Discourse analysis studies and interprets verbal and non-verbal communication for the deeper understanding of language in social life and not just the literal interpretation of the words. Broadly speaking, discourse studies can be divided into three groups: micro-level, meso-level and macro-level studies. Micro-level studies involve analysing language in use – by initially understanding the participant’s cultural and communicative patterns on a 1:1 level. Meso-level studies focus on broader social and cultural contexts at the individual, but typically wider level. Macro-level studies explore language and ideology in society and examine how the language may set barriers on our discourse.
The study I selected, entitled A discourse analysis of difficult clinical situations in relation to nutrition and hydration during end of life care1, constructed focus groups of palliative care physicians and nurses in relation to the challenges they faced when managing the care of patients at the end of life. The study particularly focused on the tensions in the discourses and the challenges regarding nutrition and hydration at the end of life.
The two main points it taught me were:
- In solely palliative cases, the act of withdrawing nutrition is considered much harder than the act of withdrawing life support. The non-verbal act of ensuring the patient is ‘comfortable’ through food and water provisions ultimately means more to the families of patients who know the patient is on the brink of death than any amount of verbal or written communication.
- When dealing with particularly sensitive issues such as quality of life v. prolongation of life, health professionals will differ greatly in their opinions. It is very important to articulate clearly to the team as ultimately these decisions are life and death.
