Discharge decision-making, enabling occupations, and client-centred practice

Abstract

Background: Occupational therapists working in hospitals are confronted with increasingly complex discharge decisions. However, the relationship of discharge-planning strategies to the professional concepts of client-centred practice and enabling occupations has been unclear.

Purpose: This study explored the relationship between the models of decision-making used by occupational therapists, and the professional issues of enabling occupation and client-centred practice.

Methods: Qualitative interviews were conducted with 10 occupational therapists. Data were analyzed for the presence and emergence of themes.

Results: Therapists try to balance the sometimes competing issues of safety and autonomy. Therapists often engage in negotiated decision-making. However, clients are sometimes excluded, despite therapists' commitment to client-centred processes. Consideration of occupations is often neglected.

Practice implications: Client-defined models of decision-making are insufficient for frail, cognitively- impaired people. A new, client-centred Negotiated Model of Decision-Making is proposed, which facilitates decisions to enable older people with their occupations.