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Aims: To explore the effects of power dynamics and hospital organizational structure upon neonatal intensive care nurses' experiences caring for infants and families from a substance‐exposed pregnancy (SEP). Design: This secondary data analysis further investigated the results of a primary study after the original analysis suggested differences in work environments may impact relationship‐building opportunities between nurses and mothers/families. Critical discourse analysis served as both the theoretical lens and analytic technique. Method: Nine (9) nurses from the southeast region of the United States (U.S.) were interviewed in 2019. Fifty‐one (51) stories of caregiving experiences were analysed with a focus on narratives related to organizational structure and care delivery. Results: Study findings revealed nurses experienced challenges providing high‐quality, family‐centered care for patients in the neonatal intensive care unit (NICU) affected by substances during pregnancy. Nurses described the central challenge of workload, exacerbated by power imbalances and structural constraints within the hospital's organizational structure. Findings suggest workload issues may endorse stigma by inhibiting opportunities to build relationships. Nurses report manageable workloads can support healthcare teams and recipients of care. Conclusion: The study suggests power imbalances between nurses, families and adjacent healthcare professionals can inhibit the delivery of high‐quality care. Supporting healthcare teams and recipients of care while centering the role of organizational structure is critical. Questions emerged about workload demands impacting the potential production of stigma in clinical environments. Impact: This study examines the intersection of nurses' care experiences and hospital organizational structure. It identifies how the unique needs of caring for infants and families from a SEP increase the complexity of power imbalances and organizational constraints to further increase workload demands. Findings have implications for global healthcare organization leaders who build and maintain the structural integrity of clinical environments and nurse leaders who advocate and guide clinical teams to provide high‐quality care in stressful healthcare environments. Reporting Method: EQUATOR guidelines were followed, using the COREQ checklist. Patient or Public Contribution: NICU nurses were interviewed about their care‐provision experiences. Interviews were analysed in the primary study and the current analysis of secondary data. [ABSTRACT FROM AUTHOR]

Aims and objectives: To examine how gendered discursive norms and notions of masculinity are (re)produced in professional conversations about men cared for as patients in forensic psychiatric care, with a particular focus on the centrality of language and gender. Background: During verbal handovers and ward rounds, care staff converse to share information about patients and make decisions about their mental status. Spoken language is thus a pivotal tool in verbal handovers and ward rounds, one able to reproduce discourses and gender norms. Design: Qualitative. Data collected from audio recordings of verbal handovers and ward rounds in a forensic psychiatric clinic were subjected to discourse analysis. The COREQ checklist was used. Results: While discussing patients, staff subordinated them by reproducing a discourse typical of heteronormative, family‐oriented care. The overarching discourse, which we labelled subordinated masculinities, was supported by three other discourses: being unable to take responsibility, being drug‐addicted and performing masculinity. Such discourse was identified as a disciplining practice that subordinate's patients as a means to maintain order, rules and gender norms. Conclusion: The study reveals a caring practice that position male patients as children or disabled individuals and, in that way, as subordinated other men within a context were staff reproduces a heteronormative family structured care. The process also reveals a practice were downplaying aggressive and deviant behaviour could disempower and reduce patients´ responsibility for personal actions and their possibilities to participate in their care. That finding especially seems to contradict previous findings that patients want to be able to act responsibly and, to that end, want care staff to help them. Relevance to clinical practice: Nurses need to deepen their understanding of how language (re)produces discursive norms of gender and masculinity in forensic care and that process's consequences for such care. [ABSTRACT FROM AUTHOR]

Aims and objectives: To collate, synthesise and discuss published evidence and expert professional opinion on enablers and barriers to the development and sustainability of specialist and advanced practice roles in nursing and midwifery. Background: Expanded practice is a response to population health needs, healthcare costs and practitioners’ willingness to expand their scope of practice through enhanced responsibility, accountability and professional autonomy. Design: This discursive paper is based on a rapid review of literature on enablers and barriers to the development and sustainability of specialist and advanced practice roles and is part of a wider policy analysis. Methods: We analysed and synthesised of 36 research articles, reviews and discussion papers on enablers and barriers in the development and sustainability of expanded practice roles. Results: Several factors enable role expansion, including: role clarity; credentialing and endorsement; availability of education for expanded roles; individual practitioners’ dispositions towards role expansion; support from peers, other professionals and the work organisation; and costs. Where limited or absent, these same factors can constrain role expansion. Conclusions: Enabling nurses and midwives to practice to their full scope of education and expertise is a global challenge for disciplinary leadership, a national challenge for professional regulation and a local challenge for employers and individual clinicians. These challenges need to be addressed through multistakeholder coordinated efforts at these four levels. Relevance to clinical practice: This discursive paper synthesises empirical evidence and expert professional opinion on the factors that enable or hinder the development and sustainability of specialist and advanced practice roles. Providing a critical appraisal of current knowledge, it provides a reference source for disciplinary debate and policy development regarding the nursing and midwifery resource and informs clinicians of the myriad issues that can impact on their capacity to expand their scope of practice. [ABSTRACT FROM AUTHOR]

