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1.
Drug Alcohol Rev ; 2024 Sep 19.
Article in English | MEDLINE | ID: mdl-39297672

ABSTRACT

INTRODUCTION: Online forums provide an environment for peer discussions to anonymously share experiences about sensitive topics. In this article we explore discussions about alcohol use during pregnancy, including representations of 'appropriate' behaviour and risks, in relation to alcohol use. METHODS: We sampled Mumsnet posts from 2016 to 2021 and analysed these using a two-staged approach: describing the content of original posts and employing discourse analysis on the entire thread which focused on unpacking the significance, activity and identity within the discourse. RESULTS: Seventy-three threads with 1554 replies analysed. Users engaged with different sources of evidence and mentioned guidelines and scientific sources, though most commonly provided, requested and appreciated anecdotal information. Risk was discussed in several ways but all users engaged with 'othering' drinking they perceived as risky. Only a few prescribed risks to any and all levels of drinking. There was a lack of knowledge around drinking while trying to conceive and early pregnancy. Expectations and norms of behaviour during pregnancy engaged in a 'good motherhood' discourse. Users positioned their drinking according to perceived norms through language choices; when not pregnant (or unknowingly pregnant) being 'plastered' was justified but when pregnant drinking only 'sips' or 'tiny' quantities of alcohol was considered appropriate. DISCUSSION AND CONCLUSIONS: Forum users demonstrated a desire to adhere to 'responsible motherhood', which did not equate to abstinence if consumption was perceived as acceptable and justified. Future research should explore information needs and effective approaches to health communication for pregnant women or those planning pregnancy.

2.
Health (London) ; : 13634593241279207, 2024 Sep 19.
Article in English | MEDLINE | ID: mdl-39297785

ABSTRACT

This paper examines the rhetorical strategies used by stroke survivors to attend to identity aloneness, a phenomenon in which individuals experience a sense of disconnect from others as a consequence of identity change, for which stroke is known as an antecedent. Three stroke survivors, and their spouses, were interviewed about their stroke, social support, and experiences with loneliness and identity change. The data was transcribed using a simplified version of the Jeffersonian method and analysed using a critical discursive psychological approach. This made it possible to examine the way in which the psychological business of identity aloneness was managed in participants' talk via discursive devices such as metaphors and category entitlement, while also leaving room to consider how broader societal discourses were drawn upon. The analysis revealed two critical ways in which participants attended to the issue of identity aloneness: (1) by crafting and occupying a position of resilience; (2) by managing the impact of the post-stroke social world on their identities. These findings offer insight into how the issue of identity aloneness is made sense of by stroke survivors in the context of a discussion with an interviewer. Finally, findings informed future directions for research, including developing a comprehensive theory of identity aloneness using a grounded theory approach and developing and validating a psychometric measure of identity aloneness to be applied in a rehabilitative setting.

3.
J Relig Health ; 2024 Aug 20.
Article in English | MEDLINE | ID: mdl-39162774

ABSTRACT

Through discourse analysis of focus groups, this study investigates how palliative care professionals in Sweden engage with "spiritual care," "religion" and "spirituality." Our results reveal a common assumption that religion is "visible," but at the same time private. Furthermore, we observed a secular and nonreligious positioning, marked by frequent "us versus them" rhetoric, especially in discussions about truth telling. The findings illustrate a view of belonging to a secular society in which a discourse of static understanding of religion dominated, indicating a vague religious literacy. This study indicates a need among healthcare professionals to discern, understand and relate to non-visible forms of religion.

