Abstract
Empowerment and user participation represents an ideal of power with a strong position in the health sector. In this article we use text analysis to investigate notions of power in a program plan for health workers focusing on empowerment. Issues addressed include: How are relationships of power between users and helpers described in the program plan? Which notions of user participation are embedded in the plan? The analysis is based on Foucault’s idea that power which is made subject to attempts of redistribution will re-emerge in other forms. How this happens, and with what consequences, is our analytical concern. The analysis is contrasted with ‘snapshots’ from everyday life in a nursing home. The program plan communicates empowerment as a democracy-building instrument that the users need. It is a tool for providing expert assistance to the user’s self-help. User participation is made into a tool which is external to the user him-/herself. Furthermore, the analysis shows that the plan’s image of empowerment presupposes an ‘élite user’ able to articulate personal needs and desires. This is not very applicable to the most vulnerable user groups, who thereby may end up in an even weaker position. By way of conclusion, we argue that an exchange of undesirable dominating paternalism for a desirable empowerment will not abolish power, but may result in more covert and subtle forms of power that are less open to criticism. The paper offers insights that will facilitate reflections on the premises for practising empowerment-oriented health care.
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Notes
In the following referred to as EiB.
The program plan analysed here uses mainly the term ‘user participation’, but emphasizes that this concept is rooted in the empowerment tradition. In our text we use both terms, since we believe that both are applicable as descriptions of the plan’s content.
It is essential for us to emphasize that even if the material for our analysis is associated with a specific program plan, our critical remarks mainly target the theoretical perspectives that underpin this plan.
References
Adams, R. 1996. Social work and empowerment, 2nd ed. London: Macmillan.
Asimakopoulou, K.G., P. Newton, and S. Scambler. 2010. “First do no harm”: the potential shortfalls of empowerment in diabetes. European Diabetes Nursing 7(2): 79–81.
Cruikshank, B. 1999. The will to empower. Democratic citizens and other subjects. Ithaca, NY: Cornell University Press.
Dean, M. 2010. Governmentality. Power and rule in modern society, 2nd ed. London: Sage.
Derrida, J. 1997. Of grammatology. Baltimore: Johns Hopkins University Press.
Donzelot, J. 1979. The poverty of political culture. Ideology and Consciousness. 5: 73–86.
Engebretsen, E. 2006. Barnevernet som tekst. Nærlesning av 15 utvalgte journaler fra 1950- og 1980-tallet. Faculty of Humanities, Univerisity of Oslo, Oslo, Norway.
Etterutdanning i brukermedvirkning (EiB). 2005. N.K.S. Kløverinstitusjoner as, http://www.klover.org/aktuelt/klovernytt/doc_download/6-etterutdanningen-i-brukermedvirkning Accessed 5 April 2011.
Fairclough, N. 1995. Critical discourse analysis. Boston: Addison Wesley.
Fleming, J., and D. Ward. 1999. Research as empowerment: the social action approach, empowerment practice: developing richer conceptual foundations. In Empowerment practice in social work: developing richer conceptual foundations, ed. L.M. Wells, and W. Shera. Toronto: Canadian Scholars’ Press. Inc.
Foucault, M. 1980. Power/knowledge. Selected interviews & other writings 1972–1977. New York: Pantheon Books.
Foucault, M., and L.D. Kritzman (eds.). 1988. Politics, philosophy, culture interviews and other writings, 1977–1984. XXV, 330 s vols. New York: Routledge.
Foucault, M. 1990. The history of sexuality. An introduction Volume I. New York: Vintage Books, Random House, Inc.
Foucault, M. 2002a. Questions of method. In Power. Essential works of foucault 1954–1984 Vol. 3, ed. J.D. Faubion, 223–238, 3rd ed. London: Penguin books.
Foucault, M. 2002b. Omnes et singulatim. In Power. Essential works of Foucault 1954–1984 Vol. 3, ed. J.D. Faubion, 298–325, 3rd ed. London: Penguin books.
Foucault, M., F. Ewald, M. Senellart, and A. Fontana. 2008. The birth of biopolitics. Lectures at the Collège de France, 1978–1979. Basingstoke: Palgrave Macmillan.
Freire, P. 1972. Pedagogy of the oppressed. London: Penguin.
