PERRON A and HOLMES D. Nursing Inquiry 2011; 18: 191–204Constructing mentally ill inmates: nurses’ discursive practices in correctionsThe concepts of discourse, subjectivity and power allow for innovative explorations in nursing research. Discourse take many different forms and may be maintained, transmitted, even imposed, in various ways. Nursing practice makes possible many discursive spaces where discourses intersect. Using a Foucauldian perspective, were explored the ways in which forensic psychiatric nurses construct the subjectivity of mentally ill inmates. Progress notes and individual interviews (...) constitute discursive spaces within which nurses construct patients’ subjectivities. Progress notes provide a written (and permanent) form of discourse, while interviews set the space for a more fluid and contextual form of discourse. We identified five types of subjectivities – the (in)visible patient, the patient as risk, the deviant patient, the disturbed patient and the disciplined patient. These subjectivities were rooted in various types of discourses circulating in the selected setting. Despite the multiple discursive dimensions of forensic psychiatric nursing, progress notes remain the main formal source of information regarding nursing care even though it is not representative of the care provided nor is it representative of nurses’ complex discursive practices in corrections. (shrink)

Emergency care in large urban hospitals across the country is in the midst of major redesign intended to deliver quality care through improved access, decreased wait times, and maximum efficiency. The central argument in this paper is that the conceptualization of quality including the documentary facts and figures produced to substantiate quality emergency care is socially organized within a powerful ruling discourse that inserts the interests of politics and economics into nurses' work. The Canadian Triage and Acuity Scale figures prominently (...) in the analysis as a high‐level organizer of triage work and knowledge production that underpins the way those who administer the system define, measure and evaluate emergency care processes, and then use this information for restructuring. Managerial targets and thinking not only dominate the way emergency work is understood, determined, and controlled but also subsume the actual work of health‐care providers in spaces called ‘wait times’, where it is systematically rendered ‘unknowable’. The analysis is supported with evidence from an extensive institutional ethnography that shows what nurses actually do to manage the safe passage of patients through their emergency care process starting with the work of triage nurses. (shrink)

This paper delineates a postmodern discourse analysis that is positioned within a semiotic theory of language. This theory of language foregrounds the performative aspects of language usage and provides the theoretical space from which to theorize the interrelationship between social organizations or structure and social agents or individuals. Our version of discourse analysis contends that social structure is enacted (production and reproduction) through the employment of various vocabularies: social structure is not something outside of, behind, or underneath these performances, and (...) we argue that social organization is not produced by external structures operating upon or causing people to adopt certain behaviours. Rather, social structure is an effect of taking up practices and reproducing and modifying them. From this perspective, individuals are constituted by being recruited into and reproducing discursive practices. Hence, by looking at the actual employment of language – its tactical, practice dimensions – one can avoid the usual binary of seeing the person as either the autonomous origin of his or her experience or the ideological pawn of social determination. This methodology calls into question how the narratives or stories that individuals recount are imbricated within relational plays of power, and concomitantly, how subjects reauthorize their own positions. We assert that the methodological challenges of research addressing social injustice cannot be reduced to either: (i) interpersonal relationships between researcher and participants, or (ii) relegated to ‘social structures’ acting upon or outside of individuals. (shrink)

Textual portrayals of nursing can be ‘read’ from a number of possible viewing positions, which play a very real part in the way that our reality is constructed and understood. The image depends on which viewing position is chosen by or constructed for the viewer, and how the viewer interacts with that position. Thus without the viewer the image is incomplete. This paper is a beginning exploration of the nature of texts diat portray nursing, and what Kaplan has termed the (...) ‘delicate negotiation’ between the reader and the text in producing, in this case, understandings of nursing. Consequently die discussion focuses on how texts represent nursing, not in terms of what they portray, but how understandings of that portrayal are arrived at. This is to move exploration of portrayals of nursing from the descriptive to the discursive realm. In so doing the aim is to begin to explore and uncover the way in which we are positioned, and position ourselves, as readers of portrayals of nursing in text. (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)