Client-centred discharge planning? Occupational injustice brought to light through the lens of relational autonomy

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... [ view full 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.
Methods: Taking a critical bioethics perspective informed by relational autonomy theory, we used microethnographic case studies to examine discharge planning processes in one Canadian rehabilitation setting from the perspectives of older adult clients and healthcare professionals. This paper presents a secondary analysis of this data in order to examine how discourses of client-centred practice and of prioritizing safety were reflected in discharge planning with older adults and consider the implications of potential conflicts between these discourses.
Results: The results indicated that healthcare professionals interpreted client-centred practice to require abiding by client wishes, as long as this was safe. Healthcare professionals and older adults alike described as important - in relation to their home - values such as being comfortable and having familiarity with one’s own space, as well as having the capacity to participate in occupations that were meaningful to them. In the practice of discharge planning, however, prioritizing safety took precedence over other considerations like values around home, and therefore client-centred practice was often compromised.
Conclusion and Implications for Practice: Applying a relational autonomy lens to practice could promote approaches that better facilitate client-centred practice in discharge planning.