Negotiating uncertainty following a severe traumatic brain injury: Family impact and influence.

摘要

Negotiating Uncertainty is a substantive middle range theory that outlines the general pattern of concerns, experiences, and actions of family members following the severe traumatic brain injury of a close relative. Most variations within the overall pattern are explained by the injured person's trajectory of recovery, and relationships and resources within the family and the health care system. Family members go through the process of Negotiating Uncertainty both individually, and collectively, as members of a family unit.; The study was conducted using the grounded theory method of research over an 18-month period within the context of two acute care neurosurgical units, in Level 1 trauma facilities in Toronto, Canada. There were a total of 36 participants in the study: eleven individuals who were injured and 25 close family members. The data collection process included as many family members as wished to be involved. The ethnic backgrounds of the participants reflected the rich cultural and religious diversity of Toronto, the world's most multicultural city. Data were collected using a combination of strategies including formal audiotaped family interviews, clinical conversations and observations, follow-up conversations by email and telephone, observations of family meetings, and chart reviews. All interviews and field notes were transcribed.; Four phases and 13 categories were identified in the basic social process of Negotiating Uncertainty. Following the injury, there is unrelenting uncertainty concerning the process of healing and the potential for recovery. In the beginning even survival is in doubt. Later, there is uncertainty as to whether the individual will become aware of self, others, or the environment, and whether they will regain the abilities needed to process information and act independently.; As the process unfolds, there is an evolving recognition by family members that the individual will not be the same person that he/she was prior to the injury. Optimism for a full recovery declines over time. However, there is hope that the individual who sustained the injury will continue to make positive incremental gains. The support of family members is ongoing. Families, in the study, exhibited remarkable strength, resilience, and commitment to the injured relative.