Hollnagel, H., and K. Malterud. 2000. From risk factors to health resources in medical practice. Medicine, Health Care and Philosophy 3(3): 255–262.
Karlsen, M.P., and K. Villadsen. 2008. Who should do the talking? The proliferation of dialogue as governmental technology. Culture and Organization 14(4): 345–363.
Kristeva, J. 1984. Revolution in poetic language. New York: Columbia University Press.
Laclau, E., and C. Mouffe. 1985. Hegemony and socialist strategy. Towards a radical democratic politics. Verso: London and New York.
Lorentzen, P. 2003. Fra tilskuer til deltaker. Samhandling og kommunikasjon med voksne utviklingshemmede. Oslo: Universitetsforlaget.
Mcfadden, D.L., and E.P. Burke. 1991. Developmental-disabilities and the new paradigm—directions for the 1990’s. Mental Retardation 29(1): R3–R6.
Miller, P., and N. Rose. 2008. Governing the present. Cambridge: Polity Press.
Naue, U. 2008. ‘Self-care without a self’: Alzheimer’s disease and the concept of personal responsibility for health. Medicine, Health Care and Philosophy 11(3): 315–324.
Norwegian Ministry of Health and Care Services. 1999. LOV 1999-07-02 nr 63: Lov om pasientrettigheter (pasientrettighetsloven). http://www.lovdata.no/all/hl-19990702-063.html. Accessed 16 March 2011.
Norwegian Ministry of Health and Care Services. 2009. St.meld.nr. 47. Samhandlingsreformen. Rett behandling—på rett sted—til rett tid. http://www.regjeringen.no/nb/dep/hod/dok/regpubl/stmeld/2008-2009/stmeld-nr-47-2008-2009-.html?id=567201. Acessed 16 March 2011.
Paterson, B. 2001. Myth of empowerment in chronic illness. Journal of Advanced Nursing 34(5): 574–581.
Piper, S. 2010. Patient empowerment: emancipatory or technological practice? Patient Education and Counseling 79(2): 173–177.
Powers, P. 2003. Empowerment as treatment and the role of health professionals. Advances in Nursing Science 26(3): 227–237.
Roberts, K.J. 1999. Patient empowerment in the United States: a critical commentary. Health Expectations 2(2): 82–92.
Rose, N. 1999. Powers of freedom: reframing political thought. Cambridge: Cambridge University Press.
Rose, N., P. O’Malley, and M. Valverde. 2006. Governmentality. Annual Review of Law and Social Science 2(1): 83–104.
Salmon, P., and G.M. Hall. 2003. Patient empowerment and control: a psychological discourse in the service of medicine. Social Science and Medicine 57(10): 1969–1980.
Salmon, P., and G.M. Hall. 2004. Patient empowerment or the emperor’s new clothes. Journal of the Royal Society of Medicine 97(2): 53–56.
Schaap, A. 2000. Power and responsibility: should we spare the King’s head? Politics 20(3): 129–135.
Seattle 2000 Decleration. 2000. Seattle 2000 Declaration on Self-Determination and Individualized Founding. http://members.shaw.ca/individualizedfunding/Declaration.htm. Accessed 14 Dec 2010.
Selbaek, G., O. Kirkevold, and K. Engedal. 2008. The course of psychiatric and behavioral symptoms and the use of psychotropic medication in patients with dementia in Norwegian nursing homes—a 12-month follow-up study. American Journal of Geriatric Psychiatry 16(7): 528–536.
Skelton, R. 1994. Nursing and empowerment: concepts and strategies. Journal of Advanced Nursing 19(3): 415–423.
Solomon, B.B. 1976. Black empowerment social work in oppressed communities. New York: Columbia University Press.
Starrin, B., C. Heyerdahl, and O.P. Askheim. 2007. Empowerment i teori og praksis. Oslo: Gyldendal akademisk.
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This project has been financially supported by the Norwegian ExtraFoundation for Health and Rehabilitation through EXTRA funds.
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Juritzen, T.I., Engebretsen, E. & Heggen, K. Subject to empowerment: the constitution of power in an educational program for health professionals. Med Health Care and Philos 16, 443–455 (2013). https://doi.org/10.1007/s11019-012-9412-x
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DOI: https://doi.org/10.1007/s11019-012-9412-x