How the Family Centred Care Discourse Fails Mothers of Hospitalised Children

Abstract

When a child is admitted to a hospital children's ward the expectation of the family and the nurses is that a family member will accompany the child. The discourse of Family Centred Care (FCC) acknowledges the family as experts in the child's care with nurses supporting the family in that role. FCC fails to acknowledge that the family member predominantly involved in the hospitalised child's care is the mother. The underlying assumption is that the relationship between the mother and the nurses is "socially coherent" and unproblematic. This study aims to reveal the discourses deployed by mothers and nurses in a hospital children's ward by analysing the text of transcribed conversations of three mothers and three nurses about the relationship between nurses and mothers within the hospital children's ward. The competing and complementary discourses of the mother as carer and the nurse as carer of the hospitalised child disclose the power/knowledge nexus of the relationship. The text was analysed by adopting a poststructural approach to discourse analysis methodology informed by a combination of Foucault's (1977) power/knowledge nexus and social psychologists Potter and Wetherell's (1987, 1994, 2001). Analysis surfaced two conflicting discourses confirming that the mother-nurse relationship is a complex matrix of power and knowledge. The nursing discourse of "nursing-relational control" founded in tasks and behavioural skills is in conflict with the revealed mother discourse, of "mothering- relational seeking" which is constituted in purpose and concern. This study provides an alternative critical perspective of the mother-nurse relationship in a hospital children's ward. It reveals that FCC operates as a regime of control offering mothers a position that has little agency in a hospital context. As a contribution to New Zealand nurses' knowledge, this outcome has several implications for future poststructural research, nursing practice, education, policy development and consumers.