Critical discourse analysis takes texts, often media or policy documents, and analyses how language is used in them, consciously or unconsciously, to forward a certain perspective on the issue at hand. Even images can be analysed. I have not made a discourse analysis on digitalization of nurses’ work, but just a couple of Google searches give some food for reflection.
Digitalization of healthcare is blue. If I google the combination of ‘digitalization’ and ‘healthcare’ and look for images, the screen turns very blue. It is not light blue or sky blue, but the very ‘technical’, cold, dark blue. In surprisingly many images symbols for ‘digital’ are foregrounded, with part of a human figure in the background. That goes for blogs, messages from the industry and for more policy document kind of texts.
But, of course, the humans are there. In the texts which these images are attached to, both patients and doctors appear. According to the texts, patients are delivered the best care possible, they are benefitted, their outcomes are improved, their health is monitored, they become more transparent (?), their health is tracked – and in spite of all these quite passivating effects, they are also empowered.
Digitalization will empower them to better manage their chronic diseases. However, also medical staff will be more empowered, as they can constantly monitor patients’ condition. Patient data will empower payers because it can be used to ensure a good cost/effectiveness ratio. Insurance companies will be empowered, as they can monitor patient health more closely. In addition, patient data will empower healthcare industry, as well as medical and pharmaceutical industry: I learn that instead of shaky patient-generated data, the digital sensors can provide reliable patient-generated data for research and development purposes. Hopefully there will be no power conflicts with all this empowerment – but it seems likely that there will be.
According to the texts behind the images, doctors seem almost to be in the losing end. Surely, they will use big data to make diagnosis quicker and easier. But instead of seeing a certain patient at intervals, they seem to be constantly monitoring patient activity. They will be alert and intervene before issues are actually showing signs of becoming a real problem. They will have lots of data to try to integrate in their clinical practice. They can manage more than one area, as the patients are sitting in their homes and video chatting. Still they will engage more with their patients. Maybe this is made possible by them also being able to use the mobile devices on the go.
And what do nurses do? Nothing. There are no nurses behind those blue images. Actually, we know that lots of the monitoring and chatting that is attributed to doctors will actually be made by nurses and that it well can be the nurses who are in the losing end. But nothing is said about them. They are absent in the general images of digitalization of healthcare.
A google search on ‘digitalization’ and ‘nurses’ gives a set of different images. The dark blue is there, but there are also smiling nurses, at screens and with tablets. So, what do these nurses do? They are trained, they are customers to digital health industry, they are relieved from unnecessary communication, they are affected by technology decisions, they adapt to new technologies, they are pushed into retirement because of the new requirements but they also respond to the opportunities in digitalization, and the e-savvy nurses actually make choices. The empowerment that is quite frequently used about patients is not a word connected to nurses.
What does this very short overview give us? Overall, in digitalization of healthcare the digital is foregrounded, with humans of different categories getting quite passive roles. And it is not surprising if the digitalization of healthcare does not particularly improve nurses’ working conditions, as they seem to be conspicuously absent in the general discourse. There are contradictory messages about whom the digitalization empowers, but nurses are not among those that are expected to be empowered. Their work will be different, they will adapt to new working conditions that supposedly are better, but empowerment in their professional role is almost absent in digitalization.
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