Inclusion and exclusion in action research on person-centered health care: A framework for cultivating the tensions in dialogue

This chapter presents a social constructionist theoretical framework for engaging in critical, reflexive analysis of the tensions integral to dialogue and illustrates its application in an action research project attached to “Active Patient Support”, a patient-centred health care initiative in which nurses engage in collaborative counselling with citizens with chronic diseases in telephone conversations. The framework draws on Bakhtin in order to theorise dialogue in terms of the tensional negotiation of meanings across multiple voices and on Foucault in order to address how tensions arise in the play of power/knowledge in which certain voices dominate. Two types of tensions are identified and explored: tensions in counselling conversations and tensions in the action research process. First, we show how the nursing team and university researchers, in action research workshops, drew on the framework in joint analysis of a range of tensions arising in counselling conversations in order to develop a model of dialogic communication that could further develop counselling practices. Second, we show how tensions arose in the action research process itself between opening up for multiple nursing voices and managing the process in order to produce a communication model. In conclusion, the chapter discusses limitations of the framework.