The Power of Patient Empowerment: An Analysis of Shared Descision Making in Mental Health Care

Simon Nørregaard Jensen

Student thesis: Master thesis

Abstract

This thesis examines the operation of the regime of patient empowerment in practice by studying the model of shared decision making as a technology of power. Patient empowerment is considered as an essential part of the future health care system in Denmark in which the model of shared decision making assumes a key role in securing the involvement of patients in the course of treatment. Therefore, this thesis aims at examining the present frontrunners of patient empowerment in order to provide reflective criticism on future focus points when implementing management tools for the exercise of patient empowerment nationwide. Thus, the research question asks: ‘How is it that the model of shared decision making has assumed a key role for the patients' recovery-process and how does it constitute the framework for treating the patient? Further, what is the relationship between the explicit aims of patient empowerment and the operation of the regime in practice?’ The empirical constructed data making up the foundation for analysis in the thesis is based on six interviews and three observational studies supplemented by documents including a strategy and scientific papers on patient empowerment and the recovery perspective. First, I analyze how the Mental Health Care of the Capital Region tries to establish a ‘decisionmaking’ patient inventing a group of patients sharing the same interests and powers having the ultimate purpose of being able to master their own illness. This is followed by an analysis showing how the different practices and techniques are being applied in the course of treatment in order to empower the patients to entering into dialogue and in seeking to make them act like decision-makers. Thus, in the course of treatment, patients are to take over the functions of gaining educational insights on the recovery-process being encouraged through motivational and self-evaluating techniques. Subsequently, an analysis shows how the model of shared decision comes to promote certain forms of identities fostering the patient and nurse to identify themselves with specific capabilities. Hence, being governed through the locus of freedom, the patient comes to identify himself with capabilities of responsibility, control, and motivation. The capabilities being fostered regarding the nurses are characterized by a more facilitating identity. Finally, a critical analysis is made based on the three-dimensional governmentality analysis diagnosing the current issues of patient empowerment by showing how the operation of the regime of patient empowerment in practice conflicts with central ambitions of the explicit aims of conducting patient empowerment. Issues pronounced in the current way of conducting patient empowerment through the model of shared decision making involve the cooperation, or lack thereof, between nurse and doctor; the risk of leading to even more inequality in the course of treatment; and structural barriers being embedded in the model of shared decision making.

EducationsMSocSc in Political Communication and Managment, (Graduate Programme) Final Thesis
LanguageEnglish
Publication date2015
Number of pages83