Modes of rationality in nursing documentation: biology, biography and the ‘voice of nursing’

Abstract

Publication informationNursing inquiry, 12 (2) ABSTRACTThis article is based on a discourse analysis of the complete nursing records of 45 patients and concerns the modes of rationality that mediated text-based accounts relating to patient care that nurses recorded. The analysis draws on the work of the critical theorist, Jürgen Habermas, who conceptualised rationality in the context of modernity according to two types: purposive rationality based on an instrumental logic and value rationality based on ethical considerations and moral reasoning. Our analysis revealed that purposive rationality dominated the content of nursing documentation, as evidenced by a particularly biocentric and modernist construction of the workings of the body within the texts. There was little reference in the documentation to central themes of contemporary nursing discourses, such as notions of partnership, autonomy, and self-determination which are associated with value rationality. Drawing on Habermas, we argue that this nursing documentation 2 depicted the colonisation of the socio-cultural lifeworld by the bio-technocratic system. Where nurses recorded disagreements that patients had with medical regimes, the central struggle inherent in the project of modernity became transparent -the tension between the rational and instrumental control of people through scientific regulation and the autonomy of the subject. The article concludes by problematising communicative action within the context of nursing practice.

Social regulation, medicalisation and the nurse's role: Insights from an analysis of nursing documentation

“…As we have argued both here and elsewhere (Hyde et al, 2005;Irving et al in press), nursing documentation in this study was heavily dominated by a biomedical perspective whereupon documented aspects of nurses' management of ADLs were mediated by a pharmacological response to almost every functional deficit. This suggests that nurses are struggling to express the psychosocial aspect of their role in nursing records.…”

“…This suggests that nurses are struggling to express the psychosocial aspect of their role in nursing records. (In Hyde et al (2005) we raised the question as to whether documenting complex psychosocial aspects is even feasible.) This heavily medicalised worldview of functional restoration is interesting, given the increasing attention to Complementary and Alternative Therapies (CAM) in nursing (Tovey and Adams, 2003).…”

“…The focus of this paper is on one of the data sets, namely documentation data, gathered as a basis for constructing the NMDS. (Two further papers focusing on different aspects of discourses embedded in documentation have been published separately (Hyde et al, 2005;Irving et al in press).) The documentation used in this analysis is confined to data gathered in a general nursing setting.…”

“…Data suggest that every deviation from the expected level at which an activity of daily living ought to be performed tended to be moderated through biomedical means. (Elsewhere, we have linked the biocentrism in nursing documentation with the technocratic hegemony associated with late modernity (Hyde et al, 2005).) In the clinical setting, the maintenance of normative standards of ADLs was mediated by a heavily medicalised worldview, with a 'pill for every ill', or rather, a pill for every deviation in an ADL, such as in sleeping patterns, in eliminating, for anxiety and so on.…”

Nursing documentation in palliative care: An integrative review

“…Clear and coherent documentation can prevent negative outcomes caused by miscommunication [7]. Nursing documentation is a communication tool demonstrating not only evidence of what the nurse actually does for the patient, but also provides a tool to audit the written record of the patient's journey [8]. While having clear documentation is an essential requirement for nursing practice, there is also a need for the profession to make their contribution to healthcare visible [9][10][11].…”