Moats Gillian, Doble Susan
Dalhousie University, Halifax, Nova Scotia.
Can J Occup Ther. 2006 Dec;73(5):303-11. doi: 10.1177/000841740607300507.
Occupational therapists are frequently involved in discharge accommodation decision making with older adults.
The literature regarding this process is reviewed. The ways in which risk avoidance and autonomy promotion philosophies influence decisions are examined and a new approach is proposed.
One approach is based on risk avoidance, where decisional control rests with professionals, but the client is left out of the process. Another is that of autonomy promotion, in which decisional control rests with the client. When risks are high, this can result in ethical dilemmas. The importance of the environment, its relationship to occupational performance, and differing interpretations of client-centred processes are important considerations.
In response to the inadequacy of models grounded in risk avoidance or autonomy promotion, occupational therapists are challenged to move toward a balanced approach to decision making with older people, grounded in partnership, shared power, and negotiation.
职业治疗师经常参与与老年人出院后的住宿安排决策。
回顾关于这一过程的文献。研究风险规避和自主性促进理念影响决策的方式，并提出一种新方法。
一种方法基于风险规避，决策控制权掌握在专业人员手中，但客户被排除在决策过程之外。另一种是自主性促进方法，决策控制权掌握在客户手中。当风险很高时，这可能会导致伦理困境。环境的重要性、其与职业表现的关系以及对以客户为中心的过程的不同解释都是重要的考虑因素。
鉴于基于风险规避或自主性促进的模型存在不足，职业治疗师面临挑战，要转向一种与老年人进行决策的平衡方法，这种方法基于伙伴关系、共享权力和协商。
