Community occupational therapists' professional reasoning processes when considering positive risk-taking for individuals with traumatic brain injury

Date of Award


Document Type

Thesis - ECU Access Only


Edith Cowan University

Degree Name

Master of Medical and Health Science by Research


School of Medical and Health Sciences

First Supervisor

Mandy Stanley

Second Supervisor

Libby Callaway


Introduction: Participation in meaningful occupations can be limited due to a range of risks and safety concerns following traumatic brain injury (TBI). Research has shown that positive risk-taking, an approach that embraces risk whilst enabling choice and control, has led to positive client-centred outcomes. However, there is no literature available to support the application of or guide the professional reasoning processes for positive risk-taking for occupational therapists working in the field of community TBI practice.

Objectives: Describe occupational therapists' profession reasoning processes when facilitating positive risk-taking with community dwelling adults with TBI.

Method: A qualitative descriptive research design was employed to gather the reflections of eight experienced Australian-based occupational therapists working in community TBI practice (experience ranging from 8 – 32 years). Semi-structured in-depth interviews and vignettes were used to elicit information about professional reasoning and risk, Transcripts were analysed thematically.

Findings: Participants provided rich descriptions of the perceived challenges faced by occupational therapists when attempting to support participation in meaningful occupations whilst balancing safety concerns with community-dwelling adults with a TBI. Themes included red flags and perceived responsibility for safety; mutually accepted performance expectations and safety parameters; team and family consensus upon an acceptable level of risk; and the occupational therapist’s willingness to embrace risk. A combination of professional reasoning processes were utilised to foster positive risk-taking for individuals with TBI, including a range of practical strategies to navigate risk of harm whilst also promoting choice and control with community-dwelling adults.

Conclusion: This study research has contributed new knowledge, and appears to be the first Australian-based study to investigate the professional reasoning processes utilised to embrace positive risk-taking by community occupational therapists. A significant ethical dilemma was highlighted, as occupational therapists expressed concerns about litigation, in the event of an injury whilst supporting a client’s engagement in valued roles and routines that exhibited some form of risk. Whilst acknowledging an element of risk is to be expected in everyday life, this exploratory study has begun to fill the evidence gap in relation to positive risk-taking, and provides practical guidance to help promote choice and control in the presence of safety concerns for adults with TBI. Further research is required to develop guidelines for practice to improve outcomes for people living with TBI.



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