Advertisement

A discourse analysis of the representation of nursing in the National Disability Insurance Scheme pricing guide and eligibility criteria

Published:September 03, 2022DOI:https://doi.org/10.1016/j.colegn.2022.08.007

      ABSTRACT

      Background

      The Australian National Disability Insurance Scheme (NDIS) is conceptually grounded in the social model of disability, which focuses on removing disabling structures of society to allow people with disabilities full participation and improved quality of life. The social model rests on a dichotomous relationship against a medical model and its focus on treating impairments, and incorrectly places nursing within this paradigm.

      Aim

      To undertake a discourse analysis of nursing as represented in the NDIS pricing guide and eligibility criteria, and to understand how the profession is conceptualised and valued within the scheme.

      Methods

      Informed by Lauclau and Mouffe's poststructuralist theory, a discourse analysis of the floating signifier of nursing against the dominant nodal point of the social model of disability was undertaken through a close reading of the NDIS pricing guide and eligibility criteria.

      Findings

      The nursing scope of practice is confined to physical/medicalised supports for people with disabilities. Nursing is excluded from offering therapeutic and behaviour supports and is structured and fiscally valued differently to other professions.

      Discussion

      Despite its base in holistic and person-centred care, due to its conceptualisation within the medical model, the full scope of nursing practice is restrictive within the NDIS. This misarticulation of nursing excludes key aspects of adaptive, therapeutic, and holistic practice which can improve health outcomes for people with disabilities.

      Conclusion

      The NDIS in its conceptual construction based on the social model of disability has upheld a vision of nursing inconsistent with practice relevant to caring for people with disabilities.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Collegian
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. Australian Bureau of Statistics. (2020). Characterstics of National Disability Insurance Scheme (NDIS) participants, 2019: analysis of linked data. Available from: https://www.abs.gov.au/articles/characteristics-national-disability-insurance-scheme-ndis-participants-2019-analysis-linked-data

      2. Australian Nursing and Midwifery Board. (2018). Nurse practitioner standards for practice – effective January 2014, updated March 2018.Available from: https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/professional-standards/nurse-practitioner-standards-of-practice.aspx

      3. Barnes, L. (2012). Understanding the social model of disability: past, present and future. In N. Watson (Ed.), Routledge handbook of disability studies (pp. 26-43). doi:10.4324/9780203144114-8

        • Bigby C.
        Dedifferentiation and people with intellectual disabilities in the Australian National Disability Insurance Scheme: bringing research, politics and policy together.
        Journal of Intellectual and Developmental Disability. 2020; 45: 309-319https://doi.org/10.3109/13668250.2020.1776852
        • Cashin A.
        • Gallagher H.
        • C N.
        • Hughes M
        Autism and the cognitive processing triad: a case for revising the criteria in the diagnostic and statistical manual.
        Journal of Child and Adolescent Psychiatric Nursing. 2012; 25: 141-148
        • Cashin A.
        • Buckley T.
        • Donoghue J.
        • Heartfield M.
        • Bryce J.
        • Cox D.
        • et al.
        Development of the nurse practitioner standards for practice Australia.
        Policy, Politics, & Nursing Practice. 2015; https://doi.org/10.1177/1527154415584233
        • Cashin A.
        • Heartfield M.
        • Bryce J.
        • Devey L.
        • Buckley T.
        • Cox D.
        • et al.
        Standards for practice for registered nurses in Australia.
        Collegian. 2017; 24: 255-266
        • Cashin A.
        Understanding how to care for and support people with intellectual disability and/or autism is every nurse's business.
        Australian Critical Care. 2021; 34: 401-402
      4. Centre for Disability Research and Policy. (2017). Audit of disability research in Australia: update report 2017. University of Sydney. Available from: https://nla.gov.au/nla.obj-640802934/view

