Social regulation, medicalisation and the nurse's role: Insights from an analysis of nursing documentation

Abstract

Background: Medicine is recognised as a dominant source of governmentality and social regulation, and although nursing has been implicated in the same process, analytical work in this area has been sparse. Objectives: The article aims to present an analysis of nursing records in order to understand the structural and social processes that mediate the texts. Methods: 45 sets of nursing records drawn from four clinical sites in Ireland were subjected to a discourse analysis. Results: This article focuses on two main themes that were derived from data: (i) the manner in which nurses controlled, regulated and invigilated patients’ activities of daily living and (ii) the way in which activities of daily living were mediated by a biomedical worldview in the clinical settings. Through the organising framework of Activities of Daily Living (ADLs), normative social practices relating to hygiene, eating and drinking, sleeping and so forth were surveyed and monitored within clinical settings. We construct qualitative categories around a range of ways that nurses assessed and judged patients’ capacities at ADLs. Furthermore, it is argued that the framework of ADLs epitomises the medicalisation of normative social practices, whereupon the most mundane of normal functions become redefined as an actual or potential clinical pathology, legitimating nursing interventions. According to the nursing documentation, biochemical interventions in the form of various medications were the most dominant means through which nurses attempted to restore or improve the functional capacity of an ADL. Conclusion: We conclude by proposing that nurses’ invigilation of patients’ ADLs is not necessarily a repressive feature of nursing practice, but rather has the potential to be used to advocate on patients’ behalf in certain circumstances.