4.
BMC Psychol ; 12(1): 423, 2024 Aug 02.
Article in English | MEDLINE | ID: mdl-39095852

ABSTRACT

BACKGROUND: The dramatic reconfigurations of work-family roles and social boundaries resulting from the social restrictions imposed during the Covid-19 pandemic led working mums to look for online sites as spaces of emotional support and regulation where they could vent their emotions, share their concerns and griefs, and seek advice. They also became interactional spaces where mums' relevant identities were reassessed and enacted as they aimed to balance work-family roles and improve their wellbeing. The paper explores how working mums discursively negotiated their multiple identities in an online support forum during times of global struggle, how these identity constructions reflect the domains of Work-Family Conflict (WFC) and how working mums perceived these identities are related to their mental health. METHODS: 127 posts of Chilean working mums published in a public online support forum for working mums collected during the first half of 2020 were analysed in three phases. The first one involved a thematic analysis to identify themes and subthemes related to working mums' identity construction in the data. The second phase involved conducting a narrative analysis of working mums' microstorias in order to identify a master narrative crafted by these working mums, and contesting and conforming ideologies of motherhood, among others. Finally, the third phase involved a fine-grained discourse analysis of the most representative extracts illustrating working mums' identity negotiation. RESULTS: The sociolinguistic analysis showed that working mums' discourses displayed three themes of self-reflection, namely, diminishing self-care, reassessing their self, and enhancing self through self-care. Identity-related sub-themes for each main theme are discussed and discursively analysed. Two main points are emphasised: (1) the identity that was most salient in working mums' discourse was their personal identity (rather than work-family roles and identities), and (2) microstorias allowed working mums to challenge the hegemonic power of dominant discourses around their identities and their work-family roles. CONCLUSIONS: The study shows that a sociolinguistic approach to the exploration of working mums' identity negotiation is useful to highlight the ways in which mums contest binary assumptions of work-family roles and the need to reconsider working mums' life domains so that they reflect working mums' actual identity needs and lived experiences. Future lines of research are outlined.


Subject(s)
COVID-19 , Mental Health , Humans , COVID-19/psychology , Female , Adult , Family/psychology , Social Identification , Mothers/psychology , Social Support , Work-Life Balance , SARS-CoV-2
5.
BMC Psychol ; 12(1): 432, 2024 Aug 09.
Article in English | MEDLINE | ID: mdl-39123258

ABSTRACT

BACKGROUND: Mental health is an issue of social and economic importance. Sociocultural and scholarly attention has largely focused on the negative aspects of mental health. That is, on mental disorders and illness and how they adversely impact our lives. In contrast, this paper forms part of a recent alternative empirical perspective in discourse-based research, by focusing on the positive aspects of mental health. In this article, we investigate how end-of-life care workers construct their positive psychological states. METHODS: Our data are 38 audio-recorded and transcribed semi-structured interviews with end-of-life care workers from Hong Kong and the United Kingdom. We utilized thematic analysis to identify common categorial strands across the data and discourse analysis to identify the linguistic strategies that these interviewees used to talk about their mental health. RESULTS: Our thematic analysis generated a superordinate theme across the interviews-namely, that of end-of-life care workers talking about their positive psychological states. We identify three generic ways that end-of-life care workers talked about these psychological states; by "foregrounding the positive," "reformulating the negative," and "dismissing the negative." Our analysis also explicates how interviewees connected social and organizational support to being a benefit to their psychological states. CONCLUSIONS: Our work contributes to existing discourse-based and sociolinguistic research on mental health by turning their focus towards a consideration of its positive dimensions. We also identify recurrent linguistics strategies used by people to construct their mental health. Our analyses point to the importance of investigating mental health as a multidimensional concept that considers participants' own reflections on their mental health.


Subject(s)
Terminal Care , Humans , Terminal Care/psychology , Hong Kong , United Kingdom , Female , Male , Adult , Mental Health , Health Personnel/psychology , Middle Aged , Qualitative Research , Anxiety/psychology
6.
Physiother Theory Pract ; : 1-15, 2024 Aug 26.
Article in English | MEDLINE | ID: mdl-39186496

ABSTRACT

BACKGROUND: Sustainability has become a ubiquitous imperative across all sectors of society, including healthcare. Building on the broader discourse on sustainable development, sustainability is used in relation to social, ecological, and economic concerns with varying degrees of emphasis and often related to a sense of durability. OBJECTIVE: To provide a detailed analysis of the concept of sustainability in current physical therapy literature and advance its deliberate future implementation. METHODS: Setting out from a critical exposition of prevalent models of sustainability, we conducted a critical discourse analysis to (1) examine the implementation of the concept of sustainability in physical therapy academic literature and (2) critically evaluate its hitherto use in light of the broader discourse surrounding sustainability. RESULTS: Our analysis identified a focus on the cost-effectiveness of healthcare interventions, and the use of so-called "weak" and "strong sustainability" models in the physical therapy literature. Other models and the broader critical discourse surrounding sustainability are only gradually finding their way into physical therapy literature. CONCLUSION: Physical therapy lacks comprehensive exploration of both general and profession-specific understandings of sustainability. Nuanced engagement with sustainability and its alternatives is necessary to ensure its meaningful implementation in physical therapy research, education, and practice.

