Critical discourse analysis is a useful and productive qualitative methodology but has been underutilized within nursing research. In order to redress this deficiency the research presented in this article represents an exploration of the way in which critical discourse analysis may be applied to the analysis of public debates around policy for nursing practice. In this article the author discusses the history of the application of critical discourse analysis and provides an example of its application to the debate around the (...) use of nurse practitioners within the Australian healthcare system. (shrink)

SCHOFIELD I, TOLSON D and FLEMING V. Nursing Inquiry 2012; 19: 165–176 [Epub ahead of print]How nurses understand and care for older people with delirium in the acute hospital: a Critical Discourse AnalysisDelirium is a common presentation of deteriorating health in older people. It is potentially deleterious in terms of patient experience and clinical outcomes. Much of what is known about delirium is through positivist research, which forms the evidence base for disease‐based classification systems and clinical guidelines. There is little (...) systematic study of nurses’ day‐to‐day practice of nursing patients with delirium. The aim was to uncover the kinds of knowledge that informs nurses’ care and to explicate the basis of that knowledge. Critical Discourse Analysis is underpinned by the premise that powerful interests within society mediate how social practices are constructed. Links were made between the grammatical and lexical features of nurses’ language about care in interviews and naturalistic settings, and the healthcare context. Care focused on the continuous surveillance of patients with delirium by nurses themselves or vicariously through other patients, and containment. Nurses influenced by major discourses of risk reduction and safety, constructed patients with delirium as risk objects. The philosophy of person‐centred and dignified care advocated in nursing literature and government policy is an emerging discourse, though little evident in the data. The current dominant discourses on safety must give space to discourses of dignity and compassion. (shrink)

The purpose of this paper is to present the theoretical and philosophical assumptions of the Nursing Manifesto , written by three activist scholars whose objective was to promote emancipatory nursing research, practice, and education within the dialogue and praxis of social justice. Inspired by discussions with a number of nurse philosophers at the 2008 Knowledge Conference in Boston, two of the original Manifesto authors and two colleagues discussed the need to explicate emancipatory knowing as it emerged from the Manifesto . (...) Our analysis yielded an epistemological framework based on liberation principles to advance praxis in the discipline of nursing. This paper adds to what is already known on this topic, as there is not an explicit contribution to the literature of this specific Manifesto , its significance, and utility for the discipline. While each of us have written on emancipatory knowing and social justice in a variety of works, it is in this article that we identify, as a unit of knowledge production and as a direction towards praxis, a set of critical values that arose from the emancipatory conscience-ness and intention seen in the framework of the Nursing Manifesto. (shrink)

The purpose of this paper is to present the theoretical and philosophical assumptions of the Nursing Manifesto, written by three activist scholars whose objective was to promote emancipatory nursing research, practice, and education within the dialogue and praxis of social justice. Inspired by discussions with a number of nurse philosophers at the 2008 Knowledge Conference in Boston, two of the original Manifesto authors and two colleagues discussed the need to explicate emancipatory knowing as it emerged from the Manifesto. Our analysis (...) yielded an epistemological framework based on liberation principles to advance praxis in the discipline of nursing. This paper adds to what is already known on this topic, as there is not an explicit contribution to the literature of this specific Manifesto, its significance, and utility for the discipline. While each of us have written on emancipatory knowing and social justice in a variety of works, it is in this article that we identify, as a unit of knowledge production and as a direction towards praxis, a set of critical values that arose from the emancipatory conscience-ness and intention seen in the framework of the Nursing Manifesto. (shrink)

This paper uses a semiotic, performative theory of language and post-colonial theory to argue that nursing's representations of ‘multiculturalism’ need to be grounded in a theory of whiteness, an historicized understanding of how ethnic/cultural differences come to be represented in the ways they are and informed by Foucault's notions of power/knowledge. Using nursing education and ‘cultural compentency’ as examples, the paper draws on a range of literatures to suggest more critical and politically productive ways of approaching difference from within nursing's (...) largely white interpretive framework. (shrink)

This study aimed to explore the conditions for nurses' daily patient education work by focusing on managers' way of speaking about the patient education provided by nurses in hospital care. An explorative, qualitative design with a social constructionist perspective was used. Data were collected from three focus group interviews and analysed by means of critical discourse analysis. Discursive practice can be explained by the ideology of hegemony. Due to a heavy workload and lack of time, managers could ‘see’ neither their (...) role as a supporter of the patient education provided by nurses, nor their role in the development of nurses' pedagogical competence. They used organisational, financial, medical and legal reasons for explaining their failure to support nurses' provision of patient education. The organisational discourse was an umbrella term for ‘things’ such as cost‐effectiveness, which were prioritised over patient education. There is a need to remove managerial barriers to the professional development of nurses' patient education. Managers should be responsible for ensuring and overseeing that nurses have the prerequisites necessary for providing patient education as well as for enabling continuous reflective dialogue and opportunities for learning in practice. (shrink)

Managing aggression in mental health hospitals is an important and challenging task for clinical nursing staff. A majority of studies focus on the perspective of clinicians, and research mainly depicts aggression by referring to patient-related factors. This qualitative study investigates how aggression is communicated in forensic mental health nursing records. The aim of the study was to gain insight into the discursive practices used by forensic mental health nursing staff when they record observed aggressive incidents. Textual accounts were extracted from (...) the Staff Observation Aggression Scale-Revised (SOAS-R), and Fairclough’s Critical Discourse Analysis was used to identify short narrative entries depicting patients and staffs in typical ways. The narratives contained descriptions of complex interactions between patient and staff that were linked to specific circumstances surrounding the patient. These antecedents, combined with the aggression incident itself, created stereotyping representations of forensic psychiatric patients as deviant, unpredictable and dangerous. Patient and staff identities were continually (re)produced by an automatic response from the staff that was solely focused on the patient’s behavior. Such response might impede implementation of new strategies for managing aggression. (shrink)

Recent events around the globe reflect the tensions and ethical dilemmas of the postmodern, postcolonial and neocolonial world that have far reaching implications for health, well-being, and human suffering. As we consider what is at stake, and what this means for local lives and human relationships, we need to examine whether the theories we draw on are adequate to further our understanding of health, and the social and material conditions of human suffering. In this paper I begin to explore the (...) question, ‘Can postcolonial feminist theories provide an inclusive scholarship that would further our understanding of human suffering and open up a path to healing?’ At issue here is whether this scholarship adds another dimension to a praxis-oriented nursing science. (shrink)

Gender, ‘race’, poverty, health and discourses of health reform in the context of globalization: a postcolonial feminist perspective in policy researchIn this paper, I draw on extant literature and my empirical work to discuss the impact of globalization and healthcare reform on the lives of women — those from countries of the South as well as of the North. First, I review briefly the economic hardships identified in different sectors of the population that have been attributed to how globalization is (...) now working. Second, I examine what these global processes mean for health, with particular focus on poverty, gender, racialization and health. Third, I reflect on how nurse scientists might develop research agendas in the 21st century that would foster social transformation and social justice for all people. The position taken here is not an indictment of globalization. Rather, I argue that globalization is a fact in all of our lives. There are positive aspects of globalization. There are also negative aspects which we must collectively address, given that the issues identified can have deleterious consequences for the world’s poor, women in particular. I suggest that, to construct knowledge for practice and praxis, research agendas of the future should be inclusive of subaltern voices. I argue that drawing on a postcolonial feminist epistemology might help us to define such agendas, and express the multilayered sociopolitical contexts of health and illness in advocacy with policy‐makers. (shrink)