Reflecting on challenges and opportunities for the practice of person-centred rehabilitation

Abstract

Objectives To (1) reflect on challenges to the practice of person-centred rehabilitation; and (2) propose opportunities for the development of person-centred rehabilitation. Challenges Person-centred practice has received widespread endorsement across healthcare settings and is understood to be an important, positive approach in rehabilitation. However, the rhetoric of this approach does not always translate meaningfully into practice. Emphasis on patient choice, patient involvement in decision making, and increasing patient capacity for self-management have become a proxy for person-centred rehabilitation in lieu of a more fundamental shift in practice and healthcare structures. System (e.g. biomedical orientation), organisational (e.g. key performance indicators) and professional (e.g. identity as expert) factors compete with person-centred rehabilitation. Opportunities Four key recommendations for the development of person-centred rehabilitation are proposed including to: (1) develop a principles-based approach to person-centred rehabilitation; (2) move away from the dichotomy of person-centred (or not) rehabilitation; (3) build person-centred cultures of care in rehabilitation; and (4) learn from diverse perspectives of person-centred rehabilitation. Conclusion Fixed assumptions about what constitutes person-centred rehabilitation may limit our ability to respond to the needs of persons and families. Embedding person-centred ways of working is challenging due to the competing drivers and interests of healthcare systems and organisations. A principles-based approach, enabled by person-centred cultures of care, may achieve the aspirations of person-centred rehabilitation.

‘Physical well‐being is our top priority’: Healthcare professionals' challenges in supporting psychosocial well‐being in stroke services

“…Our work suggests that addressing health professionals' experiences is imperative to enabling holistic support for people with stroke as care that supports the whole person can only take place within systems that value and uphold the well-being and personhood of all-patients, family and health professionals. 21,23,65,66 The prevailing culture of stroke care makes it challenging to support well-being, 17 and it is unsurprising that well-being is not prioritised. However, we posit that the status quo is deeply problematic for health professionals and for people with stroke.…”

“…Within the current culture of care, health professionals may manage their emotional response by focusing on the areas where they feel they have knowledge, skills and competence, doing their best in the situation. Our work suggests that addressing health professionals' experiences is imperative to enabling holistic support for people with stroke as care that supports the whole person can only take place within systems that value and uphold the well‐being and personhood of all —patients, family and health professionals 21,23,65,66 …”

“…The systems and structures that shape stroke care are known to strongly influence practice 18,22 . The prevailing emphasis on biomedical needs, physical impairments and function, and organisational priorities of discharge 22 are shown to present challenges in enacting person‐centred care 23 . Indeed, health professionals who have transitioned into roles outside medically dominated systems of care report a sense of freedom and flexibility to engage with people, to actively listen and engage in interactions that support well‐being 24–26 .…”

“… 18 , 22 The prevailing emphasis on biomedical needs, physical impairments and function, and organisational priorities of discharge 22 are shown to present challenges in enacting person‐centred care. 23 Indeed, health professionals who have transitioned into roles outside medically dominated systems of care report a sense of freedom and flexibility to engage with people, to actively listen and engage in interactions that support well‐being. 24 , 25 , 26 Rather than assuming that health professionals are solely responsible for not addressing well‐being, it is critical to examine how the contexts of care shape practice and how this impacts on how well‐being is addressed within stroke services.…”

A general theory of rehabilitation: Rehabilitation catalyses and assists adaptation to illness

“…This theory makes the patient the central, active agent in rehabilitation, not the passive recipient presupposed in biomedical healthcare. The theory requires services to be personcentred, 44 often proclaimed but not well practised, 64 because, when adapting, the person explores and learns new ways to achieve their goals. The person must be an active learner engaged in the process.…”