Occupational therapists and physiotherapists weighing up the dignity of risk for people living with a brain injury: Grounded theory

Purpose Following a brain injury survivors may have physical, or cognitive changes or behaviours which bring safety risks into play when engaging in activities. Therapists experience tensions in enabling the dignity of participation in the context of managing risk. Materials and methods Ten occupational therapists and seven physiotherapists participated in a grounded theory study utilising semi-structured in-depth interviews to explore the tensions between dignity and management of safety risks. Data were analysed using constant comparative method and a process of moving from open coding to categories to theory development. Results The process of weighing up was central to the therapists’ approach to supporting dignity while managing risk. Respecting dignity itself is placed at risk when preventing harm is weighted higher than living a full life. Therapists who use weighing up as a process that respects dignity place greater value on the principles of respecting autonomy and promotion of justice for people with a brain injury. Conclusion Rather than taking control and attempting to minimise risk therapists who privilege the perspective of the client, and provide opportunities for learning through failure or success, enable clients to live a full life. IMPLICATIONS FOR REHABILITATION * Ensuring that clients with brain injury are safe often requires therapists to exercise control and remove agency thus removing the rights of the client to the dignity of risk and living a full life. * Providing opportunities within rehabilitation for clients to experience failure and success enables learning and thereby support dignity. * Privileging the client perspective provides clients the dignity of living a normal life