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University of South-Eastern Norway Means or meaningful? – The historical construction of the patient concept in health professions’ education - construction of the patient concept in health professions’ Means or meaningful? – The historical Faculty of Health and Social Sciences — Doctoral dissertation no. 90 2021 Vibeke Narverud Nyborg Means or meaningful? – The historical construction of the patient concept in health professions’ education Vibeke Narverud Nyborg Narverud Vibeke Vibeke Narverud Nyborg Means or meaningful? – The historical construction of the patient concept in health professions’ education A PhD dissertation in Person Centred Healthcare © Vibeke Narverud Nyborg 2021 Faculty of Health and Social Sciences University of South-Eastern Norway Drammen, 2021 Doctoral dissertations at the University of South-Eastern Norway no. 90 ISSN: 2535-5244(print) ISSN: 2535-5252 (online) ISBN: 978-82-7860-470-0 (online) ISBN: 978-82-7860-471-7 (print) This publication is licensed with a Creative Com- mons license. You may copy and redistribute the material in any medium or format. You must give appropriate credit, provide a link to the license, and indicate if changes were made. Complete license terms at https://creativecommons.org/licenses/by-nc-sa/4.0/deed.en Print: University of South-Eastern Norway Nyborg: “the historical construction of the patient concept” To Brynjar, Livia Josefine and Victor Martinius – for your love and support. No human relation gives one possession in another – every two souls are absolutely different. In friendship or in love, the two side by side raise hands together to find what cannot be reached alone. Khalil Gibran, The Prophet, 1923 ___ I Nyborg: “the historical construction of the patient concept” Dedications and acknowledgements This journey has pushed me to my limits in many directions and in every way possible for me as a person. The support from my closest family, friends and colleagues have been unquestionable. I have learned a lot, about this exciting field of health, medicine and nursing, but also about myself, my stamina, my strengths and weaknesses. This work could never been done without the support from the persons mentioned below. In my professional life, I would like to thank the Faculty of Health and Social Sciences, especially former Dean Heidi Kapstad who gave me the possibility to conduct a PhD when my current position at the University was no longer available for me. I am grateful that Heidi was brave enough to encourage me to pursue this project. It was not strategic work, but I grasped the opportunity when it came my way. Department of Nursing and Health Sciences has provided organizational structure to the work, for that I am thankful. A coincidence that has framed this project from the very beginning happened long before I considered taking on a PhD. This was my first meeting with my supervisor Professor Brendan McCormack, who I first met in 2012. This was also my first meeting with the Person-Centred Practice Framework and person-centredness as a conceptual framework within health and nursing. Five years and many meetings later another lucky coincidence made Brendan accept me as one of his PhD-candidates. I will forever be grateful for Brendan’s generosity in his supervision. With great knowledge, he has patiently let me find my own way through a jungle of challenges, new knowledge, frustrations and possibilities. Always supportive and cheering me on. I have been lucky to benefit from his expert understanding of nursing and health care as well as being an experienced supervisor. Brendan’s ability to guide me through reflections and discussions has been impressive and I have always felt wiser after our conversations. In addition, I need to thank Brendan for the laughter and fun we have shared through this journey and the generosity he has shown me beyond what can be expected of a supervisor. What will stay ___ II Nyborg: “the historical construction of the patient concept” with me from working with Brendan is the way he authentically has expressed his belief in me and made me grow as a person and as a researcher. In my team, I have also had the pleasure of having Professor Sigrun Hvalvik as my supervisor. Sigrun came into the project at a point where I was worried about whom to include in my supervisory team. Luckily for me she did not hesitate before deciding to join my work. My discussions with Sigrun have always broadened my perspective and challenged my assumptions. With a high degree of carefulness, Sigrun has gently pushed me forward, supported by huge knowledge and academic experience. I am grateful for all the interesting discussions we have had, the patience that has been shown me and the positive feedback she has provided through the four years we have worked together. The pleasure of having a supervisor that sometimes has been more enthusiastic about the project than I must not be underestimated. To both my supervisors I owe my sanity and getting to the finish line. I will continue to proclaim that I have had the best supervisory team ever. Thank you both of you. As part of the PhD programme in Person-centred Health Care, regular seminars have been organized for all PhD candidates. This arena has been a place to discuss, present and test the work before finalizing, whether it has been papers, mid-term evaluation, dissertation or trial lectures. I know it takes effort to plan and conduct such seminars with the high demanding group of persons PhD candidates are. A huge thank you to Professors Kirsti Skovdahl and Line Joranger for the facilitation and creation of a safe space to develop as researchers. Not to forget, all my PhD candidate colleagues who have participated, shared, discussed, challenged, supported and cheered, both at seminars and in every-day life in our PhD bubble. I will especially highlight the writing seminars at Eidene/Tjøme, and the participants at these seminars. I hope they will continue as I regard them priceless for both progression and social support. During the autumn 2020 some of the PhD candidates at the Programme have met once a week for ‘Shut up and Write’ seminars. Thank you to those of you who facilitated and invited to these writing days. They have been most welcome during a challenging work environment due to the ongoing pandemic. ___ III Nyborg: “the historical construction of the patient concept” Some colleagues go beyond what can be expected in the role as professional colleagues. They become friends. Friends that dare to challenge and know when you need a cup of coffee or a comforting word. Thank you Linda Hafskjold, Elin Kjelle, Aud Mette Myklebust, Ingunn Flaata Johansen and rest of the gang on the 2nd floor at Papirbredden 2, for coffee, laughter, discussions and support. To Janne Dugstad for sharing the experience of going from a public and outward position at the Faculty to being a PhD candidate. Your insight and reflections have helped on several occasions. To Espen Brembo for sharing ups and downs, for support and believing in me as a colleague despite having no background as a health care professional. Ingunn Elvekrok has contributed with endless hours of laughing and sharing frustrations, discussing the important matters in life beside work; movies, books, music and traveling. We have shared wonderful dinners and interdisciplinary discussions. Monika Gulslett has always had supportive words and been responsible for social inclusion together with Janne. You are all knowledgeable and good colleagues that I value and appreciate. More importantly, to me you have become supportive and fun friends to trust when life goes up and down. A special thanks to the University library at Campus Drammen. The colleagues working there has contributed on several arenas, from finding old journals in medicine and health, coping with reference styles and struggle with finding specific literature and questions regarding translation. Without their competence, I would have been lost. In addition, some of my international colleagues from Queen Margaret University Edinburgh (QMU) deserves to be mentioned as they have become good friends and extended my research community. Huge thanks to all the members at SICoP, to Sharon Middelmass for organizing my visits to QMU, and a special gratefulness to Karen Rennie, Kelly Statham and Maria McKay. I know you are right behind me with high challenge and high support, and last but not least a big chunk of gin. On a more personal level, I will like to thank my family. I have a large and modern family, because family as a concept today include much more than just a couple of decades ago. This extended family has contributed to shape me into the person I am today. My parents, step-parents, former step-parents, my two sisters and three brothers, in-laws and former ___ IV Nyborg: “the historical construction of the patient concept” in-laws, you have all contributed in my personal development. Whether you have been close or distant has meant less, you have all been family. To my friends from outside work, who have supported me from a distance, you know who you are and you know what you have meant to me. My husband Brynjar deserves the greatest gratitude of everyone. Doing a PhD is a family matter. You have stood by me through endless hours of frustration, anger, tears, joy, celebrations and depressions. You have been a rock, and at the same time challenged me and pushed me forward, urging me to “hang in there.” Your inclination to never accept an assertion without sufficient argumentation has both frustrated me and taught me how to set up sufficient arguments for my position. Our discussions during my work have been most valuable.