Toward an ontology of the mutant in the health sciences: Re/defining the person from Cronenberg's perspective.

Traditional health sciences (including nursing) paradigms, conceptual models, and theories have relied heavily upon notions of the 'person' or 'patient' that are deeply rooted in humanistic principles. Our intention here, as a collective academic assemblage, is to question taken-for-granted definitions and assumptions of the 'person' from a critical posthumanist perspective. To do so, the cinematic works of filmmaker David Cronenberg offer a radical perspective to revisit our understanding of the 'person' in nursing and beyond. Cronenberg's work explores bodily transformation and mutation, with the body as a fragile and malleable vessel. Cronenberg's work allows us to interrogate the body in all its complexity, contingency, and hybridity and provides avenues of rupture within current understandings of 'the person'. Reinventing the definition of what it means to be human, critical posthumanism offers opportunities to both critique humanist theories and build affirmative futurities. Also drawing on the work of Deleuze and Guattari, specifically, their concept of becoming, we propose a critical posthumanist alternative to the conceptualization of the person in the health sciences, that of the becoming-mutant, so frequently explored in Cronenberg's films. Such a conceptualization permits the inclusion of various technological interventions of the contemporary subject: The postperson. This position offers the health science disciplines a radical reconceptualization of the conceptual and theoretical approaches, extending beyond those trapped within the quagmire of humanistic principles.

Vanishing academics: On the importance of speed and becoming-imperceptible.

Under the influence of neoliberalism, academic work faces mounting pressure to align with imperatives of visibility and perceptibility. Traditionally criticised for working in isolated 'ivory towers', academics are now compelled to showcase the societal value of their work through performance metrics and evaluations. Paradoxically, these efforts have unintentionally led to the rigidification and commodification of academic work, stifling the production of knowledge beyond predefined parameters. In this paper, we contend that academics should resist the imposition of this neoliberal 'grid' and instead seek a path of 'becoming-imperceptible', drawing inspiration from the insights of Deleuze and Guattari. Becoming-imperceptible does not entail silent disengagement; rather, it represents a creative form of resistance challenging prevailing modes of assessment rooted in visibility and perceptibility. By incorporating the concept of 'fast feminism' to subvert Paul Virilio's hypermasculine speed theory, we uncover the transformative potential of temporary absences. Leveraging these moments of absence, academics can intensify their affective connections with both their peers and their work, making them undiscernible to the confines of the academic establishment. We argue that these instances of imperceptibility create fertile ground for creative and inventive academic endeavours on the margins of established boundaries, where original scholarship can flourish. Such a subversive approach is particularly relevant in fields like nursing and the health sciences, where it can challenge the dominant discourses that typify neoliberal academia.

The shiny new object: Deconstructing the patient-oriented paradigm in health sciences.

RATIONALE: A 'patient-oriented' research paradigm, also known as patient and public engagement, has infiltrated the field of health sciences and continues to spread. At first blush, it is difficult to reprove anything labelled 'patient-oriented'; however, the patient-oriented paradigm may easily become an ideological 'good', leading to unintended consequences that may well prove more detrimental than beneficial. While patient-oriented research has its roots in more radical forms of patient and public engagement, its recent instantiation betrays its roots and forecloses on more radical forms of engagement, such as critical participatory research. AIM AND OBJECTIVES: The objective of this article is to deconstruct the patient-oriented research narrative and to demonstrate how such a discourse imposes itself as a dominant approach in health sciences. APPROACH: Following Derrida's deconstructive approach, we bring to light the unexamined presuppositions, false pretences, and presumed 'goodness' and 'naturalness' of patient-oriented discourse. DISCUSSION: By deconstructing the patient-oriented narrative we demonstrate how pre-existing power structures (biomedical, economic, etc.) shape the conduct of the approach and serve to depoliticize the truly participatory aspects of research. Rather than being modelled on the evidence-based movement or seen as its natural 'evolution', patient-oriented research should resist by affirming itself as a radical form that is both participatory and emancipatory.

From domestication to imperial patronage: Deconstructing the biomedicalisation of occupational therapy.

