What even is client centred?

The term "client-centred" or "person-centred" or "patient-centred" is supposed to mean that the one receiving health care is the one directing their own experience. But sometimes it's hard. Can we always make it possible?

[clientcentredness]

Coordination of Care - Family goals

When on placement there were meetings that coordinated different services related to the child in the school system: OT, PT, SLP, Teacher and EA, Principle (or vice principle) and the parents (both if possible). At these meetings the overall family goals were established: goals that would be universal through all the interventions given to the child. And even though the parents were always involved, the child was never present at the meetings. Additionally, all the professionals (OT’s included) could only work within the limits of the school system and then within their funding and time limitations - so sometimes what could be done was restricted. Is this what it means to be client centered? 

[clientcentredness]

Ugh. 

With all the talk of health care being patient-centred, these things still infuriate me. Clothes can tell a lot about a person, but I’m pretty sure these gowns only serve to remove any sense of personhood. I understand that it’s the most efficient way for health care workers to examine their patients and remove all extra tasks patients have to do, like removing pants to poop. 

I guess the rationale for these things makes sense. You want to make things as easy as possible for everyone involved. But there’s just so many assumptions that come with wearing a gown. Any things that defined you seem to get stripped away: your history, your personality, your knowledge, and even sometimes your personal problems. It feels like it doesn’t matter  whether you have a mysterious headache, or a dozen failing organs -everyone just looks like a blue bag.

[clientcentredness]

Want to do vs. Need to do vs. Expected to do

Working in supportive housing, clients only had one common space aside from a smoking area outside. This area was used to sit on couches, watch TV and listen to music. Most of the time staff would stay in their office “respecting the living space of the residents.” This created a lack of opportunity for clients in their environment to take part in any meaningful activities. There was no clear therapeutic value in such an environment and an obvious need for recreation/structure. However, given the staff’s perspective on this situation and a lack of funding, client’s were instead left to fend for themselves. Institutionalization and dependence seems to take over. Is this what client’s wanted to do? Needed to do? Should they be expected to do more? 

[clientcentredness]

Too many cooks

Working in a community setting, I witnessed a scenario where it was said a client was “to be moved” at the end of the month. With one week to go, the client had still not been informed. When the client’s worker came in for a meeting he was furious to have not been informed and advocated that his client was not ready for the move and succeeded in halting the process. Nevertheless, I was shocked by the lack of info relayed to one another because of how convoluted the system is. With too many cooks, messages that can completely turnover someone’s life get lost in translation.

[medicalstate]

The Bleed

"Unhook me from these machines. I am going home now and not a moment later."

More than an hour before, I stood by the bedside and watched as the team worked furiously to resuscitate him. Esophageal varices, a cluster of severely dilated and pressurized veins, had been slowly brewing within him over his many years of alcoholism. With the tension of its walls reaching the breaking point, the time bomb had exploded in a torrential gush of blood.

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[clientcentredness]

Client Centred Hospital

During my placement I had a client who was ALC, waiting for long-term care. Unfortunately, due to her poor physical health, she was unable to cope at home alone, however, she was cognitively intact. She craved social interaction and was always feeling bored in her room on the medical floor. After completing a COPM interview with her, I was aware of her interests, and made all effort to see her needs met! I contacted the recreation team to ensure she was included in all events and activities in the hospital. Personally, I made time to see her everyday so we could work on pole transfers, practice her one-arm drive wheel chair, and even complete jigsaw puzzles - all of which were goals she expressed, making her treatment and intervention 100% client centred. 

[clientcentredness]

in home care

During my placement experience I witnessed a great example of ‘client-centered’ care. While at the Hospital I was placed in an outpatient Geriatric Assessment Intensive Network, where frail elderly patients would come to receive support and care from a geriatrician and the allied care. One patient was limited in her mobility and unable to leave her house in order to attend her appointment. During this occasion the team decided it would best to visit the client’s house to complete the appointment. The client was touched that the team was willing to visit her in her home and the in home context facilitated a thorough and relevant assessment. Yay client-centered care!  

[psych-quotes]

What matters is not how the counselor assesses the client but the client’s self-assessment. From a person-centered perspective, the best source of knowledge about the client is the individual client.

Client-Centered Therapy (via psych-quotes)