Forståelse og etik i patientstøtten - en hermeneutisk analyse af den coachende tilgang i Aktiv Patientstøtte

Madsen, Rasmus Søgaard

4. semester

Anvendt Filosofi, Kandidat

2018

2018-05-30

64 pages

Abstract This master's thesis is based on “Aktiv Patientstøtte”, which is a nationwide project where nurses telephonically coach patients with chronic diseases to become more self-reliant and achieve fewer hospitalizations. Overall, I find the project sympathetic because it is outgoing in relation to patient needs and focuses specifically on the impact of the conversation. Conversely, I am also critically opposed to the coaching approach that focuses on efficiency and goals. Because of this, I hold my self critical and ethical in the thesis regarding to Kenneth Gergen's social constructionist ideas, which is the overall theoretical basis for coaching methods. This I base on Hans-Georg Gadamer's philosophical hermeneutics, supplemented by Anders Lindseth's philosophical practice. There seems to be an idea in the social constructionist view that patients can reconstruct their perceptions of their problems and disease experiences into possibilities and in a more positive direction through the nurse's coaching questions, which focuses on resources and opportunities. From a hermeneutical perspective, I argue that there is a risk that this approach will make the patients responsible for their inability to use the language in at positive way. At the same time, there is a risk that the patients seek to live up to the positive expectation, as well as those who fail to formulate the positive intention of the conversation, are considered unwilling to change and may be excluded from the project. The hermeneutic point is that patients cannot just reconstruct and control their understanding. The individual does not have the ability to construct its perceptions as desired because they are conditioned by pre-understanding and historical context. If the understanding is to be revised, it requires open dialogue movement, where the interlocutors mutually bring their pre-understanding into play to explore and understand the subject matter. The language is not a tool that can be controlled by the coaching nurse nor the patient, which seems to be the case in social constructionism. The language has its own spirit and a new understanding is something that happens and surprises us in the open dialogue process. Furthermore, I argue that the hermeneutical dialogue focusing on understanding a common question and Lindseth's supplement on understanding as comforting and the disease as an indispensable life experience is an essential ethical demand, which in turn is absent from social constructionist coaching, focusing on methods and techniques for individual action and change. This thesis holds a clarification of the Gamemaster model and the solution-focused approach, which are the methods the nurses apply, as well as Gadamer's dialogue concept and Lindseth's methodological approach to the philosophical practice. This leads op to a discussion of the positions that involves qualitative interviews with the patients as well as statements from the nurses, which functions as empirical material that actualizes and nuances the discussion.

Dialog, coaching, forståelse, etik, hermeneutik, socialkonstruktionisme

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