Nurses and electronic health records in a Canadian hospital: examining the social organisation and programmed use of digitised nursing knowledge.

Institutional ethnography (IE) is used to examine transformations in a professional nurse's work associated with her engagement with a hospital's electronic health record (EHR) which is being updated to integrate professional caregiving and produce more efficient and effective health care. We review in the technical and scholarly literature the practices and promises of information technology and, especially of its applications in health care, finding useful the more critical and analytic perspectives. Among the latter, scholarship on the activities of economising is important to our inquiry into the actual activities that transform 'things' (in our case, nursing knowledge and action) into calculable information for objective and financially relevant decision-making. Beginning with an excerpt of observational data, we explicate observed nurse-patient interactions, discovering in them traces of institutional ruling relations that the nurse's activation of the EHR carries into the nursing setting. The EHR, we argue, materialises and generalises the ruling relations across institutionally located caregivers; its authorised information stabilises their knowing and acting, shaping health care towards a calculated effective and efficient form. Participating in the EHR's ruling practices, nurses adopt its ruling standpoint; a transformation that we conclude needs more careful analysis and debate.

Aid effectiveness and women's empowerment: practices of governance in the funding of international development.

Although the empowerment of women is a prominent goal in international development, feminist development professionals, activists, and scholars remain deeply dissatisfied with the limited extent to which women's empowerment is actually achieved. Their experiences and analyses raise questions about the connections and disjunctions between discourse, institutional practices, and everyday life. A major effort to reform development aid guided by the Paris Declaration on Aid Effectiveness raises new questions about the place of gender in development practice. Drawing on recently conducted research on women and development in Kyrgyzstan and using a range of institutional texts, we interrogate how development professionals and activists engage with the aid effectiveness discourse. Our analytic approach, institutional ethnography, shares with work on governmentality an empirical focus on practices undertaken by diversely situated people and how these practices constitute a particular field of action. Institutional ethnography directs analytic attention to the operation of texts as local and translocal coordinators of people's everyday activities. The product of this coordinated work is what we call, in this case, the development institution. For those concerned about women and development, we see the usefulness of making visible how global governance is accomplished in both enactments of and resistance to institutional practices, but in ways that do not necessarily benefit women.