"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.

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.

The productive partnerships framework: harnessing health consumer knowledge and autonomy to create and predict successful rehabilitation outcomes.

PURPOSE: This article examines the role of power distribution in partnerships between health consumers and professionals in determining successful desired outcomes, and the contributing role of consumer knowledge and autonomy. Recognition is given to the lack of practical tools, from both consumer and professional perspectives, to assist in the creation of productive partnerships. METHOD: A conceptual analysis of the notions of consumer knowledge and autonomy in the context of outcomes, followed by the development of a prototype framework that aims to facilitate productive health partnerships. RESULTS: The authors present prototype tools, which are shared between health consumer and professional, for identifying the strength of their cumulative power relative to their alignment to a common desired outcome (goal). The tools provide a choice of power contexts for the partnership to operate within, and a simple method for testing alignment to a common goal. CONCLUSION: Increased health consumer knowledge and autonomy is associated with improved outcomes and these can in turn be influenced through productive health partnerships. The P2 framework is one approach to establishing robust working relationships between health professionals and consumers.