Juritzen Truls I, Engebretsen Eivind, Heggen Kristin
Department of Health Sciences, Faculty of Medicine, Institute of Health and Society, University of Oslo, P.O. Box 1089 Blindern, 0317 Oslo, Norway.
Med Health Care Philos. 2013 Aug;16(3):443-55. doi: 10.1007/s11019-012-9412-x.
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.
赋权与用户参与体现了一种在卫生部门占据重要地位的权力理想。在本文中，我们运用文本分析来研究一项针对卫生工作者的、以赋权为重点的项目计划中的权力观念。所探讨的问题包括：该项目计划中如何描述用户与帮助者之间的权力关系？计划中蕴含了哪些用户参与的观念？分析基于福柯的观点，即受到重新分配企图影响的权力会以其他形式重新出现。权力如何重新出现以及会产生何种后果是我们分析的关注点。该分析与一家养老院日常生活中的“快照”形成对比。该项目计划将赋权传达为一种用户所需的民主建设工具。它是一种为用户自助提供专家协助的工具。用户参与被变成了一种对于用户自身而言外在的工具。此外，分析表明该计划中赋权的形象预设了一个能够表达个人需求和愿望的“精英用户”。这对于最脆弱的用户群体不太适用，他们因此可能最终处于更弱势的地位。作为结论，我们认为用一种理想的赋权取代不良的主导性家长作风并不会消除权力，反而可能导致更隐蔽、更微妙的权力形式，这些权力形式更不易受到批评。本文提供的见解将有助于对实施以赋权为导向的医疗保健的前提进行反思。
