Femdal I, Knutsen I R
Department of Health and Social work Studies, Østfold University College, Halden, Norway.
Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.
J Psychiatr Ment Health Nurs. 2017 Oct;24(8):600-609. doi: 10.1111/jpm.12407. Epub 2017 Aug 3.
WHAT IS KNOWN ON THE SUBJECT?: Implementation of user participation is described as a change from a paternalistic healthcare system to ideals of democratization where users' voices are heard in relational interplays with health professionals. The ideological shift involves a transition from welfare dependency and professional control towards more active service-user roles with associated rights and responsibilities. A collaborative relationship between users and professionals in mental health services is seen as important by both parties. Nevertheless, the health professionals find it challenging in practice to reorient their roles and to find productive ways to cooperate. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This study illuminates how user participation is negotiated and involves multiple and shifting subject positions in the collaboration between users and professionals in community mental health care. By taking different positions, the relationship between users and professionals develops through dynamic interaction. This study challenges understandings of equality and implicit "truths" in user participation by illuminating subtle forms of power and dilemmas that arise in user-professional negotiations. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Instead of denying the appearance of power, it is important to question the execution of power in the interplay between users and professionals. Focusing on the negotiation processes between users and professionals is important for increasing reflection on and improving understanding of the dynamic in collaboration and speech. By focusing on negotiations, power can be used in productive ways in user-professional relationships.
Introduction Implementation of user participation is considered important in today's mental health care. Research shows, however, that user participation lacks clarity and provokes uncertainty regarding shifting roles. Aim To investigate negotiation of user participation in a microstudy of interplay between users and health professionals in community mental health care. Method This qualitative study is based on semi-structured in-depth interviews, involving ten service users and ten professionals in community mental health care in Norway. The analysis is inspired by Willig's model for Foucauldian discourse analysis. Results The study illuminates the dynamic nature of user participation that arises through negotiation between users' and professionals' positions as change enablers, dependents, resisters, persuaders and knowledge holders. Discussion Discourses of user participation allow for different subject positions in mental health care. User participation also involves government and questions of power, as well as ambitions of change and control. Professionals act in different ways to make and keep users active, participating, enterprising and self-governing, and users respond and take part within the same discursive framework. Implications for practice Awareness of subjects' positions in discourses is important to increase reflection on the dynamic interplay in user-professional collaboration.
关于该主题已知的信息有哪些？：用户参与的实施被描述为从家长式医疗体系向民主化理想的转变，即在与医护人员的关系互动中倾听用户的声音。这种意识形态的转变涉及从福利依赖和专业控制向更积极的服务用户角色的转变，同时伴随着相关的权利和责任。心理健康服务中用户与专业人员之间的合作关系被双方视为重要的。然而，医护人员发现在实践中重新定位他们的角色并找到富有成效的合作方式具有挑战性。
本研究阐明了在社区精神卫生保健中，用户参与是如何在用户与专业人员的合作中通过协商形成的，并且涉及多个不断变化的主体位置。通过采取不同的立场，用户与专业人员之间的关系通过动态互动得以发展。本研究通过揭示用户与专业人员协商中出现的微妙权力形式和困境，对用户参与中的平等观念和隐含的“真理”提出了挑战。
重要的是质疑用户与专业人员互动中权力的行使，而不是否认权力的存在。关注用户与专业人员之间的协商过程对于增强对合作动态和言语的反思以及增进理解至关重要。通过关注协商，权力可以在用户与专业人员的关系中以富有成效的方式加以运用。
引言 在当今的精神卫生保健中，用户参与的实施被认为很重要。然而，研究表明，用户参与缺乏明确性，并且引发了关于角色转变的不确定性。目的 在一项关于社区精神卫生保健中用户与医护人员互动的微观研究中，调查用户参与的协商情况。方法 这项定性研究基于半结构化深度访谈，涉及挪威社区精神卫生保健中的十名服务用户和十名专业人员。分析受到威利格福柯式话语分析模型的启发。结果 该研究阐明了用户参与的动态性质，这种性质通过用户和专业人员作为变革推动者、依赖者、抵制者、劝说者和知识持有者的立场之间的协商而产生。讨论 用户参与的话语在精神卫生保健中允许不同的主体位置。用户参与还涉及治理和权力问题，以及变革与控制的抱负。专业人员以不同方式促使并保持用户积极、参与、进取和自我管理，而用户则在相同的话语框架内做出回应并参与其中。对实践的启示 意识到主体在话语中的位置对于增强对用户与专业人员合作中的动态互动的反思很重要。
