Nurses’ discursive construction of older adult immigrant patients in hospitals

BMC Health Services Research

Research

Jeanne Strunck¹  Lisbeth Alnes Vestgarden²  Elin Margrethe Aasen²  Elisabeth Dahlborg³ 

[1] Department of Culture and Learning, Faculty of Social Sciences and Humanities, Aalborg University, Kroghstraede 3, 9220, Aalborg, Denmark;Department of Health Sciences in Aalesund, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Box 1517, 6025, Aalesund, Norway;Department of Health Sciences, University West, 46132, Trollhättan, Sweden;

关键词: Nurses;    Nurse-patient relations;    Older adult immigrants;    Qualitative research;    Critical discourse analysis;    Patient constructions;   

DOI  :  10.1186/s12913-023-09590-6

 received in 2023-02-21, accepted in 2023-05-23,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundThe 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.MethodsAn 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.ResultsThe 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’.ConclusionThe 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.

【 授权许可】

CC BY   
© The Author(s) 2023