Marie L. Campbell

Textual accounts, ruling action: the intersection of knowledge and power in the routine conduct of community nursing work

This paper reflects critically on nursing knowledge-based action, its increasingly scientific and text-based manifestations, and the relevance of these practices for power and powerlessness in nursing. Smiths concept of text-mediated relations of ruling (1990. 1999) provides the analytic frame to investigate how nursing case managers articulate public health services and home support for people with disabilities to specific policies, including fiscal policy. An institutional ethnography shows how a nurses routine text-mediated assessment and exercise of professional judgement establishes a ruling relation with a client (against her intention), as he is “written up” in organizational texts. The analysis of assessment texts spells out how a local perspective is subdued to the ruling discourse. A general argument is made on the basis of this analysis: nurses participate in ruling through the textualization of their knowledge and in the process it dominates their knowing and acting. An ideological construction of nursing knowledge results. The paper suggests what this means for the profession, nurses themselves, and their clients.

Institutional Ethnography (IE), Texts and the Materiality of the Social

Institutional ethnography (IE) explicates puzzles that people confront in their everyday experiences. In this approach, the social is understood to be always brought into being by peoples actions that are socially and purposefully organized. Texts are analysed as material components of social organization with the capacity to replicate in different settings concepts and language that shape local actions, coordinating people in local sites with others located elsewhere. There is ruling power in such social organization that as Dorothy Smith, IEs originator, says is put together by relations that extend vastly beyond the everyday. IE is a method of inquiry that discovers how ruling works, and texts are methodologically crucial for an institutional ethnographers tracking and mapping of the institutionally designed social relations that rule social settings. This paper illustrates doing IE with an analytic sketch of nurses using hospital information systems.

Nurses in international health care: migrants or commodities?

Nurses on the move: migration and the global health care economy by Mireille Kingma is an important book on a timely topic. It tackles the issue of the burgeoning international recruitment of nurses to remedy the socalled nursing shortage in the health care systems of industrialized countries. Kingma is a long-time employee of the International Council of Nurses where she has been immersed in socio-economic issues in nursing; in Nurses on the move she examines both ends of the current migration process, identifying the problems for which nurse migration seems to offer answers in both source and destination countries, as well as its outcomes, good and bad, for individuals and health care systems. It is gratifying to see that in researching the high-level and often contradictory policy issues associated with the problems of human resources for health care globally, Kingma does not lose sight of the nurses themselves. Nurses are not just numbers in this account, but actors in their own right and people being acted upon. The book’s salience is in making more understandable the practices through which the new trade in nurses (or rather, in skilled and credentialed nursing labour) operates around the world. A tour de force compilation and analysis of research, it shows nursing in a very different light than it usually appears. Here we are shown nurses not just as caregiving professionals, but as the focus, and too often the victims, of profit making from their education, their international recruitment and from migration, travel and financial services, and finally, from their work. It is also satisfying that the book includes careful discussion of the trade

Working across Boundaries: Exploring the Relations of Researching Gender and Development

The authors reflect on their own experience of international research collaboration to draw analytic attention to its social organization. Using institutional ethnography (Smith, 1987, 2005) they explicate the social relations of inequality into which they were drawn in spite of their best intentions. This analysis makes visible what was otherwise not recognized or recognizable, suggesting that feminists working across borders must learn how to take seriously the institutional practices in which their work is inevitably embedded. The authors explicate the institutional conditions that organize their actions within and across international sites, having real effects on research relations and outcomes.

Reviews: Nationality: Sarah Amsler, The Politics of Knowledge in Central Asia: Science between Marx and the Market. Abingdon and New York: Routledge, 2007, 188 pp., ISBN 9780415413343 (hbk), 9780203961742 (pbk), £75.00

785 but rather to local elements: Arabs, perhaps Muslims, perhaps others, who did not find the writing of al-Bustani and his colleagues congenial. I have a feeling, for example, that the article by al-Bustani; ‘Why Are We Retarded?’ (mentioned on page 164) probably aroused some resistance. But Zachs leaves this question unanswered. The second comment refers to the way the ideas are presented. As a reader who does not have direct access to the Beirut newspapers of the 19th century, I would like to have been able to read here and there some representative pieces of writing, in Arabic or translated into English. That would have given me the feeling that I was reading the original work. Zachs does not usually cite any original texts, and that is a pity. Still, despite these reservations, Fruma Zachs’ book is an important addition to the library of every researcher who is interested in the modern history of Syria, Lebanon and the Middle East.

Governing health regions/informing board members

Governing boards of Canadian regional health authorities report deficiencies and dissatisfaction with the information available for decision making. Given the importance of health personally and politically the potential impact of deficits is great. The ultimate goal of this study is the improvement of decision support for the governing boards of regionalized and vertically integrated health care systems. Our immediate purpose is to understand how board members use information in decision making. This is required to both model the current communication and information use in decision processes, as well as, to design technology solutions congruent with these. Institutional ethnography was explored as a way of doing systematic inquiry as a preliminary step in the design process. This paper provides a methodological demonstration. Ethnographic fieldwork was conducted with one regional health board. Standard ethnographic data collection methods (observation, key informant interviews, meeting transcripts and documentation) generated data that were analysed using a framework and method developed by Canadian social theorist Dorothy Smith. Taking the standpoint of the decision maker and tracing information links to locations removed in time and space from the decision making environments permits a roadmap of knowledge construction to emerge. Preliminary findings confirm that a sequential linear decision making process is not in evidence. The Board relies on the knowledge and contacts of board members to become concisely informed from sources external to the organization. More extensive information infrastructure is in the planning stages to support the board but much analysis is currently ad hoc. A rich model of the dynamic interplay of work processes, professional discourses, institutional complexes and various knowledge practices, beliefs and ideologies is made visible. The insights gained in this investigation are used as a basis for developing strategies to improve the effective use of information and communication technologies for decision support.