REVIEW ARTICLE

Discourse analysis in nursing research on child and adolescent's health

Antônia da Conceição Cylindro Machado^I; Cassiana Silva Rossi^II; Benedita Maria Rêgo Deusdará Rodrigues^III; Sandra Teixeira de Araújo Pacheco^IV; Poliana Coeli Costa Arantes^V; Bruno Rêgo Deusdará Rodrigues^VI

^INurse. Master's degree in Nursing. Assistant Professor. Student in the Doctor's Course, Universidade do Estado do Rio de Janeiro. Brazil. Email: haccmachado@oi.com.br
^IINurse. Master's degree in Nursing. Student in the Doctor's Course, Universidade do Estado do Rio de Janeiro. Brazil. Email: cassiana.rossi2@gmail.com
^IIINurse. Doctor. Full Professor at the Nursing School of Universidade do Estado do Rio de Janeiro, Brazil. Email: benedeusdara@gmail.com
^IVNurse. Doctor. Assistant Professor at the Nursing School of Universidade do Estado do Rio de Janeiro, Brazil. Email: stapacheco@yahoo.com.br
^VLinguistics Doctor. Assistant German Literature and Language Professor. Universidade do Estado do Rio de Janeiro, Brazil. Email: polianacoeli@yahoo.com.br
^VISocial Psychology doctor. Assistant Professor at Universidade do Estado do Rio de Janeiro, Brazil. Email: brunodeusdara@gmail.com

DOI: http://dx.doi.org/10.12957/reuerj.2016.25737

ABSTRACT

Objective: to identify the characteristics of scientific publications on child and adolescent nursing that have used discourse analysis as their method of data analysis. Method: this integrative bibliographical review searched virtual databases, from May to June 2016, using the keywords: discourse analysis, nursing, adolescent and child. In all, 18 papers and 10 theses/dissertations were selected. Results: the year with most publications was 2013, and most publications (82.1%) addressed the child population. The periodicals which published most were: Revista Brasileira de Enfermagem and Revista de Enfermagem da UERJ. Conclusion: review of the studies showed how discourse analysis can foster understanding of the phenomena and thinking about the importance of discovering the meaning of the discourse of clients who constitute the focus of the work of child and adolescent nursing.

Keywords: Nursing; discourse analysis; pediatric nursing; adolescent.

INTRODUCTION

Discourse analysis (DA) was born in the 60's in Europe, more precisely in France, which would later become one of the greatest centers for this subject. It arose as the result of a progressive convergence of movements with different assumptions, developed around the study of trans-phrasal productions, either oral or written, where an understanding of the social meaning of those elements was sought¹.

In DA, relationship with others is valued through the relationship of meanings considering the subject's history, a quite typical characteristic of the French DA. From this perspective, discourse, as the subject of the analysis, is formed in the specific context of ideology, since it is a sociohistorical aspect. It can thus be asserted that there is no discourse without a subject and no subject without an ideology. Thus, language only makes sense because the individual is influenced by ideology^2,3.

DA seeks to perform an analysis of oral production, which goes beyond linguistics, as it seeks to identify the meaning production mechanisms that are used by subjects in shaping their discourse. Discursive formation takes place based on the meaning assigned by the subject, which is influenced by the producer's historical and social context⁴.

There is no way of working with language without knowing the context in which a certain discourse was produced, since the text and its sociohistorical context are inseparable⁵. In this regard, linguistic materiality is understoodas

something indirectly referring to another space, another place that could represent the researcher's interest focus: that of the conditions (psychological, sociological, etc.) under which the texts being investigated are produced^6:43.

Thus, discourse can be understood as the effect of meaning produced between the issuer and the addressee, impacted by the discourse production conditions, as well as the places occupied by the issuer and the addressee. In this regard, it is coherent to say that human relations are soaked in text production, since every human action is a potential text.

Thus, DA proposes an analysis of oral production when it is in the researcher's interests to ascertain the meaning production mechanisms employed by the subject when producing the discourse⁶.

