Centre of Diaconia and Professional Practice/Faculty of Health studies, 87446VID Specialized University, Stavanger, Norway.
Work Research Institute, 60499Oslo Metropolitan University, Oslo, Norway.
Dementia (London). 2023 Apr;22(3):594-609. doi: 10.1177/14713012231155307. Epub 2023 Jan 30.
The traditional narrative of dementia, focused on cognition as constructive of personhood, has been challenged by person-centred care as well as a rights-based citizenship lens. However, reports of everyday discrimination leading to occupational deprivation and pathologising interpretations of people living with dementia in nursing homes highlight the need for further investigation. The purpose of this study was to investigate the transformative power of mundane and relational enactments of citizenship in nursing homes, exploring the potential of adding an activistic lens of citizenship to our interpretive practices. Through an ethnographic study in Norwegian nursing homes, a narrative analysis of fieldnotes and interview transcripts was conducted. Narratives were interpreted using narrative theory, occupational perspectives and theories of citizenship. Findings reveal a phenomenon of shared ownership between residents and staff, and a vulnerable balance between silence and active social and occupational engagement in the nursing homes. Further, they shed light on how group-based assessments of residents' abilities or occupational needs may constrain opportunities, and staffs' options, to facilitate co-ownership. We suggest that a lens of activistic citizenship implies interpreting residents' behaviours as mundane forms of subtle resistance. A professional and ethical responsibility building on such interpretive practices may turn attention towards structures that constrain residents' expressions of citizenship.
传统的痴呆叙事以认知为中心，强调认知在构建人格中的作用，但这种叙事受到了以患者为中心的护理以及基于权利的公民视角的挑战。然而，有关日常歧视导致职业剥夺的报告，以及对居住在养老院中的痴呆患者进行病理化解释的现象，突出表明需要进一步调查。本研究旨在探讨养老院中平凡而又关系性的公民实践所具有的变革力量，探索在我们的解释性实践中加入积极公民视角的可能性。本研究通过在挪威养老院进行的民族志研究，对现场记录和访谈记录进行了叙事分析。通过叙事理论、职业视角和公民理论对叙事进行了解读。研究结果揭示了居民和工作人员之间的共同所有权现象，以及养老院中沉默和积极的社会和职业参与之间脆弱的平衡。此外，研究结果还揭示了如何对居民的能力或职业需求进行群体评估可能会限制机会，以及工作人员促进共同所有权的选择。我们认为，积极公民视角意味着将居民的行为解读为微妙的抵抗的平凡形式。基于这种解释性实践的专业和道德责任可能会将注意力转向限制居民表达公民身份的结构。