Occupational therapy knowledge emerged in the 19th century as reformist movements responded to the industrialisation of society and capitalist expansion. In the Global North, it was institutionalised by State apparatuses during the First and Second World Wars. Although biomedicine contributed to the rapid expansion and establishment of occupational therapy as a health discipline, its domestication by the biomedical model led to an overly regulated profession that betrays its reformist ideals. Drawing on the work of Deleuze and Guattari, our aim in this article is to deconstruct the biomedicalisation of occupational therapy and demonstrate how resistance to this process is critical for the future of this discipline. The use of arts and crafts in occupational therapy may be conceptualised as a 'nomad science' aesthetically resisting the domination of industrialism and medical reductionism. Through the war efforts, a coalition of progressive nurses, social workers, teachers, artisans and activists metamorphosed into occupational therapists. As it did with nursing, biomedicine proceeded to domesticate occupational therapy through a form of 'imperial' patronage subsequently embodied in the evidence-based movement. 'Occupational' jargon is widely used today and may be viewed as the product of a profession trying to establish itself as an autonomous discipline that imposes its own regime of truth. Given the symbolic violence underlying this patronage, the future of occupational therapy should not mean behaving according to biomedicine's terms. As a discipline, occupational therapy must resist the appropriation of its 'war machine' and craft its own terms through the release of new creative energy.

[The Multi-Clientele Assessment Tool as a control mechanism in home care: A poststructuralist analysis]. / L'outil d'évaluation multi-clientèle comme mécanisme de contrôle des soins à domicile : une analyse poststructuraliste.

INTRODUCTION AND BACKGROUND: In Quebec (Canada), the Multi-clientele Assessment Tool (Outil d'évaluation multi-clientèle, OEMC) profoundly transformed the practice of home care professionals (HCP), including nurses. Since 2015, all home care patients with a completed OEMC have been counted to assess the performance of services. If performance targets are not reached, funding renewal is threatened, exerting pressure on HCPs. OBJECTIVE: The objective of this article is to review the OEMC's implementation in order to understand its political nature and its impacts on the practice of HCPs and patients' lives. MATERIAL AND METHOD: Drawing on the works of Michel Foucault and Gilles Deleuze, we propose a poststructuralist analysis of OEMC documents. RESULTS: Shifting from disciplinary societies to societies of control, the OEMC insidiously contributes to the regulation of home care services as well as patients' lives. The will of HCPs to apply their field of expertise is in opposition with the OEMC's purposes. DISCUSSION AND CONCLUSION: To not complete the OEMC when it is deemed unnecessary would require a negotiation by HCPs. However, HCPs' autonomy is compromised by discourses repressing all forms of resistance.

L'outil d'évaluation multi-clientèle comme mécanisme de contrôle des soins à domicile : une analyse poststructuraliste.

INTRODUCTION AND BACKGROUND: In Quebec (Canada), the Multi-clientele Assessment Tool (Outil d'évaluation multi-clientèle, OEMC) profoundly transformed the practice of home care professionals (HCP), including nurses. Since 2015, all home care patients with a completed OEMC have been counted to assess the performance of services. If performance targets are not reached, funding renewal is threatened, exerting pressure on HCPs. OBJECTIVE: The objective of this article is to review the OEMC's implementation in order to understand its political nature and its impacts on the practice of HCPs and patients' lives. MATERIAL AND METHOD: Drawing on the works of Michel Foucault and Gilles Deleuze, we propose a poststructuralist analysis of OEMC documents. RESULTS: Shifting from disciplinary societies to societies of control, the OEMC insidiously contributes to the regulation of home care services as well as patients' lives. The will of HCPs to apply their field of expertise is in opposition with the OEMC's purposes. DISCUSSION AND CONCLUSION: To not complete the OEMC when it is deemed unnecessary would require a negotiation by HCPs. However, HCPs' autonomy is compromised by discourses repressing all forms of resistance.

