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Dahlborg, E., Boman, Å., Eriksson, H. & Tengelin, E. (2023). Encircling discourses: A guide to critical discourse analysis in caring science. Scandinavian Journal of Caring Sciences, 38, 177-184
Open this publication in new window or tab >>Encircling discourses: A guide to critical discourse analysis in caring science
2023 (English)In: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 38, p. 177-184Article in journal (Refereed) Published
Abstract [en]

Aim

The aim of this article was to introduce Fairclough's critical discourse analysis (CDA) in caring and nursing science, to provide a guide on how to perform such an analysis, and to describe the wider context of discourse epistemology.

Design

The article is designed as a methodological paper, including (a) epistemological roots of discourse analysis, (b) an overview of discourse analytical research within caring and nursing science which points out an increased trend, and (c) a guide to conducting a CDA.

Analysis

It is important that discourse analysis is available and accessible to nursing and caring researchers. Through the process of encircling discourses, valuable insight is given into fields that otherwise would be lost or would not be available.

Conclusion

Our summary stance is that discourse analysis as it is presented in this article is strongly advisable for use in nursing and caring sciences.

Keywords
caring science, critical discourse analysis nursing, discourse analysis, research methods, social construction
National Category
Nursing
Research subject
NURSING AND PUBLIC HEALTH SCIENCE, Nursing science
Identifiers
urn:nbn:se:hv:diva-20612 (URN)10.1111/scs.13194 (DOI)001025442100001 ()37421160 (PubMedID)2-s2.0-85164575364 (Scopus ID)
Note

CC BY 4.0

Available from: 2023-08-21 Created: 2023-08-21 Last updated: 2024-05-29Bibliographically approved
Aasen, E. M., Dahl, B. M., Ottesen, A. M., Strunck, J., Eriksson, H., Dahlborg, E., . . . Tengelin, E. (2023). Scandinavian Online Cancer Information as Expressions of Governmentality. Advances in Nursing Science, 46(3), 293-305
Open this publication in new window or tab >>Scandinavian Online Cancer Information as Expressions of Governmentality
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2023 (English)In: Advances in Nursing Science, ISSN 0161-9268, E-ISSN 1550-5014, Vol. 46, no 3, p. 293-305Article in journal (Refereed) Published
Abstract [en]

We compared online distributed information provided to patients with cancer in Scandinavian countries through the lens of governmentality. A secondary comparative qualitative analysis was conducted. Discourses in online patient information showed differences in governmentality techniques across the countries: Norway used a paternalist approach, Denmark an educative approach, and Sweden an individualistic approach and expected the patients to make the “right” decisions. Online information for patients with cancer in Denmark and Norway showed high professional and health care system involvement, whereas in Sweden, there was high patient involvement. There was almost no use of the person-centered approach among the online discourses

Place, publisher, year, edition, pages
Wolters Kluwer, 2023
Keywords
biopolitics, cancer, discourse, governmentality, nursing, online information, patient, person-centeredness, involvement, Scandinavia
National Category
Nursing
Research subject
NURSING AND PUBLIC HEALTH SCIENCE, Nursing science
Identifiers
urn:nbn:se:hv:diva-19090 (URN)10.1097/ans.0000000000000436 (DOI)001041223200009 ()2-s2.0-85164580647 (Scopus ID)
Available from: 2022-08-31 Created: 2022-08-31 Last updated: 2024-04-09Bibliographically approved
Johnsson, A., Boman, Å., Wagman, P. & Pennbrant, S. (2021). Manoeuvring between interplay and context: an ethnographic study of social interaction in encounters between registered nurses, older patients and their relatives. BMC Nursing, 20(1), Article ID 232.
Open this publication in new window or tab >>Manoeuvring between interplay and context: an ethnographic study of social interaction in encounters between registered nurses, older patients and their relatives
2021 (English)In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 20, no 1, article id 232Article in journal (Refereed) Published
Abstract [en]

Background: Social interactions between registered nurses, older patients and their relatives are essential and play a central role in developing a successful care relationship in healthcare encounters. How nurses interact with patients affects the patient’s well-being. Limited time and demands for efficiency influence the encounter and complaints from patients and relatives often concern social interactions. Therefore, the aim of this study was to explore the social interaction in encounters between registered nurses, older patients and their relatives at a department of medicine for older people.

