Search

This study uses a Foucauldian discourse analysis to explore media reporting on the role of nurses as being consistently positioned 'heroes' during COVID‐19. In so doing, it highlights multiple intersecting discourses at play, with the caring discourse acting as a central one in negatively impacting nurses' ability to advocate for safe working conditions during a public health emergency. Drawing on media reports during the outbreak of COVID‐19 in Ontario, Canada in the spring of 2020 and on historical information from SARS, this study seeks to establish caring as a discourse and examine if the caring discourse impedes nurses' ability to protect themselves from harm. The results of this analysis explicate how public media discourses that position nurses as caring, sacrificial and heroic may have impacted their ability to maintain their personal safety as a result of the expectations put upon the nursing profession. [ABSTRACT FROM AUTHOR]

Internationally, primary health care has in recent years gained a more central position in political priorities to ensure sustainable health care for the population. Thus, more people receive health care locally and in their own homes, where home‐care nursing plays a large role. In this article, we investigate how home‐care nursing is articulated and made visible in contemporary Norwegian policy documents. The study is a Fairclough‐inspired critical discourse analysis seeking to uncover the position of nursing in the prevailing political ideologies on current primary health care. In the documents, we identified several complementary and conflicting understandings about home‐care nursing. Home‐care nursing is presented as a basic part of a municipality's health services, but at the same time, its content and contribution are unclear and almost invisible. We argue that the absence of nursing leads to significant perspectives being left out and tie this to the fact that some patient groups and tasks seem to be disadvantaged. The political placement of home‐care nursing in the health‐care landscape is thus not just about nursing as a professional practice but also concerns fundamental care values in our society in relation to disadvantaged groups and work tasks. [ABSTRACT FROM AUTHOR]

Despite the promise to save every life, the COVID‐19 pandemic has exposed social and racial inequalities, precarious living conditions, and engendered an exponential increase in overdose deaths. Although some lives are considered sacred, others are deliberately sacrificed. This article draws on the theoretical work of Foucault and scholars who further developed his concept of biopolitics. While biopolitics aims to ameliorate the health of populations, Foucault never systematically accounted for the unequal value of lives. In the name of saving the biological lives of people who use drugs (PWUD) during the pandemic, the harm reduction movement has emphasized the need for safe supply, decriminalization, and housing; governments have started implementing these measures, which were previously rejected as utopian and unrealistic. Paradoxically, the use of drugs itself, and therefore the increased risk of death from overdose or other medical sequelae, is the only way PWUD can achieve enough visibility to be recognized as a life worth saving. The humanitarian rationale of harm reduction concerns itself with the biological life and stipulates social and political rights in the name of its sacredness. This is what anthropologist Fassin and others called biolegitimacy—the recognition of life reduced to its physiological, biological essence. [ABSTRACT FROM AUTHOR]

Ongoing changes in many Western countries have resulted in more healthcare services being transferred to municipalities and taking place in patients' homes. This greatly impacts nurses' work in home care, making their work increasingly diverse and demanding. In this study, we explore home‐care nursing through a critical discourse analysis of focus group interviews with home‐care nurses. Drawing on insights from positioning theory, we discuss the content and delineation of their work and the interweaving of contextual changes. Nurses hold a crucial position in home healthcare, particularly in ensuring care for sicker patients with complex needs. Assessing health needs, performing advanced care, and at the same time, providing customized solutions in various homes were identified as distinctive for home‐care nurses' work. Changes have made nurses' work become driven by comprehensive tasks and acute medical needs that require much of their competence and time. Urgent care seems to take precedence in nurses' work, leaving less time and attention for other tasks such as conversations and support for coping with everyday life. This underlines the need to investigate and discuss the content and scope of nurses' work to help shape the further development of home‐care nursing. [ABSTRACT FROM AUTHOR]

