Use this URL to cite or link to this record in EThOS: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.547422
Title: A critical discourse analysis of how nurses understand and care for older patients with delirium in hospital
Author: Schofield, Irene
Awarding Body: Glasgow Caledonian University
Current Institution: Glasgow Caledonian University
Date of Award: 2009
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Abstract:
Background and Aims: Research evidence indicates that timely diagnosis and structured interventions can lead to positive outcomes for older people who develop delirium. Surveys of acute hospital care however, suggest that patients who develop delirium do not always benefit from optimum care. The aim of the study was to determine the meanings and motives underpinning nurses' understanding and care of patients who develop delirium. Methods: The study adopts a social constructionist framework in the emergent tradition of nursing research whereby versions of knowledge are created and maintained by people in their interactions with one another, according to the dominant thinking of powerful interest groups. The meaning of delirium therefore, emerges as nurses consciously engage with it and describe it in the light of their experiences with patients in the health care context. Fairclough's Critical Discourse Analysis was used to access nurses' constructions of delirium and its care through the detailed linguistic analysis of 18 audio-recorded interviews, 3 written documents and 33 sets of field notes from participant observation, thus enabling important links to be made between the micro grammatical and lexical features of the language used, and the macro social context within which it is produced. Findings: Nurses constructed patients in terms of extreme physicality with the potential to harm themselves and others. Nurses positioned themselves to give care typified by the continuous surveillance of patients and actions to contain them, governed by managerial, consumer and professional imperatives that operate within contemporary UK health services. Conclusion: The construction of patients as risk objects and their care as surveillance and containment is diametrically opposed to the philosophy of person-centred care advocated in nursing literature and government health policy. Delirium care remains overshadowed by discourses of risk avoidance and risk reduction and it is these, which currently mediate how nurses construct older people and their care. Thus nurses unwittingly adopt a custodial role believed to perpetuate sub-optimal care.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID: uk.bl.ethos.547422  DOI: Not available
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