Cherry Russell, Maureen H. Fitzgerald, Peter Williamson, Debra Manor, Samantha Whybrow; Independence as a Practice Issue in Occupational Therapy: The Safety Clause. Am J Occup Ther 2002;56(4):369-379. doi: 10.5014/ajot.56.4.369.
Download citation file:
© 2017 American Occupational Therapy Association
This article reports findings from interviews that explored the meanings occupational therapists attach to independence as a value and a therapeutic goal in interactions with elderly clients. Through a historical review of the literature, we trace the changing use of this term and identify two analytically distinct concepts associated with it: independence as self-reliance in activity and independence as autonomy, self-determination, or choice. We show how the latter has emerged in contemporary service contexts to represent an ideal of client-centered practice for persons with chronic disabilities, such as frail elderly clients. Using a “critical incident” interview approach with 12 Australian occupational therapists, we identified the therapists’ explicit and implicit understandings of independence as a value concept and practice issue. Our findings suggest that a mismatch often exists between idealized and practice-based talk about independence and that therapists narrativize this opposition around what we call “the safety clause.” That is, therapists invoke concerns about safety and duty of care as a caveat to implementing their independence ideals and justifying the retention of professional control. We identify key issues that therapists need to address if the rhetoric of independence-related client-centered practice is to be achieved in reality.
This PDF is available to Subscribers Only
For full access to this pdf, sign in to an existing account, or purchase an annual subscription.