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The Importance of Being Acceptable: Psychiatric Staffs’ Talk about Women Patients in Forensic Care
Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences. Ersta Sköndal .
Högskolan i Gävle.
Linköpings Universitet.
Umeå Universitet.
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2019 (English)In: Issues in Mental Health Nursing, ISSN 0161-2840, E-ISSN 1096-4673, Vol. 40, no 2, p. 124-132Article in journal (Refereed) Published
Abstract [en]

Currently, women comprise about ten percent of those sentenced to psychiatric forensic clinics in Sweden. Those who are sentenced to forensic care because of offending and violent behaviour have already taken a step away from the usually expected female behaviour. On the other hand, there are many women in forensic care who have not committed crimes, but who instead selfharm. Studies have identified a gender bias in diagnosing and care in psychiatric settings, but there are few studies conducted on women in forensic care. The present study therefore examined how the situation of women patients and female norms are expressed in the staff’s talk about these women during verbal handovers and ward rounds at a forensic clinic in Sweden. The aim was to explore how psychiatric staff, in a context of verbal handovers and ward rounds, talk about women who have been committed to forensic psychiatric care, and what consequences this might have for the care of the patients. The content of speech was examined using audio recordings and a method of analysis that was inspired by thematic analysis. The analysis identified that the staff talked about the women in a way that indicates that they expected the women to follow the rules and take responsibility for their bodies in order to be regarded as acceptable patients.                        

Place, publisher, year, edition, pages
2019. Vol. 40, no 2, p. 124-132
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:miun:diva-35074DOI: 10.1080/01612840.2018.1514551ISI: 000463571900006PubMedID: 30481089Scopus ID: 2-s2.0-85057627205OAI: oai:DiVA.org:miun-35074DiVA, id: diva2:1268580
Available from: 2018-12-06 Created: 2018-12-06 Last updated: 2020-10-15Bibliographically approved
In thesis
1. Språkets makt: en studie av vårdpersonals tal om psykiatriska patienter och brukare
Open this publication in new window or tab >>Språkets makt: en studie av vårdpersonals tal om psykiatriska patienter och brukare
2020 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The purpose of this dissertation was to critically examine, based on three selected psychiatric care environments, how healthcare staff talk about patients and users with a focus on how notions of gender are produced and reproduced during rounds and in reportings.

Reportings and rounds are daily activities in almost all healthcare practices. It takes place three to four times a day and is ideally aimed at creating continuity and alignment in the care. In psychiatric contexts, the reportings and rounds constitute important tools in assessing which approach and treatment are most appropriate. Studies on verbal reporting have mainly been carried out in somatic care and have been focused on the reportings’ content, type, cost and time required. Research also suggests that healthcare staff find it difficult to move away from a strictly medical perspective and that reporting and rounds take place in a ritualized way where the staff are socialized into what is valid information to pass on. The reportings can also serve as a way for healthcare staff to support each other in their work. The research also applies in psychiatric care contexts where different power structures also become apparent in the use of language. However, how psychiatric care staff talk about patients and users in reportings and on rounds based from a gender perspective has not been studied to any great extent.

The dissertation is based on four sub-studies, all with qualitative research design. The empirical material in all sub-studies consisted of sound recordings from rounds and reports in three different psychiatric care contexts; general psychiatry, forensic psychiatry and municipal psychiatry. In sub-study I and II, content analysis was employed and in sub-study III and IV, discourse analysis was employed. Sub-study I showed how the healthcare staff used everyday words and concepts in both reports as in the rounds. The words and concepts formed the basis for assessing the patient's behaviour and mental condition and decisions about nursing and treatment. Sub-study II showed that the language discourse of the healthcare staff reproduced a gender order in which the female patients were expected to behave according to feminine norms in order to be acceptable as women and, as patients. In sub-study III, the statements studied showed a family oriented caring practice and how power techniques in terms of discursive norms around masculinity contributed to the subordination of men cared for in. The results also revealed how the healthcare staff reproduced a heteronormativity gender order through the language used. In sub-study IV, the statements showed a discourse of care where various techniques of power such as intimacy and confession were used to persuade the users to behave according to feminine or masculine norms. The statements also showed a heteronormative and heterosexual order in which the paradox between the need for support and maintaining one's dignity was clarified.

The conclusion of the sub-studies together was that the reports and rounds was a scene for which everyday words and concepts were used to describe and assess patients and users. These everyday words and concepts reproduced power orders in which different disciplining power techniques were displayed. The language also reproduced a heteronormative gender order in which notions of femininity and masculinity participated in the assessments of patients and users´ mental states. Because the patients were not involved in the conversations about themselves, healthcare staff were given the possibility to describe and position the patients and users in ways that they themselves were not aware of. In order to create opportunities to break with stereotypical gender patterns as well as patterns of dominance and subordination in psychiatric nursing and care, students, as well as healthcare staff, should work with awareness and critical reflection on discursive norms and how language constructs the patient and user.