The (dis)obedient occupational therapist: A reflection on dissent against disciplinary propaganda / O terapeuta ocupacional (des)obediente: uma reflexão dissidente contra a propaganda disciplinar

Abstract Introduction Despite struggling to establish itself as an autonomous profession, occupational therapy remains extensively regulated and controlled by discursive authorities inside and outside the discipline. After overcoming the profession's reformist ideals, the military governance that supported its rapid expansion morphed into civil institutions but both were based on similar grounds: occupational therapists should obey a strict set of rules while disobedience and dissent are consistently repressed or silenced. Objective The objective of this article is to deconstruct dominant (consensual) discourses that shape the status quo in occupational therapy and envision alternative paths for the development of the discipline. Method Drawing on the work of Erich Fromm and Jacques Rancière, we propose a (critical) theoretical analysis of the concepts of disobedience and dissensus as they apply to occupational therapists. Results The concepts of disobedience (Fromm) and dissensus (Rancière) can be used to revisit the consensus shaped by discursive authorities inside and outside occupational therapy and expose the political nature of such processes. We argue that remaining oppressive forces similar to those of a warfare regime persist in regulating occupational therapy practice and knowledge by enacting a form of 'disciplinary propaganda.' Rather than threatening the development of the discipline, disobedience and dissensus constitute critical responses to disrupt dominant discourses and give rise to healthier concepts. Conclusion The use of politically charged terms such as disobedience or dissensus can be seen as controversial and unsettling for a profession like occupational therapy but we believe they are necessary for the future of our discipline.

Resumo Introdução Apesar de lutar para se estabelecer como uma profissão autônoma, a terapia ocupacional permanece amplamente regulamentada e controlada por autoridades discursivas dentro e fora da disciplina. Depois de superar os ideais reformistas da profissão, o governo militar, que apoiou sua rápida expansão, se transformou em instituições civis, mas ambos foram baseados em fundamentos semelhantes: os terapeutas ocupacionais devem obedecer a um conjunto estrito de regras enquanto a desobediência e a dissidência são consistentemente reprimidas ou silenciadas. Objetivo O objetivo deste artigo é desconstruir os discursos dominantes (consensuais) que configuram o status quo na terapia ocupacional e vislumbrar caminhos alternativos para o desenvolvimento da disciplina. Método Com base na obra de Erich Fromm e Jacques Rancière, propomos uma análise teórica (crítica) dos conceitos de desobediência e dissenso conforme se aplicam aos terapeutas ocupacionais. Resultados Os conceitos de desobediência (Fromm) e dissenso (Rancière) podem ser usados ​​para revisitar o consenso formado por autoridades discursivas dentro e fora da terapia ocupacional e expor a natureza política de tais processos. Argumentamos que as forças opressivas remanescentes semelhantes às de um regime de guerra persistem na regulamentação da prática e do conhecimento da terapia ocupacional por meio de uma forma de 'propaganda disciplinar'. Em vez de ameaçar o desenvolvimento da disciplina, a desobediência e o dissenso constituem respostas críticas para interromper os discursos dominantes e dar origem a conceitos mais saudáveis. Conclusão O uso de termos politicamente carregados, como desobediência ou dissenso, pode ser visto como controverso e inquietante para uma profissão como a terapia ocupacional, mas acreditamos que sejam necessários para o futuro de nossa disciplina.

Levers for Change and Unexpected Outcomes of a Participatory Research Partnership: Toward Fostering Older adults' Social Participation to Promote Health Equity.

Promoting health equity in aging requires ensuring older adults' effective access to community-based services fostering their social participation. This study aimed to (a) identify levers for change in community-based services to foster older adults' social participation and (b) explore unexpected outcomes of stakeholder engagement. Based in a large Canadian city, a critical participatory research partnership was formed in a district experiencing considerable health disparities. Four focus groups and seven individual interviews were followed by a collaborative workshop with 28 community stakeholders. Participants identified mainly systemic and organizational levers for change. These levers comprised changing performance indicators and the institutional culture of homecare to value services fostering social participation opportunities. Other levers included supporting individual change agency through participatory research involving community members. Stakeholder engagement led to five unexpected outcomes: "Marking a new beginning," "Expressing ourselves," "Feeling better," "Working together," and "Influencing the community." Recognizing levers for change is essential to understand how to develop services fostering social participation to promote health equity, with whom and in which contexts.

Community-based participatory research remodelling occupational therapy to foster older adults' social participation.

