Inclusion and exclusion in action research on person-centered health care

Phillips, Louise Jane; Scheffmann-Petersen, Michael

doi:10.4324/9780429289408-9

Cited by 2 publications

(6 citation statements)

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“…In the action research process, we paid reflexive attention to the tensions in dynamics of inclusion and exclusion both in the counseling conversations and in the action research process itself. In this article, we focus on the former; for an analysis of the latter, see Phillips and Scheffmann-Petersen (2019). In relation to analyses both of the counseling conversations and of the action research process, it is important to recognize as an inexorable limitation of reflexivity that the critique of power relations produced through reflexivity is circumscribed since it is itself discursively constructed from a particular perspective and imbued with power, entailing the exclusion of other perspectives.…”

Section: Theoretical Frameworkmentioning

confidence: 99%

“…At the same time, it represented a distinctive kind of action research by virtue of IFADIA's social constructionist, Bakhtinian understanding of voice as an unstable product of situated meaning-making (rather than a manifestation of a human inner core), and its post-structuralist commitment to the critical interrogation and destabilization of taken-for-granted truths as the products of discourses. These two features underpin the integration into IFADIA-informed action research of reflexive analyses of the tensional, power-imbued, negotiation of knowledge, and identities across voices (Phillips & Scheffmann-Petersen, 2019).…”

Section: The Aps Program and The Action Research Designmentioning

confidence: 99%

“…https://orcid.org/0000-0001-7493-9430 Note 1. It is a delimitation of this article that it does not contain a reflexive analysis of the tensions that arose in the action research process; as noted earlier, we have carried out and published this analysis elsewhere (see Phillips & Scheffmann-Petersen, 2019).…”

Section: Ethical Approvalmentioning

confidence: 99%

See 2 more Smart Citations

Minding the Gap Between the Policy and Practice of Patient-Centeredness: Cocreating a Model for Tensional Dialogue in the “Active Patient Support” Program

Phillips

Scheffmann-Petersen

2020

Qual Health Res

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Several studies identify obstacles to patient-centered care that can be eradicated by bridging the gap between policy goals and practice. In this article, “patient-centeredness” is theorized as an unstable entity riddled with intrinsic, ineradicable tensions. The purpose of the article is to propose a reflexive approach to the tensions as the most appropriate strategy for narrowing the gap between policy and practice. The reflexive approach is illustrated in an account of an action research project on a Danish, patient-centered initiative, “Active Patient Support.” The account focuses on the development of a dialogic communication model through collaborative, reflexive analyses of the tensions in the enactment of “patient-centeredness” in dialogue between health care practitioners and citizens—in particular, the tension between empowerment and self-discipline. Finally, the conceptual expansion of one of the dimensions of patient-centeredness, “health-practitioner-as-person,” is discussed as a platform for reflexivity, and the limitations of reflexivity are addressed.

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Section: Theoretical Frameworkmentioning

confidence: 99%

Section: The Aps Program and The Action Research Designmentioning

confidence: 99%

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Minding the Gap Between the Policy and Practice of Patient-Centeredness: Cocreating a Model for Tensional Dialogue in the “Active Patient Support” Program

Phillips

Scheffmann-Petersen

2020

Qual Health Res

Self Cite

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“…The design included a series of four all-day workshops in which we (the coauthors of this article) and the nurses carried out joint analyses of six counselling conversations that we, the university researchers, had selected from the fifty conversations they had recorded. This article presents our own analyses which we have carried out following the workshops (see Phillips and Scheffmann-Petersen [2019] for an account of the use of IFADIA to design the action research project and cultivate reflexivity about the tensions in counselling conversations and the action research process itself). The extracts that are analysed in this article emanate from two of the six conversations that were the object of joint analyses.…”

Section: Empirical Material Analytical Focus and Questionsmentioning

confidence: 99%

“…Therefore, in the action research project attached to the APS programme, we have worked to cultivate that reflexivity through joint analyses with the counselling team of nurses of extracts from counselling conversations including the ones analysed in this article (see Phillips and Scheffmann‐Petersen 2019, 2020). One of the methods used was the ‘forum play’ in which nurses did not just talk about practice but repeatedly acted out different ways of tackling the tension between self‐discipline and empowerment in a specific conversational situation.…”

Section: Conclusion and Further Perspectives On Inclusion And Exclusimentioning

confidence: 99%

Unpacking ‘patient‐centredness’: how knowledge is negotiated dialogically in the interweaving of genres and voices in counselling conversations

Phillips

Scheffmann-Petersen

2020

Sociology Health & Illness

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In the literature, difficulties in implementing policy principles of patient-centredness are often understood as obstacles to patient-centred care leading to a gap between the ideals and practice. This article proposes that what are often identified in the literature as obstacles can be usefully construed as intrinsic tensions that cannot be eradicated. It offers a theoretical framework for exploring the tensions that builds on Bakhtin's theory of dialogue and Foucault's theory of power/knowledge. The framework is designed to "unpack" the tensional, context-specific nature of "patient-centredness" through empirical exploration of how particular forms of "patientcentredness" are produced through tensional meaning-making in particular contexts. The use of the framework is illustrated in an analysis of how "patient-centredness" is ascribed specific meanings and enacted in collaborative telephone counselling conversations in a Danish patient-centred programme entitled "Active Patient Support". The analysis shows how the interweaving of genres and voices works to manage the patient's uncertainty in ways that both empower and self-discipline the patient. The discussion explores the implications of the specific form of "patient-centredness" articulated in the conversations with respect to patient empowerment and participation. It also critically reflects on the theoretical framework as a reflexive approach to tackling the tensions in "patient-centredness".

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Inclusion and exclusion in action research on person-centered health care

Cited by 2 publications

References 1 publication

Minding the Gap Between the Policy and Practice of Patient-Centeredness: Cocreating a Model for Tensional Dialogue in the “Active Patient Support” Program

Minding the Gap Between the Policy and Practice of Patient-Centeredness: Cocreating a Model for Tensional Dialogue in the “Active Patient Support” Program

Unpacking ‘patient‐centredness’: how knowledge is negotiated dialogically in the interweaving of genres and voices in counselling conversations

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