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The problem with self-management: Problematising self-management and power using a Foucauldian lens in the context of stroke care and rehabilitation
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 advo...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6584009/ https://www.ncbi.nlm.nih.gov/pubmed/31216337 http://dx.doi.org/10.1371/journal.pone.0218517 |
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author | Fletcher, Simon Kulnik, Stefan Tino Demain, Sara Jones, Fiona |
author_facet | Fletcher, Simon Kulnik, Stefan Tino Demain, Sara Jones, Fiona |
author_sort | Fletcher, Simon |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-6584009 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-65840092019-06-28 The problem with self-management: Problematising self-management and power using a Foucauldian lens in the context of stroke care and rehabilitation Fletcher, Simon Kulnik, Stefan Tino Demain, Sara Jones, Fiona PLoS One Research Article 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. Public Library of Science 2019-06-19 /pmc/articles/PMC6584009/ /pubmed/31216337 http://dx.doi.org/10.1371/journal.pone.0218517 Text en © 2019 Fletcher et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Fletcher, Simon Kulnik, Stefan Tino Demain, Sara Jones, Fiona The problem with self-management: Problematising self-management and power using a Foucauldian lens in the context of stroke care and rehabilitation |
title | The problem with self-management: Problematising self-management and power using a Foucauldian lens in the context of stroke care and rehabilitation |
title_full | The problem with self-management: Problematising self-management and power using a Foucauldian lens in the context of stroke care and rehabilitation |
title_fullStr | The problem with self-management: Problematising self-management and power using a Foucauldian lens in the context of stroke care and rehabilitation |
title_full_unstemmed | The problem with self-management: Problematising self-management and power using a Foucauldian lens in the context of stroke care and rehabilitation |
title_short | The problem with self-management: Problematising self-management and power using a Foucauldian lens in the context of stroke care and rehabilitation |
title_sort | problem with self-management: problematising self-management and power using a foucauldian lens in the context of stroke care and rehabilitation |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6584009/ https://www.ncbi.nlm.nih.gov/pubmed/31216337 http://dx.doi.org/10.1371/journal.pone.0218517 |
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