The Danish Center for Social Science Research.
The National Institute of Public Health, 74340University of Southern Denmark; UCSF - Center for Health Research, Rigshospitalet; University of the Faroe Islands.
Dementia (London). 2023 May;22(4):709-726. doi: 10.1177/14713012231161487. Epub 2023 Mar 15.
Rehabilitation is increasingly being introduced in dementia care but studies highlight extensive heterogeneity in practices, conceptual confusion and divergent perceptions of its relevance across care organizations and national contexts. As this have implications for development of dementia care as well as for people with dementia's access to care it is important to study the organizational narratives and practices in rehabilitation-oriented dementia care organizations.
The study build on qualitative interviews (individual and group interviews) with health professionals (N = 26) engaged with dementia care and rehabilitation in two Danish municipalities. The interviews were conducted in 2018-2019. The empirical data was analyzed using abductive analysis and theory-based narrative analysis, using Loseke's conceptualizations of and approach to analyzing formula stories.
Four dominant organizational narratives were constructed from the data. Each narrative produced a specific organizational narrative of client identity: the active participant in individualized rehabilitation, the inactive individual benefitting from enhanced social environments, the disengaging self and the vulnerable self.
Introducing rehabilitation in dementia care may amplify the organizational polyphonic and provide a plurality of organizational identities each expressing different perceptions of personhood and agency for people with dementia. The organizational narratives were negotiated within a specific structural context where national regulation and dominant discourses on economic challenges and ageing gave precedence to some narratives more than others. In Danish elder care, the first narrative is the most influential but risks excluding people with dementia. Instead, rehabilitation in dementia care is positioned within a social and relational perspective, which may silence important discussion of agency and resistance.
康复治疗在痴呆症护理中越来越多地被引入，但研究强调了实践中的广泛异质性、概念上的混淆以及在护理机构和国家背景下对其相关性的不同看法。由于这对痴呆症护理的发展以及痴呆症患者获得护理的机会都有影响，因此研究康复导向的痴呆症护理组织中的组织叙事和实践非常重要。
本研究基于与丹麦两个市的痴呆症护理和康复相关的卫生专业人员（N=26）的定性访谈（个人和小组访谈）。访谈于 2018-2019 年进行。使用 Loseke 对公式故事的概念化和分析方法，对经验数据进行了归纳分析和基于理论的叙事分析。
从数据中构建了四个主要的组织叙事。每个叙述都产生了特定的客户身份的组织叙述：个体化康复的积极参与者、从增强的社会环境中受益的非活跃个体、脱离的自我和脆弱的自我。
在痴呆症护理中引入康复治疗可能会放大组织的多音性，并为痴呆症患者提供不同的组织认同，表达对人性和能动性的不同看法。这些组织叙事是在特定的结构背景下进行协商的，国家法规和关于经济挑战和老龄化的主导话语优先考虑了一些叙事，而不是其他叙事。在丹麦老年护理中，第一个叙事是最有影响力的，但可能会将痴呆症患者排除在外。相反，将康复治疗定位在社会和关系的视角中，可能会使关于能动性和抵制的重要讨论变得沉默。
