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Making sense of the whole person A multiple case study exploring the normative expectation of a holistic view of the service users

By Lise Cecilie Kleppe

Abstract

This study is about discourses on professional responsibility in the field of health and social services. More specifically it explores the ideal of addressing patients and clients as whole persons by examining how central texts within the field make sense of this ideal. The ideal of addressing people as whole persons is anchored in humanism and expressed in the national curriculum as well as in the ethical principles and code of conduct for social workers and nurses. Every nurse and social worker is thus expected to demonstrate professionalism by taking responsibility for the whole person. It is not self-evident, however, how this ideal of professional conduct can be applied. What does this ideal imply in terms of concrete expectations of the professionals? How are social workers and nurses expected to act out this ideal in their professional practice? Previous research has documented a discrepancy between ideals and the work carried out. Yet, we know little about what powerful texts in the field offer in terms of conceptual resources for shaping the understanding of those working in the field of health and social services. The study is constituted by three cases: texts concerning asylum reception centres and texts used in the training of nurses and social workers. The first case deals with expectations for social workers and nurses working in a specific area within the field of health and social services, while the other two concern expectations for the nursing and social work professions in general. The cases reflect expectations for different points on a professional trajectory from training to everyday work. The first case concerns expectations for the professions in a specific work setting (asylum centres) while the other two throw light on two important educational contexts (nursing and social work training). The educational context is an important prerequisite for the professionals to be able to make sense of the expectations they meet in the work setting. The purpose of putting the three cases together is therefore not for comparison in a traditional sense, but rather to acquire deeper understanding of each case. The research design is based on Stake’s multiple case study design. Different types of textual analysis and textual analytical tools represent the applied methodology. The cases are understood as different settings in which the question “what does it mean to take care of the whole person?” becomes relevant. The following overarching research questions have guided the study: How is the ideal of addressing people as whole persons in the field of health and social services articulated in some governing texts? What significance do the different sets of articulations have for the understanding of holistic responsibility in the individual case? Can we acquire a deeper understanding of holistic responsibility if we let the different sets of normative expectations for professionals meet across the cases? The findings indicate that the normative expectation of addressing people as whole persons is present in the individual cases; however, the ideal is deconstructed when it comes to concrete actions. In the management documents for reception centres, a holistic view of the residents is articulated in connection with the dual objectives of the operation of the centres, namely as a normal place of residence and a place for personal growth and development. This implies that the asylum seeker is to be understood as both a tenant and a human being. However, when it comes to appropriate actions, the holistic view is deconstructed and responsibility becomes restricted. The employees become responsible in terms of accountability with regard to the technical procedures entailed in making the asylum centre a normal place of residence. In the nursing textbooks a holistic view means embracing the mind, body and spirit of the patient. We find a continuation of the holistic ideal: nursing is about the sick body and the patient as a human being. However, the texts focus separately on the medical condition and the human aspects of the patient. When the focus is on the diagnosis, the human aspect is of no concern and vice versa. On the one hand, the responsibility is restricted to the sick body and on the other, the responsibility becomes limitless when associated with the human aspects of the patient. While the textbooks do make a contribution by connecting the quality of work to the ideal of wholeness, there is a lack of language when it comes to HOW the ideals can be translated in terms of responsibility. In social work the holistic view of the clients is conceptualised in the term “the person in--situation” making the social worker responsible for addressing both individual problems and societal problems in order to promote justice. The analysis reveals that the textbooks create a distance between the professional ideals and the responsibility as it is carried out in practice. The gap between the definition of the problems and the solutions represents a dichotomy when it comes to the connection between “ways of seeing” and “ways of doing”. The dual responsibility is apparent in the understanding of the problems; however, when it comes to addressing them, the responsibility is restricted to addressing only the problems at the individual level. The theses concludes that when the texts incorporate an ideal of understanding people in need of health and social services in a holistic manner, but at the same time deconstruct this with respect to how this responsibility should be undertaken, it may be difficult for professionals in situations entailing conflicting expectations and ethical dilemmas to know how legitimate compromises may be made. Since the different types of texts do not offer any conceptualisation of how to be responsible in relation to the different kinds of whole, the professionals find themselves in a web of commitments related to the normative expectations of seeing people as whole persons with few concepts of how to arrive at legitimate compromises that safeguard the ideal

Year: 2015
OAI identifier: oai:www.duo.uio.no:10852/50182
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