Abstract [sv]

Syftet med avhandlingen var att utifrån tre valda psykiatriska vårdmiljöer analysera hur vårdpersonal talar om patienter och brukare med fokus på hur föreställningar om genus produceras och reproduceras vid ronder och i rapporteringar.

Rapporteringar och ronder är dagligen förekommande verksamheter inom nästan alla vårdpraktiker. Den pågår tre till fyra gånger dagligen och syftar idealt till att skapa kontinuitet och tydlighet i vården. I psykiatriska kontexter utgör rapporteringarna och ronderna extra viktiga redskap i bedömning av vilken omvårdnad och behandling vården finner lämplig. Studier kring verbal rapportering har främst genomförts inom somatisk vård och har varit fokuserad på rapporteringens innehåll, typ, kostnad och tidsåtgång. Forskning visar också att omvårdnadsper-sonal har svårt att avlägsna sig från ett medicinskt perspektiv och att rapporteringar och ronder sker på ett ritualiserat sätt där vårdpersonal socialiseras in i vad som är giltig information att föra vidare. Rapporteringarna kan också tjäna som ett sätt för vårdpersonalen att stödja varandra i arbetet. Forskningen gäller också i psykiatriska vårdkontexter där också olika maktordningar visar sig tydliga i språket. Hur psykiatrisk vårdpersonal talar om patienter och brukare på rapporteringar och på ronder med utgångspunkt i ett genusperspektiv har dock inte studerats i någon större omfattning.

Avhandlingen bygger på fyra delstudier, samtliga med kvalitativ forskningsdesign. Det empiriska materialet i alla delstudier utgjordes av ljudinspelningar från ronder och rapporteringar i tre olika psykiatriska vårdkontexter; allmänpsykiatri, rättspsykiatri och kommunal psykiatri. I delstudie I och II användes innehållsanalys och i delstudie III och IV användes diskursanalys. Delstudie I visade hur vårdpersonalen använde sig av vardagliga ord och begrepp i såväl rapporteringar som på ronder. Orden och begreppen utgjorde grund för bedömning av patientens beteende och psykiska tillstånd och beslut kring omvårdnad och behandling. Delstudie II visade att vårdpersonalens tal reproducerade en genusordning där kvinnorna förväntades uppträda enligt feminina normer för att bli acceptabla som kvinnor och patienter. I delstudie III visade utsagorna på en familjeorienterad vårdpraktik och hur makttekniker i termer av diskursiva normer kring maskulinitet bidrog till en underordning av de vårdade männen. Resultatet visade också hur vårdpersonalen genom språket reproducerade heteronormativitet och sexualiserande av kvinnor. I delstudie IV visade utsagorna på en skötsamhetsdiskurs där olika makttekniker som intimitet och bekännelse användes för att förmå brukarna att uppträda enligt feminina och maskulina normer. Utsagorna visade också på en heteronormativ och heterosexuell ordning där paradoxen mellan behov av stöd och att bibehålla sin värdighet tydliggjordes.

Slutsatsen var att rapporteringarna och ronderna fungerade som arenor där vardagliga ord och begrepp användes för att beskriva och bedöma patienter och brukare. De vardagliga orden och begreppen reproducerade maktordningar där olika disciplinerande makttekniker kom till uttryck. Språket reproducerade också en heteronormativ genusordning där föreställningar kring femininitet och maskulinitet medverkade i bedömningarna av patienternas och brukarnas psykiska tillstånd. Eftersom patienter och brukare inte var delaktiga i samtalen om dem själva gavs möjlighet för vårdpersonal att beskriva och positionera patienterna och brukarna på sätt som patienterna själva inte var medvetna om. För att skapa möjligheter att bryta med stereotypa genusmönster samt mönster av dominans och underordning i psykiatrisk omvårdnad och omsorg bör studenter likväl som vårdpersonal arbeta med medvetandegörande och kritisk reflektion kring diskursiva normer och hur vi genom språket konstruerar patienten och brukaren.

Place, publisher, year, edition, pages
Sundsvall: Mid Sweden University, 2020. p. 74
Series
Mid Sweden University doctoral thesis, ISSN 1652-893X ; 335
Keywords
Content Analysis, Discourse Analysis, Femininity, Foucault, Language Masculinity, Nursing, Patients, Power, Psychiatry, Social Constructionism, brukare, diskursanalys, femininitet, Foucault, innehållsanalys, maskulinitet, makt, omvårdnad, patienter, psykiatri, socialkonstruktionism, språk
National Category
Nursing
Identifiers
urn:nbn:se:miun:diva-40065 (URN)978-91-88947-79-6 (ISBN)
Public defence
2020-11-27, O 213, Kunskapens väg 8, Östersund, 10:00 (Swedish)
Opponent
Supervisors
Note

Vid tidpunkten för disputationen var följande delarbete opublicerat: delarbete 4 inskickat.

At the time of the doctoral defence the following paper was unpublished: paper 4 submitted.

Available from: 2020-10-29 Created: 2020-10-15 Last updated: 2020-10-29Bibliographically approved

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Eivergård, KristinaHellzén, Ove

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