        • Degener T.
        Disability in a human rights context.
        Laws. 2016; 5: 1-24https://doi.org/10.3390/laws5030035
        • Diers D.
        Speaking of nursing: narratives of practice, research, policy and the profession.
        Jones and Bartlett, Sudbury, Massachusetts2004
        • Foucault M.
        Authorship: what is an author?.
        Screen. 1979; 20: 13-34https://doi.org/10.1093/screen/20.1.13
        • Foucault M.
        Nietzsche, genealogy, history.
        in: Richardson J. Leiter B. Nietzsche. Oxford University Press, USA1977: 139-164
        • Heidegger M.
        Being and time. Blackwell Publishing, Oxford, United Kingdom1962
        • Kernohan J.
        The art and science of learning disability nursing.
        in: Moulster G. Lorizzo J. Ames S. Kernohan J. The Moulster and Griffiths learning disability model: a framework for practice. Jessica Kingsley Publishers, United Kingdom2019
        • King M.
        Dedifferentiation and difference: people with profound intellectual and multiple disabilities and the National Disability Insurance Scheme (NDIS).
        Journal of Intellectual and Developmental Disability. 2020; 45: 320-325https://doi.org/10.3109/13668250.2020.1759246
        • Hancock B.H.
        • Garner R.
        Towards a philosophy of containment: reading Goffman in the 21st century.
        The American Sociologist. 2011; 42: 316-340
      5. National Disability Insurance Agency. (2020). Participant outcomes.Available from: https://data.ndis.gov.au/reports-and-analyses/outcomes-and-goals/participant-outcomes-report

      6. National Disability Insurance Scheme. (2021). NDIS pricing arrangements and price limits 2021-22. Available from: https://www.ndis.gov.au/providers/pricing-arrangements#ndis-pricing-arrangements-and-price-limits

        • Oliver M.
        Understanding disability: from theory to practice.
        2nd ed. Palgrave Macmillan, London, United Kingdom2009
        • Oliver M.
        The social model of disability: thirty years on.
        Disability and Society. 2013; 28: 1024-1026https://doi.org/10.1080/09687599.2013.818773
        • Phillips L.
        • Jorgensen M.
        Discourse analysis as theory and method.
        Sage Publications, California, USA2002
      7. www.pandda.net/files/PANDDA-2020-Standards.pdf
      8. Sakville, R., Atkinson, R., Bennett, B., & Galbally, R. (2020). Report of public hearing 4: health care and services for people with cognitive disability. Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability. Available from: https://disability.royalcommission.gov.au/system/files/2020-10/Report%20-%20Public%20hearing%204%20-%20Healthcare%20for%20people%20with%20cognitive%20disability.pdf

        • Shakespeare T.
        Disability: the basics.
        Routledge, Oxford, United Kingdom2018
        • Smith R., Steven
        Citizenship and disability: incommensurable lives and well-being.
        Critical Review of International Social and Political Philosophy. 2013; 16: 403-420https://doi.org/10.1080/13698230.2013.795708
        • Wexler P.
        Critical social psychology.
        Routledge and Kegan Paul, United Kingdom1983
        • Wilson N.
        • Charnock D.
        • Chang A.J.
        Developmental and intellectual disability.
        in: Chang E. Johnson A. Living with chronic illness and disability: principles for nursing practice. Elsevier, Chatswood, Australia2017: 129-145
        • Wilson N.J.
        • Wiese M.
        • Lewis P.
        • Jaques H
        • O'Reilly K
        Nurses working in intellectual disability-specific settings talk about the uniqueness of their role: a qualitative study.
        Journal of Advanced Nursing. 2019; 75: 812-822https://doi.org/10.1111/jan.13898
        • Wilson N.J.
        • Collison J.
        • Feighan S.
        • Howie V.
        • Whitehead L.
        • Wiese M.
        • et al.
        A national survey of nurses who care for people with intellectual and developmental disability.
        Australian Journal of Advanced Nursing. 2020; 37: 4-12https://doi.org/10.37464/2020.373.120
        • Wilson N.J.
        • Reeve R.
        • Lin Z.
        • Lewis P.
        The financial costs of registered nurse led relationship centred care: a single-case Australian feasibility study.
        Disabilities. 2021; 1: 331-346https://doi.org/10.3390/disabilities1040023
        • Winance M.
        Rethinking disability: lessons from the past, questions for the future. Contributions and limits of the social model, the sociology of science and technology, and the ethics of care.
        Alter. 2016; 10: 99-110https://doi.org/10.1016/j.alter.2016.02.005