Constructing mentally ill inmates: nurses’ discursive practices in corrections

Abstract

The concepts of discourse, subjectivity and power allow for innovative explorations in nursing research. Discourse take many different forms and may be maintained, transmitted, even imposed, in various ways. Nursing practice makes possible many discursive spaces where discourses intersect. Using a Foucauldian perspective, were explored the ways in which forensic psychiatric nurses construct the subjectivity of mentally ill inmates. Progress notes and individual interviews constitute discursive spaces within which nurses construct patients' subjectivities. Progress notes provide a written (and permanent) form of discourse, while interviews set the space for a more fluid and contextual form of discourse. We identified five types of subjectivities - the (in)visible patient, the patient as risk, the deviant patient, the disturbed patient and the disciplined patient. These subjectivities were rooted in various types of discourses circulating in the selected setting. Despite the multiple discursive dimensions of forensic psychiatric nursing, progress notes remain the main formal source of information regarding nursing care even though it is not representative of the care provided nor is it representative of nurses' complex discursive practices in corrections.

Social science and linguistic text analysis of nurses’ records: a systematic review and critique

“…Buus () analysed the linguistic organisation of 35 nurses’ records from two psychiatric hospital wards. Buus identified four characteristic linguistic structures for describing patients and stated that nurses tended to depict each patient in similar ways across shifts: length of entries, linguistic structures and wording (Perron and Holmes () made similar observations). The records were highly conventionalised and presupposed situational knowledge to be understood correctly by a reader.…”

“…; Buus ; Jefferies et al. ), discharge notes (Hellesø ) and nurses’ entries in patient files (Perron and Holmes ), and only a minority of the articles included descriptions of the records’ particular institutional purposes and the particular recording systems used. Frequently, it was not clear whether the records were paper records or electronic records.…”

“…The most frequently used concepts were Foucault's, which were central in five articles (Chapman ; Heartfield ; Mohr ; Irving et al. ; Perron and Holmes ) and present in more. Foucault () described recording as a disciplinary technique that constitute individuals as objects of power/knowledge, of description and correction.…”

“…() analysed the discursive practices of recording and drew on Foucault's understanding of records as a surveillance technology . Perron and Holmes () drew on Foucault to conceptualise progress notes as a discursive practice that form patients’ subjectivities through the internalisation of disciplinary power.…”

“…() and Chapman () do mention patient resistance, several other studies refer to nurses and medical power over patients, but disregard the issue of patient subjectivity as resistant (Irving et al. ; Perron and Holmes ). Overall, these studies tend to affirm nurses co‐opting patients as subjects in dominant project of social order, efficiency and self‐management.…”