BACKGROUND.: Occupational therapists who provide community-based services are well positioned to foster older adults' social participation. However, community occupational therapists rarely address social participation and require support to change their practice. PURPOSE.: This study initiated a remodelling of community occupational therapy services by (a) selecting practices fostering older adults' social participation and (b) identifying factors that could affect their integration. METHOD.: A community-based participatory research study was conducted in a large Canadian city. Four focus group meetings and seven individual interviews were held with 28 key informants. FINDINGS.: A continuum of emerging practices was identified, including personalized, group-based, and community-based interventions. Potential enablers of these practices included clinical support, better communication, and user involvement. Organizational and systemic barriers were related to the institutional culture and performance indicators. IMPLICATIONS.: These results point to innovative ways to foster older adults' social participation and identify potential enablers and barriers affecting their integration.

Participation needs of older adults having disabilities and receiving home care: met needs mainly concern daily activities, while unmet needs mostly involve social activities.

BACKGROUND: Participation is a key determinant of successful aging and enables older adults to stay in their homes and be integrated into the community. Assessing participation needs involves identifying restrictions in the accomplishment of daily and social activities. Although meeting participation needs involves older adults, their caregivers and healthcare providers, little is known about their respective viewpoints. This study thus explored the participation needs of older adults having disabilities as perceived by the older adults themselves, their caregivers and healthcare providers. METHODS: A qualitative multiple case study consisted of conducting 33 semi-structured interviews in eleven triads, each composed of an older adult, his/her caregiver and a healthcare provider recruited in a Health and Social Services Centre (HSSC) in Québec, Canada. Interview transcripts and reviews of clinical records were analyzed using content analysis and descriptive statistics based on thematic saliency analysis methods. RESULTS: Aged 66 to 88 years, five older adults had physical disabilities, five had mild cognitive impairment and one had psychological problems, leading to moderate to severe functional decline. Caregivers and healthcare providers were mainly women, respectively retired spouses and various professionals with four to 32 years of clinical experience. Participation needs reported by each triad included all domains of participation. Needs related to daily activities, such as personal care, nutrition, and housing, were generally met. Regarding social activities, few needs were met by various resources in the community and were generally limited to personal responsibilities, including making decisions and managing budgets, and some community life activities, such as going shopping. Unmet needs were mainly related to social activities, involving leisure, other community life activities and interpersonal relationships, and some daily activities, including fitness and mobility. CONCLUSIONS: This study highlights the complexity of older adults' participation needs, involving daily as well as social activities. Properly assessing and addressing these needs is thus necessary to improve older adults' health and well-being. Discrepancies in the various actors' perceptions of participation needs must be further explored. Additional research would help better understand how to optimize the contribution of community organizations and caregivers.

Are health promotion and prevention interventions integrated into occupational therapy practice with older adults having disabilities? Insights from six community health settings in Québec, Canada.

BACKGROUND/AIM: Increasingly, health-care systems should promote seniors' health and prevent disability. As they enable engagement in meaningful activities within the individuals' living environment, community occupational therapists have great potential to contribute to health promotion and prevention. Despite this potential, little is known about current health promotion and prevention activities in occupational therapy community practice. This study thus aimed to: (1) identify health promotion and prevention interventions used with seniors having disabilities, and (2) explore barriers to integrating such interventions into practice. METHODS: Secondary data analysis of a qualitative study was carried out using thematic saliency analysis. Eleven community occupational therapists working with seniors having disabilities were recruited in six community health settings in Québec, Canada. Observations of 12 home visits, followed by 12 semi-structured interviews, were conducted with occupational therapists. RESULTS: Most interventions involved optimising independence in personal care and mobility. Explicit health promotion interventions were limited and included enabling healthy lifestyles by increasing health literacy and empowerment. Meaningful activities (leisure, community participation) were not targeted. Barriers to integrating health promotion into practice were clients' complex health conditions and limited openness to change combined with organisational and professional obstacles, such as a misunderstanding of occupational therapists' role in health promotion. CONCLUSIONS: Health promotion and prevention interventions are not intentionally integrated into community occupational therapy practice with seniors having disabilities. As a result, seniors' needs to engage in meaningful activities might remain unmet. Overcoming barriers to integrating health promotion and prevention in practice could help improve population health and wellbeing.