A Mixed Methods Study of the Experience of Transition to the Community of Working-Aged People with Non-Traumatic Brain Injury

Abstract

Background and aims: The 'transition' phase from hospital to home following brain injury is well established as a critical period of adjustment for individuals and their families. There is, however, a lack of knowledge about the experience of transition following nontraumatic brain injury (e.g., stroke, aneurysm) for individuals of working age. The purpose of this study was to explore the transition experiences of individuals with nontraumatic brain injury using mixed methods approach. Methods: Six individuals with nontraumatic brain injury were recruited from a larger study using maximum variation sampling criteria. Individuals participated in semistructured interviews at 6-months postdischarge and completed quantitative measures of psychosocial outcomes predischarge and at 6-months postdischarge. Results: Qualitative content analysis of interviews identified three themes: (1) changes in role performance, (2) support and services and (3) coping with life after brain injury. The transition experience was characterised by loss of valued roles including driving and work, identified as major barriers to regaining independence postdischarge. Informal support provided by family and friends were relied on, while formal supports were accessed infrequently. Life post-injury presented a number of challenges including adjusting to changes in physical and cognitive abilities and a fear of reinjury. Qualitative data were supported by an overall trend of improved functioning on the quantitative measures over the 6 months. Conclusions: Key life circumstances of working age adults with nontraumatic brain injury influence the transition experience. Clinically, the findings support the need for individualised, structured transition services pre-and postdischarge for this group.

Qualitative case studies of professional-level workers with traumatic brain injuries: A contextual approach to job accommodation and retention

“…For example, research suggests that, given the effects of TBI, some workers lose confidence in their ability to satisfy job demands [3,5]. This lack of confidence may explain why one of the participants was concerned that others might think he was not doing a good job.…”

“…The potential for a lack of fit between a person and a job is obvious in any review of TBI symptoms, which include cognitive difficulties (e.g., memory, reading, listening, organizing, and reasoning difficulties), emotional issues (e.g., problems with depression, anger management, and anxiety), physical effects (e.g., headaches, speech problems, lack of coordination, and fatigue), and psychosocial problems (e.g., feeling misunderstood, being bullied or teased, and being perceived by others as malingering or not performing consistent with capabilities [2,5,7]. Most people with TBI are employed at the time of their injuries, but only 31 percent are employed one year later [8].…”

“…The intervention combines: (a) an assessment of areas of incompatibility between worker abilities and job demands and (b) development of a job accommodation plan to increase worker productivity [5,6]. As Muenchberger et al [3] noted, without rehabilitation interventions, adults with TBI are easily overcome by the unpredictability of their symptoms and the ensuing self-doubt that is one of the primary reasons for their high post-injury unemployment rates.…”

Investigating the transition to home experience for people with mild stroke: the mild stroke transitional experience in Australia

“…It has been identified that this population experiences difficulties that only become apparent when they begin to reintegrate into daily living and the associated complex activities (Tellier & Rochette, 2009). This time from acute hospital discharge back to home and community life can be identified as the transition period and for people with mild stroke it is one of the most influential times in the recovery continuum (Hall, Grohn, Nalder, Worrall, & Fleming, 2012). This is because it is a time in which their perceptions of themselves are challenged as difficulties emerge, resulting in a need to develop new routines and accept ongoing changes (Glass & Maddox, 1992;Goodman, Scholssberg, & Andersson, 2006;Hall et al, 2012).…”

“…This time from acute hospital discharge back to home and community life can be identified as the transition period and for people with mild stroke it is one of the most influential times in the recovery continuum (Hall, Grohn, Nalder, Worrall, & Fleming, 2012). This is because it is a time in which their perceptions of themselves are challenged as difficulties emerge, resulting in a need to develop new routines and accept ongoing changes (Glass & Maddox, 1992;Goodman, Scholssberg, & Andersson, 2006;Hall et al, 2012). Difficulties experienced by this population span all domains of human functioning including: cognition, physical functioning and emotional well-being, consequently impacting the completion of daily activities (Taule & Råheim, 2014).…”