Discourse and forensic learning disability nursing practice : ideology, paradox and truth

Overview Central to successful therapeutic relationships in working with people with a learning disability is the language used by nurses; the discourses which they create and perpetuate; and resultant implications for practice. These are key issues in the current investigation. Employing retrospective data obtained during an action research programme carried out in a medium security forensic unit (MSU), it analyse types of discourse employed by the men who reside there and the staff. Part of the analysis shows having a learning disability as viewed through the eyes of the men themselves in a study extending over twenty months. Literary analyses on method, representations of learning disabilities, security and discipline, and forensic practice were carried out concurrently. Aims These are to (1) develop a critical and a post-modern approach to investigating given 'truths' about; the positives of learning disability; men with learning disability who offend; and the nature of forensic nursing: (2) develop a socio-political overview by applying critical discourse analysis to examine micro discourses and macro models associated with learning disabilities, related national and local policies, and models of nursing and disability: (3) combine the products of (1) and (2) to illustrate discourse, repertoires, paradoxes and practical ideologies justifying treatment in the MSU, revealing ideologies and beliefs regarding learning disabilities in this setting. Theory and method Foucault shows how linguistic constructions, written protocols and customary oral dialogue are used to create and sustain dominant views of 'reality' — and may also be used to challenge these. Retrospective data regarding six men living in the MSU and their staff [total N=17] were obtained using diaries, observational notes, semi-structured interviews, focus groups and evaluations originally collected as part of an action research project. National and local policies were also interrogated. Data were then reanalysed using critical discourse-analytic techniques. Outcomes Findings suggest that the men are viewed paradoxically. On one hand, they are seen negatively as different, dangerous, lacking ability: and staff as custodians restricting their rights. Paradoxically, affirmative discourse is also abundant — the men are talented and pleasant companions. Repertoires illustrate warm therapeutic relationships existing between the men and staff, demonstrating 'good nurse' characteristics expressed within a complex and restrictive environment, with humour playing an important part. These paradoxical repertoires reveal practical ideologies which defend forensic practice and justify treatment. Results have implications for the men (their views are acknowledged and disseminated); for practice through enhancing the evidence base; for nurse education through reflection on ideologies and justifications on which forensic practice is based