The discourses of control : power in nursing

There is a perception in the general public and in many nurses that nursing is not very powerful within the health care system. Certainly that view is prevalent in the literature on power in nursing, where nursing theorists and researchers join nursing leaders in urging more power for nurses. The purpose of this study was to describe the processes that nurses, patients and family members engage in to control care in the hospital setting. Based on feminist and poststructuralist theoretical perspectives, and largely framed by Foucault's theories power, knowledge, discourse. and resistance, the approach taken in this study was to focus on interactions and daily practices as nurses accomplish their work with patients, families and others in the hospital setting. The ethnographic methods of interviewing and participant observation were used to study these interactions on four study units in two hospitals over seven months. Thirty-one interviews with 24 individuals, including nurses, other health care professionals, patients, and parents were carried out. The interpretation of the data was a description of nurses creating and using a variety of discourses in order to control aspects of their practice on the units. The discourses, known collectively as the Discourses of Control, were identified as the discourses of rules, the discourses of compliance, the discourses of adolescents/adolescence, the discourses of growth and development, the discourses of chronic illness, the discourses of normalization, the discourses of family and family-centred care, the discourses of the nurse as patient and family advocate, and the discourses of cost restraint. Nurses use these discourses to "create organization", the written and unwritten rules, understandings, and practices that comprise the ethos of the unit. The discourses not only achieve some control over aspects of nursing practice, they are instrumental in the socialization of new nurses. At the same time that nurses are creating their own 'organization' through discourses, they are unconsciously incorporating dominant discourses (on gender, class, race/ethnicity, etc.) from the larger society and health care system into their own discourses and in so doing, help reproduce the ideologies of the dominant culture in the nursing culture they create.