PurposeThe 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/approachThe 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.FindingsThe 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/implicationsBecause of the specific conditions of Scandinavian healthcare policy, the findings lack generalisability. The research approach should therefore be explored further in additional contexts.Practical implicationsThe findings of this study can inform policymakers, professionals and patients of the ideological values underlying seemingly objective shifts in national policy.Originality/valueA comparative critical discourse analysis can expose patterns in the Scandinavian approaches to patient rights.
The Danish health care sector currently undergoes changes that imply a gradual transition from an evidence-based activity model to a value-based quality model centered on patient involvement and value-based governance. The patient naturally occupies a central position in health care, and the transition therefore raises important questions about health care quality and how successive national health quality strategies value quality and ascribe roles and agency to patients. To explore the complexity of these quality strategies, we analyze and discuss how political discourse moments influence the contents of the national health quality strategies and how variation in the construal of patient roles and agency indicates discursive struggle in Danish national health care policy. Underlying theoretical concepts are informed by New Public Management, the welfare state, health communication, and discourse theory. Our analytical approach is inspired by Critical Discourse Analysis and combines content analysis with linguistic analysis.
This article argues that the discourse of culture and ethnicity that has so far been found to dominate health sector communication about ethnic minority patients is being challenged by voices indicating alternative ways of talking about the cultural meeting. This assumption is corroborated by data from interviews with nurses, who construct themselves discursively as members of a nursing profession divided between institutional concerns and concerns about the individual needs of patients. In a ward with many ethnic minority patients these concerns will invariably invite reflections on the nature and significance of culture, and to what extent cultural difference is a meaningful concept in nursing practice, and our results have pointed to a counter-discourse emerging in part of the Danish health sector. The analysis presented here is based on data from a project in which we explore how health professionals and ethnic minority patients talk about culture in a specific Danish hospital ward and how this may have implications for staff-patient relationships. Our theoretical and methodological approach is mainly Critical Discourse Analysis (Fairclough 1992 [1999]; van Dijk 2008; Reisigl & Wodak 2001).
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.
This paper deals with results from an ongoing research project about how patients and health professionals talk about and enact culture in a specific Danish hospital ward, whether this may have implications for staffÁpatient relationships and how knowledge of cultural complexities may add value to patient care. The project and this paper are based on a discourse analytic and social constructivist approach and, contrary to some earlier studies focusing on health professionals' perceptions of culture in relation to the care of minority ethnic patients, this project and paper deal with culture seen from a patient perspective. Data have been collected from interviews with minority ethnic patients and with nurses about the intercultural encounter in an infectious diseases ward, and the analysis focuses on evaluating statements present in the discourses. The analysis aims at studying how such discourses may display the patients' roles and self positioning, to discuss whether such positions and roles are attributable to culture, language proficiency or social conditions.
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.
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