Abstract
In today’s push for shorter and quicker hospitalisations, everyday life often becomes a place of rehabilitation for people after they undergo surgical procedures. In order for hospitals to manage shortened periods of admission and to facilitate post-operative rehabilitation, a patient‘s active engagement has become a central element to clinical treatment and care in Denmark. For example, in the recovery from orthopedic surgery, sleep becomes a type of "homework" assignment that is a vital element of the patient‘s rehabilitation trajectory. Building on the theoretical concept of ‘engagement’ developed by Gilles Deleuze and Félix Guattari (2005), we examine the patient‘s relation to sleep as part of recovery; we refer to this as ‘sleep engagement.’ In particular, we analyze sleep as part of an institutional pedagogy in rehabilitation, and we ask how this pedagogy mobilizes rehabilitation for older patients after they have been admitted to the hospital for an orthopedic surgical procedure. Using ethnographic material, our analysis leads to a discussion of institutional expectations for what it means to be engaged in one's own patient trajectory. The article presents three results: 1) Expectations of sleep as an institutionally defined homework assignment are fulfilled through the establishment of the ‘rehabilitable and non rehabilitable body’; 2) As an active attempt to mobilize resources in rehabilitation, patient sleep engagement becomes part of a historical and contextual nexus; and 3) Institutional sleep potential creates new points of ambivalence—on the one hand, sleep is an optimization-promoting requirement in order to exercise while, on the other hand, the midday nap reflects an outdated view of old age that opposes an active lifestyle perspective.
Highlights
With the introduction of ‘fast track’ programs in Danish hospitals and generally reduced admission periods, patients’ own efforts in post-operative rehabilitation have gained importance
The purpose is to reduce the length of hospital stay and prevent readmissions, minimize surgical complications, decrease morbidity, and improve cost-effectiveness. These goals are founded on standardized regimes that are based on a large amount of research-based evidence from randomized controlled trials (RCTs)
We focus primarily on the interviews conducted after discharge, while the fieldwork conducted in the hospital is used as a backdrop to illustrate the medical pedagogies that underpins sleep, and to discuss how this relates to rehabilitation
Summary
With the introduction of ‘fast track’ programs in Danish hospitals and generally reduced admission periods, patients’ own efforts in post-operative rehabilitation have gained importance. Through our examination of older patients’ sleep-practices this article contributes to research on rehabilitative homework with the focus on the transition established between the hospital and everyday life at home This is an investigation of how institutional norms flow through mundane practices and affect the capacity to make new and relational arrangements after orthopedic trauma and/or surgery and how new ways of becoming subject is directed
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