Uncovering Complexity in Everyday Practice: A Post Modern Study of Community Nursing Assessment

Much skilled nursing practice is described by words which at face value appear low-tech and self-explanatory. Despite being acknowledged as intrinsic to practice “nursing assessment” has few operational definitions. This thesis critiques and reviews the methodological assumptions that underpin research and the frameworks commonly used to facilitate Concept Analysis (CA). Despite the apparent plethora of approaches to CA, the majority of them used (or adapted without justification or critique) the work of one author, and this was found to be simplistic and ontologically flawed. A review of the contemporary nursing literature was undertaken to identify uses of the term assessment. The subsequent Glasarian Grounded Theory Analysis revealed the Judicial as the core of seven overlapping categories. Evidence of the everyday use of the term assessment was obtained through observation and audio recording of nursing assessment practice. Following Foucault, Critical Discourse Analysis of the data recorded in the study’s field work phase was undertaken. This revealed social power and dominance facilitated through subject/object conflations and the discourses of discrimination, surveillance, repression, natural science, resistance and institutional power, and in contrast, examples of empowering practice. This thesis will argue that the process of nursing asssessment is skilled and complex, and that in order to measure and demonstrate the quality of nursing practice within an arena dominated by the hegemonic power of medicine, it requires articulation and understanding. Nurses use a matrix of approaches to build rapport and assess patients during all interactions. Their work involves integrating intuitive, predictive and logical reasoning within an empathetic and authentic communication with patients and their carers. Hierarchies of nursing practice, government policies, inter-professional agendas and dissonaces between the policy rhetoric of placing patients at the heart of assessment and actual everyday practice, produce barriers to meaningful assessments.