7.
Nurs Inq ; : e12653, 2024 Aug 04.
Article in English | MEDLINE | ID: mdl-39099253

ABSTRACT

Social justice is widely advanced as a central nursing value, and yet conceptual understandings of social justice remain inconsistent and vague. Further, despite persistently articulated commitments to upholding social justice, the profession of nursing has been implicated in perpetuating inequities in health and health care. In this context, it is essential to establish both conceptual clarity and tangible guidance for nurses in enacting practices to advance social justice-particularly through regulatory, education and accreditation documents that shape the nursing profession. This Foucauldian discourse analysis examines how social justice is discursively positioned within nursing professional documents in Canada, and illustrates that social justice was largely discursively excluded from these texts. Where social justice discourses were invoked, we identified that four central discursive patterns obscured and de-centred this nursing value: (i) Vague language undermined professional commitments to social justice; (ii) Constructions of knowledge and awareness de-emphasized practice; (iii) Individualism discourses minimized institutional/professional responsibility; and (iv) Aspirational language obscured present action. Extending from this analysis, we contend that the nursing profession must re-examine how social justice is understood and articulated, and call for a re-conceptualization of social justice grounded in nursing practice toward remediating inequities in health and health care.

8.
J Homosex ; : 1-26, 2024 Aug 05.
Article in English | MEDLINE | ID: mdl-39101761

ABSTRACT

The scientific literature shows that gender transition is effective in improving the general well-being of transgender people. However, so far, little attention has been paid to the actual role of the body concerning the existential dilemma that holds the person hostage during transition. This study investigates the relationship between the body-here considered in its concrete, experienced, imagined, and intersubjective dimensions-and gender identity. Twenty-five transgender people who live in Italy were interviewed to identify interpretive repertoires and identity positionings. Four main repertoires and positionings emerged: 1) Interpretative repertoires on the body in transition, where an enduring influence of gender binarism and biological determinants were observed; 2) Expectations regarding medically induced modifications of the body ranging from self-confidence to uncertainty; 3) Positionings toward medically induced bodily modifications, ranging from enthusiasm to resignation; and 4) Inter- and Intrapersonal positionings, where the other than self was found to act as a self-confirming resource or as a constant unpredictable and potentially threatening source of disconfirmation. Practitioners need to develop a stronger awareness of the different dimensions, meanings, and discourses surrounding bodily experience to more effectively intervene in their clinical practice with transgender people.

9.
J Neuropsychol ; 2024 Aug 17.
Article in English | MEDLINE | ID: mdl-39152689

ABSTRACT

Public perception of dementia has emerged as a key factor in the 2024 United States presidential election. The first televised presidential debate (27 June 2024) evoked a groundswell of concern about the neuropsychological health and political viability of President Joseph R. Biden, Jr. A rapid erosion of public support ensued, culminating in the collapse of the reelection campaign the following month. Political attacks on the cognitive fitness of world leaders create dissonance for clinical neuroscientists. We are ethically prohibited from remotely diagnosing public figures. Yet, we are also citizens with the right to feel and express personal concerns. In this commentary, I will address an often-uneasy relationship between politics and neuropsychology with a focus on the history and rationale for ethical guidelines such as the Goldwater Rule. I will also discuss lessons learned from recent events in the 2024 US election cycle about neurological health literacy (e.g. How is dementia diagnosed?) and broader impacts of age-based political attacks on global public health initiatives that target stigma reduction and improved early detection of dementia.