Methods: The study has an ethnographic approach including participatory observations (n = 21) and informal field conversations (n = 63), followed by a thematic analysis with an abductive approach reflecting Goffman’s interactional perspective.

Result: The result revealed a pattern where the participants manoeuvred between interplay and context. By manoeuvring, they defined roles but also created a common social situation. Nurses led the conversation; patients followed and described their health problems, while relatives captured the moment to receive and provide information. Finally, nurses summarised the encounter using ritual language, patients expressed gratitude through verbal and non-verbal expressions, while relatives verbally confirmed the agreements.

Conclusion: The social interaction between registered nurses, older patients and relatives was shaped by a pattern where the participants manoeuvred between interplay and context. When all participants assume responsibility for the social interaction, they become active and listen to each other. The approach adopted by nurses is crucial, thus training in communication and social interaction skills are important. When the asymmetry due to imbalance, is reduced, less misunderstanding and a satisfactory care relationship can be achieved.

Place, publisher, year, edition, pages
Springer Nature, 2021
Keywords
Abduction, Care encounters, Ethnography, Goffman’s interactional perspective, Interplay, Social interaction, Thematic analysis
National Category
Nursing
Research subject
NURSING AND PUBLIC HEALTH SCIENCE, Nursing science
Identifiers
urn:nbn:se:hv:diva-17812 (URN)10.1186/s12912-021-00754-5 (DOI)000719880600001 ()2-s2.0-85119409678 (Scopus ID)
Available from: 2021-11-19 Created: 2021-11-19 Last updated: 2022-03-31
Boman, Å., Dahlborg, E., Eriksson, H. & Tengelin, E. (2021). The reasonable patient: A Swedish discursive construction. Nursing Inquiry, 28(3), Article ID e12401.
Open this publication in new window or tab >>The reasonable patient: A Swedish discursive construction
2021 (English)In: Nursing Inquiry, ISSN 1320-7881, E-ISSN 1440-1800, Vol. 28, no 3, article id e12401Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to analyse how the patient is constructed and socially positioned in Swedish patient information. Corpus-assisted critical discourse analysis methodology was utilised on a sample of 56 online patient information texts about cancer containing a total of 126,711 words. The findings show an overarching discourse of informed consent guided by specific features to produce a patient norm that we name “the reasonable patient”, who is receptive to arguments, emotionally restrained and makes decisions based on information. Through the discourse of informed consent, the norm of the reasonable patient emerges, apparently to even out the imbalance of power between patient and professional, but in reality, more likely to construct a patient who is easily controlled and managed. When the self-responsibility towards health is incorporated into the everyday domestic spaces via digital health technologies, the ideas and concepts of the patient role need to be reconsidered based on these new conditions. We conclude that it is important for nursing researchers to broaden the research on patients to include the relationship of power created through language. This study demonstrates both methodological and empirical possibilities to do so

Keywords
cancer, discourse analysis, governmentality, information, nursing, patient
National Category
Nursing
Research subject
NURSING AND PUBLIC HEALTH SCIENCE, Nursing science
Identifiers
urn:nbn:se:hv:diva-16365 (URN)10.1111/nin.12401 (DOI)000609307700001 ()2-s2.0-85099821339 (Scopus ID)
Funder
Riksbankens Jubileumsfond
Available from: 2021-03-01 Created: 2021-03-01 Last updated: 2022-03-30
Dahlborg, E., Tengelin, E., Aasen, E., Strunck, J., Boman, Å., Ottesen, A. M., . . . Lassen, I. (2021). The struggle between welfare state models and prevailing healthcare policy in Scandinavian healthcare legislative documents. International Journal of Health Governance (1), 51-64
Open this publication in new window or tab >>The struggle between welfare state models and prevailing healthcare policy in Scandinavian healthcare legislative documents
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2021 (English)In: International Journal of Health Governance, ISSN 2059-4631, no 1, p. 51-64Article in journal (Refereed) Published
Abstract [en]

Purpose

The paper aims to compare and discuss the findings of discursive constructions of patients in legal texts from the three Scandinavian countries. Since traditional welfare state systems in Scandinavia are being challenged by new governance systems, new questions are being raised about patient positions and agency, carrying with them potential ethical dilemmas for healthcare professionals.

