‘It is a bit like being a parent’: A discourse analysis of how nursing identity can contextualize patient involvement in Danish psychiatry

Abstract

During an ethnographic field work in Danish psychiatry taking place between 2011 and 2013, the emergence of an exemplary textbook symbolized a dominant perception of the relationship between psychiatric nursing professionals and patients that contextualized their ways of involving the patient in clinical practice. Drawing on the discourse theory of Laclau and Mouffe, this article elucidates how this particular textbook articulates the relation between two gendered subjects: a dominant and caring mother, and a childlike male patient. This article takes up the discussion about how nursing discourse is embedded in a range of ideological structures about gender, theory of science and ethics of the psychiatric field. It proceeds to discuss what possibilities and problems it delineates for the nursing profession and for patients, and involvement and recovery of patients in daily clinical practice.

Nurses' attitudes towards support for and communication about sexual health—A qualitative study from the perspectives of oncological nurses

“…In modern societies, Foucault () shows that the child's sexuality is conceptualised as physiologically present, but experienced as subjectively and phenomenological absent until puberty. By extension, the results of this study could generate a discussion about whether nurses' articulated approaches to patients signal a tendency to perceive patients as children, as also Oute () has shown.…”

‘Men just drink more than women. Women have friends to talk to’—Gendered understandings of depression among healthcare professionals and their implications

“…Third, the professionals’ ways of managing non‐compliant and autonomous patients bear resemblance to a historical power struggle about the true understanding of the patient in Danish and Scandinavian psychiatry in the sense that they mirror a social struggle between antagonistic articulations about recognition, status and privilege between professionals and patients (Oute, ). On the one hand, the traditional hierarchical nature of the professional–patient relationship provides professionals with the proficient and ethical legitimacy to exercise control over important decisions that directly influence the patients’ treatment and their lives.…”

“…The double bind is characterized by the fact that the person can neither opt to leave the situation (as they desire and need help for their distress) nor challenge the recommendations of the professional for fear of being punished or dismissed for doing so (Bateson, 1972 Scandinavian psychiatry in the sense that they mirror a social struggle between antagonistic articulations about recognition, status and privilege between professionals and patients (Oute, 2017). On the one hand, the traditional hierarchical nature of the professionalpatient relationship provides professionals with the proficient and ethical legitimacy to exercise control over important decisions that directly influence the patients' treatment and their lives.…”

“…First, the very organization of psychiatric and drug and alcohol treatment systems contributes to the exclusion of substance‐using patients from psychiatric treatment systems (Davidson & White, ; Hansen & Bjerge, ). Second, international research, including that from Scandinavia, elucidates how disenfranchising, stigmatizing and disempowering attitudes towards patients, professionals’ unwillingness and inability to navigate complex systems, and poorly timed services within the welfare systems often obstruct such patients’ access to care (Jacobsen, ; Ness, Borg, & Davidson, ; Oeye, Bjelland, Skorpen, & Anderssen, ; Oute, ; Oute & Bjerge, ; Skorpen, Anderssen, Oeye, & Bjelland, ). However, little is known about how gendered understandings of patients can inform professionals’ discretionary actions and decisions to include and exclude patients in clinical practice (Hansen & Bjerge, ; Ness et al., ).…”

A Case Study of Casework Tinkering

“…This situation bears some resemblance to the findings of a study on patient involvement in Danish psychiatry, which referred to a similar case in which the psychiatric professionals presented themselves as being in control of the patients' rights, both to determine the relevance of their health issues and to consent to the involvement of others in these issues. In the study, Oute (2018) reports how psychiatric professionals were very protective of the hierarchy between themselves and their patients, since they saw this hierarchy as the underpinnings of the system (Oute, 2018: 9, Oute & Bjerge forthcoming). As such, concerns for a person's rights were legitimately pushed to the background or skirted around.…”