Sundhed

Volume 12 Oktober 2015

Humanisktisk Sundhedsforskning
Jens Lohfert Christensen, Malene Kjær, Anita Holm Riis

I dette nummer af Akademisk Kvarter præsenteres tolv artikler under den brede betegnelse ’humanistisk sundhedsforskning’. Artiklerne repræsenterer fire temaområder; et litterært-æstetisk, et interaktionsanalytisk, et diskursanalytisk og et filosofisk-etisk. Områderne danner tillige en ramme for artiklernes kronologi, om end der i sagens natur også forekommer overlapninger mellem temaerne. Under en samlet betragtning er de her præsenterede forskellige tilgange til den humanistiske sundhedsforskning et godt eksempel på, at såvel helt praksisnære studier som abstrakte fortællinger og filosofiske refleksioner kan bidrage til at gøre os klogere på, hvordan vi kan håndtere helse, sygdom og død som fundamentale vilkår for vores eksistens. At forstå omstændighederne omkring disse størrelser er en væsentlig drivkraft i den humanistiske sundhedsforskning, som dermed bidrager med noget andet end fx medicinsk forskning i sygdom.

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The Fomula of Plague Narratives
Jørgen Riber Christensen

The article is a narratological investigation of a selection of plague tales. The selection spans millennia and different text types, technologies and genres, from The Bible to apocalyptical films, iPhone games and testimonials from Médecins Sans Frontières. The research question is whether it is possible to establish a stable formula for plague narratives despite the spread over centuries and in different text types, and to explain this formula and possible variations of it. The initial and tentative hypothesis is that a formulaic narrative structure exists for accounts, both documentary and fictional, of epidemics. The samples include: Exodus, History of the Peloponnesian War, Samuel Pepys’ Diary, A Journal of the Plague Year, The Last Man, The Plague in Bergamo, Discipline and Punish: The Birth of the Prison, Doomsday, The Dead Zone, World War Z. An Oral History of the Zombie War, Pandemic, Plague Inc. and testimonials from Médecins Sans Frontières about the 2014-15 ebola outbreak in West Africa.

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En Verden Hinsides
Jens Lohfert Jørgensen

This article deals with the Danish author Helga Johansen’s autobiographical novel Hinsides (1900) as an example of a distinctive body of works written around the turn of the century that deal with mental disorder. The article consists of two main parts. In the first, a short reflection of the genre of the so-called pathography is followed by a longer discussion of the relationship between gender, mental disorder and writing around the turn of the century. The second part deals with Hinsides, focusing on the way in which the experience of being ill is produced by the novel, and on the pressure put on language in this process.

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Acting, interacting, enacting. Representing medical practice in theatre performance
Spencer Hazel

This study followed the rehearsals of a 2014 Copenhagen theatre production of Margaret Edson’s play WIT. The play depicts the palliative care provision of a woman diagnosed with advanced ovarian cancer, with an important theme of the narrative centering around the dehumanizing practices that result from professional medical treatment of the body, rather than of the person.

I adopt an interaction analytic approach to investigate how theatre practitioners develop representations of interaction in clinical environments. The article introduces one practice from the theatre rehearsal setting – doing notes – which forms a framework within which members reflect on their performances, and discuss possible modifications to be taken up on later occasions. This is argued to be a useful practice that may prove beneficial to other professional settings, such as in heathcare provision.

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Interaktion, instruktion og patientuddannelse for kronisk sygdom
Tine Larsen

The use of health technologies for self-management of chronic disease has in recent years become increasingly common in Denmark.At the same time, disease-specific patient educations have been created to ensure that patients possess the knowledge and skills necessary to assume the daily responsibility for their own disease. While prior research mainly has sought to document socio-economic and treatment-related benefits of self-management, the current paper presents findings from a recently completed conversation analytic project, focusing specifically on the interaction between patients and instructors (nurses) during the patient education training sessions. Describing and comparing two prominent instructional practices, explicating their relative benefits and challenges with respect to the institutional goal of training the patients, the paper seeks to illustrate one way that interactional insights may be used to support the continued use and development of self-management in Denmark.

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Seize the moment! Moments of suspended interaction as a patient resource for introducing psychosocial problems
Christel Tarber

Using the methodology of conversation analysis, this study focuses on patients’ disclosures of psychosocial problems during moments of suspended interaction, i.e. when the doctor is otherwise engaged. Contrary to most activities in the medical encounter, these disclosures are initiated by patients themselves. However, they are placed and designed so as not to require the doctor to respond, but rather to minimise the imposition on the doctor. Uptake, therefore, is not guaranteed. The placement of such disclosures exactly during suspended interaction displays a patient orientation to not derailing the progressivity of the consultation towards its end goal of treatment, an orientation also found by other interactional studies and shown to be related to low patient participation. The independent contribution of this study is that it enhances our understanding of the hitherto unexplored interactional barriers to the presentation of psychosocial problems in the medical consultation.

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Antibiotika i almen praksis. En fælles beslutning?
Johanna Lindell

Patient involvement and shared decision making (SDM) in treatment is increasingly on the health care agenda both nationally and internationally. Studies have shown that the benefits of actively including patients in decisions about their health care improves their health, satisfaction and agency, as well as being more cost-efficient (SUM 2014,2). SDM has been shown helpful in the primary sector in lowering the use of antibiotics (Legare et al 2012), where growing resistance due to antibiotic overuse is a public health problem, with primary care responsible for 90% of the prescriptions in Denmark. Using Conversation Analysis on a dataset of 13 cases this study investigates how treatment decisions for antibiotics are made in primary care and whether the interaction follows the ideal of SDM. It finds that most treatment recommendations are presented as decisions already made, not encouraging the patient to participate in the decision making.

