Exploring Nursing Practice Discourse of Keep Type 1 Diabetes Under Control Through Foucault's Medical Gaze

Monday, 18 November 2019

Sharon Lisa Hooge, MSN1
Denise Blanchard, PhD2
Annabel Matheson, PhD2
(1)School of Nursing, Midwifery and Indigenous Health, Charles Sturt University, Calgary, AB, Canada
(2)School of Nursing, Midwifery and Indigenous Health, Charles Sturt University, Bathurst, NSW, Australia

Purpose:

Diabetes Mellitus (DM) is a disease which has been present globally for centuries (Karamanou, Protogerou, Tsoucalas, Androutsos, & Poulakou-Rebelakou, 2016; Laios, Karamanou, Saridaki, & Androutsos, 2012; World Health Organization, 2016). Today, DM continues to rise globally to what is described as pandemic levels (Forouhi & Wareham, 2014; International Diabetes Federation, 2017). Although DM is distinguished into two primary types, media and medical attention, simply labels what is seen as 'diabetes' and appears to focus on Type 2 Diabetes (T2D) more overtly (World Health Organization, 2016). Globally, prevention efforts focus on lifestyle and psychosocial interventions to decrease the DM epidemic (American Diabetes Association, 2018b; National Center for Chronic Disease Prevention and Health Promotion, 2017; World Health Organization, 2016). Often, less attention is given to Type 1 Diabetes (T1D) which effects not only children, but adults as well (American Diabetes Association, 2018a). Alarmingly, T1D prevalence has risen from 5-7% to 5-10% of the global DM population and projected to continue to rise, impacting personal health care and global health care costs astronomically (American Diabetes Association, 2018a; International Diabetes Federation, 2017; Tuomilehto, 2013; World Health Organization, 2016). Notably, the key difference between the two diseases resides in pathophysiological difference of ß-cell insulin production. This difference dictates different interventions (Himsworth, 1936; Joslin, 2005). As T1D is structurally unique from T2D, with genesis or seating of the disease unknown, prevention is currently unattainable with complex control issues (DiMeglio, Evans-Molina, & Oram, 2018; Skyler, 2015).

Today, Type 1 Diabetes (T1D) contributes to significant health care problems such as: life-altering complications (microvascular and macrovascular); loss of productivity; and loss of life that are often attributed to lack of control (American Diabetes Association, 2018b). Attempts to achieve control evade both medical professionals and persons living with T1D, making T1D an ever present power within the individual’s body (American Diabetes Association, 2018d; JDRF, 2018). Also, the term control, when juxtaposed to T1D, is undefined and assumes the achievement of normoglycemic values (American Diabetes Association, 2018c; World Health Organization, 2016). It is here that the researcher’s attention is focused. The colliding discourse between a) medical professionals who prescribe individuals to do keep T1D under control and achieve medical goals of normality for blood glucose values, and b) persons with T1D who tackle the daily task of attempting to do keep it under control and achieve normality without success, is examined. The lens for this research is M. Foucault’s “medical gaze”, as explored in The Birth of the Clinic (Foucault, 1973).

Methods:

Michel Foucault in his medical analysis of the act of seeing through attention to space and language (1973), stressed looking not at what is outwardly spoken or seen, but seeking out what is being said or seen archeologically to find how the medical gaze (English translation), or in his terms, the medical regarde (French), arrives at evidence-based medical knowledge and actions or interventions which are assumed to be best medical practice. This current presentation will create discussion as to how this discourse of doing keep T1D control is situated today. It is intended that this presentation stimulate greater knowledge and awareness of T1D control in efforts to promote efficient and effective nursing care for those person’s suffering with T1D.

Results: Work in Progress

Conclusion: Work in Progress