Qualitative Research and Client-Centred Care: A Practicum Student’s Reflection on the Impact of Personal Stories on Rehabilitation Practice
Community Rehabilitation and Disability Studies, Department of Community Health Sciences,
Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
Correspondence concerning this article should be addressed to
Email: Ilona Jones
In this piece I reflect on how my qualitative research experience as a final year Community Rehabilitation and Disability Studies student has impacted me as I prepare to study occupational therapy. I first provide a brief description of my practicum project on the symbolic meaning of material objects for people who have experienced spinal cord injury (SCI), before relating how hearing participants stories has impacted me personally and shaped my vision for my own future practice. I then synthesize my research experience with critical disability studies theory and the tension that exists between the social and medical models of disability in rehabilitation practice. Finally, I conclude with implications for client-centred care - including the importance of sharing client stories and perspectives with practitioners and the central role that qualitative research plays in this exchange.
Key Words: Client-Centred Care, Rehabilitation, Occupational Therapy, Spinal Cord Injury, Disability Studies, Practicum Student
As a student in my final year of the Community Rehabilitation and Disability Studies program, my senior practicum has provided the opportunity to consolidate the theory I learned throughout the program with the real world of research and practice. The purpose of this reflective article is to relate how my involvement in the qualitative research process has impacted me personally and prepared me for my future role as an occupational therapist. I describe my research project on the meaning of material objects for people with acquired spinal cord injury (SCI), relate how hearing the stories of participants has impacted my personally and professionally, link my research experience with disability studies theory, and conclude with implications for client-centred rehabilitation practice.
My Practicum Project
For my two hundred and sixty hour senior practicum, I have been conducting research on the symbolic meaning of material objects for adults who have experienced SCI. I have been working on this project in conjunction with and under the supervision of Dr. Jennifer Mitchell and with the support and oversight of Dr. Bonnie Lashewicz and her research team. Dr. Mitchell and I conducted a secondary analysis of data from in depth interviews with seven individuals with acquired SCI and their family support. Each participant engaged in two to three interviews that ranged from one to two hours in length. Using symbolic interactionism as our theoretical lens, we analyzed the interview data for themes that shed light on the significance of material objects in the lives of adults with acquired SCI. Symbolic interactionism emphasizes the role of objects, the meaning of things, and the relationship between individuals and objects as well as interpersonal relationships (Aksan et. al., 2009). In keeping with symbolic interactionism theory, our preliminary findings suggest that material objects are significant to the experiences of adults with SCI; there is an interrelationship between objects and people and objects are integral to identity renegotiation following SCI. For example, when participants spoke about the loss of material objects following SCI, their grief was tied to what their lost possessions represented - giving up clothing, vehicles, and houses symbolized the loss of careers and aspects of former life. Our preliminary findings suggest practitioners need to be aware of and pay closer attention to the home environment and the varied ways that material objects within the home are enmeshed with experiences of identity renegotiation and maintenance as well as experiences of loss, transition, and adjustment. Dr. Mitchell and I are approaching this topic from the perspective of a registered psychologist and a disability studies student with plans to pursue occupational therapy; as such it is our hope that this project will contribute new insights toward improving practice in the rehabilitation field.
My involvement in qualitative research through my practicum has provided a unique opportunity to hear directly from individuals with lived experience of disability and has shaped my vision for my role as a future rehabilitation professional. The aspect of my practicum that I have enjoyed the most has been the opportunity to immerse myself in the personal stories of our research participants through listening and re listening to recorded interview audio, reading and analyzing the written transcripts, and discussing findings with my supervisor. This experience has impressed upon me the importance of qualitative research work and the tremendous privilege and responsibility of sharing participants’ voices.
Hearing directly from participants through listening to interview data has broadened my understanding of what it is like to be on the receiving end of rehabilitation services and given me insight into how professionals can best support their clients. For example, multiple participants shared that they were hurt or irritated by a rehabilitation professional telling them that they understand what they are going through. Although designed to be comforting, this statement is perceived as unhelpful and untrue by recipients who know it is impossible for their able bodied therapist to fully understand their experience with SCI. However, professionals who communicated their support respectfully and with an awareness of participant’s autonomy and unique experience played a positive role in participants’ adjustment process. This is in keeping with the work of Cott (2004), who explored client-centred care from the perspective of clients themselves and found that emotional support from rehabilitation staff was identified as a vital component of client-centred care. It is the client who does the hard work of recovery, yet the support and skill of rehabilitation professionals is crucial and must be communicated in a way that is sensitive to the client’s unique experience.
Ultimately, being exposed to the personal stories and experiences of adults living with SCI has shaped my vision for my own practice as an occupational therapist. When I first began my journey toward studying occupational therapy, I remember primarily wanting to pursue a career in healthcare in order to “help” people. Although having a positive impact on others is still a significant part of why I want to be an occupational therapist, my understanding of this role has since become more nuanced. Through a combination of learning disability studies theory, interacting with a wide range of service users through practicums and projects, and experiencing chronic illness in my own life, I grew to understand that people experiencing disability are the experts of their own situation. This awareness has been further reinforced through hearing the firsthand accounts of our participants over the course of my research practicum. As an occupational therapist, I want to challenge the innate power imbalance that exists between healthcare provider and client by recognizing this expertise in my clients and orientating my practice around their priorities. I now envision my therapeutic role as a dynamic partnership between myself and my clients - working with and alongside them to find solutions that meet their unique goals. Cott (2004) defines client-centred care as “a philosophy or approach to the delivery of rehabilitation services that reflects the needs of individuals and groups of clients” before going on to highlight the need to expand “definitions of evidence that is deemed credible” to “include multiple dimensions of evidence including the expertise of the client” (p. 1411). This description of client-centred care is consistent with central tenants of occupational therapy and is the prototype of practice that I want to pursue in my own career.
