Implementation of patient participation in rehabilitation: An approach caught between different ideologies.

IF 2.3 4区医学 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Health Pub Date : 2025-10-04 DOI:10.1177/13634593251374321

Elin Margrethe Aasen, Marianne Kjelsvik, Lindis Katrine Helberget, Elisabeth Dahlborg

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Abstract

The definition of specialised rehabilitation in Europe has changed from a focus on patients' bodily functions and work tasks to a patient-centred focus prioritising patients' wishes, allowing patients to actively collaborate and set their own goals. This study aimed to explore interprofessional healthcare teams' discursive practice regarding the implementation of patient participation in specialised rehabilitation units in Norway. Data were collected from three focus groups with seven different health professions, totalling 18 healthcare professionals. A corpus-assisted critical discourse analysis outlined by Fairclough was used to analyse the data. Three interdiscursive discourses based on different and opposing ideologies were found: (1) the discourse of standardisation, in which healthcare professionals used international models for rehabilitation goal setting; (2) the discourse of interprofessional experts, in which healthcare professionals constructed themselves as experts; and (3) the discourse of patient responsibility, in which the patients were constructed as having rights and autonomy. The sociocultural practice of implementing patient participation in specialised rehabilitation in Norway highlighted a hegemonic struggle between standardisation; paternalistic and autonomy ideologies; ethical dilemmas between healthcare professionals' knowledge and use of standardised goals; and patients' autonomy, knowledge, and will.

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病人参与康复的实施：一种夹在不同意识形态之间的方法。

在欧洲，专业康复的定义已经从关注患者的身体功能和工作任务转变为以患者为中心，优先考虑患者的愿望，允许患者积极合作并设定自己的目标。本研究旨在探讨跨专业医疗团队在挪威专业康复单位实施患者参与的话语实践。数据来自七个不同卫生专业的三个焦点小组，共18名卫生保健专业人员。使用费尔克劳提出的语料库辅助批评语篇分析来分析数据。基于不同和对立的意识形态，发现了三种话语间话语：(1)标准化话语，卫生保健专业人员使用国际模式来制定康复目标；(2)跨专业专家话语，医疗专业人员将自己构建为专家；(3)患者责任话语，其中患者被建构为拥有权利和自主权。在挪威实施病人参与专门康复的社会文化实践突出了标准化之间的霸权斗争；家长式和自治意识形态；卫生保健专业人员的知识和使用标准化目标之间的伦理困境；病人的自主权，知识和意志。

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来源期刊

Health Multiple-

CiteScore

4.90

自引率

0.00%

发文量

期刊介绍： Health: is published four times per year and attempts in each number to offer a mix of articles that inform or that provoke debate. The readership of the journal is wide and drawn from different disciplines and from workers both inside and outside the health care professions. Widely abstracted, Health: ensures authors an extensive and informed readership for their work. It also seeks to offer authors as short a delay as possible between submission and publication. Most articles are reviewed within 4-6 weeks of submission and those accepted are published within a year of that decision.