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The power of language on patient‐centredness: linguistic devices in the dietetic notes of patient records
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism.
Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Food, Nutrition and Dietetics.
2015 (English)In: International Journal of Applied Linguistics, ISSN 0802-6106, E-ISSN 1473-4192, Vol. 25, no 2, 225-245 p.Article in journal (Refereed) Published
Abstract [en]

n this paper, 30 notes written by Swedish dietitians in patient records are analysed, inspired by Critical Linguistics and Critical Discourse Analysis. Focusing on linguistic devices such as agency sources and evidential markers, we describe how patients are constantly referred to only in terms of the institutional patient role, or not referred to at all, through different techniques such as nominalization and passive verbs. The dietitians writing the notes are even more absent from the text, as they almost never refer to themselves as persons in the dietetic notes. There is a stated ambition in health care to provide patient-centred care and a collaborative patient-clinician relationship. However, we suggest that there might be a need for more person-centred language in dietetics.

Place, publisher, year, edition, pages
2015. Vol. 25, no 2, 225-245 p.
Keyword [en]
Patient records, dietetics, medical discourse, patient-centered care
National Category
Other Social Sciences General Language Studies and Linguistics
Research subject
Food, Nutrition and Dietetics
Identifiers
URN: urn:nbn:se:uu:diva-230206DOI: 10.1111/ijal.12064ISI: 000368177400005OAI: oai:DiVA.org:uu-230206DiVA: diva2:739207
Available from: 2014-08-20 Created: 2014-08-20 Last updated: 2017-12-05Bibliographically approved
In thesis
1. Dietetic documentation: Content, language and the meaning of standardization in Swedish dietitians’ patient record notes
Open this publication in new window or tab >>Dietetic documentation: Content, language and the meaning of standardization in Swedish dietitians’ patient record notes
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim of this thesis was to explore dietetic notes in Swedish patient records regarding content, language and the meaning of standardization.

Firstly, an audit instrument for dietetic notes in patient records, Diet-NCP-Audit, was elaborated and tested. The instrument, a 14-item scoring questionnaire based on the four steps of the Nutrition Care Process (NCP), proved to have high content validity and moderate to high inter- and intra-rater reliability. The instrument was then used in an evaluation of the content, language and structure of 147 Swedish dietetic notes. Although the nutrition intervention and some information about the evaluation were well documented, the overall result showed a need for improvement in several aspects of documentation, such as nutrition prescriptions, goals and the connection between problem-etiology-symptom.

After this, 30 of the audited dietetic notes were also included in a critical linguistic study exploring how the patients and dietitians were referred to in the notes. The dietetic notes contained several linguistic devices that impersonalized and passivized both the patient and the dietitian. Thus, the grammar of the dietetic notes did not enhance or reflect the patient-centered care and the active patient-caregiver relationship that is emphasized in most health care guidelines today.

Finally, a focus group study was performed. Swedish dietitians’ experiences of the standardized Nutrition Care Process (NCP) and its connected terminology (NCPT) were explored and analyzed from the perspective of Habermas’ system and lifeworld concepts. While recognizing many advantages with the NCP and NCPT, dietitians also expressed difficulties in combining the structured and standardized process and terminology with a flexible, patient-centered approach in nutrition care.

In summary, I argue that strategies for the improvement of dietetic documentation are needed. I also suggest that the NCP and NCPT play an essential role in dietetic professionalization. At the same time, however, this standardization may entail the risk of a reductionist view and difficulties regarding how to balance the different ideals of health care. Thus, there is a need for discussions concerning how to use and develop the NCP and dietetic language in a way that ensures the best possible care for the patient.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2015. 88 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Social Sciences, ISSN 1652-9030 ; 118
Keyword
Nutrition informatics, dietitians, Nutrition Care Process, patient records, professionalization
National Category
Other Social Sciences not elsewhere specified
Research subject
Food, Nutrition and Dietetics
Identifiers
urn:nbn:se:uu:diva-263915 (URN)978-91-554-9359-2 (ISBN)
Public defence
2015-11-20, BMC, sal A1: 111, Husargatan 3, Uppsala, 09:15 (English)
Opponent
Supervisors
Available from: 2015-10-30 Created: 2015-10-04 Last updated: 2015-11-10

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Lövestam, ElinFjellström, ChristinaKoochek, AfsanehAndersson, Agneta

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