Expanding the dialogue on dementia: (Re)positioning diagnosis and narrative

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.