In the field of DA theory lines, the French school of Discourse Analysis is a highlight, which includes as its main mentors Michel Pêcheux, Dominique Maingueneau, and Patrick Charaudeau. Another emerging branch is Critical Discourse Analysis (CDA), of an Anglo-Saxon origin, based on the Social Theory of Discourse and spread out by Norman Fairclough. These branches provide a special approach to discourse, as CDA, for instance, looks at the role of language in the reproduction of the social practices and the ideologies present in the contemporary socio-historical momentum, as well as its key role in social transformation, with a focus on investigating the discursive formations that shape power relations, representations, and social identities and the knowledge and belief systems^7-9.

The interest in discourse analysis has been growing in the last few decades, due to the fact that it enables the intentions behind discourse to be deciphered, through all of its statements and silence. It is being used by several professionals, not specifically from the field of language, such as journalists, law experts, historians, sociologists, and nurses. Considering DA as a perspective for the field of healthcare enables a closer contact and the inclusion of language in an abstract system, where the individuals' discourse leads to the production of meanings which evidence their understanding about the health-disease process.Thus, this understanding is explained through the individuals' subjectivity and singularity aspects, associated with the particularities and structural matters¹⁰.

In the field of nursing research, DA is more and more frequently used as an analysis tool. This method allows us to unveil, through the discourses of those who are undergoing the nursing care, a whole universe that goes beyond the meaning of words, since it enables an understanding about what is taking place beyond discourse.

The use of DA for nursing constructs has also been allowing for a more in-depth analysis of the different subjects of study in this field, so as to provide a better understanding on subjects, systems, and power relations, based on the meanings that they have assigned in their speeches. This analysis leads to an actual comprehension about them and their historical and cultural contexts.

Considering the growing use of DA in nursing, this study raises the following question: What are the characteristics of scientific publications in the field of child and adolescent nursing that employed discourse analysis as a method for analyzing the data gathered? The rationale behind it is the expansion of this subject into several fields of human sciences as well as studies involving the child and adolescent clientele.

In this regard, this review has aimed to identify the characteristics of scientific publications in the field of child and adolescent nursing that used Discourse Analysis as a method for analyzing the data gathered by qualitative studies.

METHODOLOGY

An integrated review of the literature has been chosen for designing this research, which is qualitative in type and descriptive in nature. This method allows for a compilation of already published studies, which leads to general conclusions regarding a certain field of study, the final product of which is the current state of knowledge about the topic investigated¹¹.

This integrated review follows the methodological process proposed by Ganong, which consists in selecting the hypotheses or matters for review; establishing the selection criteria; presenting the primary characteristics; analyzing the data; interpreting the data and presenting the review¹².

For this study, the following research questionhas been defined: What are the characteristics of the studies in the field of child and adolescent nursing that employed DA in their analysis process?

After the guiding question was determined, the following criteria were established on which to base article selection: studies conducted by nurses or in partnership with other healthcare professionals, in the child and adolescent field; available in full in national and international periodicals, indexed to electronic databases, in English, Spanish, and Portuguese, and using DA as a data analysis method. No time criterion was established for the scientific work to be examined. The exclusion criteria adopted were: studies of a theoretical nature, such as literature review (or bibliographic review) articles, reflections, assays and editorials, documental research, and articles that fail to answer the research question.

Data collection was carried out in May through June 2016, by means of online searches on the website Virtual Health Library (BVS) and the Brazilian Digital Assay and Dissertation Library (BDTD), using the descriptors: Adolescent, Child, Nursing, and Discourse Analysis. The material researched on BVS covered electronically available theses and articles published in domestic periodicals indexed to the Nursing Database (BDENF) and to the Latin-American and Caribbean Health Sciences Literature (LILACS). These databases were chosen in view of the fact that they include the main scientific publications on nursing.

At the next stage, a strict evaluation of the studies was conducted through a exploratory reading of the full text, for the purpose of collecting the data, based on an instrument that sought to identify the following study characteristics: title, authors, periodical (year, volume, number), whether a thesis/dissertation, place where the study was conducted, methodology used, study participants, scenario, and DA currents. This instrument has helped the authors classify those studies that employed DA as a method for analyzing data.

