Power and partnership: a critical analysis of the surveillance discourses of child health nurses

AIMS: To explore surveillance discourses within New Zealand child health nursing and to identify whether surveillance practices have implications in this context for power relations. BACKGROUND: In New Zealand child health nurses are called Plunket nurses, who are employed by a voluntary organization, the Royal New Zealand Plunket Society (RNZPS). These nurses primarily work in the community with the families of new babies and preschool children. Their work is called child health surveillance and this is considered to involve routine and unproblematic practices, which are generally carried out in homes and clinics in the context of an ongoing relationship between the Plunket nurse and the mother of a baby. However, suggestions in the literature that surveillance, wherever it is practised, has implications for power relations cast doubt on official claims that this nurse-mother relationship is mediated through a partnership model of care. METHODS: Five experienced and practising Plunket nurses were each interviewed twice. The texts generated by these semi-structured interviews were analysed using a Foucauldian approach to critical discourse analysis. RESULTS: In contrast with the conventional view of power as held and wielded by one party, this study revealed that, in the Plunket nursing context, power is exercised in various and unexpected ways. Although the relationship between the mother and the nurse cannot be said to operate as a partnership, it is constituted in the nurses' discourses as a dynamic relationship in which the mother is actively engaged on her own terms. The effect of this is that it is presented by the nurses as a precarious relationship that has significant implications for the success of their work.