In this article,we address how the professionalization process is reflected in the way Danish nursing textbooks present ‘nursing’ to new members of the profession during the 20th century. The discussion is based on a discourse analysis of seven Danish textbooks on basic nursing published between 1904 and 1996. The analysis was inspired by the work of Michel Foucault, in particular the concepts of rupture and rules of formation. First, we explain how the dominating role of the human body in nursing (...) textbooks disappears in the mid‐20th century. This transformation can of course be attributed to changes in tasks and responsibilities for nurses or to the implementation of increasing amounts of knowledge and theories from other disciplines than medicine into the nurses’ knowledge base. However, inspired by Foucault, we consider these historical changes to be the conditions of possibilities and not causes. The second part of the analysis shows that along with ‘the disappearance of the body’, a second discursive change appears: the role of doctors and medicine changes fundamentally from about mid‐20th century. Finally, we argue that this discursive reorganization enabling new patterns of thought to emerge was driven by a professional interest in describing nursing as an independent profession. (shrink)

The research into patient involvement is seldom concerned with the significance of cultural and structural factors. In this discussion paper, we illustrate our considerations on some of the challenges in implementing the ideal of patient involvement by showing how such factors take part in shaping the ways in which the intentions to involve patients are converted to practical interventions. The aim was to contribute to the approach dealing with contextual and structural factors of significance for patient involvement. With the idea (...) of “institutional logics,” borrowed from the Danish scholar, Erik Riiskjær, we first demonstrate, with examples from our own research, how patient involvement is interpreted differently within the different logics. Then, we show how the different interpretations of patient involvement meet and conflict in mutual competition as the ideals are sought to be converted to practical interventions. At last, we argue that an adequate theoretical model for the development in the future health care system should be expanded with a “patient logic.”. (shrink)

This study takes its point of departure in an oft‐voiced critique that the French philosopher Michel Foucault gives discourse priority over practice, thereby being deterministic and leaving little space for the individual to act as an agent. Based on an interpretation of the latter part of Foucault's oeuvre, we argue against this critique and provide a methodological discussion of the perception that Foucault's method constitutes, primarily, discourse analysis. We argue that it is possible to overcome this critique of Foucault's work (...) by the application of methodological tools adapted from Foucault's later writings and his diagnosis of his own work as studies of forms of problematization. To shed light on the possibilities that this approach offers to the researcher, we present a reading of aspects of Foucault's work, with a focus on his notion of forms of problematization. Furthermore, we elaborate on concepts from his so‐called genealogical period, namely ‘the dispositive’, strategy and tactics. Our interpretation is supported by examples from a study of the emergence of Danish nursing education, which is based on an analytical framework that we developed in the light of an interpretation of aspects of Foucault's work. (shrink)

In this paper, we introduce the notion of ‘rupture’ from the French philosopher Michel Foucault, whose studies of discourse and governmentality have become prominent within nursing research during the last 25 years. We argue that a rupture perspective can be helpful for identifying and maintaining a critical potential within nursing research. The paper begins by introducing rupture as an inheritance from the French epistemological tradition. It then describes how rupture appears in Foucault's works, as both an overall philosophical approach and (...) as an analytic tool in his historical studies. Two examples of analytical applications of rupture are elaborated. In the first example, rupture has inspired us to make an effort to seek alternatives to mainstream conceptions of the phenomenon under study. In the second example, inspired by Foucault's work on discontinuity, we construct a framework for historical epochs in nursing history. The paper concludes by discussing the potential of the notion of rupture as a response to the methodological concerns regarding the use of Foucault‐inspired discourse analysis within nursing research. We agree with the critique of Cheek that the critical potential of discourse analysis is at risk of being undermined by research that tends to convert the approach into a fixed method. (shrink)

Although principles such as ‘patient participation’ and ‘patient involvement’ have become ideals in health‐care, they have proven to be difficult to apply in practice. In 2014, one Danish region issued an official document that included the vision of ‘the patient as partner’. However, little is known about how such a vision affects clinical practice. The purpose of this study was to investigate nurses’ views on how partnerships between them and patients are established considering this vision. We conducted semi‐structured interviews with (...) eight nurses working in Danish hospitals. Then, we analysed the interviews in a Norman Fairclough‐inspired critical discourse analysis. During this three‐dimensional analysis, we identified three discourses. We found that a liberalistic discourse wins hegemony based on the nurses’ expectations of the patient's role. Nurses construct a picture of the patient's role, expecting the patient to be responsible and to participate. For the partnership to arise as envisioned, the patient is perceived as being dependent on the nurse's professional knowledge. Surprisingly, the nurses’ articulations of the patient's role were identical to the vision's elements. Therefore, we suggest that the vision reflects prevailing societal norms for individuals, thereby reflecting society's attitude towards people's responsibility for their own lives. (shrink)

