“The final piece of the puzzle to fit in”: an interpretative phenomenological analysis of the return to employment in New Zealand after spinal cord injury

Abstract

Purpose: Little is known about employment experience after spinal cord injury (SCI) because most research to date concentrates on employment predictors. We explored the experiences of people with SCI, and vocational rehabilitation (VR) professionals working for a VR programme, in pursuing a return to employment in New Zealand (NZ) post-SCI. Methods: Twelve people with SCI (four employed, three job-seeking, five unemployed) and six VR professionals were interviewed, and the transcripts subjected to an Interpretative Phenomenological Analysis. Results: The core meaning of employment post-SCI was to live a normal life. Work advantages were social connectedness, a sense of self-worth, earning a living, and being occupied. Employment was the zenith of rehabilitation but not the first priority post-SCI. Employment barriers and facilitators were congruent with those found in similar studies. The role of VR was to sow the seeds of return to employment and to partner with the SCI client. Conclusions: For persons employed pre-SCI, we posit that employment identity modification is part of the return to employment process, alongside a supportive social context and networks, and adapted work environments. VR professionals may facilitate return to employment through understanding and fostering the process of employment identity modification and supporting clients to find work opportunities congruent with employment identity.

Implications for Rehabilitation

• Employment rates after spinal cord injury (SCI) vary considerably; the average is about 35%.

• Being employed post-SCI is a sign to self and others of living a normal life.

• For previously employed persons, adaptation of employment identity is part of the return to work process.

• Vocational rehabilitation practice can support adaptation of employment identity and help match this with work opportunities.

Keywords::

• Spinal cord injury
• employment
• work
• vocational rehabilitation
• employment identity

Acknowledgements

We particularly thank the participants who took part in the project and shared their experiences with us. We gratefully acknowledge the support we received from the Burwood Academy of Independent Living, NZ Spinal Trust, Kaleidoscope, the Auckland and Burwood Spinal Units, and the Swiss Paraplegika, Nottwil, Switzerland in the planning and implementation phases of this study.

Declaration of Interest: This research was funded by an independent grant from the Burwood Academy of Independent Living. The funder had no role in the study design, data collection, data analysis or interpretation, preparation of the paper for publication or the decision on where to submit the paper. The views expressed in this paper are those of the authors. J.H.-S., B.D., and J.N. report no declarations of interest. K.A.S. was the Western Pacific Co-ordinator for the ICF Core Sets for SCI project.

Appendix

Topics covered in interviews with participants with SCI

• Description of typical day (pre-injury, now), including: differences and similarities, pre-injury work, post-injury “occupations” or work.

• First thoughts about working again.

• Description of return to work or job-seeking process (if employed or job seeking).

• Main influences on decisions about returning to post-injury work.

• Experience with prior employer post-injury.

• Opinions of influential others about return to work post-injury.

• Interaction with Accident Compensation Corporation or Ministry of Health regarding work.

• Experience of Kaleidoscope.

• Relationship between self, Kaleidoscope and (prospective) employer (for employed or job-seeking participants).

• Current perspective on employment post-SCI.

• Sustainability of current level/type of work (for employed participants).

• Opinion of main barriers and facilitators of return to work post-injury, including what could be done about any barriers.

Topics covered in interviews with VR professionals

• Description of role and background.

• The aims of the Kaleidoscope programme.

• Description of process when a person with SCI is referred.

• Outcomes of intervention.

• Importance of return to work for persons with SCI.

• Influences on a return to work for a person with SCI, including own influence.

• Relationship between self/Kaleidoscope, person with SCI and (prospective) employer.

• Opinion of main barriers and facilitators of return to work post-injury, including what could be done about any barriers.