Improving Client-Centered Brain Injury Rehabilitation Through Research-Based Theater

Abstract

Traumatic brain injury often results in physical, behavioral, and cognitive impairments perceived by health care practitioners to limit or exclude clients' full participation in treatment decision making. We used qualitative methods to evaluate the short-and long-term impact of "After the Crash: A Play About Brain Injury", a research-based drama designed to teach client-centered care principles to brain injury rehabilitation staff. We conducted interviews and observations with staff of two inpatient neurorehabilitation units in Ontario, Canada. Findings demonstrate the effectiveness of the play in influencing practice through the avoidance of medical jargon to improve clients' understanding and participation in treatment; newfound appreciation for clients' needs for emotional expression and sexual intimacy; increased involvement of family caregivers; and avoidance of staff discussions as if clients were unaware. These findings suggest that researchbased drama can effect reflexivity, empathy, and practice change to facilitate a client-centered culture of practice in brain injury rehabilitation.

Using interactive theatre to help fertility providers better understand sexual and gender minority patients

“…Research-informed productions have been developed for the purpose of disseminating research findings to healthcare providers, students, patients and the general public on the topics of mental illness,34 41 substance use,42 breast cancer,43 ovarian cancer,44 end of life care,45 46 traumatic brain injury47 48 and Alzheimer's disease,49–51 among others 29. Indeed, of the 71 studies reviewed by Boydell et al , after photo-based methods (n=23), theatre was the most common arts-based KTE method used by health researchers (n=21) 40.…”

The intraprofessional and interprofessional relations of neurorehabilitation nurses: a negotiated order perspective

“…Identified themes did not include practices impacted by the intervention (see Kontos et al . , for intervention evaluation).…”

Grief, Anger, and Relationality

“…It is possible this is similar to the high levels of "self-monitoring" engaged in by US nurses who, in the context of managed care, opted for disengagement since resources to support emotion work were scant (Bone, 2002, p.146). In Canada, the enormity of clients' unmet rehabilitative and psychiatric needs under inadequately publicly funded rehabilitative care (Kontos et al, Forthcoming;Kontos et al, 2012) may render staff unable to incorporate grief-related emotion work given existing demands of practice. It is also possible that practitioners' suppression of empathy is, as other studies have shown, a consequence of individual-level behaviours such as compassion fatigue (Robins, Meltzer, & Zelikovsky, 2009), discipline specific training (Papadimitriou, 2008), or institutional policy directives (Kontos et al, Forthcoming).…”

“…Theatre contributes significantly to medical education because it has "a uniquely compelling emotional quality, making it difficult to avoid or intellectualize the struggles and suffering portrayed" (Shapiro & Hunt, 2003, p. 923). While there is increasing empirical support for the effectiveness of research-based drama for learning about illness and humane patient care in various clinical areas (Gray et al, 2003;Gray et al, 2000;Shapiro & Hunt, 2003), it is used with surprising infrequency in educational interventions to improve the quality of brain injury rehabilitation (for exceptions see Colantonio et al, 2008 andKontos et al, 2012).…”

“…For example, an excited new mother on a maternity ward and an aggressive psychiatric inpatient present vastly different patient-provider interactions, care burdens and rewards; these, in turn, influence the emotion work efforts required of staff (see for example Grandey, Foo, Groth, & Goodwin, 2012;Hunter, 2001). Yet the therapeutic emotion work of health care providers has yet to be fully examined in the context of traumatic brain injury (TBI) rehabilitation (for a preliminary investigation see Kontos et al, 2012). This is a significant omission given the emotional impacts of TBI on patients and their family members (Carroll & Coetzer, 2011;Kreutzer et al, 2009;Verhaeghe, Defloor, & Grypdonck, 2005), including family care partners (Dupuis & Gillies, 2014) who provide unpaid, non-professional, informal care.…”