Halvard Vike

Facing diversity under institutional constraints: challenging situations for community nurses when providing care to ethnic minority patients

AIMS To explore the challenges faced by community nurses when providing home health care to ethnic minority patients. BACKGROUND Norway has a growing number of immigrants, including older immigrant patients. Community nurses who provide home care encounter considerable challenges when delivering services to an increasingly diverse patient population. DESIGN A qualitative study based on a hermeneutics approach. METHODS A qualitative study was conducted involving 19 nurses in Norwegian home health care districts, which had high proportions of minority patients. Data were collected in 2008. FINDINGS We identified three critical aspects of the encounters between community nurses and minority patients. The first was intimate care. Nurses perceived the fear of mistakes and crossing boundaries related to the cultural and religious practices of minority patients as particularly stressful. The second was rehabilitation after stroke. The beliefs of nurses in the benefits of rapid rehabilitation conflicted with those of the minority patients and their relatives who favoured extended rest during recovery. Third, the commitment of community nurses to transparency in the care of dying patients was tested severely when they met relatives who believed in religious explanations for the destinies of patients and who wanted to conceal the true diagnosis from terminally ill patients. CONCLUSION Community nurses encountered various challenges due to a lack of experience with highly diverse patient populations. This situation will continue to create difficulties for nurses and minority patients if management support and appropriate training measures are not provided.

Family Therapy and Holistic Complexity—An Ethnographic Approach to Therapeutic Practice in a Norwegian Psychiatric Clinic

Family therapy emerges from an intellectual trajectory that, in the aftermath of World War II, generated a particular psychotherapeutic ambition to deal not only with individual pathology, but also with relational systems and the way they failed to adapt adequately to a changing environment. We find this ambition highly fascinating, as it seems to have produced a particular inspiration toward experimentation and intellectual, existential reflection. On the basis of anthropological fieldwork at Modum Bad Psychiatric Clinic, Norway, in 2013, we explore in this chapter how therapists and patients at the Family Unit constructed social contexts that could serve as vehicles for reflection, experimentation, and change. An important part of our task, as we came to see it, was to try to understand the therapeutic effects of contextual shifts, as the particular experience of social complexity it generated seemed very meaningful and helpful for patients. We argue that the intellectual resources provided by family therapy as an academic and therapeutic tradition have been applied at Modum Bad so as to make mental problems and relational challenges as a more or less common human set of issues to be dealt with in therapeutic arenas that take the form of “public spaces.” As all actors take part in contextual shifts but grasp the opportunity this provides for assuming different roles, points of view, and ways to talk about problems, they “objectify” problematic aspects of their own selves and behavioral patterns such as to make them into potentially transparent objects of manipulation.

The Politics of Resistance

This chapter offers a historical perspective on the emergence of political resistance, and its constitutive role in state formation in Norway and Scandinavia. It provides a review of some important instances of political challenges to state power from below. In addition, it includes an attempt to sketch some important phases in state building and state institutions in Denmark/Norway leading up to the present. I try to substantiate my claim that municipal politics in Norway have generally been heavily influenced by organized interests (trust networks) which to some extent have been able to challenge the logics of state governance, and assume that the relative success of such challenges may in part explain the emergence of the welfare state as we know it. In Norway in particular, local institutions—municipalities, above all—have been key arenas for the social organization of political interests, and have only partially served as extensions of state power.

The Protestant Ethic and the Spirit of Political Resistance: Notes on the Political Roots of Egalitarianism in Scandinavia

This chapter looks at processes that have contributed to accommodating trust networks into public politics. In Scandinavia, this seems to have happened to a great extent, and the chapter explores some aspects of how this has occurred, and why, and examines some of its implications. In comparative terms, popular political mobilization in Scandinavia was quite successful in influencing the state, not only by forcing it to make concessions, but also by integrating forms of trust, horizontal loyalty, and certain values and interests that became important for developing policy—such as individual autonomy and universalism. Trust networks were not simply absorbed by the hierarchical—and partly clientelistic—logic of the state apparatus. The first section of the chapter discusses the nature of organized popular opposition to state power and its implications. In the second section, dealing with contemporary local politics, how oppositional interests form alliances that challenge routine politics of governance is shown.

The Welfare Municipality: Universalism, Gender, and Service Provision

This chapter describes the relationship between the central state, the municipality, and the street-level bureaucrats. The case in point is elder care, which serves as an illustration of the welfare state’s capacity problem. As the overwhelming majority of the street-level bureaucrats in municipal service provision are women, the capacity problem seems to be dealt with through a highly gendered synthesis of policy making and organizational governance. I demonstrate how the central state and the municipalities utilize this resource, how its uses are negotiated, and how the gradual appropriation of municipal and professional autonomy by the central state influences service quality and, in the long run, seems to undermine universalism. In this chapter, the analytical distinction between what I call utopian time and contemporary time is used in order to illuminate how a certain temporal asymmetry serves as a mechanism for decentralizing responsibility and dilemma, while centralizing power.

Introduction: Egalitarianism in a Scandinavian Context

This Introduction sets out different ways of engaging with the history of the Scandinavian countries to create a framework of the themes and positions regarding egalitarianism in Scandinavia that is pursued in the following chapters. After briefly discussing egalitarianism as a theoretical possibility, it is explored in relation to the ideological and social construction of Scandinavian welfare states, investigating in particular the role of civil society and politics. Then is shown how, in historical terms, egalitarian popular movements have become institutionalized and tied to state policy. One characteristic of this region appears to be that egalitarian movements in Scandinavia have largely been picked up, co-opted by, and made part of the state and its institutions. Then a further elaboration on what egalitarianism as a cultural and social value in Scandinavia may mean, and an exploration of its institutionalization in this context are given. In the final section, how the political project of egalitarianism has been pursued in an era of migration is discussed.

Setting the Stage: In and Out of Institutions

The present book explores how political mobilization from “below” may influence the distribution and dynamics of power in the context of a thoroughly bureaucratized, democratic state.

Borders, Boundaries, and Bureaucratic Reform

In this chapter, I return to the municipality of Skien and discuss, through a case study of a municipal reorganizational process, how managerial interests struggle to achieve control over the organization. Also, it is shown that municipal employees have alternative pathways of action, and do not necessarily comply with the ideology of loyalty and managerial control. Moreover, the chapter shows how the consequences of control measures affect different categories of municipal employees, and how these employees perceive their role in the organization and the wider context of the welfare state, more or less “betwixt and between” their role as advocates of universalism and the users/local population, on the one hand, and municipal functionaries.

No Direction Home? Doing Anthropology in Norway

In this chapter I discuss some challenges involved in what anthropologists somewhat awkwardly have called “doing anthropology at home.” This is discussed in relation to a review of some key characteristics of anthropology as a discipline, especially its development in the Norwegian context, and defines my own position in relation to it. I also address some of the questions that seem to have fascinated observers of Scandinavia for a long time, especially as these questions concern trust in institutions and in “the state.”

The Politics of Universalism

In Skien municipality, as in local politics in Norway in general, welfare policy (along with primary education), and the budget problems related to it constitute major issues and concerns, and loom larger in local public debate than any other issue. In the fall of 1993, the Municipal Assembly voted on a general budget that, as it turned out, would involve serious cutbacks in the Health and Welfare Department. This became a big challenge for the Health and Welfare Committee, the political body that serves as the Municipal Assembly and Municipal Council executive body.