Relatives’ strategies in subacute brain injury rehabilitation: The warrior, the observer and the hesitant

Abstract

Background: Relative involvement is crucial in rehabilitation when patients are incapable of being involved due to cognitive and functional dysfunction. However, studies have shown that this is complex because of differing understandings of the meaning of involvement as well as diverse needs to be involved. Aims and objectives: To explore the experience of the rehabilitation process from the perspectives of relatives of patients with a traumatic brain injury. The aim of the study was, through a theoretical-empirical analysis, to identify relatives’ strategies and practices in the rehabilitation process as evidenced in meetings with providers. Design: A longitudinal study with a qualitative approach, drawing on the theory of Pierre Bourdieu. Methods: Data were generated using participant observation and semi-structured interviews. Participants were eleven relatives of patients with a severe traumatic brain injury, followed through in-patient rehabilitation varying from 9–12 weeks. Analysis was undertaken using both an inductive and deductive approach. Findings: Drawing on Bourdieu's concept of strategy, three relative positions were identified, the warrior, the observer and the hesitant. These positions illustrate how different relative positions and their related dispositions influence the strategies used by relatives of patients with a severe traumatic brain injury evidenced in how they act, participate and relate to both the patient and the providers during the course of rehabilitation. Conclusions: Acknowledging the relatives’ positions during the rehabilitation process enables better understanding and support of the relatives in the rehabilitation process to meet their (and thus the patients’) diverse needs. Relevance to clinical practice: The findings have practical implications in informing how clinicians meet, interact, communicate and involve relatives of adult patients’ with traumatic brain injury in decision-making during rehabilitation.