The provision of person-centred care in mental health care settings through recreation therapy professionals

Abstract

This manuscript-based thesis explores the complex dynamics that shape the practice of recreation therapy (RT) within mental health care settings in Western Canada, focusing on person-centred care (PCC), patient privileges, and the staffing practices of RT professionals. It aims to clarify how these factors interact to shape the quality of care and the experiences of both RT professionals and patients. In the first manuscript, a concept analysis was conducted to define and analyze the concept of PCC. This analysis identified five key attributes of PCC: care tailored to the person, active engagement, clear communication and active listening, a holistic perspective, and empathy and compassion. These findings emphasized the importance of fostering an environment that prioritizes personhood, highlighting the need for increased time with patients and the promotion of active listening. The second manuscript utilized institutional ethnography (IE) as a method of inquiry to examine how institutional practices surrounding patient privileges impact RT professionals’ work. By analyzing data from institutional texts and 18 in-depth interviews, this research revealed that institutional practices around patient privileges influence RT professionals’ ability to engage with patients and maintain therapeutic effectiveness. The study identified that variations in practices impacted patient and professional autonomy, privilege assignment, and patient attendance in RT programs. In the final manuscript, IE was used as a method of inquiry to investigate managerial structures and staffing practices that influence the work of RT professionals. Findings from this study suggest that managerial support, well-defined roles, and consistent staffing are essential to improving both the work environment for RT professionals and the quality of care provided to patients. Together, findings from these studies highlight the need for integrated approaches to mental health care that prioritize PCC, ensure clear and consistent institutional practices around patient privileges, and address staffing challenges. This thesis contributes to a deeper understanding of how organizational and relational dynamics in mental health care can be optimized to improve both patient outcomes and professional well-being.