The micro-politics of caring: tinkering with person-centered rehabilitation

Abstract

Purpose: In this paper, we critically investigate the implementation of person-centered care with the purpose of advancing philosophical debates regarding the overarching aims and delivery of rehabilitation. While general agreement exists regarding person centered care's core principles, how practitioners reconcile the implementation of these principles with competing practice demands remains an open question. Materials and methods: For the paper, we drew on post-qualitative methods to engage in a process of "diffractive" analysis wherein we analyzed the micro-doings of person-centered care in everyday rehabilitation work. Working from our team members' diverse experiences, traditions, and epistemological commitments, we engaged with data from nine "care events" generated in previous research to interrogate the multiple forces that co-produce care practices. Results: We map our analyses under three categories: scripts mediate practice, securing compliance through "benevolent manipulations", and care(ful) tinkering. In the latter, we explore the notion of tinkering as a useful concept for approaching person centered care. Uncertainty, humility, and doubt in one's expertise are inherent to tinkering, which involves a continual questioning of what to do, what is best, and what is person centered care within each moment of care. The paper concludes with a discussion of the implications for rehabilitation and person-centered care. ä IMPLICATIONS FOR REHABILITATIONDeterminations of what constitutes good, better, or best rehabilitation practices are inevitably questions of ethics. Person-centered care is promoted as good practice in rehabilitation because it provides a framework for attending to the personhood of all engaged in clinical encounters. Post-critical analyses suggest that multiple interacting forces, conditions, assumptions, and actions intersect in shaping each rehabilitation encounter such that what constitutes good care or personcentered care cannot be determined in advance. "Tinkering" is a potentially useful approach that involves a continual questioning of what to do, what is best, and what is person-centered care within each moment of care. ARTICLE HISTORY

Returning to work or working on one’s rehabilitation: Social identities invoked by impaired workers and professionals in health care and employment services

“…These findings tap into the recognised complexities in applying a person‐centred philosophy in rehabilitation practice (Gibson et al, 2020), especially its involvement of patients and their perspectives and the ability to meet the requirements as developed by patients (Jesus et al, 2019). When professionals, despite considering an injured person’s life circumstances, prioritise the healing perspective inherent in the patient role rather than putting weight on the healing power of returning to work, they ignore both impaired peoples’ anti‐discrimination rights to reasonable adjustment and a possible resource in the rehabilitation process.…”

How congruent is person-centred practice with labour activation policy? Person-centred approach to vocational interventions on immigrant jobseekers in Norway

“…Indeed, even though 'activation' aims at inclusion through work and contribution to society, it may in fact generate social exclusion instead: first, by guiding and nudging a person towards a decision considered appropriate by the social worker, or by making the decision on her or his behalf instead of encouraging self-determined choice and assisting in pursuing it (Gibson et al, 2019;van Hal et al, 2012). Second, by failing to assist those who are unable to articulate their needs or ask for help when they need it (van Hal et al, 2012).…”

From rehabilitation to ultrabilitation: moving forward

“…From the University of Toronto, Barbara Gibson and her Canadian, Australian and New Zealand colleagues, Gareth Terry, Jenny Setchell, Felicity Bright, Christine Cummins and Nicola Kayes [32], move forward the debate on the aims and delivery of rehabilitation. To consider how flourishing through good rehabilitation can be coproduced, these authors construct rehabilitative practice as micro-acts of person-centred care (PCC).…”