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Open Access Expanding the Dialogue on Dementia: (Re)Positioning Diagnosis and Narrative Élargir le dialogue sur la démence: (Re)positionner le diagnostic et le récit

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The biomedical model that guides the processes of assessment and diagnosis of dementia is based on assumptions and approaches which, while critical to medicine, may render them less consequential for nursing. Although gerontological nurses' research concerning dementia frequently uses the diagnosis as an inclusion criterion for projects, and screening tools are often employed to evaluate the impact of interventions, we may wish to consider expanding our views of assessment and evaluation to include the person's narrative. The purpose of this paper is to argue for this expanded dialogue and to suggest that nurses reposition the medical diagnosis behind the narrative of the individual patient. To that end, this paper explores and critiques the limitations of the diagnostic process and questions its relevance to nursing. The alternative considerations that are discussed include constructionist and interpretivist approaches, the exploration of assumptions, and a relational approach to supporting personhood.

Le modèle biomédical qui oriente les processus d'évaluation et de diagnostic de la démence est fondé sur des hypothèses et des approches qui, bien qu'essentielles sur le plan médical, peuvent diminuer l'importance de ces processus pour les soins infirmiers. Même si la recherche du personnel infirmier en gérontologie sur la démence utilise fréquemment le diagnostic comme critère d'inclusion pour les projets et bien que les outils de dépistage soient souvent utilisés pour évaluer l'impact des interventions, il serait peut-être bon de penser à élargir nos points de vue sur les évaluations pour y inclure le récit du patient. Ce document prend position en faveur de cet élargissement du dialogue et propose que le personnel infirmier repositionne le diagnostic médical pour tenir compte du récit du patient. Dans cette optique, le document examine et critique les limites du processus de diagnostic et met en doute sa pertinence pour les soins infirmiers. Les autres facteurs qui sont abordés sont notamment les approches constructioniste et interprétiviste, l'exploration des hypothèses et une approche relationnelle pour soutenir l'identité individuelle.


Document Type: Research Article

Publication date: June 1, 2005

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