Risks with Older Adults in Acute Care Settings: Occupational Therapists' and Physiotherapists' Perceptions

By Atwal, Anita; Wiggett, Claire et al. | British Journal of Occupational Therapy, September 2011 | Go to article overview

Risks with Older Adults in Acute Care Settings: Occupational Therapists' and Physiotherapists' Perceptions


Atwal, Anita, Wiggett, Claire, McIntyre, Anne, British Journal of Occupational Therapy


Introduction

In the United Kingdom (UK), health care policy advocates that patients should have more control in health care decision making (Department of Health 2005). Although this policy is welcomed by most health care professionals, it brings with it new challenges for therapists. One of these challenges is balancing older adults' risk taking, rights, autonomy and empowerment with issues of preventing potential harm associated with these risks (Moats 2006, Taylor 2006).

Risk taking is an accepted part of everyday life, even though it may be associated with an increased chance of sustaining an injury (Gurney 2000, Turner et al 2004). It is no wonder that the management of risk with clients has been found to cause uncertainty and anxiety among professionals. Indeed, one of the reasons for professionals being risk averse may be because risk is closely linked to accountability and blame (Alaszewski and Horlick-Jones 2002). The term 'risk aversion' refers to the 'manifestation of people's general preference for certainty over uncertainty, and for minimising the magnitude of the worst possible outcomes to which they are exposed' (Kolakowski 2011, p204). Thus therapists need to control and manage risk, and to use risk assessment to 'evaluate the chance of an undesired outcome' (Bowling and Ebrahim 2001, p5). Douglas (1992) viewed risk as a strategy for dealing with perceived dangers and was keen to ascertain and explore why some dangers are seen as presenting risks while others are not. This author suggested that anger, hope and fear were part of most risky situations.

In professional practice, one way of managing difficult decisions associated with risk is through referral and assessment (Huby et al 2004). Another strategy that may be used is the use of risk assessments, which occurs in all aspects of practice; for example, in the manual handling of loads, the prevention of pressure sores and discharge planning. Risks need to be documented in relation to health and safety requirements and the risk situations that therapists face in daily practice.

Because the management of risk may be problematic, frameworks have been published in the UK (Department of Health 2007, 2010) to guide clinicians to manage risk in practice. However, diverse professionals assess and manage risk with older adults, and personal experience as well as group (or team) membership have been acknowledged as influencing risk taking and management (Mitchell and Glendinning 2008). One reason for the need for increased guidance is that risk can create conflict due to its subjectivity (Tulloch and Lupton 2003). Reich et al (1998) also suggested that subtle forms of persuasion commonly occur when professionals unconsciously present discharge options in a biased and subjective manner.

Taylor (2006) explored health professionals' perspectives of risk and decision making regarding the long-term care of older adults, incorporating 19 focus groups and nine semi-structured interviews from four community health and social services in Northern Ireland. The participants were multidisciplinary and included occupational therapists, social workers, community nurses, medical staff, managers, care managers and members of discharge support teams. The findings from this research highlighted how professionals relied upon work experiences and informal learning through colleagues to guide their approach to risk. Clemens and Hayes (1999) suggested that each professional in a team may have different perceptions and/or tolerance of risks, which reflect the values of the individual. Clark (2000) also identified differences between the perceptions of risk of professionals, people with dementia and their carers. The professionals emphasised the physical and environmental aspects of safety, but maintaining self-identity and interpersonal relationships were more important to people with dementia and their families.

In the acute health care setting, a grounded theory study of physiotherapy practice from the United States (US) found that the main focus of physiotherapy practice was on patients' mobility and safety, which were integral to discharge planning (Masley et al 2011). …

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