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Perpetuating ‘New Public Management’ at the expense of nurses’ patient education: A discourse analysis
University of Borås, Faculty of Caring Science, Work Life and Social Welfare.
2015 (English)In: Nursing Inquiry, ISSN 1320-7881, E-ISSN 1440-1800, Vol. 22, no 3, p. 190-201Article in journal (Refereed) Published
Sustainable development
The content falls within the scope of Sustainable Development
Abstract [en]

This study aimed to explore the conditions for nurses' daily patient education work by focusing on managers' way of speaking about the patient education provided by nurses in hospital care. An explorative, qualitative design with a social constructionist perspective was used. Data were collected from three focus group interviews and analysed by means of critical discourse analysis. Discursive practice can be explained by the ideology of hegemony. Due to a heavy workload and lack of time, managers could ‘see’ neither their role as a supporter of the patient education provided by nurses, nor their role in the development of nurses' pedagogical competence. They used organisational, financial, medical and legal reasons for explaining their failure to support nurses' provision of patient education. The organisational discourse was an umbrella term for ‘things’ such as cost-effectiveness, which were prioritised over patient education. There is a need to remove managerial barriers to the professional development of nurses' patient education. Managers should be responsible for ensuring and overseeing that nurses have the prerequisites necessary for providing patient education as well as for enabling continuous reflective dialogue and opportunities for learning in practice.

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Ltd. , 2015. Vol. 22, no 3, p. 190-201
National Category
Nursing
Research subject
Integrated Caring Science
Identifiers
URN: urn:nbn:se:hb:diva-1976DOI: 10.1111/nin.12085ISI: 000359871900002PubMedID: 25327764Scopus ID: 2-s2.0-84939221647Local ID: 2320/14479OAI: oai:DiVA.org:hb-1976DiVA, id: diva2:870054
Available from: 2015-11-13 Created: 2015-11-13 Last updated: 2018-12-21Bibliographically approved
In thesis
1. Sjuksköterskors patientundervisande arbete: Ett otydligt fält
Open this publication in new window or tab >>Sjuksköterskors patientundervisande arbete: Ett otydligt fält
2016 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aim: The overall aim of this thesis is to explore, describe and critically assess conditions for nurses’ patient education work. This was carried out in two stages. In the first stage, the aim was to describe nurses’ experiences and perceptions of patient education work in relation to organisation, environment, professional cooperation and pedagogical competence, as well as describe differences between primary, municipal and hospital care. In the second stage, the aim was to identify discourses in the ways managers speak of the conditions for nurses’ patient education work in primary and hospital care.

Methods: In studies I and II, a randomised selection of nurses (842) received a questionnaire of 47 items concerning factual experiences and perceptions patient education, and 13 background items. Questionnaires were returned by 83 % of the participants. The items concerned organisation, environment, professional cooperation (I), and pedagogical competence (II). Descriptive statistics, non-parametric tests and content analysis for open-ended items were used. In studies III and IV, data was collected from three focus group interviews with managers (n=10) in hospital care, and three focus groups interviews with managers (n=10) in primary care. An explorative, qualitative design with a social constructionist perspective was used. The data was analysed with a critical discourse analysis.

Results: Nurses’ perceptions of conditions for patient education differ between healthcare settings, in favour of primary care (I, II). The nurses in primary care had better conditions and more managerial support, for example in the allocation of uninterrupted time (I). The primary care nurses had an advantage in relation to those in municipal or hospital care when it came to following research in patient education as well as how they perceived their own competences, pedagogical education and post graduate specialisations (II). Due to a heavy workload and a lack of time, the managers in hospital care could neither see the importance of their role as a supporter of the patient education provided by the nurses nor their role in the development of the nurses’ pedagogical competence. The managers used (mainly) organisational, financial, medical and legal discourses for explaining their failure to support the nurses’ providing patient education (III). The discursive practice in primary care comprised a discourse order of economic, medical, organisational and didactic discourses. The economic discourse was the predominant one, to which the organisation had to adjust. The medical discourse was self-evident and unquestioned. The managers initiated reorganisations, generally due to financial constraints. The nurses’ pedagogical competence development was unclear. Practicebased experiences of patient education were considered very important, whereas theoretical pedagogical knowledge was considered less important (IV).

Conclusions: Nurses’ patient education work must be made visible and be given sufficient resources. In this process, support from their managers is considered vital. Managers’ support for nurses’ practical and theory-based pedagogical competence development needs to be strengthened.

Place, publisher, year, edition, pages
Göteborg: Göteborgs universitet, 2016. p. 68
Keywords
nurse, manager, patient education, teaching, information, pedagogical, critical discourse analysis
National Category
Medical and Health Sciences Nursing
Research subject
Människan i vården
Identifiers
urn:nbn:se:hb:diva-9555 (URN)978-91-628-9744-4 (ISBN)978-91-628-9745-1 (ISBN)
Public defence
2016-04-29, Sal: Åke Göransson, Medicinaregatan 11, Göteborgs universitet, Göteborg, 13:00 (Swedish)
Available from: 2016-04-07 Created: 2016-04-07 Last updated: 2017-05-04Bibliographically approved

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Bergh, Anne-Louise

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