Procedure manuals and textually mediated death

Abstract

The procedure manual as a document represents the practice of nursing care. Analysis of such manuals allows us to explore discourses of nursing and the ways in which they frame nursing practice. A critical analysis of a hospital procedure manual using discourse analysis was undertaken. A specific excerpt concerning 'Last offices' is used as an example of the institutionalisation of organisational values and beliefs as these influence nursing care. 'Last offices' directs nursing practices related to the death of a patient, and the laying out as preparation for the funeral director or coroner. The analysis shows that procedure manuals reproduce hegemonic ideologies of nursing. The analysis also shows how nursing practices are constituted by intersecting forces of differing locations such as the hospital as an organisation, the healthcare system and the wider society within which these function.

Medical practice, procedure manuals and the standardisation of hospital death

“…The authors analyse the text of a procedure manual in an Australian acute care hospital, dealing with the ‘last offices’ and nursing care of dead bodies. Quested and Rudge (2001) point out that such nursing procedure manuals as well as interaction involving death are unexplored areas in nursing research (Quested and Rudge 2001, 264).…”

“…The authors claim that their critical analysis highlights the ‘structural underpinnings and the intersecting interests that coincide in current nursing practice in acute care settings’ (Quested and Rudge 2001, 264). They attempt to uncover the rift between the practice of the individual nurse and the institution's demands on the nurse's provision of care:…”

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It is our contention that tension arises from the differing ‘pulls’ between the medico‐legal milieu of death in an acute care institution and the social and emotional context of a death of a person for their family and nursing staff. (Quested and Rudge 2001, 264)

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Therefore, when the nurse chooses to provide individualised care based on their expertise and the subtlety of the specific patient context, the nurse may be forced to challenge the power and authority embedded in the Clinical practice manual . (Quested and Rudge 2001, 270)

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Further investigation of the actual practice of the individual procedures (and comparison with their textual representation) may also tell us much of the social construction of care practices within the hospital. (Quested and Rudge 2001, 271)The potential for further research exists in the slippage between procedure care and actual clinical nursing practice, which would lead to a better understanding of the ‘reality’ of nursing care of the dead bodies. (Quested and Rudge 2003, 559)

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