Disability Studies Theory
As a Community Rehabilitation and Disability Studies student, I have sought to integrate my knowledge of critical disability studies theory with my growing awareness of the embodied experience of people living with long term disabilities such as SCI. Yoshida et al. (2016) speak of the need to approach rehabilitation practice through a critical disability studies lens - a core component of this approach is hearing and valuing the lived experience of disability that is “embedded in the social circumstances that influence ones experiences” (p. 317). Reading and conducting qualitative research that prioritizes the voices of participants is therefore crucial to fostering client-centred rehabilitation practice.
The tension between the medical and social models of disability is also worthy of consideration as it relates to client perspectives and service provision. In my research project on SCI, participants shared their struggles with accessibility and the barriers they face both environmentally and socially. The environmental barriers that participants shared consist of inaccessible design features of the built environment, but perhaps more challenging are the social barriers that arise from being treated differently because they are in a wheelchair. The social model of disability holds that the source of disability lies in the environment, while the medical model views a person’s health condition as the source of impairment. Gzil et al. (2007) discuss how achieving a person centred rehabilitation approach requires considering these opposing views of disability and clarifying the medical and non medical components of rehabilitation in order to accurately represent the complexity of disability.
In conclusion, my involvement in the qualitative research process over the course of my practicum has impacted the way I think about my future role as a rehabilitation professional and suggested broader implications for practice.
Most importantly, it has impressed upon me the necessity of hearing directly from people with lived experience of disability and allowing their perspectives to shape priorities in service provision. I was struck by the argument made by Whalley Hammell (2012) on the need to ensure that occupational therapy’s commitment to client-centred care is informed by clients themselves rather than merely functioning as a politically and professionally expedient rhetoric. Cott (2004) describes how truly client-centred care results in rehabilitation outcomes that are “meaningful and relevant to the client” and translate directly into “participation in society and everyday life” (p. 1419). Those who have personally experienced life with a disability are uniquely positioned to provide insight into the priorities and concerns of those accessing rehabilitation services. Recognizing their expertise and learning from their stories is key to the future of client-centred care in rehabilitation.
Finally, in order to achieve client-centred care that is informed by client’s themselves, client experiences must be transmitted to practitioners and qualitative research is a key conduit through which this occurs. As stated by Handley Maxwell et al. (2007) “qualitative research approaches offer rehabilitation scholars and practitioners avenues into understanding the lives and experiences of people with disabilities and those people and systems with whom they interact” (p. 99). Qualitative research that draws on people’s stories is particularly powerful and this type of research has played a key role in developing current understandings of the “complexities of disability in its social context” (O'Day & Killeen, 2002, p. 9). As I have experienced throughout my practicum, much can be learned about the nuances of living with a disability from in depth personal stories that cannot be learned through less comprehensive approaches such as surveys. There is therefore an ongoing need for further research that explores client’s stories and experiences of rehabilitation practice. My qualitative research experience during my practicum has reinforced my passion for client-centred cared and sparked my interest in contributing to best practice through further research.
Aksan, N., Kısac, B., Aydın, M., & Demirbuken, S. (2009). Symbolic interaction theory. Pro-cedia
- Social and Behavioral Sciences, 1(1), 902-904. https://doi.org/10.1016/j.sbspro. 2009.01.160
Cott, C. (2004). Client-centred rehabilitation: Client perspectives. Disability and Rehabilitation, 26(24), 1411-1422. https://doi.org/10.1080/09638280400000237
Gzil, F., Lefeve, C., Cammelli, M., Pachoud, B., Ravaud, J. F., & Leplege, A. (2007). Why is rehabilitation not yet fully person-centred and should it be more person-centred? Disability and Rehabilitation, 29(20-21), 1616-1624. https://doi.org/10.1080/09638280701618620
Hanley-Maxwell, C., Al Hano, I., & Skivington, M. (2007). Qualitative research in rehabilitation counseling. Rehabilitation Counseling Bulletin, 50(2), 99-110. https://doi.org/10.1177/00343552070500020801
O'Day, B., & Killeen, M. (2002). Research on the lives of Persons with Disabilities. Journal of Disability Policy Studies, 13(1), 9-15. https://doi.org/10.1177/10442073020130010201
Whalley Hammell, K. R. (2012). Client-centred practice in occupational therapy: Critical reflections. Scandinavian Journal of Occupational Therapy, 20(3), 174-181. https://doi.org/10.3109/11038128.2012.752032
Yoshida, K. K., Self, H., & Willis, H. (2016). Values and principles of teaching critical disability studies in a physical therapy curriculum: Reflections from a 25-Year journey—Part 1: Critical disability studies value framework. Physiotherapy Canada, 68(4), 315-318. https://doi.org/10.3138/ptc.68.4.gee2
International Journal of Disability, Community &
Volume 19, Student Perspectives