An ethnographic study of Acquired Brain Injury survivors: Meaningful occupation and recovery in the acute setting

Abstract

Evidence suggests early activity-dependent experiences post brain injury can support neuroplastic regeneration and reorganisation of the brain for improved functional recovery. It is imperative that this early phase of recovery includes opportunities for meaningful occupation in a motivating environment. Hospitals embody a complex system of cultural symbols and actions yet this cultural influence on Acquired Brain Injury (ABI) recovery has been poorly researched in general acute UK hospitals. The aim of this study was to explore how hospital culture influenced the experience of meaningful occupation and recovery for ABI survivors. As an interpretivist study, symbolic interactionism provided the theoretical framework for an ethnographic methodology. Methods of data collection included 144 hours of participant observation on the wards of a general hospital in Northwest England and twenty-three semi-structured interviews. Participants were purposively selected adults admitted following an ABI, and their significant others. Data were analysed using Reflexive Thematic Analysis. Three themes were constructed from the data: Occupation disconnect ‘too much and too boring’; A way of ‘being’ in hospital; Acceptance ‘that’s how it is’. An overarching theme also captured an umbrella concept: Hospital is the wrong place for recovery. Hospital culture has encompassing tendencies, a characteristic of total institutions, stifling person-centred care and limiting opportunities for ABI survivors to experience meaningful occupations resulting in occupational injustice and adaptive coping strategies that are not beneficial for recovery. This is of great concern during a critical period of neuroplastic brain recovery. Recommendations for policy and practice include expedited discharge from the acute hospital because current cultural processes do not facilitate recovery. Furthermore, this study recommends enhanced training for healthcare staff to optimise acute ABI recovery through embedding person-centred care and opportunities to engage in occupation for health and activity-dependent neuroplasticity. Practical changes on the wards are recommended such as providing clocks, televisions and changing intrusive call bell systems. Greater attention is needed to facilitate circadian rhythm to improve sleep as an occupation integral to brain injury recovery.