The lived experience of return to paid work following brain injury

Introduction In Western industrialised societies and cultures paid work is valued and it is generally accepted that being in paid work is good for an individual’s health and allows them to be less dependent on others. Only one third of the brain injury population are believed to return to paid work. Those that return do not return at the same level or for the same hours and often for less pay. Paid work provides benefits such as a financial income, improved emotional wellbeing, increased self-esteem, more independence, social roles and a sense of identity. Those unable to return to paid work are more likely to have poorer general and mental health and to become depressed. Rehabilitation outcome can be viewed as successful when it results in return to paid work post injury, but the cost of rehabilitation is significant. Life expectancy following a brain injury is often unaffected and current return to paid work success in the United Kingdom is poor. The factors involved in return to paid work following a brain injury warrant exploration because of the social and financial consequences and the majority of these individuals being of working age. In this research I explored the factors which impact on the return to paid work of individuals following a brain injury with the aim of improving return to paid work rehabilitation for people with an acquired or traumatic brain injury. Method I used a qualitative, descriptive phenomenological research approach, developed by Giorgi (1985), to systematically recruit, collect and analyse data from twenty seven participants. Sixteen of the participants had experienced either a moderate to severe traumatic or acquired brain injury and had returned to paid work. Eleven of the participants were employers who had been involved in the return to paid work of similar individuals following a brain injury. All participants were interviewed face to face and their lived experiences explored with them. Descriptive phenomenological analysis of all of the data was used to establish a general situated structure and story of the phenomenon of return to paid work following a brain injury. Findings Following phenomenological analysis of the general situated structure, the deeper meaning of the phenomenon was explored using free imaginative variation, responsive reflective writing and categorial intuition. Four themes emerged from the structure: occupational needs; experiencing loss, grief and adjustment; self-identity; and social inclusion and return to the workplace. A return to paid work conceptual framework was developed from evaluation of the research findings. Discussion The emergent conceptual framework to facilitate return to paid work rehabilitation of individuals following acquired or traumatic brain injury discusses a new and different way to help these individuals, their employers, professionals and relevant others to plan and manage return to paid work following a brain injury. The framework advocates that individuals should have their occupational nature, drive and needs acknowledged and assessed. Their losses also need to be acknowledged and addressed, grief recognised as well as challenges to their self- identity. Social inclusion in the workplace needs to be promoted in addition to support provided to facilitate adjustment to injuries and selfidentity. Conclusions Current practice needs to change to prevent individuals from missing essential information about brain injury and rehabilitation. Vocational rehabilitation services would be enhanced by inclusion of assessment of occupational needs, loss and grief counselling and the provision of coping strategies to inform employers and individuals following a brain injury regarding how to manage loss and adjustment in the workplace. Addressing changes in self-identity would help individuals come to terms with their changing identity. Government legislation could also be developed that could guarantee the provision of vocational rehabilitation following a brain injury and the delivery of education to tackle discrimination and social exclusion in the workplace.