Although guidelines to regulate user involvement in research have been advocated and implemented for several years, literature still describes the process as challenging. In this qualitative study, we take a critical view on guidelines that are developed to regulate and govern the collaboration process of user involvement in research. We adapt a social constructivist view of guidelines and our aim is to explore how guidelines construct the perception of users and researchers and thus the process of involvement. Twenty‐two guidelines published between 2006 and 2019 were analyzed iteratively. The analysis focuses on values which are emphasized in the guidelines on the distribution of entities, knowledge, and tasks between users and researchers. The analysis indicates that users and researchers are constructed differently; researchers are mainly constructed as responsible initiators and caretakers, while users are constructed as powerless and vulnerable. The guidelines portray the collaboration process as harmonious and assume a normative perspective. In doing so, challenges described in the literature related to power imbalances are not addressed. Based on these findings, we ask if these guidelines might function to maintain existing power imbalances between users and researchers. [ABSTRACT FROM AUTHOR]

It is widely recognised that the delivery of services across health-care sectors faces multiple challenges related to incoherence in patient pathways. There are multiple reasons for this incoherence, which are often dealt with through national legislation and policy-making. This paper discusses policies as powerful actors and explores how effects of a concrete policy are adapted for intersectorial collaboration in Danish health-care. The paper is based on a critical discourse analysis of a central policy document in Danish health-care known as the 'Health Agreements'. Using Fairclough's three-dimensional model for discourse analysis, we explored the document to clarify the construction of actors participating in intersectorial collaboration. The analysis revealed the Health Agreement as a 'negotiated text', appearing as an overriding document legitimising one possible discourse regarding the premises of intersectorial collaboration. The premises of intersectorial collaboration are maintained through a specific presentation of actors leaving little room for discussion, where professionals are constructed as actors who are expected to develop ways of collaborating according to the Triple Aim approach in order to promote productivity and efficiency. Furthermore, this presentation constructs citizens and patients as active, participating individuals who consciously prioritise and act with the purpose of controlling their life situation. [ABSTRACT FROM AUTHOR]

The Swedish welfare debate increasingly focuses on market liberal notions and its healthcare perspective aims for more patient-centered care. This article examines the new Swedish Patient Act describing and analyzing how the patient is constructed in government documents. This study takes a Foucauldian discourse analysis approach following Willig's analysis guide. The act contains an entitlement discourse for patients and a requirement discourse for healthcare personnel. These two discourses are governed by a values-based healthcare discourse. Neo-liberal ideology, in the form of New Public Management discourse, focusing on the value of efficiency and competition, is given a hegemonic position as laws and regulations are used to strengthen it. The new Swedish Patient Act seems to further strengthen this development. The Act underlines the increased entitlement for patients, but it is not legally binding as it offers patients only indirect entitlement to influence and control their care. To safeguard the patient's entitlement under the Patient Act, healthcare personnel should be made aware of the contents of the Act, so that they can contribute to the creation of systems and working methods that facilitate respect of the Act's provisions in daily healthcare work. [ABSTRACT FROM AUTHOR]

Two nurses diagnosed with opioid addiction launched legal action after being found guilty of unprofessional conduct due to addiction‐related behaviors. When covered by the media, their cases sparked both public and legal controversies. We are curious about the broader discursive framings that led to these strong reactions, and analyze the underlying structures of knowledge and power that shape the issue of opioid addiction in the profession of nursing through a critical discourse analysis of popular media, legal blogs and hearing tribunals. We argue that addiction in nursing is framed as personal choice, as a failure in the moral character of the nurses, as decontextualized from addiction as disease arguments, and as an individualized issue devoid of contextual factors leading to addiction. Our investigation offers a critical case study of a nursing regulatory body that upheld popular assumptions of addiction as an autonomous, rational choice replete with individual‐based consequences – a framing that is inconsistent with evidence‐based practice in health‐care. We put forth this critical interrogation to open up possibilities for counterdiscourses that may promote more nuanced and effective responses to the issue of addiction in nursing. [ABSTRACT FROM AUTHOR]

