What Does Autonomy Really Mean for a Person with a TBI?

Ron Broughton of Brookhaven Hospital talks about ways that healthcare providers can use flexibility to help their patients continue to make progress on a daily basis.

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I think overall the progress is slow. It depends on the individual, again. One of the things I like to talk about is with TBI, I think, success is measured sometimes in inches rather than feet. I mean, just having a good day sometimes was a pretty good outcome for that individual. On the other hand, other individuals who are more cognizant of the issues-- it kind of is an ebb and flow. But, what you're looking for is the angle, or the regression line, to continue move up to gradual improvement and continued improvement. There's going to be fluctuations up and down, but as long as we have a continual movement up, I think, is very successful. Autonomy, I think, is very, very important in the sense of allowing the individual to be a part of the treatment team themselves. And, a lot of times, any program--ours, I think, is similar to everyone else's-- in the fact that sometimes we don't grant that from day to day. I spoke to that recently at a conference regarding the day to day autonomy and expression and the individual's capacity to express themselves. Unfortunately, sometimes the model is that they don't know what's best because they have a brain injury, and we know what's best because we're the professionals. When, in fact, that could be argued from moment to moment and situation to situation. If someone's in an aggressive, acting-out behavior, then they're probably not cognizant, nor have the capacity to make a decision in relation to their treatment. On thee other hand, if you can de-escalate them from that behavior, and speak to them and offer them alternatives, and present the information in a way-- I usually talk in terms of analogy-- trying to say the same thing over and over again in different ways until you see the light in the individual's eyes come on, and they begin to get what you're talking about. So, what I'm saying is in the expression of autonomy, it is important for us to say things in different ways, as professionals, and not just stick to our old model of this is our treatment program-- this will work for you--trust and believe us--we're the professionals. One example--the other day when I watched a nurse who was giving a medication, and the patient refused their medication. So, the nurse attempted to tell the patient, "It is time for your medication. It's 9:00. That's the prescribed time. Let's take, it." The patient refused--adamantly refused. It created kind of a verbal outburst, and then the patient stomped away angry and didn't receive their medication. You think about that logistically, and you think, "Okay. Well, I understand that it was supposed to be given at 9:00," but is there going to be a problem giving it at 10:00 or 9:30? And, go back and try and, again, not get stuck in that rigid viewpoint of the the time of medication administration. Ironically, that will work because if the person has been overwhelmed and frustrated via that interaction, and you give them time to calm down. Then, come back and approach it in a different way, and say, you know, for example, "Now that I see you're calmed down, what are your thoughts about medication for you today?." As opposed to, "It's time for your medication--here."
Posted on BrainLine November 7, 2012. Reviewed December 25, 2017.

Produced by Victoria Tilney McDonough and Erica Queen, BrainLine, and Dan Edblom.