10.
Med Teach ; : 1-7, 2024 Aug 20.
Article in English | MEDLINE | ID: mdl-39161980

ABSTRACT

PURPOSE: International Medical Programmes (IMPs) form a distinctive modality in medical education, with diverse student populations, English as a language of instruction and 'globalized' curricula. A lack of common understanding of IMPs' purposes and role in the medical education landscape triggers critiques. This study aims to document the effects of different discourses used to justify the purpose of IMPs. METHODS: We use a discourse analysis approach to explore the different ways in which the purposes of IMPs are constructed at the regulatory, institutional, and individual level, and how these discourses interact. The research situates in two IMPs, in the Netherlands and in Hungary. Key-informant interviews, policy documents, and scholarly literature form the archive. RESULTS: The purpose of IMPs is constructed discursively around three distinct narratives and associated practices: around serving the institutions that host them, around serving the (global) public interest, and around serving individual students. Co-existence and misalignments of these three discourses cause conflicting practices and confusion among stakeholders. CONCLUSIONS: This study illustrates how diverging perspectives on internationalization in medical education create tensions for learners and staff. Articulating a clear and explicit meaning to internationalization may reduce uncertainties, and may reinforce realistic expectations of what constitutes a good outcome.

11.
BMC Psychol ; 12(1): 433, 2024 Aug 09.
Article in English | MEDLINE | ID: mdl-39123219

ABSTRACT

BACKGROUND: In the context of stigma and mental health research, limited empirical studies examine stigma through the positioning of individuals within interview contexts. This study addresses this gap by investigating the positioning processes in interviews with mothers with a mental illness, with a specific focus on the use of contrast devices as a strategy identified through analysis. By analysing how mothers position themselves through contrast devices and to which discourses they refer, this study provides insights into how stigmatising discourses are evident in the narratives of mothers with a mental illness. METHODS: This study is based on 20 semi-narrative interviews with mothers with a mental illness who participated in the Village Project (a pilot project co-created for children of parents with mental illness in Tyrol, Austria). Our analysis focuses on identifying stigmatising discourses related to motherhood and mental illness by examining the use of contrast devices in their accounts. RESULTS: The analysis shows insights into mothers' efforts to distance themselves from labels such as 'bad mother', 'not normal/crazy women' and 'weak person'. These positions often carry a gendered dimension, with motherhood emerging as a central position. Our study highlights the challenges mothers with a mental illness face in navigating societal norms and expectations related to motherhood during research interviews. CONCLUSION: The research contributes to a deeper understanding of mental health stigma in the context of motherhood, emphasising the importance of considering gendered dynamics and societal expectations in mental health research.


Subject(s)
Mental Disorders , Mothers , Qualitative Research , Social Stigma , Humans , Mothers/psychology , Female , Mental Disorders/psychology , Adult , Narration , Middle Aged , Interviews as Topic
12.
J Appl Res Intellect Disabil ; 37(6): e13293, 2024 Nov.
Article in English | MEDLINE | ID: mdl-39205334

ABSTRACT

INTRODUCTION: Easy Read health documents prepared for people with intellectual disabilities are often generated from Standard Texts. Language in Easy Read versions is typically assumed to be simpler. However, simplification of language may have unintended consequences. This study aimed to explore the differences in language used between Easy Read health material and the Standard Text versions of the same material produced for the general population. METHODS: Five Easy Read/Standard Text pairs were sampled and analysed using Systemic Functional Linguistics. This addressed: how people with intellectual disabilities and others were represented by language, the author stance in relation to the reader and the overall organisation of the text. RESULTS: The Easy Read versions often used language that was less empowering and inclusive. CONCLUSION: Increased awareness of author power and better knowledge of the impact of language choice could help to redress these issues.


Subject(s)
Intellectual Disability , Linguistics , Humans , Language , Health Literacy , Consumer Health Information/standards
13.
Appl Nurs Res ; 78: 151808, 2024 Aug.
Article in English | MEDLINE | ID: mdl-39053985

