Competing discourses as barriers to change in rehabilitation nursing: a discourse analysis

Front. Rehabil. Sci., 2023 · DOI: 10.3389/fresc.2023.1267401 · Published: December 12, 2023

Patient Experience Nursing Research Methodology & Design

Simple Explanation

This article explores challenges in changes resulting from an action research (AR) study investigating nurses’ possibilities to facilitate patient participation in a Danish rehabilitation unit for patients with spinal cord injury. The study highlights the contrast between the ideal of patient-centered care and the reality of task-driven routines in rehabilitation settings. The research identifies two competing discourses: a biomedical discourse (focus on physical aspects) and a biopsychosocial discourse (holistic approach). The nurses favored the latter but were constrained by the former due to organizational structures.

Study Duration

2 years

Participants

Eight nurse co-researchers, patients at a Danish rehabilitation center for spinal cord injury

Evidence Level

Original Research, Discourse Analysis, Action Research

Key Findings

1
Nurses found it difficult to incorporate patient perspectives due to organizational structures that prioritize task-based routines.
2
The study identified a conflict between a biomedical discourse, which emphasizes physical training and efficiency, and a biopsychosocial discourse, which values patient dialogue and holistic care.
3
Engaging patients in dialogue led to better understanding, motivation, and individualized rehabilitation, but required time and space not readily available within the existing system.

Research Summary

This study explores the challenges in implementing patient participation in a rehabilitation unit, despite new insights from an action research project. It identifies competing discourses – biomedical and biopsychosocial – as barriers to change. The research highlights how organizational structures, driven by a biomedical approach, often prevent nurses from fully adopting a biopsychosocial approach that prioritizes patient dialogue and holistic care. The study concludes that achieving genuine patient participation requires a shift in organizational culture, resource allocation, and a mutual understanding among all professional groups to embrace the biopsychosocial approach.

Practical Implications

Organizational Redesign

Healthcare organizations should allocate dedicated time and resources for patient-nurse dialogue to facilitate a biopsychosocial approach.

Interprofessional Collaboration

Foster a collaborative team environment where all health professionals understand and value the biopsychosocial model in rehabilitation.

Discourse Awareness

Promote critical awareness of dominant discourses within healthcare settings to challenge and reorganize practices that hinder patient-centered care.

Study Limitations

1
The study is limited by its focus on a single rehabilitation center in Denmark, which may not be generalizable to other settings.
2
The data analysis relies on the interpretations of the researchers, potentially introducing subjective bias.
3
The action research data was collected between 2016 and 2018, and the healthcare landscape may have evolved since then.

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