Risk in Occupational Therapy Practice
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Occupational therapists working with older adults in discharge planning are often working with patients who have multiple co-morbidities and complex social needs impacting on functional abilities. The combination of a national policy to reduce hospital stays and admission to long term care, combined with family anxiety, and health professionals who are not trained to manage risk taking has created pressures and uncertainties around discharge planning for older people. The aim of this research was to explore how occupational therapists understand and negotiate risk taking in discharge planning with older adults and their families. This research was positioned within social constructionist epistemology and used a qualitative descriptive methodology. Participants were occupational therapists working in acute settings who are regularly involved with patient discharges. Data collection included focus groups and follow-up interviews with key informants. Data analysis utilised an inductive approach to produce three primary themes: acknowledging risk, looking into how risk is a part of occupational therapy practice; working with the risky discharge, looking at the unique tools occupational therapists have, the impact of discharge pressures, risks for therapists and working with a team; and patients, families and risk, looking at the barriers occupational therapists face in discharge planning with families, and the sharing of knowledge to reduce fears. One of the key findings was that risk is a part of everyday life, but that it impacts on people in different ways depending on their previous experiences, knowledge and its current social context. This makes risk an undeniable part of occupational therapy practice. Working in discharge planning for older adults involves consideration of not only the patient’s wishes, but understanding how they view risk and whether the potential benefits in the patient’s view outweighs the potential for an adverse event. Acute services for older adults is an area of practice that is often construed as suitable for new graduate therapists. However, this study identified that new graduates do not necessarily identify real risks and support should be provided specifically in relation to identifying and discussing risk and risk viewpoints with patients and their families. This research further suggests that there is potential for occupational therapists not only to recognise but to make use of the positive aspects of risk and its potential positive impact on quality of life.
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