ABSTRACT

In the fall of 2021, the Wick Poetry Center, a recognized international leader in creative writing interventions, launched the website Sacred Breath: Voices of Ohio Nurses in Response to COVID-19 (sacredbreathproject.com) with funding from the Ohio Nurses Foundation. The purpose of the website was to offer Ohio nurses an accessible platform to reflect on their personal and professional lived experiences as caregivers during an historic time of pandemic, sacrifice, uncertainty, and scarcity, and to share their voice with others. What resulted was 204 submissions over a three-month period with participant responses touching on widespread sentiments including grief, fatigue, anger, and resilience. It was from the gap in the current literature on pandemic narratives that the researchers of this study began a basic qualitative thematic analysis of the Sacred Breath project website (SBP) responses to gain a better understanding of how nurses, nurse educators, and nursing students made sense of and gave voice to their personal and professional lived experiences during the ongoing COVID-19 pandemic. While stories of nursing during the Covid-19 pandemic have been widely available and disseminated by popular media, academic studies have been slower to utilize qualitative and experimental methods to specifically address pandemic narratives and the resulting discourses by nurses working in and around clinical settings. The Wick Poetry Center at Kent State University has spent nearly forty years working in the community to address urgent social needs using expressive writing methods that are often overlooked by traditional social and arts outreach. The Wick Poetry Center engaged local academic networks and community health partners to invite nurses, nursing students, and nurse educators the Sacred Breath Project By evaluating responses to the intervention website, this qualitative study is aimed to fill this gap in the current literature as well as begin to understand how nurses made sense of their work lives during the ongoing Covid-19 pandemic. What does this paper contribute to the wider global clinical community? What is already known: What this paper adds.


Subject(s)
COVID-19 , Pandemics , COVID-19/nursing , Humans , Ohio , Adult , Female , Male , Middle Aged , SARS-CoV-2
14.
Health Aff Sch ; 2(7): qxae082, 2024 Jul.
Article in English | MEDLINE | ID: mdl-38979103

ABSTRACT

Designing effective childhood vaccination counseling guidelines, public health campaigns, and school-entry mandates requires a nuanced understanding of the information ecology in which parents make vaccination decisions. However, evidence is lacking on how best to "catch the signal" about the public's attitudes, beliefs, and misperceptions. In this study, we characterize public sentiment and discourse about vaccinating children against SARS-CoV-2 with mRNA vaccines to identify prevalent concerns about the vaccine and to understand anti-vaccine rhetorical strategies. We applied computational topic modeling to 149 897 comments submitted to regulations.gov in October 2021 and February 2022 regarding the Food and Drug Administration's Vaccines and Related Biological Products Advisory Committee's emergency use authorization of the COVID-19 vaccines for children. We used a latent Dirichlet allocation topic modeling algorithm to generate topics and then used iterative thematic and discursive analysis to identify relevant domains, themes, and rhetorical strategies. Three domains emerged: (1) specific concerns about the COVID-19 vaccines; (2) foundational beliefs shaping vaccine attitudes; and (3) rhetorical strategies deployed in anti-vaccine arguments. Computational social listening approaches can contribute to misinformation surveillance and evidence-based guidelines for vaccine counseling and public health promotion campaigns.

15.
Soc Sci Med ; 353: 117039, 2024 Jul.
Article in English | MEDLINE | ID: mdl-38971112

ABSTRACT

Since the depathologisation movement in 2007 to challenge the pathologisation of trans identities in Western psychiatry, significant developments have occurred, including revisions to Standards of Care and diagnostic criteria such as ICD-11's gender incongruence and DSM-5's gender dysphoria, acknowledging gender diversity as an expected part of human development. This paper argues that Japanese medical models reflect global issues but also have unique aspects shaped by cultural and linguistic nuances. Using critical discourse analysis, this paper examines how depathologisation discourses are perceived in the Japanese medical community, focusing on the term seidouitsusei-syogai (gender identity disorder), presenting three ways in which seidouitsusei-syogai is used: psychiatric disorder, syogai/sikkan (impairment/disability/disorder), and diagnostic category. These uses are influenced by legal and social reforms, healthcare access and alignment with international classifications, while the medical profession's authority remains unexamined. Reflecting the structural challenges of diagnostic models in trans medicine, the interpretation of seidouitsusei-syogai differs from the English phrase 'gender identity disorder' due to the specific connotations of syogai in the Japanese context. By examining Japan's approach to depathologisation and medicalisation, this paper enriches the understanding of trans medicine and the impact of depathologisation discourse in Japan.


