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

Abstract

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. Smith's 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 nurse's 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.