Between power and powerlessness – discourses in the individual plan processes, a Norwegian dilemma

Åshild Slettebø,Elisabet Hellem,Grete Alve,Vigdis Helen Madsen,Birgitta Langhammer,Kari Anette Bruusgaard

doi:10.1080/15017419.2011.574846

Åshild Slettebø, Elisabet Hellem + Show 4 more

Open Access

https://doi.org/10.1080/15017419.2011.574846

Copy DOI

Abstract

The purpose of this article is to explore what may cause tensions in the work with IP processes and discuss this in the light of power and powerlessness. The project is designed as a multi-case study. Qualitative data were collected through semi-structured individual interviews and observations from group meetings. Quantitative data were collected through a questionnaire focusing on activities of daily living, as well as from documents such as the available individual plan itself and official minutes of the meetings. The analysis of the material is based on a sociological discourse analysis. The three power discourses disclosed were power of knowledge, power of language, and power of definition. Power of knowledge refers to the clients' expert knowledge of themselves as well as the professionals' knowledge whereas the informants experienced power of language, as a physical, psychological, and social instrument to present the client's case. The holder of power of knowledge and power of language possesses the power of definition regarding the individual plan process, but the study revealed nuances in this relationship. More attention and self-awareness should be paid to the relationship between the trust professionals are given by the clients and the position of power this entails when collaborating in IP processes.

Highlights

In order to deal with a challenge described as a dilemma between standardized solutions and lack of individual help in rehabilitation (Storting White Paper no. 25 1996Á97), the Norwegian Parliament approved an act on the statutory right to have an Individual Plan (IP) drawn up
The power of definition seems to be a result of the knowledge possessed by the client and the coordinator, and how this knowledge is expressed through language and communication
The feeling of distrust and the need of negative exposure lead to a feeling of powerlessness. Another client who was a novice in the health system chose to hand over more of the responsibilities and leave the decisions to the professional experts as to what kind of help he would need to have at home: In principle, I must say that it is appropriate that the experts are those who handle my rehabilitation

Summary

Introduction

In order to deal with a challenge described as a dilemma between standardized solutions and lack of individual help in rehabilitation (Storting White Paper no. 25 1996Á97), the Norwegian Parliament approved an act on the statutory right to have an Individual Plan (IP) drawn up. Clients who are users of long-term, coordinated health and/or social services are entitled to an IP. This is regulated in Health Care Act of 1999 and in Social Work Act of 2003 (Kjellevold 2005). The individual plan should be voluntary and based on informed consent Informed consent in this context implies that the client should be informed about exchange of information between different professionals included in the planning process, what information is exchanged, and the client’s right to refuse such exchange. The clients have the right to participate throughout the planning process They are the best judges of their own situation, and professional personnel know which solutions and assistance are available to them (Health and Care Department 2004)

Objectives

Methods

Results

Discussion

Conclusion