Subject(s)
Gender Identity , Humans , Japan , Gender Dysphoria/diagnosis , Gender Dysphoria/psychology , Transsexualism/psychology , Female , Male , Transgender Persons/psychology
16.
J Aging Stud ; 69: 101232, 2024 Jun.
Article in English | MEDLINE | ID: mdl-38834247

ABSTRACT

This research investigates the representation of older adults in Turkish newspaper reports during the first national lockdown due to the COVID-19 pandemic in Turkey in order to understand the representation and reinforcement of ageism in this context. To this end, fifty newspaper reports from five top-selling Turkish newspapers at the time were selected randomly and analysed using critical discourse analysis for the text producers' linguistic choices in the representations of older adults. The findings show that the older adults were represented predominantly in relation to the lockdown measures and as members of a homogeneous group. They were mainly evaluated negatively as a vulnerable, passive, and at risk group who lacked truthfulness and exhibited unusual behaviour. They were also found to be not among the intended readers of the newspaper reports. This resulted in the infantilisation of older adults and the removal of their agency. Our findings point to the linguistic choices realising these discursive practices in the Turkish context. We argue that these findings follow a trend of representation of older adults in discursive practices and that these practices are instrumental in forming ageist stereotypes and reinforcing age-related bias.


Subject(s)
Ageism , COVID-19 , Newspapers as Topic , Humans , Turkey/epidemiology , COVID-19/epidemiology , COVID-19/psychology , Ageism/psychology , Newspapers as Topic/statistics & numerical data , Aged , SARS-CoV-2 , Male , Female
17.
Nurs Inq ; 31(3): e12651, 2024 Jul.
Article in English | MEDLINE | ID: mdl-38940314

ABSTRACT

This article uses critical discourse analysis to investigate artificial intelligence (AI) generated images of aged care nurses and considers how perspectives and perceptions impact upon the recruitment and retention of nurses. The article demonstrates a recontextualization of aged care nursing, giving rise to hidden ideologies including harmful stereotypes which allow for discrimination and exploitation. It is argued that this may imply that nurses require fewer clinical skills in aged care, diminishing the value of working in this area. AI relies on existing data sets, and thus represent existing stereotypes and biases. The discourse analysis has highlighted key issues which may further impact upon nursing recruitment and retention, and advocates for stronger ethical consideration, including the use of experts in data validation, for the way that aged care services and nurses are depicted and thus valued.


Subject(s)
Artificial Intelligence , Stereotyping , Humans , Artificial Intelligence/trends , Personnel Selection/methods , Geriatric Nursing/methods , Geriatric Nursing/trends , Nurses/psychology
18.
Gerontologist ; 64(8)2024 08 01.
Article in English | MEDLINE | ID: mdl-38835189

ABSTRACT

BACKGROUND AND OBJECTIVES: This study explores the narrated experiences of individuals with advanced stages of late-onset dementia, focusing on their diagnosis awareness. Such framing is motivated by 2 reasons. Firstly, there is a lack of consensus regarding the prevalence of anosognosia among people with dementia. Secondly, research on anosognosia often neglects to address the important issues of shame and stigma associated with receiving a dementia diagnosis. RESEARCH DESIGN AND METHODS: For this qualitative study, a total of 27 participants ranging in age from 66 to 94 were involved. The data collected were analyzed using textual-oriented discourse analysis. RESULTS: Our findings indicated that individuals with dementia struggled to comprehend the medical terminology used to describe their experiences within biomedical standards. The interviewees utilized 5 negative discourses on dementia, which shaped their attitudes toward the condition and people diagnosed with it. These discourses depicted dementia as an illness, negative aging, a devaluation, a burden, and a life tragedy. Moreover, study participants did not outright reject the diagnosis but rather negotiated its acceptance within the context of shame associated with dementia. DISCUSSION AND IMPLICATIONS: The concept of anosognosia can serve as a mechanism of social control and stigmatization of people with dementia within the dominant biomedical discourse.


