title: Contradictions in client-centred discharge planning: through the lens of relational autonomy.
abstract: BACKGROUND
  While client-centred practice has received wide support, it remains difficult to apply in many practice settings. Identified barriers include constraints on time, resources, and services imposed by healthcare policies. Healthcare professionals' prioritizing of client safety over (other) interests that clients may name may further restrict the application of client-centred practice. Discharge planning is one area where such considerations can conflict.
  
  
  OBJECTIVE
  This paper presents a secondary analysis of data examining the process of discharge in one Canadian rehabilitation setting. It examines how discourses of client-centred practice and of prioritizing safety were reflected in discharge planning with older adults and considers the implications of potential conflicts between these discourses.
  
  
  METHODS
  Taking a critical bioethics perspective informed by relational autonomy theory, microethnographic case studies were used to examine discharge planning from the perspectives of older adult clients and healthcare professionals.
  
  
  RESULTS
  Healthcare professionals interpreted client-centred practice to require abiding by client wishes, as long as this was safe; furthermore prioritizing safety took precedence over other considerations in discharge planning.
  
  
  CONCLUSIONS
  Client-centred practice was not promoted in discharge planning processes in the research setting. Applying a relational autonomy lens to practice could promote approaches that better facilitate client-centred practice.
authors.affiliation: School of Physical and Occupational Therapy, Faculty of Medicine, McGill University , Montréal, Québec , Canada.
authors.forename: Evelyne
authors.initials: E
authors.lastname: Durocher
authors.forename: Elizabeth Anne
authors.initials: EA
authors.lastname: Kinsella
authors.forename: Carolyn
authors.initials: C
authors.lastname: Ells
authors.forename: Matthew
authors.initials: M
authors.lastname: Hunt
mesh_terms: D000368:Aged; D001675:Bioethics; D002170:Canada; D005260:Female; D006282:Health Personnel; D006801:Humans; D008297:Male; D009788:Occupational Therapy; D010351:Patient Discharge; D061214:Patient Safety; D018802:Patient-Centered Care / Q000379:methods*; D026684:Personal Autonomy
keywords: critical bioethics; ethical tensions; feminist bioethics; microethnographic case studies; patient safety