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Udvikling af et klinisk blik. Lokationsbåret praksis i hospitalsregi
Malene Kjær

The article sheds light on a specific practice in the hospital wards: Student nurses developing a clinical professional vision by participating in interactions with patients in clinical settings. Through a multimodal interactional analysis of four short data excerpts the article aims to show how a professional vision is not just learned by being a participant with the patient, but how instruction beforehand and assessment after works together with the practice of participating with the patient. More over the article shows how these three different practices: instruction, participation and assessment takes place in four different locations. It is the claim that the practice of participation and developing a clinical professional vision are shaped not only by different practices in situ but also by the different locations and the affordances these locations have for the interactions taking place

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Identitetskonstruktioner af patienter
Inger Lassen, Aase Marie Ottesen, Jeanne Strunck

This article focuses on the discursive construction of patient identity in the Danish Health Act. Traditionally, the ideology of the welfare state has been based on equality and solidarity, and the state has so far been responsible for the provision of health care services. Recent research suggests, however, that the implementation of New Public Management influences the welfare model in a neo-liberal direction. The study focuses on how such underlying ideologies may influence the dominant discourses present in the Health Act and how these discourses may construct different subject positions and identities. The analysis points to two competing, hegemonic discourses: a welfare discourse and a New Public Management discourse. Those reveal an asymmetrical relationship between three groups: health professionals occupying dominant subject positions, patients empowered to make free choices within the limits stipulated by policy makers and patients constructed as objects in need of care.

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Vi skal passe på os selv. En diskursanalytisk undersøgelse af Sundhedsstyrelsens italesættelse af patienters selvmonitorering
Lisbeth Kappelgaard

Self-monitoring is increasingly used as part of treatment and prevention in the Danish healthcare system. An example may be the chronically ill individual who measures different physical fluctuations in the body, or it may be citizens with depression history who monitor their energy level or mood to increase their own awareness of a possible relapse. The technological opportunity for self-monitoring is often articulated as patient-caring – as ways individuals can help themselves. With theoretical and methodological inspiration from discourse theory, the objective of this article is to illustrate the articulations, hegemonic positions and rationales, which construct self-monitoring as self-caring.

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At vælge det sunde fra. Akrasia og uinteresse
Ellie Lavan

A recurring challenge in health promotion and prevention practice is the phenomenon of people choosing not to follow the health advice given by professionals, the people who appear to be ‘non-motivated’ for a healthy lifestyle. This phenomenon is the subject of this article. Based on the concepts of akrasia (weakness of the will) (with an inspiration from Martha C. Nussbaum and Alaisdair MacIntyre) and rationality of des-interest, (as proposed by Sam Paldanius) it unfolds a theoretical and philosophical framework for understanding the rationales that lie behind not following recommended health guidelines. Through an empirical analysis of the case of Poul, a diabetes2patient that refuses to change his lifestyle, the article shows how not choosing the healthy lifestyle must not be understood as only an irrational lack of motivation. The concepts akrasia and des-interest contribute to an understanding of how human reflections on the ’right choice’ is an ongoing and time-extended process, involving incommensurable goods, resistance and uncertainty as to finding the perfect balance between the conflicting desires that we as humans are subjected to.

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”Vi har lært at blive små sammen omkring de store spørgsmål.” Hvordan forske i eksistentiel og åndelig omsorg, når fokus er på den filosofiske samtaledimension i palliativt arbejde?
Finn Thorbjørn Hansen

This article describes a ‘third way’ to a work with spiritual care in palliation. Normally spiritual care is theoretically understood and practically unfolded through either a psychological (therapeutic) or theological (pastoral counselling) approach. In a 3-year action research project on a Danish hospice the action researcher and the ‘actors’ or co-inquirers from the hospice had a shared inquiry into how philosophical conversations may be another way to strengthen a palliative team’s qualifications to lead conversations with patients, relatives and other colleagues about the Big Question of Life and Death. The article focus on the special kind of Socratic and phenomenological action research that is needed compare to other more empirical-descriptive research approaches when we are working with existential, ethical and spiritual experiences.

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A conceptual framework for the ethics of synthetic biology
Mette Ebbesen, Svend Andersen, Finn Skou Pedersen

Synthetic biology is an emerging and promising interdisciplinary field of research. Synthetic biology deals with the design of new biological units, devices to build artificial life, or the redesign of existing natural biological systems with possible applications within many diverse areas such as energy, environment, food, and medicine. In this way, synthetic biology may help solve some of the challenges the world is facing in the 21st century. However, it is of the utmost importance to consider, at an early stage, the ethics of new emerging technologies such as synthetic biology and nanoscience. In this article, we argue that analogues can be drawn between nanoscience and synthetic biology. Firstly, we show that the ethical principles of beneficence, nonmaleficence, respect for autonomy, and justice are important for nanoscience, and we reveal that these principles are part of the bioethical theory of the American ethicists, Tom L. Beauchamp and James F. Childress. Secondly, we argue that analogues can be drawn between the ethical problems of nanoscience and those of synthetic biology, and thirdly, we conclude that the theory of Beauchamp and Childress can also be used to analyze ethical issues of synthetic biology. In this article we use an oncolytic poxvirus for delivery and expression of transgenes in tumors as an example to illustrate how to use Beauchamp and Childress’ theory to analyse ethical problems of synthetic biology.

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