UBC Theses and Dissertations
An exploration of the discursive practices that shape and discipline nurses' response to postoperative delirium Kjorven, Mary Colleen
Delirium is a common, costly, and dangerous condition, especially among older adults. Delirium is a medical emergency, which requires early recognition and immediate evaluation and treatment of the underlying cause(s) to prevent negative outcomes. Although delirium is classified as a medical emergency, it is often not treated as such by health care providers. Perhaps because of the prevailing myth that confusion is a normal change that occurs in aging adults, recognition and prognostic significance of delirium is often overlooked. Powerful discourses have served to construct delirium in such a way that it is approached as less important than other clinical phenomenon. The aim of this study was to critically examine the language practices and discourses that shape and discipline nurses’ care of older adults with postoperative delirium (POD) with a purpose to question accepted nursing practice. By illuminating these great systems, good theories and vital truths and exploring the knowledge/power link through a poststructural, Foucauldian concept of discourse, it is possible to raise questions toward new possibilities of improvements in nursing care and patient outcomes. The study was based on data collected from face-to-face, in-depth, personal interviews with six nurses (four Registered Nurses and two Licensed Practical Nurses) who work on an acute 37 bed surgical unit which provides postoperative care for orthopedic, urology and neurology patients. This unit is located in a 450-bed tertiary care hospital in Western Canada. Interviews were conducted at a time and place that was convenient for the participants. Data was digitally recorded and transcribed by the researcher verbatim. Five analytic readings of the data identified two prominent discourses at work in nursing practice, which influenced the care of patients with POD. These were identified as discourses of legitimacy/illegitimacy and discourses of nursing work. Through the process of poststructural analysis it became evident that one overriding discourse served to direct, legitimize and govern all other discourses. This discourse remains the biomedical/scientific discourse. The findings of this study have implications for nursing knowledge and practice, education, improved patient outcomes and length of hospital stay.
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