Scholars since the 19th century have focused on the provision of care in group homes and have demonstrated that structure (that is, the staff, facilities, and equipment), is critical in the delivery of care. The researchers, however, advocate doing for, rather than doing with the clients the activities that address the clients' welfare. The purpose of this study is to investigate how a client-centered approach would affect the quality of care delivered to the mentally challenged individuals (MCIs) in a group home. The study employed the quality-care framework in which the emphasis is on structure (skills), process (efficiency), and outcome (results). The research questions examined operational values underpinning company sanctioned work processes, how personal values underpin work processes of the direct caregivers, configuration of personal values the caregivers believe should be supported in the group home context, and how critical incidents shaped the value set of direct caregivers in regard to care processes. Using structured questionnaires and observing staff as they delivered care to their clients, data were collected from participants who were direct caregivers (n = 7), a facility administrator, and a nurse. The data were coded, categorized, and analyzed for emergent themes. The results of the analysis indicated that there was discord between staff and the organizational leadership. This discord could be improved through increased interaction between the mentioned stakeholders. The results further depicted that client-centered care may have a positive impact on the health of the MCIs that would enable the MCIs to make notable contributions to social change.

Syftet med litteraturöversikten var att beskriva kunskapsläget vad gäller arbetsterapeutiskt hemrehabilitering vid stroke med fokus på klientcentrering. Metoden som använts under litteraturöversiktens gång bygger på 10 artiklar hämtade från fyra databaser inriktade på arbetsterapi och rehabilitering; PubMed, CINAHL, AMED och PsycINFO. Författarna har granskat de valda artiklarna, identifierat likheter och skillnader i resultatet som resulterade i tre kategorier. Resultatets kategorier blev; Hemmiljöns betydelse för den klientcentrerade rehabiliteringen, klientens delaktighet under den klientcentrerade hemrehabiliteringen och det sociala nätverkets påverkan på den klientcentrerade hemrehabiliteringen. Resultatet visar på att hemmiljön vid rehabilitering efter stroke har stor betydelse för klienten och den fortsatta rehabiliteringen i hemmet. Klientens delaktighet vid rehabiliteringen är viktig för att rehabiliteringen ska bli så bra som möjligt och för att få effektiva resultat. Anhöriga och andra personer runt klienten är viktiga för rehabiliteringen efter stroke. Slutsatsen som författarna kom fram till var att det behövs rutiner för att trygga klienter vid hemrehabilitering. Utbildning och information till anhöriga måste säkerställas. Klienters känsla av delaktighet i rehabiliteringen behöver stärkas. Ytterligare forskning på hemrehabilitering och klientcentrering i samband med stroke behövs.

<p><strong>Introduction:</strong> Client-Centred Care (CCC) is emerging as a best practice in health care organizations around the world. Partnerships between patient, family, and health professionals in planning and delivery of health care services are known to improve outcomes and satisfaction with care. Studies report lack of understanding of the elements involved in creating this partnership, and identify the need for valid and reliable measures of client-centredness for adults</p> <p><strong>Objectives:</strong> 1) To explore the historical evolution and current state of CCC as these were used in adult health care settings; 2) to evaluate the performance of the adapted MPOC for Adults (MPOC-A) and MPOC-SP (A) as measures of client-centredness from the perspectives of adult clients and their HCPs, respectively; and 3) to develop an in-depth understanding of health professionals’ and clients’ experiences of engaging in CCC.</p> <p><strong>Methods: </strong>A narrative review was completed to explore the development and conceptualization of CCC. Two validation studies looked at psychometric properties of the Measure of Processes of Care for Adults (MPOC-A) in orthopedic surgery and in-patient neurological rehabilitation settings, and the Measure of Processes of Care for Service Providers working with Adults (MPOC-SP (A)) in in-patient neurological rehabilitation programs. A qualitative study using Grounded Theory methodology explored experiences of CCC, barriers, and supports to developing successful partnerships from patients’, families’, and health care professionals’ perspectives.</p> <p><strong>Results: </strong>The narrative review presented theoretical conceptualizations and definitions of CCC and identified areas that needed further development, e.g., clinical implementation of CCC principles into adult health care, development of valid and reliable outcome measures for adult clients, etc. In the validation studies, good to excellent internal consistency and moderate to good correlations between domains supported internal reliability of the tools. Results of confirmatory factor analysis of MPOC-SP (A) supported the original multi-dimensional structure of the tool.</p> <p>Being on common ground was the main category identified by both clients and HCPs in the qualitative study. All participants repeatedly highlighted the importance of good communication and information flow among all the parties.</p> <p><strong>Conclusions: </strong>The MPOC-A and MPOC-SP (A) will be useful in assisting with program evaluation and quality control. The qualitative components of this study will help to improve our understanding of attributes of programs and health professionals that clients consider important for good quality care, and will provide some practical recommendations for clinicians on implementation of CCC into practice.</p> / Doctor of Rehabilitation (RhD)