The micro-politics of caring: tinkering with person-centered rehabilitation

Abstract

Purpose: In this paper, we critically investigate the implementation of person-centered care with the purpose of advancing philosophical debates regarding the overarching aims and delivery of rehabilitation. While general agreement exists regarding person centered care’s core principles, how practitioners reconcile the implementation of these principles with competing practice demands remains an open question.

Materials and methods: For the paper, we drew on post-qualitative methods to engage in a process of “diffractive” analysis wherein we analyzed the micro-doings of person-centered care in everyday rehabilitation work. Working from our team members’ diverse experiences, traditions, and epistemological commitments, we engaged with data from nine “care events” generated in previous research to interrogate the multiple forces that co-produce care practices.

Results: We map our analyses under three categories: scripts mediate practice, securing compliance through “benevolent manipulations”, and care(ful) tinkering. In the latter, we explore the notion of tinkering as a useful concept for approaching person centered care. Uncertainty, humility, and doubt in one’s expertise are inherent to tinkering, which involves a continual questioning of what to do, what is best, and what is person centered care within each moment of care. The paper concludes with a discussion of the implications for rehabilitation and person-centered care.

Implications for rehabilitation

• Determinations of what constitutes good, better, or best rehabilitation practices are inevitably questions of ethics.

• Person-centered care is promoted as good practice in rehabilitation because it provides a framework for attending to the personhood of all engaged in clinical encounters.

• Post-critical analyses suggest that multiple interacting forces, conditions, assumptions, and actions intersect in shaping each rehabilitation encounter such that what constitutes good care or person-centered care cannot be determined in advance.

• “Tinkering” is a potentially useful approach that involves a continual questioning of what to do, what is best, and what is person-centered care within each moment of care.

Keywords:

• Professional–patient relations
• ethics
• postmodernism
• critical thinking
• qualitative research

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Acknowledgements

We would like to thank the study participants from the original studies for their time and contributions, and the following collaborators: Bhavnita Mistry, Patty Thille, Thomas Abrams, Laura McAdam, Donya Mosleh, Linda Worrall, David Antiss, Suzie Mudge, Duncan Babbage, Kara Dennison, Peter Larmer, and Kath McPherson. Barbara Gibson is supported by the Bloorview Kids Foundation Chair in Childhood Disability Studies. Jenny Setchell is supported by an NHMRC Early Career Fellowship. This research was supported by grants from the Health Research Council of New Zealand and the AMS Phoenix Project.

Disclosure statement

The authors report no conflicts of interest.

Notes

1 The Centre for Person Centred Research (PCR) at Auckland University of Technology is an interdisciplinary research centre focussed on 'rethinking rehabilitation'. The core principle underpinning PCR research is person-centredness, which informs the focus of inquiry and how research is conducted. https://cpcr.aut.ac.nz/

2 To protect confidentiality, we have not provided the practitioner’s discipline.

Additional information

Funding

Barbara Gibson is supported by the Bloorview Kids Foundation Chair in Childhood Disability Studies. Jenny Setchell is supported by an NHMRC Early Career Fellowship. This research was supported by grants from the Health Research Council of New Zealand and the AMS Phoenix Project.