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Research Article  |   July 2002
Independence as a Practice Issue in Occupational Therapy: The Safety Clause
Author Affiliations
  • Cherry Russell, BA, PhD, is Associate Professor, School of Behavioural and Community Health Sciences, Faculty of Health Sciences, The University of Sydney, PO Box 170, Lidcombe, New South Wales 1825, Australia; C.Russell@cchs.usyd.edu.au
  • Maureen H. Fitzgerald, RN, BIS, MA, PhD, is Senior Lecturer, School of Occupation and Leisure Sciences, Faculty of Health Sciences, The University of Sydney, Lidcombe, New South Wales, Australia
  • Peter Williamson, BAppSc (Occupational Therapy), Debra Manor, BA, BAppSc (Occupational Therapy), and Samantha Whybrow, BAppSc (Occupational Therapy) (Hons), are Research Assistants, School of Occupation and Leisure Sciences, Faculty of Health Sciences, The University of Sydney, Lidcombe, New South Wales, Australia
Article Information
Geriatrics/Productive Aging / Rehabilitation, Participation, and Disability / Independence and Safety
Research Article   |   July 2002
Independence as a Practice Issue in Occupational Therapy: The Safety Clause
American Journal of Occupational Therapy, July/August 2002, Vol. 56, 369-379. doi:10.5014/ajot.56.4.369
American Journal of Occupational Therapy, July/August 2002, Vol. 56, 369-379. doi:10.5014/ajot.56.4.369
Abstract

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.