The text analysis was performed by interpreting the information from both data collection instruments and through rigorous reading of the selected studies in order extract the characteristics of studies in the field of child and adolescent nursing that employed DA in their analysis process.

RESULTS AND DISCUSSION

The data have been organized into two sets, namely, those associated with a quantitative description of the variables characterizing the articles and those associated with exploitation of their contents.

At first, 86 theses/dissertations and 142 articles were found. Following exhaustive reading of the abstracts, all materials that were duplicates were excluded, as well as those that were unrelated to the study subject. Thus, five theses, five dissertations, and 18 articles remained to be analyzed more in depth.

The publications selected and included in the study^13-40 are shown and described in Figure 1, in chronological publication order.

Keys: MCS (Sensitive Creative Method); DA (Discourse Analysis); CDA (Critical Discourse Analysis)
FIGURE 1: List of publications included in the study, in chronological publication order.

As to the period of publication of the studies, it varied between 2008 and 2016. In this time interval, the year in which the production was most intense was 2013, with 6 (21.4%), following by 2015, with 5 (17.8%).

With regard to periodicals, 1 (5.5%) articles was published in Revista Latino Americana de Enfermagem, 1 (5.5%) in Revista Gaúcha de Enfermagem, 1 (5.5%) on Online Brazilian Nursing, 1 (5.5%) in Acta Paulista, 1 (5.5%) in Ciência, Cuidade e Saúde, 1 article (5.5%) in Escola Anna Nery Revista de Enfermagem, 2 (11%) in Revista Texto e Contexto, 2 (11%) on Revista Eletrônica de Enfermagem, 2 (11%) in Revista de Enfermagem da UFSM, 3 (17%) in Revista Brasileira de Enfermagem, and 3 (17%) in Revista Enfermagem UERJ.

Out of the 28 studies selected, 23 (82.1%) covered a child population and 5 (17.8%) an adolescent population. The studies that addressed the child population included 9 (39.1%) theses and dissertations and 14 (60.8%) articles. The remaining five studies referred to teenage, including three articles, one thesis, and one dissertation.

With regard to the place of conduction of the studies, 12 (42.8%) took place in the country's Southeast, followed by the South area with 9 (32.1%), Northeast with 5 (17.8%), 1 (3.5%) in the North area, and 1 (3.5%) in the central-west area. This fact may be associated with the fact that a certain area has a large number of institutions with graduate-level courses, which favors scientific production, as well as has many academic places promoting research, which are pioneers in and promoters of DA, such as in Campinas, São Paulo, and Rio de Janeiro.

In the Southeast area, the Rio de Janeiro state should be highlighted as it has the largest number of studies. Specifically in the field of nursing, the graduate course of the Anna Nery Nursing School of the Federal University of Rio de Janeiro (UFRJ's EEAN) was in the early times of this millennium at the forefront of DA use in Rio de Janeiro, which leveraged scientific production with this approach, thus allowing for a dissemination of this kind of study in the field of child and adolescent care.

As to the study methodology, hospital was evidenced as the scenario where most research studies were conducted, with 8 (28.5%), followed by a residential environment with 7 (25.0%), and in the third place Outpatient Care Units with 6 (21.4%), Higher Education Institutions with 3 (10.7%), Nursery Homes with 3 (10.7%), and Schools with 1 (3.5%) study.

The higher percentage of studies conducted in a hospital setting can be justified by the fact that it is a space where nursing professionals can more actively practice their assistance to the child and adolescent population, as well as the Basic Healthcare Units, a place also established as a site for providing care to that clientele ^{13,15,19,20,26,28,33}.

The residential space ranks second in the studies conducted, with 7 (25%). This data reflects the displacement of nurse researchers, crossing the institutional walls, founded all over the years, as the principal place of performance of such professionals, and their entry in the context of the families.

