Petriwskyj Andrea, Gibson Alexandra, Webby Glenys
The University of Queensland, UQ/ Blue Care Research and Practice Development Centre, 56 Sylvan Rd, Toowong, Qld 4066, Australia.
Blue Care, 56 Sylvan Rd, Toowong, Qld 4066, Australia.
J Aging Stud. 2014 Dec;31:119-31. doi: 10.1016/j.jaging.2014.09.007. Epub 2014 Oct 4.
Despite growing recognition in health and care services of the necessity for client engagement, it is still not easily put into practice. This is owing to a range of factors relating to participating staff and clients, as well as the broader institutional context. One of the central factors affecting client engagement is the challenge it poses to traditional power relations inherent in care relationships and contexts. This is particularly the case in aged care services, which have traditionally positioned older adults in passive roles as "recipients" of care, or as lacking capacity to participate in care decision making. This paper presents an exploration of client engagement practices within a large aged care service provider in Australia. Interviews and focus group discussions with clients and staff were analysed for the ways in which clients were positioned - by both themselves and by staff - in terms of the roles that they hold within engagement practices. Four positions were identified: "Passivity, disempowerment and bestowal of power", "Role of expert/consumer", "Resistance, compliance and manageability", and "Complexity, diversity and uniqueness". While clients were positioned at times in empowering roles, they were simultaneously limited by personal, relational, or organisational constraints, making opportunities for client engagement provisional. This reflects a tension between passive and empowered client roles in the context of aged care provision.
尽管健康和护理服务领域越来越认识到服务对象参与的必要性，但它仍然不容易付诸实践。这是由于一系列与参与的工作人员和服务对象相关的因素，以及更广泛的机构背景。影响服务对象参与的核心因素之一是它对护理关系和环境中固有的传统权力关系构成的挑战。在老年护理服务中尤其如此，传统上老年人被定位为护理的“接受者”，处于被动角色，或者被认为缺乏参与护理决策的能力。本文探讨了澳大利亚一家大型老年护理服务提供商内部的服务对象参与实践。对与服务对象和工作人员的访谈及焦点小组讨论进行了分析，以了解服务对象在参与实践中所扮演的角色，包括他们自己以及工作人员对他们的定位方式。确定了四个定位：“被动、无权和权力赋予”、“专家/消费者角色”、“抵抗、顺从和可管理性”以及“复杂性、多样性和独特性”。虽然服务对象有时被定位为具有赋权作用的角色，但他们同时受到个人、关系或组织方面的限制，使得服务对象参与的机会具有临时性。这反映了在老年护理服务背景下，服务对象被动角色和赋权角色之间的紧张关系。