In crisis situations, the authority of the nurse is legitimised by legal powers and professional knowledge. Crisis stakeholders include those who directly use services and their families, and a wide range of health, social service and justice agencies. Alternative strategies such as therapeutic risk taking from the perspective of socially inclusive recovery policy coexist in a sometimes uneasy relationship with mental health legislation. A critical discourse analysis was undertaken to examine mental health policies and guidelines, and we interviewed service users, families, nurses and the police about experiences of accessing services. For those who attempt to access services early in crisis, as is suggested to lead to a better outcome, provision of services and rights appear to be reversed by an attempt to exclude them through practices that screen them out, rather than prioritising a choice in access. [ABSTRACT FROM AUTHOR]

Within the context of global debates about safety and ethics of supporting women to give birth at home, it is important to analyse documents governing midwifery and obstetric practice and influence decision‐making around place of birth. In Australia, the United States and the United Kingdom, relatively small numbers of women choose to give birth at home despite their midwifery colleges' support. In the United States and Australia, the obstetric colleges do not support homebirth and these countries have lower numbers of women who birth at home, compared with the United Kingdom. There are numerous regulatory and industry challenges for midwives attending homebirths. This paper reports on a Foucauldian analysis of Australian obstetric and midwifery colleges' position statements about homebirth, who have conflicting views, with the view to understanding their arguments and underlying assumptions. The documents highlighted tensions between competing discourses of risk and autonomy and differences in academic argument. Opportunities for strengthening their statements are highlighted. The methodology is applicable for future analysis of similar documents governing practice in other countries. [ABSTRACT FROM AUTHOR]

Quality of care is a prominent discourse in modern health‐care and has previously been conceptualised in terms of ethics. In addition, the role of knowledge has been suggested as being particularly influential with regard to the nurse–patient–carer relationship. However, to date, no analyses have examined how knowledge (as an ethical concept) impinges on quality of care. Qualitative semi‐structured interviews were conducted with 26 patients with palliative and supportive care needs receiving district nursing care and thirteen of their lay carers. Poststructural discourse analysis techniques were utilised to take an ethical perspective on the current way in which quality of care is assessed and produced in health‐care. It is argued that if quality of care is to be achieved, patients and carers need to be able to redistribute and redevelop the knowledge of their services in a collaborative way that goes beyond the current ways of working. Theoretical works and extant research are then used to produce tentative suggestions about how this may be achieved. [ABSTRACT FROM AUTHOR]

The health of a nation tells much about the nature of a social contract between citizen and state. The way that health care is organised, and the degree to which it is equitably accessible, constitutes a manifestation of the effects of moments and events in that country's history. Research around health inequalities often focuses on demonstrating current conditions, with little attention paid to how the conditions of inequality have been achieved and sustained. This article presents a novel approach to inequalities research that focuses on examining powerful historical discourses as legitimising processes that serve to sustain unequal conditions. The use of this Foucauldian historical genealogical approach in a study of the Irish health care system is explored and proposed as a novel approach to the research of health inequities. [ABSTRACT FROM AUTHOR]

This article uncovers the current discursive practices concerning socially vulnerable people in Danish society. A discourse analytical approach inspired by Michel Foucault, along with contributions from Erving Goffmann's work 'Stigma', is utilized throughout the analysis. First, the dominant discursive formations are described across the data material, consisting of sociopolitical and health policy documents. Second, we uncover how problematizations and mechanisms of power along with the emergence of the competition state push socially vulnerable people out into the periphery of society. Finally, we discuss responsibility regarding social vulnerability and the structural injustice that follows. Our aim is to facilitate critical awareness of how socially vulnerable people are constructed and contribute to destabilizing accepted meanings and perceptions of social vulnerability. This study shows that being categorized as socially vulnerable is associated with poor health behavior and perceived as being in a dependent relationship with superior systems. The analysis points to a focus on strengthening and developing the work capacity of socially vulnerable people. Thus, the objective of the analyzed documents revolves around securing socially vulnerable people's contribution to society's economy. This article contributes with a perspective on how society, and therefore also healthcare professionals, perceive and interact with socially vulnerable people. [ABSTRACT FROM AUTHOR]