Abstract
Goal setting is an important professional method and one of the key concepts that structure a practical field such as physical rehabilitation. However, the actual use of goals in rehabilitation practice is much less straightforward than the general acceptance of the method suggests as goals are frequently unattained, modified or contested. In this paper, I will argue that the difficulties of goal setting in day-to-day medical practice can be understood by unravelling the normative assumptions of goal setting, in this case three different tensions that come along with it. First, goals are developed for a future state that may require activities that clash with necessities of the present situation. Second, professionals in clinical rehabilitation centres elaborate goals for an environment that differs in terms of spatial and social characteristics from the environment in the centre, where people train for the accomplishment of goals. Finally, goal setting requires active patient participation and individual control that sometimes appears impossible, unrealistic, and undesirable. I will describe how professionals deal with these tensions in a creative and dynamic way. With my articulation of the assumptions of goal setting, I hope to contribute to the self-reflection of rehabilitation practitioners as well as to theoretical discussions of goal setting in contexts other than rehabilitation.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
REFERENCES
Akrich, M., and Pasveer, B. (2000) Multiplying Obstetrics: Techniques of Surveillance and Forms of Coordination. Theoretical Medicine and Bioethics 21,63–83.
Albrecht, G.L., Seelman, K.D., and Bury, M. (2001) Handbook of Disability Studies. Thousand Oaks: Sage.
Baker, S.M., Marshak, H.H., Rice, G.T., and Zimmerman, G.J. (2001) Patient Participation in Physical Therapy Goal Setting. Physical Therapy 81, 1118–1126.
Barnes, M.P., and Ward, A.B. (2000) Textbook of Rehabilitation Medicine. Oxford: Oxford University Press.
Bauman, A.E., Fardy, H.J., and Harris, P.G. (2003) Getting it Right: Why Bother with Patient-Centred Care? Medical Journal of Australia 179, 253–256.
Benschop, R.J., Horstman, K., and Vos, R. (2003) Voice Beyond Choice: Hesitant Voice in Public Debates About Genetics in Health Care. Health Care Analysis 11, 141–150.
Berg, M. (1997) Rationalizing Medical Work: Decision-Support Techniques and Medical Practices. Cambridge, MA: MIT Press.
Berg, M., Ter Meulen, R.H.J., and Van den Burg, M. (2001) Guidelines for Appropriate Care: The Importance of Empirical Normative Analysis. Health Care Analysis 9,77–99.
Charmaz, K. (1983) Loss of Self: A Fundamental Form of Suffering in the Chronically Ill. Sociology of Health and Illness 5, 168–195.
Charmaz, K. (1995) The Body, Identity, and Self: Adapting to Impairment. The Sociological Quarterly 36, 701–724.
Davis, L.J. (1997) The Disability Studies Reader. New York: Routledge.
DeJong, G. (1983) Defining and Implementing the Independent Living Concept. In N.M. Crewe and I.K. Zola (Eds.), Independent Living for Physically Disabled People. San Francisco: Jossey-Bass.
De Laet, M., and Mol, A. (2000) The Zimbabwe Bush Pump: Mechanics of a Fluid Technology. Social Studies of Science 30, 225–263.
Engelhardt, J.H.T. (1996) The Foundations of Bioethics. Oxford: Oxford University Press.
Gomart, E., and Hennion, A. (1999) A Sociology of Attachment: Music, Amateurs, Drug Users. In J. Law and J. Hassard (Eds.), Actor Network Theory and After (pp. 220–247). Oxford: Blackwell.
Hasler, G., and Schnyder, U. (2002) Setting and Changing of Goals in Psychiatric Psychotherapeutic Treatments. Nervenarzt 73,54–58.
Kirschner, K.L., Stocking, C., Wagner, L.B., Foye, S.J., and Siegler, M. (2001) Ethical Issues Identified by Rehabilitation Clinicians. Archives of Physical Medicine and Rehabilitation 81(Suppl.), S2–S8.
Law, J., and Mol, A. (2002) Local Entanglements or Utopian Moves: An Inquiry into Train Accidents. In M. Parker (Ed.), Utopia and Organization (pp. 82–105). Oxford: Blackwell.
McPeak, L.A. (1996) Physiatric History and Examination. In R.L. Branddom (Ed.), Physical Medicine and Rehabilitation (pp. 3–42). Philadelphia: W.B. Saunders.
Mol, A., and Law, J. (Submitted) Embodied Action, Enacted Bodies: The Example of Hypoglycaemia. Body &; Society.
Molewijk, A.C., Stiggelbout, A.M., Otten, W., and Dupuis, H.M. (2003) Implicit Normativity in Evidence-Based Medicine: APlea for Integrated Empirical Ethics Research. Health Care Analysis 11,69–92.
Morris, L.L., and Fitz-Gibbon, C.T. (1978) How to Deal With Goals and Objectives. Beverly Hills: Sage.
Murphy, R.F. (1987) The Body Silent. New York: W.W. Norton.
Reeve, C. (1998) Still Me. New York: Ballantine Books.
Schermer, M. (2002) The Different Faces of Autonomy: Patient Autonomy in Ethical Theory and Hospital Practice. Dordrecht: Kluwer Academic Publishers.
Suchman, L.A. (1987) Plans and Situated Action: The Problem of Human-Machine Communication. Cambridge: Cambridge University Press.
Tauber, A.I. (2001) Historical and Philosophical Reflections on Patient Autonomy. Health Care Analysis 9, 299–319.
Timmermans, S., and Berg, M. (2003) The Gold Standard: The Challenge of Evidence-Based Medicine and Standardisation in Health Care. Philadelphia: Temple University Press.
Winance, M. (2001) Thèse et Prothèse. Le processus d'habilitation comme fabrication de la personne. L'Association Francaise contre les Myopathies face au handicap, Ecole des Mines Paris.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Struhkamp, R. Goals in Their Setting: A Normative Analysis of Goal Setting in Physical Rehabilitation. Health Care Analysis 12, 131–155 (2004). https://doi.org/10.1023/B:HCAN.0000041187.93819.17
Issue Date:
DOI: https://doi.org/10.1023/B:HCAN.0000041187.93819.17