Social regulation, medicalisation and the nurse's role: Insights from an analysis of nursing documentation

Abstract

Background: Medicine is recognized as a dominant source of governmentality and social regulation, and although nursing has been implicated in the same process, analytical work in this area has been sparse. Objectives: The article aims to present an analysis of nursing records in order to understand the structural and social processes that mediate the texts. Methods: 45 sets of nursing records drawn from four clinical sites in Ireland were subjected to a discourse analysis. Results: This article focuses on two main themes that were derived from data: (i) the manner in which nurses controlled, regulated and invigilated patients' activities of daily living; and (ii) the way in which activities of daily living were mediated by a biomedical worldview in the clinical settings. Through the organizing framework of Activities of Daily Living (ADLs), normative social practices relating to hygiene, eating and drinking, sleeping and so forth were surveyed and monitored within clinical settings. We construct qualitative categories around a range of ways that nurses assessed and judged patients' capacities at ADLs. Furthermore, it is argued that the framework of ADLs epitomises the medicalisation of normative social practices, whereupon the most mundane of normal functions becomes redefined as an actual or potential clinical pathology, legitimating nursing interventions. According to the nursing documentation, biochemical interventions in the form of various medications were the most dominant means through which nurses attempted to restore or improve the functional capacity of an ADL. Conclusion: We conclude by proposing that nurses' invigilation of patients' ADLs is not necessarily a repressive feature of nursing practice, but rather has the potential to be used to advocate on patients' behalf in certain circumstances.

The other side of caring: abuse in a South African maternity ward

“…The abuse reported by both patients and nurses seemed to be clearly related to issues of power and control, hierarchy and order. Within hospitals throughout the developed and developing world, the dominant discourse regarding childbirth is a medical discourse (Hyde et al, 2006;KabakianKhasholian et al, 2000;Weaver, 2000). While the medical discourse, like most discourses, is not a monolithic discourse, but itself an outcome of specific historical developments in particular contexts (Treichler, 1990), it can be said that within all medical discourses the ideal childbirth is one that is ordered, surveillant, technocratic and risk-averse (Adams, 1994;Cosslett, 1994;Davis-Floyd, 1994;El-Nemer, Downe & Small, 2006;Kruger, 2006;Marshall & Woollett, 2000;Treichler, 1990;Wall, 2001).…”

An ergonomic evaluation of tasks of healthcare unit personnel in different shifts in General Hospitals in West Bengal

“…Various studies show that WMSDs are common among healthcare workers [28][29][30]. Nuikka et al [31] showed that workload in primary care situations and in transporting the patient can be classified as moderately heavy, based on heart rate and relative workload.…”

A glimpse into nursing discursive behaviour in interprofessional online learning

“…Many medical terminologies were borrowed in the development of nursing [49,50] . For this reason, nurses would have possessed prior knowledge in the context of nursing which was external to the online conference.…”

“…Also, these diagnoses and the subsequent nursing treatment plans were based on nurses' unique knowledge to guide nursing practice. Yet, the contents were communicated to non-nursing healthcare professionals for actions [50] . In this regard, nursing documentation as an important source of social regulation of patients' activities of daily living was also a critically dominant source of governmentality [51] which targeted not only nurses, but also all other allied health professionals [50] .…”

“…Yet, the contents were communicated to non-nursing healthcare professionals for actions [50] . In this regard, nursing documentation as an important source of social regulation of patients' activities of daily living was also a critically dominant source of governmentality [51] which targeted not only nurses, but also all other allied health professionals [50] . Given the fact that nursing documentation was indeed implicated by medicine, constructing the online text which shared its genres, nurses would have no problem constructing their legitimate position to assess and judge learning within the interprofessional online learning space.…”