Design/methodology/approach

The methodology of the paper is inspired by critical discourse analysis. Comprehensively analysing the findings of previous discourse studies on how "the patient" is constructed in central policy texts, this study compares the position of the patient in Norway, Sweden and Denmark.

Findings

The paper reveals ideological struggles across the Scandinavian countries, operating at a political level, a legislative level and a healthcare level. It is shown that national governance systems still exert hegemonic power by strongly influencing patients' degree of choice and autonomy. The discursive struggle between welfare state governance and other governance systems in Scandinavia indicates a shift towards a commercial healthcare market although a traditional welfare model is advocated by professionals and researchers

Research limitations/implications

Because of the specific conditions of Scandinavian healthcare policy, the findings lack generalisability. The research approach should therefore be explored further in additional contexts.

Practical implications

The findings of this study can inform policymakers, professionals and patients of the ideological values underlying seemingly objective shifts in national policy.

Originality/value

A comparative critical discourse analysis can expose patterns in the Scandinavian approaches to patient rights.

Keywords
Discourse, Ideology, New public management, Patient rights, Policy, Scandinavia
National Category
Nursing
Research subject
NURSING AND PUBLIC HEALTH SCIENCE, Nursing science
Identifiers
urn:nbn:se:hv:diva-16053 (URN)10.1108/IJHG-04-2020-0041 (DOI)000592667200001 ()2-s2.0-85096144476 (Scopus ID)
Funder
Riksbankens Jubileumsfond, F17- 1120:1
Available from: 2020-11-24 Created: 2020-11-24 Last updated: 2022-01-19Bibliographically approved
Tengelin, E., Dahl, B. M., Boman, Å. & Ottesen, A. M. (2020). The Struggle Between Ancient Welfare Thinking and Prevailing Health Care Policy in Scandinavian Health Care Legislative Documents. Paper presented at 25th Annual Qualitative Health Research (QHR) Conference, October 25- 29, 2019, Vancouver, Canada. International Journal of Qualitative Methods, 19, 53-54
Open this publication in new window or tab >>The Struggle Between Ancient Welfare Thinking and Prevailing Health Care Policy in Scandinavian Health Care Legislative Documents
2020 (English)In: International Journal of Qualitative Methods, E-ISSN 1609-4069, Vol. 19, p. 53-54Article in journal, Meeting abstract (Refereed) Published
Place, publisher, year, edition, pages
Sage Publications, 2020
Keywords
healthcare strategies
National Category
Nursing Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
NURSING AND PUBLIC HEALTH SCIENCE, Nursing science
Identifiers
urn:nbn:se:hv:diva-15123 (URN)10.1177/1609406920909934 (DOI)000523471900153 ()2-s2.0-85091312592 (Scopus ID)
Conference
25th Annual Qualitative Health Research (QHR) Conference, October 25- 29, 2019, Vancouver, Canada
Available from: 2020-04-16 Created: 2020-04-16 Last updated: 2024-01-17Bibliographically approved
Johnsson, A., Wagman, P., Boman, Å. & Pennbrant, S. (2019). Striving to establish a care relationship -Mission possible or impossible?: Triad encounters between patients, relatives and nurses. Health Expectations, 22(6), 1304-1313
Open this publication in new window or tab >>Striving to establish a care relationship -Mission possible or impossible?: Triad encounters between patients, relatives and nurses
2019 (English)In: Health Expectations, ISSN 1369-6513, E-ISSN 1369-7625, Vol. 22, no 6, p. 1304-1313Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: When patients, relatives and nurses meet, they form a triad that can ensure a good care relationship. However, hospital environments are often stressful and limited time can negatively affect the care relationship, thus decreasing patient satisfaction.

OBJECTIVE: To explain the care relationship in triad encounters between patients, relatives and nurses at a department of medicine for older people.

DESIGN: A qualitative explorative study with an ethnographic approach guided by a sociocultural perspective.

METHOD: Participatory observations and informal field conversations with patients, relatives and nurses were carried out from October 2015-September 2016 and analysed together with field notes using ethnographic analysis.

RESULT: The result identifies a process where patients, relatives and nurses use different strategies for navigating before, during and after a triad encounter. The process is based on the following categories: orienting in time and space, contributing to a care relationship and forming a new point of view.

