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


OBJECTIVE
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.


CONCLUSIONS
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.
Moats
Gillian
G
Rehab and Geriatrics Program, Deer Lodge Centre, Winnipeg, MB, Canada. jmoats@deer-lodge.mb.ca
D000203:Activities of Daily Living; D000368:Aged; D003657:Decision Making; D006801:Humans; D009788:Occupational Therapy / Q000379:methods* / Q000523:psychology; D010351:Patient Discharge; D010358:Patient Participation; D017060:Patient Satisfaction; D018802:Patient-Centered Care / Q000379:methods*; D011369:Professional-Patient Relations; D011788:Quality of Life