title: The rhetoric of patient and family centred care: an institutional ethnography into what actually happens.
abstract: OBJECTIVE
  This paper uses Dorothy Smith's institutional ethnography to examine technological advances designed to improve nurses' work. The analysis interrogates how nurses' work is coordinated, in disquieting ways, in an apparent commitment to 'patient and family centred care'.
  
  
  BACKGROUND
  The discussion is part of a larger programme of research that focuses ethnographic attention on nurses' activating technological managerial improvement strategies.
  
  
  METHODS
  This discussion paper describes suboptimal hospital experiences to show how they were organized. The institutional ethnographic analysis addresses discrepancies that arise between the different organizational standpoints. Overall the discussion focuses on how institutional ethnographers enquire into people's everyday activities to discover and make understandable, in the material world, what actually happens that shapes them.
  
  
  METHODS
  Data include observations and interviews with nurses, nurse managers, patients and families. It also includes screenshots of computer fields and other documents being used by nurses.
  
  
  CONCLUSIONS
  Nursing work is methodically being oriented to interests that undermine nurses' capacity to contribute their knowledgeable activity to intervene in people's health and well-being.
  
  
  CONCLUSIONS
  Nurses' work is overwhelmed with the imperative to discharge patients. This happens with an ideological construction of patient centred care that obscures what is actually happening.
authors.affiliation: Faculty of Nursing, University of Calgary in Qatar, Doha, Qatar.
authors.forename: Janet M
authors.initials: JM
authors.lastname: Rankin
mesh_terms: D000884:Anthropology, Cultural; D001292:Attitude to Computers; D001294:Attitude to Health; D002170:Canada; D016638:Critical Illness / Q000451:nursing; D006801:Humans; D016347:Medical Records Systems, Computerized; D009723:Nurse-Patient Relations; D009741:Nursing Staff, Hospital / Q000458:organization & administration*; D018802:Patient-Centered Care / Q000458:organization & administration*
keywords: discharge planning; institutional ethnography; managerial technologies; nursing practice; patient and family centred care; professional issues