Discourse analysis: towards an understanding of its
place in nursing practice: Marie Crowe
Methodology that focuses on how social relations, identities,
knowledge and power are constructed in spoken and written
texts
•use of language and text as a form or symbol of social practice
(Fairclough)
• heavily context driven
•macro context.
•Highlights oppressive relationships
(I feel this comes from the Faucaidean approach to
institutions. I would prefer to consider that it examines the text
to reveal less obvious or implicit meaning.)
Discourse analysis: towards an
understanding of its place in nursing
practice: Marie Crowe
• Uses Media –any text or visual media such as
film and photography
• Requires Critical skills -a commitment to
reading a wide variety of texts to develop an
understanding of the context of the research
question.
• Focusses on Language (communication)around identifying oppressive practices
•
What are the nurses attitudes to adolescents who
are brought to emergency with a suicide
attempt/intoxicated ?
Quantitative analysis- context free, objective – “clean”
measurable, reliable
demographics
questionnaire using a likert scale,
Traditional qualitative approaches - subjective ideological
position, represented linguistically
interviews, ethnographic study
Discourse analysis- “ places the person who is being
researched, in this case nurses in a historical and social
context which has been created by language- maybe policy,
education,”
also places the subject in their own context
What are the nurses attitudes to
patients who are brought to
emergency with a suicide attempt?
What are the tools, policies, procedures,
educational manuals, that nurses use to
assess suicidal patients and how does this
affect their attitude and care?
Labelling: words and phrases have specific meaning
and value determined by the culture
hospitals versus health sciences centre,
cure versus heal
palliative care vs terminally ill vs dying
treat vs manage
retarded vs developmentally delayed,
mental health vs mental illness,
youth vs adolescent
recreational drug use vs substance abuse,
an asthmatic vs a person with asthma
language has a cultural form, participants
adhere to communal conventions in order
to be understood
What are the nurses attitudes to patients who are
brought to emergency with a suicide attempt
• What are the tools, policies, procedures, educational
manuals, that nurses to assess suicidal patients and
how does this affect their attitude and care?
•
after addressing Labelling:
• What are the tools, policies, procedures,
educational manuals, that nurses use/ are
provided with to assess/ interact with suicidal
patients/people and how does this affect their
attitude during care/ the (clinical) encounter?
What are the nurses attitudes to patients who are
brought to emergency with a suicide attempt?
Old Phrasing: What are the tools, policies, procedures,
educational manuals, that nurses use/are provided with to
assess/interact with suicidal patients/people and how does
this affect their attitude and care/the (clinical) encounter
Discourse analysis contributes to the construction
• of subject positions( ways of being in the world)
• social relationships between people
•systems of knowledge and belief
New Phrasing: How do the socio-political influences (reflected
in documents, media, etc ) on nursing practice, and the
situated social framework of persons who attempt suicide
combined with the social representation/symbolism of the
hospital emergency department affect nursing attitudes and
the clinical relationship when suicidal persons are brought to
the Emergency department for treatment?

Nursing discourse analysis: protocols, education pamphlets,
health policies, media representations, transcripts interviews
•Narrative: tell a story, temporal ordering
•Argumentative: use contrastive devices- e.g. a dietary pamphlet
•Descriptive: predominately local elements e.g. service pamphlet
•Instructive: argumentative and enumerative
Titscher ( 2002) seven constitutive characteristics of texts
1.Cohesion: recurring vocabulary grammar
ellipsis- shared world knowledge
abbreviations-ICU, ED, Code blue,
conjunctions- relationships, connections to other
discourse
2.coherence: structure of text
3.intentionality: specific purpose
4.acceptability: text must be identified by participants
recognised as being able to provide something
5.informativity: new or revised material that identifies it as a
particular text
6. situationality: situationally and culturally appropriate
7.intertextuality: relationship with other texts
Process rather than step-by-step methodology
Use paradigms to direct inquiry: choose theory and examine text in
that context
Examples:
•Foucauldian approach: genealogical, investigates relations between
power,
knowledge and body
- produces historically specific forms of
subjectivity
•Derridean approach: examines binary oppositions that underpin
ways of
thinking e.g. Labelling
•Fairclough:
texts constructs social and cultural practice
.
Determine discourse type:
types of texts (e.g. Titschler), and then discourse audience such as medical vs nursing
Describe intertextual chains:
•how it relates to other texts, implications, history
•this takes one beyond the text itself
•can be very broad (e.g. media, DSM manual, other research)
Identify social practices of text production:
• publication, dissemination
Analysis of text: (subjective)
•Examine linguistic strategies to determine how reality is presented,
• key words,
•labelling
•categorizing thematic structure
• how social relations are constructed- power relationships ( experts)
•how subject positions are constructed ( e.g. “normal” or “deviant”)
This is the so what? Or “Discussion”
Social or professional relationships that are affected
Practices and experiences that are transformed by the discourse
“Relationships between consumers of mental health services and
mental health nurses inevitably reflect the way in which psychiatric
discourse constructs the relationship between the ill person needs to
listen to the advice and direction of the professional who has expert
knowledge”
• Does
the research question ‘fit’ discourse analysis?
• Do the texts under analysis ‘fit’ the research question?
• Have sufficient resources been sampled, e.g.
historical,political, clinical?
• Has the interpretative paradigm been described clearly?
• Are the data gathering and analysis congruent with the
interpretative paradigm?
• Is there a detailed description of the data gathering and
analytical processes?
• Is the description of the methods detailed enough to
enable readers to follow and understand context?
• Have the linkages between the discourse and
findings been adequately described?
• Is there adequate inclusion of verbatim text to
support the findings?
• Are the linkages between the discourse and the
interpretation plausible?
• Have these linkages been described and supported
adequately?
• How are the findings related to existing knowledge
on the subject
Denzin and Lincoln(1994) evaluated by the
“historical situatedness of the inquiry, the
extent to which the inquiry acts to erode
ignorance and misapprehensions and the extent
to which it provides a stimulus to action, that is
to the transformation of existing structure.”
What are the tools, policies, procedures, educational manuals, that
nurses use/are provided with to assess/interact with suicidal patients/people
and how does this affect their attitude and care/the (clinical) encounter
Discourse analysis contributes to the construction
• of subject positions( ways of being in the world)
• social relationships between people
•systems of knowledge and belief
How do the socio-political influences (reflected in documents,
media, etc ) on nursing practice, and the situated social
framework of persons who attempt suicide combined with the
social representation/symbolism of the hospital emergency
department affect the nursing attitudes and the clinical
relationship when suicidal persons are brought to the Emergency
department for treatment?