Experiences of a novel, role-based approach to goal setting in inpatient brain injury rehabilitation: eight event-focused case studies

Background/Aims Despite goal setting being a common component of brain injury rehabilitation, there has been little exploration of its implementation in practice settings. The aim of this study was to explore perspectives and experiences of people with severe acquired brain injury, their significant others and their key workers about goal setting in an extended brain injury rehabilitation setting. Methods A series of descriptive, event-focused case studies using semi-structured interviews were conducted. Within and across case thematic analysis was used to explore the experiences and perspectives of key stakeholders of goal setting in an extended inpatient rehabilitation setting. Results Participants included eight people with brain injury, their six family members and six allied health and nursing professionals. Two themes were identified: what is done to carry out person-centred, collaborative goal setting, and the multiple mediating factors that influence person-centred goal setting practice. Factors mediating person-centred, collaborative goal setting included complexity and time for goal setting and key worker attributes, family involvement, collaborative teamwork, the goals and a range of factors related to the person. Conclusions The role-based goal setting approach was broadly perceived as positive and facilitated collaborative, person-centred goal setting. Challenges were highlighted related to complexities of goal setting, time commitment, and a range of person factors impacting on the engagement of people with acquired brain injury in the process. Findings highlight strategies to facilitate person-centred, collaborative goal setting. Implications for practice Targeted approaches to goal setting are needed in extended brain injury rehabilitation settings. A collaborative team approach is integral to fostering person-centred goal setting in extended brain injury rehabilitation settings. Because of the importance of family involvement in goal setting, allied health professionals should consider strategies to enable inclusion, such as flexible options to enable attendance at meetings and regular communication. Targeted training and ongoing supervision in collaborative, person-centred goal setting practices is required to develop and maintain clinician confidence and competence. Alignment of key worker clinical expertise with patient needs is recommended to enhance person-centred goal setting practices. Services considering implementing role-based goal setting should include organisational support for clinicians to allocate time and support to develop or change required processes (e.g. documentation) and structures (i.e. team meetings), training for new staff and ongoing training to ensure sustainability (e.g. rotating staff, staff turnover).