Population ageing has been posed as a problem for contemporary governing in relation to the allocation and consumption of finite health care resources, in particular acute hospital care. This thesis explores how nursing practice is a key resource in the management of this ???problem???. Employing Foucault???s concept of governmentality, nursing practice is examined as a form of social government that is central to the regulation of hospital care to older people. A governmentality approach enables consideration of the relationship between the macro political context of governing, as embodied in prevailing political rationalities, and their outworking beyond the arenas of formal government in the micro practices of nurses. Specifically, in this research, it reveals how contemporary entrepreneurial rationalities of governing work at a distance to discursively shape the local practices of nurses in the regulation of hospital care to older people. Discourse analysis of interview texts, literature and documents revealed how enterprise rationality was invested in the discourses circulating in the study site, highlighting the power relationships and subject positions available to registered nurses and outcomes produced in the regulation of hospital care to older people. The analysis details how registered nurses activated a range of technologies and practices as they engaged with enterprise discourses, constituting nursing practice as an activity aimed at making up older people as dischargeable subjects. It shows how enterprise is both a practice and way of thinking that directs us toward a particular truth of hospital, hence nursing, care of older people. The thesis illustrates how changes in the ways of governing hospitals have actively transformed the meaning and practice of nursing in the provision of hospital care to older people. It shows how the values and practices that make entrepreneurial modes of government possible penetrate each layer of an organisation and can create new mentalities or ways of thinking. This was evident in this research whereby an entrepreneurial mode of governance had re-imagined the social practice of nursing as a form of the economic, such that neither recovery, nor health, but discharge assumed pre-eminence as the focus and aim of hospital care for older people and hence the goal of nursing practice. These findings suggest that hospital care of older people has become a political and economic, rather than therapeutic concern. Furthermore, nursing interventions in the hospital care of older people have become administrative rather than therapeutic, with nursing practice focused on individual older people only insofar as they are constituted as part of a population at risk of delayed discharge. The thesis contends that nurses are implicated in the politics of health care in new and different ways amid entrepreneurial rationalities of governing that promote an ethos of risk management, individualism and responsibilisation in relation to health. It argues that the replacement of an ethos of nursing as care based on client need with an ethos of nursing as risk management substitutes the therapeutic intent and practices of nursing with the technical intent of managing risk. In so doing, the thesis illustrates dangers and possibilities arising from the re-framing of health care through entrepreneurial modes of governance. It enables a critically informed consideration of what kind of practice acute care nursing could be into the future and how nurses and others can take action to positively contribute to the futures of older people they provide care to. / Thesis (PhD)--University of South Australia, 2010
| Identifer | oai:union.ndltd.org:ADTP/285576 |
| Date | January 2010 |
| Creators | Gibson, Maria |
| Source Sets | Australiasian Digital Theses Program |
| Language | EN-AUS |
| Detected Language | English |
| Rights | Copyright 2010 Maria Teresa Gibson |
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