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Nurses' discursive construction of older adult immigrant patients in hospitals
Department of Health Sciences in Aalesund, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Box 1517, Aalesund 6025 (NOR).
University West, Department of Health Sciences, Section for nursing - graduate level. (LOVHH)ORCID iD: 0000-0003-3702-8202
Department of Culture and Learning, Faculty of Social Sciences and Humanities, Aalborg University, Kroghstraede 3, Aalborg 9220 (DNK).
Department of Health Sciences in Aalesund, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Box 1517, Aalesund 6025 (NOR).
2023 (English)In: BMC Health Services Research, E-ISSN 1472-6963, Vol. 23, no 1, article id 586Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The immigrant population across Europe is ageing rapidly. Nurses will likely encounter an increasing number of patients who are older adult immigrants. Moreover, access to and equal provision of healthcare is a key issue for several European countries. The relationship between nurses and patients is asymmetrical with unequal power relations; however, the way nurses construct the patient through language and discourse can help maintain or change the balance of power. Unequal power relations can affect access and be a hindrance to equal healthcare delivery. Hence, the aim of this study is to explore how older adult immigrants are discursively constructed as patients by nurses.

METHODS: An exploratory qualitative design was used. Data were collected through in-depth interviews with a purposive sample of eight nurses from two hospitals. The nurses' narratives were analysed using critical discourse analysis (CDA) as described by Fairclough.

RESULTS: The analysis identified an overarching, stable, and dominant discursive practice; 'The discourse of the other', with three interdiscursive practices: (1) 'The discourse on the immigrant patient versus an ideal patient'; (2) 'The expert discourse'; and (3) 'The discourse of adaption'. Older immigrant adults were constructed as 'othered' patients, they were different, alienated, and 'they' were not like 'us'.

CONCLUSION: The way nurses construct older adult immigrants as patients can be an obstacle to equitable health care. The discursive practice indicates a social practice in which paternalism overrides the patient's autonomy and generalization is more prevalent than a person-centred approach. Furthermore, the discursive practice points to a social practice wherein the nurses' norms form the basis for normal; normality is presumed and desirable. Older adult immigrants do not conform to these norms; hence, they are constructed as 'othered', have limited agency, and may be considered rather powerless as patients. However, there are some examples of negotiated power relations where more power is transferred to the patient. The discourse of adaptation refers to a social practice in which nurses challenge their own existing norms to best adapt a caring relationship to the patient's wishes.

Place, publisher, year, edition, pages
2023. Vol. 23, no 1, article id 586
Keywords [en]
Critical discourse analysis, Nurse-patient relations, Nurses, Older adult immigrants, Patient constructions, Qualitative research
National Category
Nursing
Research subject
NURSING AND PUBLIC HEALTH SCIENCE, Nursing science
Identifiers
URN: urn:nbn:se:hv:diva-20138DOI: 10.1186/s12913-023-09590-6ISI: 001002985400003PubMedID: 37286985Scopus ID: 2-s2.0-85161256131OAI: oai:DiVA.org:hv-20138DiVA, id: diva2:1776232
Note

CC BY 4.0

Available from: 2023-06-27 Created: 2023-06-27 Last updated: 2024-01-12Bibliographically approved

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Dahlborg, Elisabeth

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