Knifton Chris, Yates Scott
De Montfort University, Leicester, UK.
J Res Nurs. 2019 Jun;24(3-4):212-230. doi: 10.1177/1744987119831737. Epub 2019 Mar 22.
Debates relevant to both undergraduate and postgraduate nurse education regarding the conceptualisation and disciplinary ownership of dementia, including its framing as a neuro-psychiatric condition, a terminal illness or a consequence of ageing, are important in supporting an understanding of the lived experience of dementia for individuals and their family carers and how, as a condition, it has come to be problematised in Western society. The work of Michel Foucault is useful in setting this debate within a critical historical context.
Using Foucault's 'history of problematizations' we present such debates around dementia's conceptualisation in Western society and consider how a Foucauldian critical historical project influences nursing education by re-examining the problematisation of dementia within society, what it is to be a person with dementia, and how alternative conceptualisations shape how we see the condition - as well as how we provide learning opportunities for dementia-care professionals.
Six differing ways of conceptualising or problematising dementia were found (as a natural consequence of ageing, a mental disorder, a bio-medical disease, a neuro-cognitive disorder, a disability and a terminal illness), each offering alternative ways we might present it in an educational context.
We argue for both undergraduate and postgraduate student nurses to engage in learning that locates what it is to be a person with dementia within particular conceptual frameworks that would allow understanding of how these ideas or constructs are reliant on historically contingent assumptions. Here, taken-for-granted assumptions are unsettled, and a more critically reflective position is adopted. This will have an impact on the type of nurse to emerge from educational institutions, thus also affecting service delivery and the dementia care provided, as well as the knock-on effects for dementia education in other medical, health and social care courses and for institutions whose role it is to approve professional practice curricula content.
关于本科和研究生护理教育中痴呆症的概念化及学科归属的争论十分重要,这些争论涉及痴呆症被界定为神经精神疾病、绝症或衰老的后果等方面,有助于理解痴呆症患者及其家庭护理人员的生活经历,以及痴呆症作为一种病症在西方社会是如何成为问题的。米歇尔·福柯的著作有助于将这场争论置于批判性的历史背景中。
运用福柯的“问题化历史”,我们呈现西方社会围绕痴呆症概念化的此类争论,并思考福柯式的批判性历史项目如何通过重新审视社会中痴呆症的问题化、作为痴呆症患者意味着什么,以及不同的概念化如何塑造我们看待这种病症的方式——以及我们如何为痴呆症护理专业人员提供学习机会,从而影响护理教育。
发现了六种不同的痴呆症概念化或问题化方式(作为衰老的自然结果、精神障碍、生物医学疾病、神经认知障碍、残疾和绝症),每种方式都为我们在教育背景中呈现痴呆症提供了不同的途径。
我们主张本科和研究生护理专业学生参与相关学习,即在特定概念框架内定位作为痴呆症患者意味着什么,这将有助于理解这些观念或构建如何依赖于历史偶然假设。在此,那些被视为理所当然的假设受到质疑,并采取更为批判性的反思立场。这将对从教育机构培养出来的护士类型产生影响,进而也会影响服务提供和所提供的痴呆症护理,以及对其他医学、健康和社会护理课程中的痴呆症教育以及负责批准专业实践课程内容的机构所产生的连锁反应。