It has been found that 18 (64.2%) studies had as their participants the family members or caregivers and 5 (17.8%) with nursing professionals. Out of the studies with child and adolescent populations, 4 (14.2%) were related to the pediatric clientele and 4 (14.2%) to the adolescent clientele. It is worth highlighting that some studies were concomitantly conducted with more than on type of participant such as family members and children^22,24.

Among the child and adolescent population, the subject of focus of 17 studies (60.7%) related to children with special healthcare needs (CRIANES)^{14-20,24,25,27,28,30-32,36}, followed by 4 (14.2%) that related to children with oncologic problems^23,26,28,33.

It is worth stressing that, in the studies about the CRIANES subject, family members/caregivers were predominant¹². Only one study had health professionals as its participants. One may find researchers to be looking to emphasize the day-by-day routine involving the care provided by family members/caregivers to CRIANES, highlighting the challenges that they faced, from more complex care precautions, which require training to be performed, to routine child care actions requiring adaptations and new care methods.

Regarding the prevailing data collection technique, the Sensitive Creative Method needs to be highlight, 20 (71.4%), following by the semi-structured interview, 6 (21.4%). Other methods, such as non-structured interview, group dynamic, drawing, story telling, and workshops, were used just as frequently, 1 (3.5%).

The Sensitive Creative Method arose in the late 90's and was developed by Nurse Dr. Ivone Evangelista Cabral. The foundations of the method are laid on a triad: group discussion, creativity and sensitivity, and participant observation, and it is conduct by means of group activities, which favor a partial liberation of repressed senses and speech, which are sometimes mute, enabling the participants to organize their thoughts to shape their discourse, thus preparing for the analysis process^16,23.

When looking at the DA currents that were used the most in the investigated studies, the French DA was found to be predominant, 24 (85.7%), and 4 (14.2%) used Critical Discourse Analysis.

A researcher using DA reads the text focused on a discursive position of the subject, legitimated by a union of their social, historical, and ideological dimensions.

The analytical devices used in the scientific production examined were the following: silencing, concealing, imaginary formation, polysemy, interdiscourse, paraphrase, metaphor, and others, which have enabled us to identify in the studies listed the meaning production mechanisms used by the subjects in their discourse.

This form of analysis has allowed us to identify, in the discourses, not only what language brings as a semantic meaning, but also what is brought my means of it, that is, the various human manifestations such as power relations, institutionalization of social identities, and ideological unconsciousness processes⁸.

Thus, the studies demonstrated a possibility provided by the analytical method to unveil, through an assessment of the participants' statements, the meanings assigned by them to the study subject approached, going beyond a comprehension on the semantic construction of discourse, which enabled them to read the inter-discourses and value senses in their interaction with others, taking into account the historical and social context in which they find themselves^{14,16-18,20,25,28,29,30,36,39}.

The French DA takes language in its historical process, prioritizing the text production and reception conditions, as well as the meaning effects, understanding language as a social practice in its concrete use and the meaning production of discourse as the result of a social interaction process⁸.

CDA was identified in the studies that tried to perform a macro-sociological analysis, with analytical characteristics of the organizational and institutional circumstances of a certain event, identifying the nature modeling forms of their discursive and social practices^16,22,24.

CDA is thus designated because it is based on the social practice transforming society, in which the analysis plays the role of a social intervener, through their work, as they conduct a study that opposes to the structures and strategies of the elites' discourse. It introduces itself as a tool for analyzing the discursive practices that build various social orders currently in force and that are permeated by several power relations⁸.

CONCLUSION

The studies shown in this review showed how DA can enable an understanding on the phenomena and a general reflection on the production conditions and apprehension of the texts produced by various subjects, who constitute the focus of performance of the child and adolescent nursing professionals.

Also worth highlighting are family members as well as an expansion of the researchers' views toward this clientele, valuing them as an allied element in child and adolescent care, learning about their demands and jointly pondering on new care possibilities.

The results can provide the reader with reflections about the subject, helping understand the construction of new ways of thinking and dealing with the various realities of the routine care activities in child and adolescent nursing.

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