Independence as a practice issue in occupational therapy: the safety clause.

Full Abstract

This article reports findings from interviews that explored the meanings occupational therapists attach to independence as a value and a therapeutic goal in interactions with elderly clients. Through a historical review of the literature, we trace the changing use of this term and identify two analytically distinct concepts associated with it:
independence as self-reliance in activity and independence as autonomy, self-determination, or choice. We show how the latter has emerged in contemporary service contexts to represent an ideal of client-centered practice for persons with chronic disabilities, such as frail elderly clients. Using a "critical incident" interview approach with 12 Australian occupational therapists, we identified the therapists' explicit and implicit understandings of independence as a value concept and practice issue. Our findings suggest that a mismatch often exists between idealized and practice-based talk about independence and that therapists narrativize this opposition around what we call "the safety clause." That is, therapists invoke concerns about safety and duty of care as a caveat to implementing their independence ideals and justifying the retention of professional control. We identify key issues that therapists need to address if the rhetoric of independence-related client-centered practice is to be achieved in reality.

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Author information

Author/s: Russell, Cherry (C); Fitzgerald, Maureen H (MH); Williamson, Peter (P); Manor, Debra (D); Whybrow, Samantha (S);

Affiliation: School of Behavioural and Community Health Sciences, Faculty of Health Sciences, The University of Sydney, Lidcombe, New South Wales, Australia. C.Russell(-atsign-)cchs.usyd.edu.au

Journal and publication information

Publication Type: Journal Article; Research Support, Non-U.S. Gov't

Journal: The American journal of occupational therapy. : official publication of the American Occupational Therapy Association (Am J Occup Ther), published in United States. (Language: eng)

Reference: -2002 Jul-Aug; vol 56 (issue 4) : pp 369-79

Dates: Created 2002/07/19; Completed 2003/01/03; Revised 2007/11/15;

PMID: 12125826, status: MEDLINE (last retrieval date: 11/6/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Humans
Interviews as Topic
Occupational Therapy - methods
Patient-Centered Care
Personal Autonomy
Safety

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