Nursing inquiry
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Delirium is a common presentation of deteriorating health in older people. It is potentially deleterious in terms of patient experience and clinical outcomes. Much of what is known about delirium is through positivist research, which forms the evidence base for disease-based classification systems and clinical guidelines. ⋯ Nurses influenced by major discourses of risk reduction and safety, constructed patients with delirium as risk objects. The philosophy of person-centred and dignified care advocated in nursing literature and government policy is an emerging discourse, though little evident in the data. The current dominant discourses on safety must give space to discourses of dignity and compassion.
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A discursive exploration of the practices that shape and discipline nurses' responses to postoperative delirium Although delirium is classified as a medical emergency, it is often not treated as such by health care providers. The aim of this study was to critically examine, through a poststructural, Foucauldian concept of discourse, 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. The study was based on data collected from face-to-face, in-depth, personal interviews with six nurses who work on an acute postoperative patient care unit. ⋯ Through the process of poststructural analysis it became evident that one overriding discourse - the biomedical/scientific discourse - served to direct, legitimize and govern all other discourses. The findings of this study have implications for nursing knowledge and practice, length of hospital stay and improved patient outcomes. This study builds on previous work and is the first study to conduct a discourse analysis illuminating nurses' responses to POD through comparison with other acute medical emergencies from a poststructural perspective.
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The aim of this study was to explore what problems are reported by healthcare professionals in primary healthcare concerning the use of interpreters and what the problems lead to. The study involved a single case in a real-life situation with qualitative content analysis of 60 incident reports written by different healthcare professionals. ⋯ Other consequences were limited possibilities to communicate and thus consultation was carried out without a professional interpreter, using family members instead. The results highlight the importance of developing good co-operation between the interpreter agency and the primary healthcare centre in order to fulfil the existing policy of using professional interpreters to provide the right interpreter at the right time and guarantee high-quality care.
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Recovering at home: participating in a fast-track colon cancer surgery programme Fast-track surgery programmes are examples of the changes in health care toward implementation of evidence-based practice, decreasing hospitalisation, and increasing demands on patients for self-care after discharge. Documented knowledge of fast-track programmes is primarily related to a medical perspective whereas the patients' perspective is lacking. The aim of this study was to explore the lived experience of participating in a fast-track programme after discharge from the patients' perspective. ⋯ For the patients, the illness represented a fall from equilibrium into an existential limbo, and they needed to re-establish a sense of balance. Recovering from surgery and regaining strength was only one aspect of this process. Healthcare professionals need to pay more attention to the individual patient's lifeworld and to recognise the influence of lifeworld on the individual patient's recovery process.
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Historical Article
Reform and community care: has de-institutionalisation delivered for people with intellectual disability?
Reform and community care: has de-institutionalisation delivered for people with intellectual disability? In this paper we provide a post structural analysis of the theoretical shifts informing changes to service delivery over the past 150 years in relation to people with intellectual disability. We utilise the New Zealand experience of reform as it reflected global knowledge at any given period. Firstly, we address the historical modes of treatment and care, with reference to the eugenics movement, the concepts informing 'Prisons of protection' and moral treatment. ⋯ Covering such significant changes leads us to assess the state of de-institutionalisation' as it stands today and how it may be perceived in the future. We assert that Foucault's genealogical approach provides analytic tools to uncover the dynamics of changing attitudes and approaches to service delivery. In applying a Foucauldian lens to the trajectory of reforms concerning institutionalisation to de-institutionalisation we question whether a form of re-institutionalisation may be occurring.