Discourse analysis: towards an understanding of its place in nursing practice: Marie

Crowe

Methodology that focuses on how social relations, identities, knowledge and power are constructed in spoken and written texts

•use of language and text as a form or symbol of social practice (Fairclough)• heavily context driven•macro context.

•Highlights oppressive relationships (I feel this comes from the Faucaidean approach to institutions. I would prefer to consider that it examines the text to reveal less obvious or implicit meaning.)

Discourse analysis: towards an understanding of its place in nursing

practice: Marie Crowe

• Uses Media –any text or visual media such as film and photography

• Requires Critical skills -a commitment to reading a wide variety of texts to develop an understanding of the context of the research question.

• Focusses on Language (communication)-around identifying oppressive practices

•

What are the nurses attitudes to adolescents who are brought to emergency

with a suicide attempt/intoxicated ?

Quantitative analysis- context free, objective – “clean” measurable, reliable

demographicsquestionnaire using a likert scale,

Traditional qualitative approaches - subjective ideological position, represented linguistically

interviews, ethnographic study

Discourse analysis- “ places the person who is being researched, in this case nurses in a historical and social context which has been created by language- maybe policy, education,”

also places the subject in their own context

What are the nurses attitudes to patients who are brought to emergency with a suicide

attempt?

What are the tools, policies, procedures, educational manuals, that nurses use to assess suicidal patients and how does this affect their attitude and care?

Labelling: words and phrases have specific meaning and value determined by the culture

hospitals versus health sciences centre, cure versus heal palliative care vs terminally ill vs dying treat vs manageretarded vs developmentally delayed, mental health vs mental illness, youth vs adolescent recreational drug use vs substance abuse, an asthmatic vs a person with asthma

language has a cultural form, participants adhere to communal conventions in order to be understood

What are the nurses attitudes to patients who are brought to emergency with a suicide

attempt

• What are the tools, policies, procedures, educational manuals, that nurses to assess suicidal patients and how does this affect their attitude and care?

• after addressing Labelling:

• What are the tools, policies, procedures, educational manuals, that nurses use/ are provided with to assess/ interact with suicidal patients/people and how does this affect their attitude during care/ the (clinical) encounter?

What are the nurses attitudes to patients who are brought to emergency with a suicide

attempt?

Old Phrasing: What are the tools, policies, procedures, educational manuals, that nurses use/are provided with to assess/interact with suicidal patients/people and how does this affect their attitude and care/the (clinical) encounter

Discourse analysis contributes to the construction• of subject positions( ways of being in the world)• social relationships between people •systems of knowledge and belief

New Phrasing: How do the socio-political influences (reflected in documents, media, etc ) on nursing practice, and the situated social framework of persons who attempt suicide combined with the social representation/symbolism of the hospital emergency department affect nursing attitudes and the clinical relationship when suicidal persons are brought to the Emergency department for treatment?

Nursing discourse analysis: protocols, education pamphlets, health policies, media representations, transcripts interviews 

•Narrative: tell a story, temporal ordering

•Argumentative: use contrastive devices- e.g. a dietary pamphlet

•Descriptive: predominately local elements e.g. service pamphlet

•Instructive: argumentative and enumerative

Titscher ( 2002) seven constitutive characteristics of texts

1.Cohesion: recurring vocabulary grammar ellipsis- shared world knowledge

abbreviations-ICU, ED, Code blue, conjunctions- relationships,

connections to other discourse2.coherence: structure of text3.intentionality: specific purpose4.acceptability: text must be identified by participants

recognised as being able to provide something5.informativity: new or revised material that identifies it as a particular text6. situationality: situationally and culturally appropriate7.intertextuality: relationship with other texts

Process rather than step-by-step methodology

Use paradigms to direct inquiry: choose theory and examine text in that context

Examples: •Foucauldian approach: genealogical, investigates relations between power, knowledge and body

- produces historically specific forms of subjectivity

•Derridean approach: examines binary oppositions that underpin ways of thinking e.g. Labelling

•Fairclough: texts constructs social and cultural practice

.Determine discourse type: types of texts (e.g. Titschler), and then discourse audience such as medical vs nursing Describe intertextual chains: •how it relates to other texts, implications, history•this takes one beyond the text itself•can be very broad (e.g. media, DSM manual, other research)

Identify social practices of text production:• publication, dissemination

Analysis of text: (subjective)•Examine linguistic strategies to determine how reality is presented,• key words, •labelling •categorizing thematic structure• how social relations are constructed- power relationships ( experts) •how subject positions are constructed ( e.g. “normal” or “deviant”)

This is the so what? Or “Discussion”

Social or professional relationships that are affected Practices and experiences that are transformed by the discourse

“Relationships between consumers of mental health services and mental health nurses inevitably reflect the way in which psychiatric discourse constructs the relationship between the ill person needs to listen to the advice and direction of the professional who has expert knowledge”

• Does the research question ‘fit’ discourse analysis?• Do the texts under analysis ‘fit’ the research question?• Have sufficient resources been sampled, e.g. historical,political, clinical?• Has the interpretative paradigm been described clearly?• Are the data gathering and analysis congruent with the interpretative paradigm?• Is there a detailed description of the data gathering and analytical processes?• Is the description of the methods detailed enough to enable readers to follow and understand context?

• Have the linkages between the discourse and findings been adequately described?• Is there adequate inclusion of verbatim text to support the findings?• Are the linkages between the discourse and the interpretation plausible?• Have these linkages been described and supported adequately?• How are the findings related to existing knowledge on the subject

Denzin and Lincoln(1994) evaluated by the “historical situatedness of the inquiry, the extent to which the inquiry acts to erode ignorance and misapprehensions and the extent to which it provides a stimulus to action, that is to the transformation of existing structure.”

What are the tools, policies, procedures, educational manuals, that nurses use/are provided with to assess/interact with suicidal patients/people and how does this affect their attitude and care/the (clinical) encounter

Discourse analysis contributes to the construction• of subject positions( ways of being in the world)• social relationships between people •systems of knowledge and belief

How do the socio-political influences (reflected in documents, media, etc ) on nursing practice, and the situated social framework of persons who attempt suicide combined with the social representation/symbolism of the hospital emergency department affect the nursing attitudes and the clinical relationship when suicidal persons are brought to the Emergency department for treatment?