Living Stories of Care: Exploring Discursive Clashes Through Storytelling by Nurses
Abstract: Purpose: Nurses constitute a key group to focus on due to their close proximity to the core of health care, the patient. We aim to understand the care discourse in the practice of nursing within public health care organizations, and its coexistence with the current marketization discourse promoted by the New Public Management paradigm. Our intention with this approach is not only to nuance and problematize the research done to date, but to delineate and illustrate what practitioners actually draw upon in their construction of care-giving. Methodology: By avoiding embarking from pre-prepared narratives and focusing on stories evoked in the moment, this study allows important discursive perspectives to naturally emerge. Analyzing the ethics in storytelling creates awareness and new room for an unheard voice, that of the nurse, and explores the nuances inherent therein. Ethics are inextricably connected to the experiences of people. Seen in the light of this, the ambivalent coexistence of care and marketization discourses calls for a need to empirically as well as methodologically nuance the way patients, and interactions with them are conceptualized. A discourse analysis of how an ethics of care is drawn upon will expand the boundaries of our understanding whether a care discourse is dominant, or is being amalgamated by customer ideals. Theoretical perspectives: Implications of New Public Management in health care organizations are introduced. Further, a feminist Ethics of Care is critically discussed, from which three versions are identified: Care as an orientation, care as a practice, and care as a moral framework. A brief overview of Ethics of Care in nursing literature is provided. This provides a theoretical framework to better understand the ethics drawn upon in the storytelling by nurses Empirical foundation: Empirical data in collected through six semi-structured qualitative interviews with nurses with different specializations and experiences, working at five different hospitals within Region Skåne. Further, a discourse analysis of the talks by politicians, hospital managers, and medical practitioners during a seminar held by the Ethics Council of Region Skåne is provided. Conclusions: The study’s knowledge contribution is directed towards the conflicting subject positions embodied in the dichotomy of ‘patient’ and ‘customer’. The empirical results show that the conceptualization of the one cared for (patient) as a ‘customer’, in practice brings few benefits and rather many ponderous problems for both practitioner and said patient. The in policy much professed benefits said to be won by a union between patient and customer ideals are thus nuanced. This in the sense that the thesis has problematized their claimed complementary properties by taking the voices of nurses into account. We argue that emancipating the perspective of nurses by virtue leads to a more nuanced understanding for future research and policy-making efforts. Thus allowing them to be directed towards constructing increased concordance with the practice of care-giving and its inherent ethics.
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