Independence as a practice issue in occupational therapy: the safety clause

Area of Science:

• Gerontology
• Occupational Therapy
• Health Services Research

Background:

• Independence is a core value and goal in occupational therapy for elderly clients.
• The concept of independence has evolved, encompassing self-reliance and autonomy.
• Client-centered practice ideals emphasize autonomy and choice, particularly for those with chronic disabilities.

Purpose of the Study:

• To explore occupational therapists' understandings of independence as a value and therapeutic goal.
• To investigate the practical application of independence ideals in therapy with elderly clients.
• To identify barriers to achieving client-centered independence in practice.

Main Methods:

• Qualitative study using critical incident interviews.
• 12 Australian occupational therapists were interviewed.
• Analysis of explicit and implicit understandings of independence.

Main Results:

• A discrepancy exists between idealized independence and its practice.
• Therapists frequently invoke safety and duty of care concerns (the "safety clause").
• The "safety clause" justifies professional control and limits client autonomy.

Conclusions:

• Achieving client-centered independence requires addressing the conflict between ideals and practice realities.
• Therapists must navigate safety concerns while promoting client autonomy.
• Strategies are needed to bridge the gap between independence rhetoric and actual practice for elderly clients.