Caring to death: a discursive analysis of nurses who murder patients.

Abstract

Murder is not a phenomenon that sits comfortably with the typical image of nurses and yet the number of cases of nurses accused and convicted of murdering patients is mounting. The nursing literature is quiet on the subject and therefore what is generally known on the topic predominantly comes from the media. An analysis of this seemingly unfathomable phenomenon is required to re-consider the problem and understand from new perspectives how and why this is happening. The aim of the study is to provide information for health professionals and organisations that will help them work together to recognise situations in which murder by nurses can occur. The research question is: How do the various discourses surrounding murder committed by nurses on patients in the course of their work shape the definition and treatment of these crimes? A discursive analysis of texts guided by a number of discourse theorists is undertaken to reveal the social construction of murder of patients by nurses. Texts related to the media and professional reporting of over 50 cases of registered nurses, enrolled and licensed nurses and assistants were retrieved from searches of Factiva, CINAHL and MEDLINE between 1980 to 2006. The software program JBI-NOTARI® (Joanna Briggs Institute, 2003b) houses the texts and facilitated analysis. Discursive constructions are reported in four findings chapters and include: the profile of murderous nurses; types of murders; contexts in which murder takes place; factors that aid detection and apprehension; legal processes that guide charges, convictions and punishment; and finally the reactions of the public, the profession, the regulators and the families. The murder of patients by nurses is construed as a combination of extraordinary nurses, extraordinary deeds in ordinary contexts. While members of the nursing profession may not be held accountable for the actions of aberrant nurses who murder there is a responsibility to understand how hospitals and units form crucibles in which murder can take place. The recommendations from this study relate to both practice and research. Practitioners are recommended to critically reflect on structures and processes.