How nurses’ use of language creates meaning about healthcare users and nursing practice

Abstract

Nursing practice occurs in the context of conversations with healthcare users, other healthcare professionals, and healthcare institutions. This discussion paper draws on symbolic interactionism and Fairclough's method of critical discourse analysis to examine language that nurses use to describe the people in their care and their practice. We discuss how nurses’ use of language constructs meaning about healthcare users and their own work. Through language, nurses are articulating what they believe about healthcare users and nursing practice. We argue that the language nurses use can contribute to viewing their practice as tasks on bodies that must be accomplished efficiently and objectively within the biomedical model, rather than relational and person‐centered. Moreover, the language nurses use can perpetuate a sense of powerlessness within healthcare systems yet paradoxically they are in a position of power over healthcare users. Nurses’ compliance with the efficiency and biomedical model results in a lack of emphasis on the full breadth of nursing work, which could be enacted in relational rather than power‐laden practices. We conclude by positing that careful use of language among nurses in all settings is essential, if we are to begin to articulate what nursing is to ourselves and to others.

The European Standard EN 17398:2020 on Patient Involvement in Health Care – a Fairclough-Inspired Critical Discourse Analysis

“…The document's main objectives are for the involved organisations to achieve minimum requirements and structures to facilitate patient involvement and patient-centred care, with an underlying idea that this also equals cost-effective care ( Kremer et al, 2020 ). From the perspective of Fairclough's framework, if efficiency is what healthcare institutions value, healthcare professionals such as nurses who are task-driven to complete medical tasks could be viewed as a model of efficiency ( Dahlke & Hunter, 2020 ). A number of catchwords, or concepts, which can also be recognised in nursing education ( Cowling, 2013 ; Schneider & Ruth-Sahd, 2015 ), are used to pin down the essence of and means to achieve partnered care through collaboration between personnel and patients, such as the importance of the patient ´s narrative, shared decision-making, information sharing, patient involvement, and person-centred care.…”

“…The patient is referred to as an active subject and not a passive object; a formulation that goes in line with the ideas of agency and patient empowerment ( Abrahamson & Wilson, 2019 ; Boudioni et al, 2017 ). This, together with striving for a partnered collaboration between professionals and patients, moves away from paternalistic approaches in healthcare towards participatory approaches ( Dahlke & Hunter, 2020 ). Such a motion is per se positive, as it addresses an inbuilt power imbalance between patients and professionals, at least normatively or in theory.…”

“…Nevertheless, awareness of such asymmetries by healthcare professionals is essential to facilitate and encourage empowerment and participation originating from patients, based on individual needs and wishes ( Glasdam et al, 2020a ). The emphasis on considering healthcare users individually is in keeping with person-centred or person-directed care, a (rhetorical) movement away from a paternalistic provision of healthcare in which consumers play an active role in their care ( Dahlke & Hunter, 2020 ; Hammell, 2013 ).…”

Dialogue avec l’entourage des patients en réanimation

“…Cette perception peut être renforcée par mimétisme de l’attitude de certains médecins. Même le langage appris professionnellement et utilisé sans nuances peut renforcer l’impression de dépersonnalisation vécue par le patient et ses proches [32] . L’apprentissage de l’attention et du respect des familles n’est donc pas un chemin évident et facile.…”

Mini-organs, maximizing value:

“…Dahlke and Hunter (2020) have observed how the language used by nurses co-creates their view of themselves as caregivers and of those they care for, and recommend a recalibration of this language to make practice more people-centered 110 . Similarly, we contend that a shift is needed in biobanking discourse; rather than assuming passivity and non-reciprocity, it should work towards normalizing the idea of tissue provision as a reciprocal act, and tissue providers as active participants.…”