CONCLUSION: The result indicates that nurses, who are aware of the process and understand how to navigate between the different perspectives in triad encounters, can acknowledge both the patient's and relatives' stories, thus facilitating their ability to understand the information provided, ensure a quality care relationship and strengthen the patient's position in the health-care setting, therefore making the mission to establish a care relationship possible.

Keywords
care relationship, ethnography, nurses, older patient, relative, triad encounter
National Category
Nursing
Research subject
NURSING AND PUBLIC HEALTH SCIENCE, Nursing science
Identifiers
urn:nbn:se:hv:diva-14582 (URN)10.1111/hex.12971 (DOI)000503237700013 ()31588667 (PubMedID)2-s2.0-85073923765 (Scopus ID)
Available from: 2019-10-14 Created: 2019-10-14 Last updated: 2020-02-24
Tengelin, E., Misund Dahl, B., Boman, Å. & Ottesen, A. M. (2019). The struggle between ancient welfare thinking and prevailing health care policy in Scandinavian health care legislative documents. In: 25th Annual Qualitative Health Research (QHR) Conference: Book of Abstracts. Paper presented at 25th Annual Qualitative Health Research (QHR) Conference, October 25- 29, 2019, Vancouver, Canada (pp. 67).
Open this publication in new window or tab >>The struggle between ancient welfare thinking and prevailing health care policy in Scandinavian health care legislative documents
2019 (English)In: 25th Annual Qualitative Health Research (QHR) Conference: Book of Abstracts, 2019, p. 67-Conference paper, Oral presentation with published abstract (Other academic)
Abstract [en]

Traditional welfare state systems in Scandinavia are challenged by new governance systems. Demands for efficiency and productivity in healthcare increase, raising questions about patients' positions and agency. This also implies ethical dilemmas for healthcare professionals. Comprehensively analysing the findings of previous discourse studies on how the patient is constructed in central policy texts, this study compares the position of the patient and the accompanying ideological struggles in Norway, Sweden, and Denmark. The purpose was to compare and discuss the findings of discursive constructions of patients in law and policy text from the three countries. We found an ideological struggle across the Scandinavian countries, operating at a political level, a legislative level and a healthcare level, with variation in how the new value-based patient care is constructed. We conclude that national governance systems still exert hegemonic power by strongly influencing patients' degree of choice and autonomy. The Scandinavian countries may all be heading towards a commercial healthcare market, despite their tradition of a welfare model of healthcare. Today, healthcare strategies move in the opposite direction, controlled by politicians' financial goals. The ideological struggle between welfare state governance and other governance systems, may exist also in other western countries in our globalized world.

Keywords
Welfare systems, health care policy, Scandinavia
National Category
Nursing Health Care Service and Management, Health Policy and Services and Health Economy
Research subject
NURSING AND PUBLIC HEALTH SCIENCE, Public health science; NURSING AND PUBLIC HEALTH SCIENCE, Nursing science
Identifiers
urn:nbn:se:hv:diva-14784 (URN)
Conference
25th Annual Qualitative Health Research (QHR) Conference, October 25- 29, 2019, Vancouver, Canada
Available from: 2019-12-19 Created: 2019-12-19 Last updated: 2021-05-23Bibliographically approved
Boman, Å. (2018). Learning by supporting others: experienced parents' development process when supporting other parents with a child with Type 1 diabetes. Journal of Clinical Nursing, 27(5-6), E1171-E1178
Open this publication in new window or tab >>Learning by supporting others: experienced parents' development process when supporting other parents with a child with Type 1 diabetes
2018 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 27, no 5-6, p. E1171-E1178Article in journal (Refereed) Published
Abstract [en]

AIMS AND OBJECTIVES: This study's purpose was to describe and analyze coach-parents' development process when supporting parents of children recently diagnosed with Type 1 Diabetes Mellitus (T1DM).

BACKGROUND: It has been found repeatedly that providing social support for families with a child diagnosed with T1DM promotes health and wellbeing for both the child and the parents. Less explored are the processes experienced by those who provide this support. However, research has found that acting as a provider of social support promotes personal development, strengthens communication skills, and increases self-confidence.

METHODS: The study design was based on Constructivist Grounded Theory and data were collected, through Repeated Focus Group Discussions, from eight coach-parents at a Swedish hospital from 2012-2015.

