Dancing with Agency: How rehabilitation nurses seek to promote and preserve personhood following traumatic brain injury

Abstract

Traumatic Brain Injury (TBI) can alter consciousness, cognition and behaviours, threatening traditional understandings, recognition and expression of personhood during rehabilitation nursing care. This thesis presents a substantive theoretical understanding of the social processes that rehabilitation nurses engage in to promote and preserve personhood during inpatient TBI rehabilitation. Using purposive and theoretical sampling, 16 patients, 12 family members, and 39 nurses from three Australian TBI rehabilitation units were engaged in semi structured interviews, supported by field observations. Analysis followed Constructivist Grounded Theory methods, guided by symbolic interactionism and social constructionism.

Findings indicated that nurses’ main concern when aiming to promote and preserve personhood is their need to engage with multiple and demanding decision-makers encountered in their everyday practice. The subsequent Basic Social Process of Dancing with Agency explains how nurses select strategies and interact with the agency of others in delivering care. The theory of Dancing with Agency has three components. First, as nurses are protecting the body of the person, physiological integrity takes priority over promoting the personal’s agency. Second, nurses actively engage the person who is the patient to understand their personhood, promote their agency, and to encourage participation in self-care activities. Third, nurses hand over the baton, gradually ceding their own agency and expertise to support the person, family, and carers to take-back control and decision-making. Contextual factors influencing this Dance include rigid and ineffective team practices, the locked rehabilitation environment and use of restraints, and the values, beliefs and experience of the individual nurse. Rehabilitation nurses’ nuanced Dance with Agency has implications for the personhood of patients and the enactment of clinical judgement in supporting rehabilitation goals.