A social constructionist analysis of talk in episodes of psychiatric student nurses conversations with clients in community clinics.
OBJECTIVE
This paper is a report of a study of the 'discursive doings' of psychiatric nursing students' practice as they are jointly constructed in conversations with clients in community psychiatric clinics.


BACKGROUND
This construction of psychiatric nursing as a therapeutic, holistic, person-centred, interactional process is central to the identity of psychiatric nursing as a discipline. However, recent studies are beginning to suggest a dissonance between the person-centred rhetoric and institutional practice.


METHODS
A discourse analysis was conducted in 2002-03 using the transcripts of seven conversations between nursing students and clients visiting psychiatric community clinics on a monthly basis. These were selected from a sample of 20 conversations based on their clarity and completeness. Texts were analysed using the notational systems of Silverman and Mishler and some of Fairclough's analytic text structure features.


RESULTS
In all the transcripts, an agenda for surveillance was explicitly established in the students' opening sequences of each text. Almost all exchanges in the texts were organized around cycles of questions from students and responses from clients, which allowed students to control the conversations. Information delivery was also found to be at work within the texts, although it is not as prominent or as persistent as the question and answer structure. Students took up the responses of clients selectively as though working to a pre-set agenda.


CONCLUSIONS
These discursive activities manifest a symptom-like approach to nursing care and have the effect of disabling the development of client-authorized expressions of agency.
Middleton
Lyn
L
School of Nursing, Faculty of Health Sciences, University of KwaZulu-Natal, South Africa. middletonl@ukzn.ac.za
Uys
Leana
L
D000328:Adult; D001291:Attitude of Health Personnel; D003142:Communication; D003152:Community Health Nursing / Q000193:education*; D003156:Community Mental Health Services / Q000379:methods* / Q000592:standards; D004645:Empathy; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D009723:Nurse-Patient Relations; D011568:Psychiatric Nursing / Q000193:education*; D013338:Students, Nursing / Q000523:psychology*