Power and politics in post-operative cardiothoracic critical care pain management :
[Thesis]
Lee, Susan E. C.
a Foucauldian analysis of clinical nursing practice
University of Liverpool
2010
Ph.D.
University of Liverpool
2010
At the philosophical heart of this study is the recognition that the implementationand use of the evidence-base regarding pain management in cardiothoracic criticalcare is problematic because clinical nursing practice within the context of themulti-disciplinary team is not straightforward; the practice of nursing is mediatedthrough layers of professional hierarchy and power relationships which constrainand limit it. Its contribution to the knowledge base is its account of the effects ofthe multi-disciplinary team on nursing practice using a Foucauldian discourseanalytic framework. Achieving patient throughput was the main goal of care;effective pain management was not prioritised. The underpinning approaches arequalitative; data were collected through observation of practice, interviews andwritten texts. The 24-hour span of clinical practice was observed within a largecardiothoracic unit for a total period of 5 weeks; 21 qualified nurses (all grades,full- and part-time, purposively sampled) were interviewed. The fllldings of thestudy impose Foucauldian discourse analysis terms of nonnalisation, hierarchicalobservation, examination, discipline, docile bodies, surveillance, 'the gaze', andpanopticism, as well as the nurses' resistance practices, to describe the techniquesof power and authority which are utilised (and resisted) within clinical practice.