Abstract: Aim: To examine and describe disciplinary discourses conducted through professional policy and regulatory documents in nursing and midwifery in Ireland. Background: A key tenet of discourse theory is that group identities are constructed in public discourses and these discursively constructed identities become social realities. Professional identities can be extracted from both the explicit and latent content of discourse. Studies of nursing's disciplinary discourse have drawn attention to a dominant discourse that confers nursing with particular identities, which privilege the relational and affective aspects of nursing and, in the process, marginalize scientific knowledge and the technical and body work of nursing. Design: We used critical discourse analysis to analyse a purposive sample of nursing and midwifery regulatory and policy documents. Method: We applied a four‐part, sequential approach to analyse the selected texts. This involved identifying key words, phrases and statements that indicated dominant discourses that, in turn, revealed latent beliefs and assumptions. The focus of our analysis was on how the discourses construct professional identities. Findings: Our analysis indicated recurring narratives that appeared to confer nurses and midwives with three dominant identities: “the knowledgeable practitioner,” the “interpersonal practitioner” and the “accountable practitioner.” The discourse also carried assumptions about the form and content of disciplinary knowledge. Conclusions: Academic study of identity construction in discourse is important to disciplinary development by raising nurses’ and midwives’ consciousness, alerting them to the ways that their own discourse can shape their identities, influence public and political opinion and, in the process, shape public policy on their professions. [ABSTRACT FROM AUTHOR]

Aims and objectives: To examine how the concept of compassion is socially constructed within UK discourse, in response to recommendations that aspiring nurses gain care experience prior to entering nurse education. Background: Following a report of significant failings in care, the UK government proposed prior care experience for aspiring nurses as a strategy to enhance compassion amongst the profession. Media reporting of this generated substantial online discussion, which formed the data for this research. There is a need to define how compassion is constructed through language as a limited understanding exists, of what compassion means in health care. This is important, for any meaningful evaluation of quality, compassionate practices. Design: A corpus‐informed discourse analysis. Methods: A 62,626‐word corpus of data was analysed using Laurence Anthony software “AntCon”, a free corpus analysis toolkit. Frequent words were retrieved and used as a focal point for further analysis. Concordance lines were computed and analysed in the context of which frequent word‐types occurred. Patterns of language were revealed and interpreted through researcher immersion. Results: Findings identified that compassion was frequently described in various ways as a natural characteristic attribute. A pattern of language also referred to compassion as something that was not able to be taught, but could be developed through the repetition of behaviours observed in practice learning. In the context of compassion, the word‐type “nurse” was used positively. Conclusion: This study adds to important debates highlighting how compassion is constructed and defined in the context of nursing. Compassion is constructed as both an individual, personal trait and a professional behaviour to be learnt. Educational design could include effective interpersonal skills training, which may help enhance and develop compassion from within the nursing profession. Likewise, ways of thinking, behaving and communicating should also be addressed by established practitioners to maintain compassionate interactions between professionals as well as nurse–patient relationships. Future research should focus on how compassionate practice is defined by both health professionals and patients. Relevance to clinical practice: To maintain nursing as an attractive profession to join, it is important that nurses are viewed as compassionate. This holds implications for professional morale, associated with the continued retention and recruitment of the future workforce. Existing ideologies within the practice placement, the prior care experience environment, as well as the educational and organisational design, are crucial factors to consider, in terms of their influences on the expression of compassion in practice. [ABSTRACT FROM AUTHOR]

Aim To explore nostalgic constructions of nurse education in British National newspapers. Background British newspaper discourse relating to the increased academic level of nurse education in the UK is negative, evoking comparisons between negative constructions of nurse education in the present and an idealized nostalgic view of the past. Design Discussion paper. Data Sources This study used a critical discourse analysis approach to analyse 11 British Newspaper articles, which exemplify nostalgic constructions of nurse education. This was a purposive sample from a database search (LexisNexis) of British national newspaper articles relating to the increasing academic level of nurse education in the period from 1999-2012. Implications for Nursing A dominant nostalgic discourse constructs a 'golden era' of nurse education, which idealizes the past, making the present flawed in comparison. Nostalgic constructions create group identities creating contrasting 'caring' nurses educated in the idealized past with those educated now, who are perceived as too educated to care. An inherent characteristic of the nostalgic discourse is the notion that the solution to current problems with nurse education is a return to an idealized version of the past. Another less common newspaper discourse views nostalgia as a problematic construct. Conclusion Nostalgic discourse with a focus on the past potentially acts as a barrier to creating an effective nurse education system for the 21st Century. This focus on an idealized past also has potential consequences in terms of public opinion and legitimization of government policy, which might otherwise be viewed as retrograde. [ABSTRACT FROM AUTHOR]