An exploration of the discursive practices that shape and discipline nurses' response to postoperative delirium

Delirium is a common, costly, and dangerous condition, especially among older adults. Delirium is a medical emergency, which requires early recognition and immediate evaluation and treatment of the underlying cause(s) to prevent negative outcomes. Although delirium is classified as a medical emergency, it is often not treated as such by health care providers. Perhaps because of the prevailing myth that confusion is a normal change that occurs in aging adults, recognition and prognostic significance of delirium is often overlooked. Powerful discourses have served to construct delirium in such a way that it is approached as less important than other clinical phenomenon. The aim of this study was to critically examine the language practices and discourses that shape and discipline nurses’ care of older adults with postoperative delirium (POD) with a purpose to question accepted nursing practice. By illuminating these great systems, good theories and vital truths and exploring the knowledge/power link through a poststructural, Foucauldian concept of discourse, it is possible to raise questions toward new possibilities of improvements in nursing care and patient outcomes. The study was based on data collected from face-to-face, in-depth, personal interviews with six nurses (four Registered Nurses and two Licensed Practical Nurses) who work on an acute 37 bed surgical unit which provides postoperative care for orthopedic, urology and neurology patients. This unit is located in a 450-bed tertiary care hospital in Western Canada. Interviews were conducted at a time and place that was convenient for the participants. Data was digitally recorded and transcribed by the researcher verbatim. Five analytic readings of the data identified two prominent discourses at work in nursing practice, which influenced the care of patients with POD. These were identified as discourses of legitimacy/illegitimacy and discourses of nursing work. Through the process of poststructural analysis it became evident that one overriding discourse served to direct, legitimize and govern all other discourses. This discourse remains the biomedical/scientific discourse. The findings of this study have implications for nursing knowledge and practice, education, improved patient outcomes and length of hospital stay.Health and Social Development, Faculty of (Okanagan)Nursing, School of (Okanagan)Graduat

Keeping dad safe : an autoethnography of double-duty caregiving in the context of risk as an advanced practice nurse in geriatrics caring for a hospitalized frail older adult parent

Particular challenges emerge when children who are health professionals become caregivers for their older adult parents who are hospitalized. This double-duty caregiving involves performing multiple roles and can create tensions for formal and informal caregivers that may impact the care of the older adult. In my case double-duty caregiving meant positioning as a daughter of an older adult family member and as a clinical nurse specialist in geriatrics within a change in risk culture toward patient-and-family centered care. Using autoethnography informed by poststructural perspectives, I conducted a discourse analysis and identified subject positions produced through and by these discourses. I applied analytic and evocative autoethnographic methods to my data that included medical records of my dad from two separate hospital admissions, journal notes, memory, and emails. Additionally, I conducted semi-structured interviews with my dad, three siblings, and the health service director at the hospital where my dad was hospitalized. My double-duty caregiving experience is reflected in my autoethnography that applied historical perspectives of risk and the influence of risk culture on in-the-moment caregiving. I identified safety as a predominant discourse that I, my participants, and the health care providers who cared for my dad took up and performed in my experience of double-duty caregiving for my dad. Within the safety discourse were sub-discourses of competency/incompetency, surveillance, trust/mistrust, fear, and control. Through this process of discourse analysis, biomedical discourses were unveiled as the most dominant discourses that produced the culture of risk within the context of double-duty caregiving for my frail older adult parent, and the tension between biomedical discourses and patient-and-family centered care is revealed. This study is unique in using autoethnography to look at double-duty caregiving for an older adult parent within the context and culture of risk. This research supports other findings that enacting trust in relationships is complex when individuals not only position themselves in relation to multiple selves, but are positioned by others for a number of purposes. Future research into how best to shift the focus of risk imbued by biomedical discourses to a patient- and family-centred and team-based approach is essential.Health and Social Development, Faculty of (Okanagan)Nursing, School of (Okanagan)Graduat

Older Adults’ Risk Practices From Hospital to Home : A Discourse Analysis

Purpose: To understand risk-related practices of older adults returning home post-hospitalization. Research Design: Qualitative methods informed by critical discourse theory, designed to uncover linkages between broader social practices and peoples’ talk and stories, were used. Methods: Eight older adults, screened as high-risk from an inpatient cardiology unit, and six partners were interviewed face-to-face within three weeks of discharge. A discourse analysis of participants’ accounts of risk was conducted: the cultural and social understandings or conceptual frameworks used to understand risk were identified. Results: Ableism, a discourse in our society that privileges abledness, was found to permeate the data. Participants underscored that being abled was normal and being disabled was abnormal. Ableism, as a discourse or conceptual framework, compelled participants to appear and act abled, or to perform “compulsory abledness”. That, in turn, produced their responses to risk: a pressure to preserve ableist identities created internal and external tensions related to objects and situations of risk, and forced participants to use strategies to diminish and minimize risk. Participants created a new response – a position of “liminality,” or in-between – where their accounts portrayed them as neither abled nor disabled. This discourse of liminality allowed them to reconcile tensions associated with risk. Implications: Critical discourse analysis sheds new light on older adults risk practices. This approach challenges accepted ways of acting and thinking about what constitutes risk and produces possibilities for alternate ways of representing the same reality.Health and Social Development, Faculty of (Okanagan)Non UBCNursing, School of (Okanagan)Social Work, School of (Okanagan)ReviewedFacultyUnknow

Geriatric Education and Training Program : implementing the GET program

Applied Science, Faculty ofNursing, School ofNon UBCUnreviewedFacultyOthe