Faculty of Health, Social Care and Education, Kingston University and St George's, University of London, London, United Kingdom.
School of Health Professions, University of Plymouth, Plymouth, United Kingdom.
PLoS One. 2019 Jun 19;14(6):e0218517. doi: 10.1371/journal.pone.0218517. eCollection 2019.
Self-management is a concept which is now firmly established in Western healthcare policy and practice. However, the term remains somewhat ambiguous, multi-faceted and contentious. This is evident in stroke care and rehabilitation, in which a self-management approach is increasingly adopted and advocated, yet interpreted in different ways, resulting in contradictions and tensions around control, responsibility, power and discipline. This paper aims to further our understanding of tensions and contradictions in stroke self-management, by critically examining contemporary self-management practices. We use a Foucauldian theoretical lens to explore the various power dynamics in the operationalisation of self-management, in addition to the complexity of the term self-management itself. Conducting a secondary analysis of interview and focus group data from the Self-Management VOICED study, supplemented with analysis of relevant documentary evidence from policy and practice, we describe the multiple aspects of power in operation. These include rhetorical, hierarchical, personal and mutual forms of power, representing interweaving dynamics evident in the data. These aspects of power demonstrate underlying agendas and tacit and explicit understandings of self-management which exist in clinical practice. These aspects of power also give insight into the multiple identities of 'self-management', acting as a simultaneous repressor and liberator, directly in keeping with Foucauldian thinking. The findings are also consistent with Foucault's notions of bodily docility, discussions around governance and biopower, and contemporary discipline. Our analysis positions self-management as a highly nuanced and complex concept, which can fluctuate in its conceptualisation depending on the structures, routines, and the individual. We encourage healthcare professionals, policymakers and commissioners in the field of self-management to reflect on these complexities, to make transparent their assumptions and to explicitly position their own practice accordingly.
自我管理是一个在西方医疗保健政策和实践中已经牢固确立的概念。然而，这个术语仍然有些模糊、多方面且有争议。这在中风护理和康复中表现得尤为明显，在这些领域中，自我管理方法越来越被采用和倡导，但却以不同的方式进行解释，导致在控制、责任、权力和纪律方面存在矛盾和紧张。本文旨在通过批判性地审视当代自我管理实践，进一步了解中风自我管理中的紧张和矛盾。我们使用福柯的理论视角来探讨自我管理实施中的各种权力动态，以及自我管理本身的复杂性。我们对自我管理 VOICED 研究中的访谈和焦点小组数据进行二次分析，并补充政策和实践中的相关文件证据进行分析，描述了运作中的多种权力方面。这些方面包括修辞、等级、个人和相互形式的权力，代表了数据中交织的动态。这些权力方面表现出临床实践中存在的潜在议程以及对自我管理的隐性和显性理解。这些权力方面也洞察了“自我管理”的多种身份，既是压抑者，也是解放者，与福柯的思想直接一致。研究结果也与福柯关于身体温顺性、治理和生物权力的讨论以及当代纪律的概念一致。我们的分析将自我管理定位为一个高度复杂和微妙的概念，其概念化可以根据结构、常规和个体而波动。我们鼓励自我管理领域的医疗保健专业人员、政策制定者和决策者反思这些复杂性，使其假设透明，并相应地明确自己的实践立场。