In this study, we demonstrate how perceptions of nursing are constructed in close connection with the development of the Nordic welfare states. Drawing on Gillian Rose's framework for analysing the social and political implications of visual materials, we analysed selected visual representations of nursing published in Danish and Norwegian professional nursing journals in the period 1965 to 2016. The analyses were conducted in an iterative process in three phases. First, we reviewed all visuals spanning the entire period to obtain an (...) overview of developmental trends in the material. Second, selected visuals and associated captions were subjected to more thorough analysis. Third, we further examined and discussed the visuals in light of societal and political movements and ideologies in Danish and Norwegian healthcare policies over this period. Our analysis shows that visual representations of the nurse–patient relationship and of the patient's and the nurse's roles and responsibilities changed over this period and that the visualisations corresponded with and supported developments in the Danish and Norwegian welfare states as these first consolidated and then moved towards individualisation and the competition state. Our study demonstrates that nurses in these states are political actors implementing health policies embedded in various knowledge regimes. (shrink)

Discourse analysis has been introduced into nursing research as an approach which has the potential to offer new perspectives and to pose new questions to taken‐for‐granted assumptions. However, critique has arisen that when applied to nursing studies, the epistemological foundation of the discourse analysis is often overlooked. It is furthermore claimed that the methodological inspiration does not lead to any new insights and that these studies can hardly be differentiated from more traditional studies. This study supports this critique, arguing that (...) the challenges of implementing discourse analysis in nursing research reflect a dominant pattern of thought in the discourse of the nursing profession that have held sway throughout the last century. We argue that this pattern of thought stems from the Western philosophy of consciousness and the conception of the sovereign subject. By applying a discourse analytical perspective to the discourse of the nursing profession itself, this study elucidates the challenges of applying discourse analysis in nursing research. (shrink)

Nowadays, it is common that newly built hospitals are designed with single‐room accommodation, unlike in the past, where shared accommodation was the favoured standard. Despite this change in hospital design, very little is known about how single‐room accommodation affects nurses' work environment and nursing care. This study evaluates how the single‐room design affects nurses and nursing care in the single‐room hospital design. Nurses working in the single‐room design predominantly work alone with little opportunity for peer training, interaction and reflection. In (...) addition, the single‐room design affects the nurses' work environment due to changes in sensory stimulation and increased walking distances. Furthermore, a change in the discourse, namely, regarding the single room as the patient's home, makes the nurses react to queries, demands and tasks in a new way. Overall, the new hospital design forces the nurses into a more reactive role and affect their way of providing nursing care. Despite this, the nurses find single‐room accommodation beneficial for the patients and their nursing care. (shrink)

Intersectoral collaboration (IC) plays a significant role in the delivery of diabetes care and treatment of patients with type 2 diabetes (DM2), as the treatment and care of these patients take place in both primary care and specialist settings. The collaboration involves a large number of actors from primary and secondary healthcare sectors, who are expected to fulfil various roles when they engage in IC. We explored the actors' roles by applying the framework of positioning theory with the aim of (...) revealing seemingly embedded understandings of such roles. The empirical data consisted of individual and focus group interviews. Our results indicate that naturalised understandings of the roles of actors interact with the way in which health professionals, patients, managers and relatives strive to develop IC that aims to help and guide patients who live with DM2. (shrink)

Several studies describe intersectoral collaboration in Western healthcare as hampered by lack of coordination of care and treatment and incoherent patient pathways. We performed an ethnographic study following elderly patients from admission to an emergency unit (EMU) to discharge and further treatment and care at other facilities in the healthcare system. The aim was to explore how health professionals work together across sectors in the Danish healthcare system and how they create patient pathways for elderly patients (+65) with multiple chronic (...) illnesses. Intersectoral collaboration was identified as distant relations between large numbers of health professionals, where communication was conveyed by electronic health record (EHR) formats which promoted information delivery that focused on patients’ immediate symptoms. Other significant ‘mediators’ of communication were the telephone that seemed to resemble face‐to‐face communication and the patient who delivered information from one professional to another. We suggest that the communication among professionals at various facilities interacts with the format and functionalities of the EHRs, which typically fall short in delivery of information across sectors, because the often complex needs of patients with multimorbidity do not fit in with the available functionalities of the EHR. (shrink)

Ethnic minority patients have been discussed and problematised in Western health literature. Drawing on an interpretation of central parts of the French philosopher Michel Foucault's authorship, we analysed a broad selection of materials to identify mechanisms through which the truth about ethnic minority patients is constructed. We identified a single, yet consistent discursive strategy that we termed ‘figure of inconvenience’ in which ethnic minority patients were classified and assigned a specific subjection illustrating them as ‘inconvenient’ to the nurse's practice. Concurrently, (...) their relatives were afforded the position of substitutes. The discourse exemplifies how the behaviour or appearances of ethnic minority patients cannot be reconciled with the traits of ethnic Danish patients. Finally, we discussed implications that such a strategy may have for the provision of healthcare services for ethnic minority patients in Denmark. (shrink)