RESULTS: The core category in the data was identified as a learning process where coach-parents emphasized their own learning in the dyad supporter - supported, and in the interaction with other parents in the Repeated Focus Group Discussions. The coach-parents' motivation for participation was a wish to learn more and to help other parents in a life-changing situation. They also pointed out hindrances and their frustration when unable to provide support.

CONCLUSIONS: This study leads to the conclusion that people who provide support benefit from doing so. Encountering people with similar experiences in a supportive situation promotes a reciprocal learning process, based on the supporter's wish to help people in a situation they recognize. A further conclusion is that social support is not only essential initially, but is also important over a longer period and that it follows various life stages.

RELEVANCE TO CLINICAL PRACTICE: Setting up repeated focus group discussions might be a relevant and effective tool for pediatric diabetes nurses to use in promoting health and wellbeing for both families with a newly diagnosed child and experienced families. This article is protected by copyright. All rights reserved.

Keywords
Child, diabetes mellitus type 1, focus groups, learning, social support
National Category
Nursing
Research subject
NURSING AND PUBLIC HEALTH SCIENCE, Nursing science
Identifiers
urn:nbn:se:hv:diva-11983 (URN)10.1111/jocn.14235 (DOI)000428419400029 ()29266575 (PubMedID)2-s2.0-85041103192 (Scopus ID)
Note

Online since 21 December 2017

Funders: General Inheritance Fund.

Available from: 2018-01-16 Created: 2018-01-16 Last updated: 2019-01-23Bibliographically approved
Johnsson, A., Boman, Å., Wagman, P. & Pennbrant, S. (2018). Voices used by nurses when communicating with patients and relatives in a department of medicine for older people: An ethnographic study. Journal of Clinical Nursing, 27(7-8), E1640-E1650
Open this publication in new window or tab >>Voices used by nurses when communicating with patients and relatives in a department of medicine for older people: An ethnographic study
2018 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 27, no 7-8, p. E1640-E1650Article in journal (Refereed) Published
Abstract [en]

AIM: To describe how nurses communicate with older patients and their relatives in a department of medicine for older people in western Sweden.

BACKGROUND: Communication is an essential tool for nurses when working with older patients and their relatives but often patients and relatives experience shortcomings in the communication exchanges. They may not receive information or are not treated in a professional way. Good communication can facilitate the development of a positive meeting and improve the patient's health outcome.

DESIGN: An ethnographic design informed by the sociocultural perspective was applied.

METHOD: Forty participatory observations were conducted and analyzed during the period October 2015 to September 2016. The observations covered 135 hours of nurse-patient-relative interaction. Field notes were taken and 40 informal field conversations with nurses and 40 with patients and relatives were carried out. Semi-structured follow-up interviews were conducted with five nurses.

RESULTS: In the result, it was found that nurses communicate with four different voices: a medical voice described as being incomplete, task-oriented and with a disease perspective; a nursing voice described as being confirmatory, process-oriented and with a holistic perspective; a pedagogical voice described as being contextualized, comprehension-oriented and with a learning perspective; and a power voice described as being distancing and excluding. The voices can be seen as context-dependent communication approaches. When nurses switch between the voices this indicates a shift in the orientation or situation.

CONCLUSION: The results indicate that if nurses successfully combine the voices, while limiting the use of the power voice, the communication exchanges can become a more positive experience for all parties involved and a good nurse-patient-relative communication exchange can be achieved.

RELEVANCE TO CLINICAL PRACTICE: Working for improved communication between nurses, patients and relatives is crucial for establishing a positive nurse-patient-relative relationship, which is a basis for improving patient care and healthcare outcomes. This article is protected by copyright. All rights reserved.

Keywords
communication, ethnography, nurses’ voices, older patient, relative, sociocultural perspective
National Category
Nursing
Research subject
NURSING AND PUBLIC HEALTH SCIENCE, Nursing science
Identifiers
urn:nbn:se:hv:diva-12202 (URN)10.1111/jocn.14316 (DOI)000430825100036 ()29493834 (PubMedID)2-s2.0-85045891204 (Scopus ID)
Available from: 2018-03-07 Created: 2018-03-07 Last updated: 2020-03-05Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0003-3792-6600

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