Subject(s)
Dementia , Qualitative Research , Shame , Social Stigma , Humans , Female , Male , Aged , Dementia/psychology , Aged, 80 and over , Awareness , Agnosia/psychology
19.
Health Expect ; 27(3): e14101, 2024 06.
Article in English | MEDLINE | ID: mdl-38855873

ABSTRACT

BACKGROUND: The WHO advocates patient and public involvement as an ethical imperative, due to the value of the lived experience of patients. A deeper understanding of the shared meanings and underlying beliefs of healthcare professionals and managers for and against including patients in care pathway development. OBJECTIVE: To explore the considerations of healthcare professionals and managers on the involvement of patients and public in care pathway development. METHODS: In a medical rehabilitation centre we conducted a single case study that was part of a 2-year action research programme on blended care pathway development. Following 14 semistructured interviews with healthcare professionals and managers, we analysed their discourses on the value of patient involvement as well as the potential threats and opportunities. RESULTS: We identified four discourses. Patient as expert frames involvement as relevant, as adding new perspectives and as required to fully understand the patient's needs. Skills and representation is based on the construct that obtaining valuable insights from patients requires certain skills and competences. Self-protection focusses on personal, interprofessional objections to patient involvement. Professional knows best reveals expertise-related reasons for avoiding or postponing involvement. CONCLUSION: These discourses explain why patient and public involvement in care pathway development is sometimes postponed, limited in scope and level of participation, and/or avoided. The following strategies might minimise the paralysing effect of these discourses: strengthen the capabilities of all stakeholders involved; use a mix of complementary techniques to gain involvement in distinct phases of care pathway development; and create/facilitate a safe environment. Put together, these strategies would foster ongoing, reciprocal learning that could enhance patient involvement. PATIENT OR PUBLIC CONTRIBUTION: This study belonged to an action research programme on blended care pathway development (developing an integrated, coordinated patient care plan that combines remote, digital telehealth applications, self-management tools and face-to-face care). Multidisciplinary teams took a quality collaborative approach to quality improvement (considering patients as stakeholders) to develop 11 blended care pathways. Although professionals and managers were instructed to invite patients onto their teams and to attend care pathway design workshops, few teams (3/11) actually did. Unravelling why this happened will help improve patient and public involvement in care pathway development.


Subject(s)
Critical Pathways , Health Personnel , Patient Participation , Humans , Health Personnel/psychology , Interviews as Topic , Attitude of Health Personnel , Qualitative Research
20.
Rech Soins Infirm ; 156(1): 58-66, 2024 06 26.
Article in French | MEDLINE | ID: mdl-38906823

ABSTRACT

Critical discourse analysis is a methodological approach that allows for the questioning of structures that relegate certain ideas and certain people to the margins. In health sciences, this approach, with its origins in the field of critical linguistics, is useful for highlighting the many societal processes that privilege certain conceptions of health and health care while labelling other perspectives as « alternative" or "fringe". However, critical discourse analysis is still underused in nursing science despite its emancipatory potential. We attribute this reluctance, among other things, to its theoretical anchoring, to its linguistic origin, and to the vagueness and variability of its analysis methods. The objective of this article is therefore to better understand how critical discourse analysis can be used in the discipline of nursing to shed light on the power dynamics and social inequalities that persist. Different examples of studies carried out using critical discourse analysis are also presented to concretely illustrate how this approach can be used in nursing sciences.


L'analyse critique du discours est une approche méthodologique qui permet une remise en question des structures qui relèguent certaines idées et personnes à la marge. Dans le domaine de la santé, cette approche, issue de la linguistique critique, est utile pour mettre en relief les nombreux processus sociétaux qui privilégient une certaine conception de la santé et des soins au profit d'autres perspectives considérées comme « alternatives ¼. Pourtant, en sciences infirmières, l'analyse critique du discours est encore trop peu utilisée malgré son potentiel émancipatoire. Nous attribuons cette réticence entre autres à ses ancrages théoriques, à son origine linguistique, et au flou et à la variabilité dans ses méthodes d'analyse. L'objectif de cet article est donc de mieux comprendre comment l'analyse critique du discours peut être utilisée dans la discipline des sciences infirmières afin de mettre en exergue les inégalités sociales et enjeux de pouvoir. Différents exemples d'études réalisées en utilisant l'analyse critique de discours sont aussi présentés afin d'illustrer concrètement comment cette approche peut être utilisée en sciences infirmières.


Subject(s)
Nursing Research , Humans , Nursing Research/methods , Nursing Research/trends , Nursing Theory
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