries in the brain making them prone to split or rupture (NHS Choices, 2016). Stroke is the second biggest killer in the world and the number one cause of complex disability (Stroke.org, 2015).Within conflict theory, there are a number of health disparities created by class, the poor are more likely to experience illness caused by poor diet as well as living and working in an unhealthy environment (Crossman, 2017). In 2014-15, around 940,000 people (18%) were living in poverty in Scotland (Scottish Goverment, 2016). Living in poverty can bring with it many external stressors, such as poor health, lack of work and financial difficulties. Throughout medicine, “stress” is one of the most common patient complaint (Dimsdale, 2010). In cardiology, complaints of stress take on special prominence because of the links between the brain and heart (Heart Math Institute, 2016). Living with chronic, long-term stress contributes to a large number of stroke risk factors. Stress hormones increase blood pressure, and blood sugar levels, potentially leading to diabetes, atherosclerosis, and heart disease – which are all stroke risk factors, smoking is also a common coping mechanism for dealing with stress and is a leading cause of stroke (Flint Rehab, 2015). The physiological model of stress is concerned with the bodies reaction to stress. In the book, The Stress of Life Hans Seyle states that: “stress is the non-specific response of the body to any demand made upon it” (Selye, 1984, p. 200). Seyle, discovered through experiments that a variety of different stimulants applied intensely and for long enough are capable of producing common effects. He called this response pattern “General Adaption Syndrome” (My Tutor, 2016). Seyle identified 3 stages of response to stressful situation. Stage1: alarm, if stress is not removed – stage2: resistance, then if stress is not removed – stage 3: exhaustion. If this cycle continues, the body can no longer resist the stress due to a lack of energy. The body stops adapting to stress which can result in serious long-term illness or death (Gutenberg, 2002). “stress reactions use up a lot of the bodies recourses, so the body can’t devote the same amount of effort to fighting off disease and illness” (Hayes, 1993 page 400).For my therapeutic activity, I will attempt to play dominoes with a patient who has suffered a stroke. This activity has been discussed with the physiotherapists, speech and language therapist and senior nurse in charge of the ward. It was agreed that this activity would be suitable and beneficial to a stroke patient by all parties. A stroke can change the life of a healthy individual very quickly, removing their ability to carry out basic tasks (Saebo, 2015). It often affects dexterity in the hands, and can also affect speech. I will be using Roper, Laughlin, and Tierney’s holistic approach to treating and assisting people as it is appropriate for this activity. Their approach combines 12 activities of daily living (ADLs) with 5 determining factors creating the basis for a care strategy (Kindly Care, 2017). To independently perform ADL’s, you need good hand function. Hand therapy can help to regain function that translates directly into everyday activities such as buttoning up a shirt or eating. The aim of this activity is to help the client regain some of the dexterity in their hands by practicing to grip move and balance the dominoes pieces. I also hope to build the clients confidence with speech through active conversation over a period of time under non-stressful circumstances. in order to carry out the therapeutic activity, I would require a table, a set of dominoes and a period of time to complete the activity un-interrupted. There are certain risks that could be associated with this activity, the level of movement required may be too hard for the client or at least too difficult at the time. They may also struggle to communicate with me. This could lead to feelings of low-self-esteem or an unwillingness to participate in future rehabilitation activities. The client may not enjoy board games or could feel that playing a game with a student nurse is degrading. My responsibility in the process is to make an attempt to pursue a therapeutic relationship with the client before carrying out the activity, helping them to feel comfortable around me and enabling them to be an equal partner in their healing process. A therapeutic relationship is defined as:”a purposeful, goal orientated relationship, that is directed at advancing the best outcome for the client” (Registered Nurses’ Association of Ontario, 2006 p10). “It is a relationship based on effective communication that incorporates caring behaviour (Pullen, 2010). Simple things such as introducing myself, shaking the patient’s hand and using their name can quickly establish trust and respect. I will attempt to build a therapeutic relationship with my client by using the time I spend taking Observations, carrying out personal care or simply being around the ward getting to know them and allowing them to get to know me whilst maintaining professional boundaries. I will treat them respectfully and make sure they are involved in any care I carry out with them. I will Attempt to actively listen when they try to communicate with me. Before carrying out the activity I will talk to the client and ask if they want to take part, ensuring that dominos is a good choice or if the client has another preference. I will fully discuss the process and benefits of the activity with the client, as well as giving clear guidance throughout. When carrying out the activity I will speak slowly without complicated language so the client is able to understand me and engage fully. I will also leave enough time for the client to process and respond to questions. After the activity, I will record any progress made in their care notes as well as discussing it with the people relevant to their care. This is an activity that can be undertaken daily either with a carer, family member or friend. If the activity appears to successfully improve the client’s skills, or bring enjoyment, it is something that can easily be continued for as long as it benefits them, the game can be changed but the therapeutic effects will be the same. In the event that my original therapeutic activity is not possible, due to difficulty level or unwillingness to participate, I will attempt to carry out a meditation exercise with the client. The aim of this exercise would be to relieve stress and tension, as stress can be a contributing factor to ill health, especially stroke symptoms. I would require a private noise-free space in order to carry out this activity, a period of time without disturbance and possibly a music player and headphones so that relaxing sounds or a step by step meditation could be played for the client. It may not be possible to find the right space to carry out this activity in, or the client may not feel comfortable once carrying out the activity which could actually raise levels of stress and discomfort. My role in this process would be to gain consent from the client and others relevant to their care. I should make sure there is a good trusting relationship between myself and the client as meditation can be very personal. I would discuss different methods of meditation to ensure that the one most suited to their personal preference is being carried out. I would also make a record of success by asking the client to rate how they feel on a scale of 1-10 after the activity. Mediation is something that can be done daily or whenever it is felt necessary and should be continued as long as the client feels the benefit of it. Meditation tapes make it possible for the client to go through the process alone or even whilst in the hospital with headphones on.