Acquired Brain Injury, Occupation and Recovery (ABIOAR) Version 1
Research type
Research Study
Full title
An Ethnographic Study of Acquired Brain Injury (ABI) - Meaningful Occupation and Recovery in the Acute setting
IRAS ID
309754
Contact name
Katy Cottrell
Contact email
Sponsor organisation
University of Chester
Duration of Study in the UK
1 years, 6 months, days
Research summary
Research Summary
This research aims to address the question; ‘How does hospital culture influence meaningful occupation and recovery for acquired brain injury survivors?’
Early brain recovery processes are strongest when linked to meaningful occupations in an enriched environment. Occupation refers to meaningful, purposeful and often pleasurable activities that people need or want to do for quality of life and to improve health. Engagement in occupations has been linked to improved health yet the literature tells us patients spend most of their time alone, inactive and bored with little social interaction. There is a lack of research exploring the culture of acute hospital settings from the perspective of brain injury survivors. The study aims to examine the UK hospital culture using ethnography to scrutinise behaviour, interaction, and communication and how this influences the experience of meaningful occupation.
Patients can participate if they have a diagnosis of an acquired brain injury (any damage to the brain sustained after birth), are over 18, and admitted to the hospital wards. Significant others of 6 participants will also be asked to consent to interview.
Following consent, participants will be observed on the ward over four 6 hour sessions at different times. The researcher will assist with certain routines, ask questions about daily experiences, and observe what is seen and heard on the ward, what activities are carried out and who is interacting with the participant. Documents and physical environment artefacts (medical notes, personal effects and belongings, occupational tools and possessions) will be recorded. The participant and their significant other will be asked to attend an interview with the researcher in the hospital and a follow-up interview three months after discharge. This study aims to inform recovery pathways for brain injury survivors currently spending weeks in acute hospital settings.Summary of Results
I would like to thank all the brain injury survivors and their families who participated in this study for sharing their experiences.
This study entitled, An Ethnographic Study of Acquired Brain Injury Survivors: Meaningful Occupation and Recovery in the Acute Setting, was conducted for the degree of Professional Doctorate in Health and Social Care. Course fees were funded by Countess of Chester Hospital Trust and Elizabeth Casson Trust.
Data collection took place in a general hospital in Northwest England between June 2022 and June 2023. The research was required because evidence suggests early activity-dependent experiences post brain injury can support neuroplastic regeneration and reorganisation of the brain for improved functional recovery after brain injury. It is therefore imperative that this early phase of recovery includes opportunities for meaningful occupation in a motivating environment. The cultural influence on meaningful occupation in hospital and acquired brain injury 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 acquired brain injury survivors.
The study recruited fourteen people. Adults admitted to hospital following an acquired brain injury, and their significant others engaged in participant observation on the wards of a general hospital and semi-structured interviews.
Reflexive thematic analysis of the data resulted in the construction of three themes and an overarching theme: 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.
The study concludes that hospital culture has encompassing tendencies, a characteristic of total institutions, stifling person-centred care and limiting opportunities for acquired brain injury survivors to experience meaningful occupations resulting in occupational injustice and adaptive coping strategies. This is of great concern during a critical period of neuroplastic brain recovery.
The study has helped provide recommendations for policy and practice. These include improving the discharge pathway from the acute hospital once medically well, because current cultural processes do not facilitate recovery. Development of an improved process for identifying specialist enriched placements in the community for brain injury survivors is required. Furthermore, this study recommends enhanced training for healthcare staff to optimise acute brain injury 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.
This study is being disseminated locally and regionally and will be submitted for publication. Any further information regarding the study, please contact katy.cottrell@nhs.netREC name
Wales REC 4
REC reference
22/WA/0121
Date of REC Opinion
13 Jun 2022
REC opinion
Further Information Favourable Opinion