Implementing a client-centred approach in rehabilitation: an autoethnography

Abstract

Purpose: Client-centred practice is widely considered a key element of rehabilitation.However, there is limited discussion of how it should be implemented. This study explored how client-centred practice was operationalised during a clinical trial of innovative goalsetting techniques.Method: This study drew on principles of co-autoethnography. The personal experiences of three clinical researchers were explored to identify insights into client-centred practice, and seek understanding of this within the broader socio-cultural context. Data were collected through group discussions and written reflections. Thematic analysis and coding were used to identify the dominant themes from the data. Results:The primary way that client-centred practice was operationalised was through listening in order to get to know, to uncover and to understand what was meaningful. Four strategies were identified: utilising mindful listening, allowing time, supporting clients to prioritise what is meaningful and viewing the therapists' role differently.Conclusion: Whilst technical competence in rehabilitation is important, our study suggested a starting point of 'being with' rather than 'doing to' may be beneficial for engaging people in their rehabilitation. We have highlighted a number of practical strategies that can be used to facilitate more client-centred practice. These approaches are consistent with what clients report they want and need from rehabilitation services.

The Encounters and Challenges of Ethnography as a Methodology in Health Research

“…This might be indicative of the fact that the value of fieldwork is not acknowledged in existing health studies (Bright et al, 2012;Braaf, Manias, & Riley, 2014;Carroll, Iedema, & Kerridge, 2008;Gustafsson, Kristensson, Holst, Willman, & Bohman, 2013). From the studies in Table 2, it becomes apparent that health researchers use the most convenient form of ethnography to explore a particular phenomenon.…”

“…This may be viewed as a positive aspect of modern ethnography, as ethnography is becoming more manageable as a methodology, which may reflect modern research standards and demands. It is evident that new forms of ethnographies used in health research studies (such as Bright et al, 2012) do not incorporate a wide range of conventional ethnographic features and often result in less time spent in the field. Furthermore, ethnographers are no longer in surroundings that are neither geographically distant nor unknown.…”

“…Recent studies in health research have used a wide range of advance techniques to collect data such as DVD, video recordings (Liu, Manias, & Gerdtz, 2012;McCabe & Holmes, 2013), and picture/snapshots (Gates, Lackey, & Brown, 2001). Further, journal entries (White & Seibold, 2008), written reflections of the participants' experiences (Bright, Boland, Rutherford, Kayes, & McPherson, 2012), and reflexive focus groups (Liu et al, 2012) are being used as a major sources of data collection in ethnographic health research studies. The use of multiple methods enhances the trustworthiness (i.e., accuracy) of the data collected and guides the ethnographer in making decisions as the study progresses.…”

Understanding and supporting occupational therapists clinical decision-making for the management of upper limb post stoke sensory impairment

“…This is consistent with recommendations from professional groups and accrediting agencies for occupational therapists to practice from a client-centred perspective and involve the client in shared decision-making (Bright et al, 2012;Maitra & Erway, 2006). SDM is not just valuing the client's views regarding intervention preferences and goals but also the client's role in the decision-making process (Legare, Ratté, Gravel, & Graham, 2008).…”

“…Similarly, client centred care is a key element of rehabilitation and prioritising the client's story, their values and main concerns is fundamental to the process (Bright, Boland, Rutherford, Kayes, & McPherson, 2012). Thus when devising intervention plans for ULPSSI, it is important for clinicians to understand and incorporate the stroke survivor's experience and perspective.…”