"Fluctuation is the norm": Rehabilitation practitioner perspectives on ambiguity and uncertainty in their work with persons in disordered states of consciousness after traumatic brain injury

The purpose of this study is to describe the clinical lifeworld of rehabilitation practitioners who work with patients in disordered states of consciousness (DoC) after severe traumatic brain injury (TBI). We interviewed 21 practitioners using narrative interviewing methods from two specialty health...

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Bibliographic Details
Published in:PloS one 2022-04, Vol.17 (4), p.e0267194-e0267194
Main Authors: Papadimitriou, Christina, Weaver, Jennifer A, Guernon, Ann, Walsh, Elyse, Mallinson, Trudy, Pape, Theresa L Bender
Format: Article
Language:English
Subjects:
Ambiguity
Biology and Life Sciences
Brain
Brain Injuries - rehabilitation
Brain Injuries, Traumatic - therapy
Clinical medicine
Codes
Consciousness
Consciousness Disorders - rehabilitation
Culture
Data collection
Decision making
Grounded theory
Head injuries
Humans
Injuries
Interviews
Medicine and Health Sciences
Patients
Physical therapists
Qualitative research
Recovery (Medical)
Rehabilitation
Rehabilitation Centers
Social Sciences
Speech therapists
Traumatic brain injury
Uncertainty
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Summary:The purpose of this study is to describe the clinical lifeworld of rehabilitation practitioners who work with patients in disordered states of consciousness (DoC) after severe traumatic brain injury (TBI). We interviewed 21 practitioners using narrative interviewing methods from two specialty health systems that admit patients in DoC to inpatient rehabilitation. The overarching theme arising from the interview data is "Experiencing ambiguity and uncertainty in clinical reasoning about consciousness" when treating persons in DoC. We describe practitioners' practices of looking for consistency, making sense of ambiguous and hard to explain patient responses, and using trial and error or "tinkering" to care for patients. Due to scientific uncertainty about diagnosis and prognosis in DoC and ambiguity about interpretation of patient responses, working in the field of DoC disrupts the canonical meaning-making processes that practitioners have been trained in. Studying the lifeworld of rehabilitation practitioners through their story-making and story-telling uncovers taken-for-granted assumptions and normative structures that may exist in rehabilitation medical and scientific culture, including practitioner training. We are interested in understanding these canonical breaches in order to make visible how practitioners make meaning while treating patients.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0267194