Managing home nursing care: visibility, accountability and exclusion

The paper examines managerial practices shaping contemporary home nursing care. Foucault's writings on governmentality are used to appraise managerial and nursing practices understood as exemplars of forms of government of people's health. An ethnographic study of organizational practices shaping contemporary home nursing care reveals that the everyday work of managers involves making particular forms of nursing practice visible. Through careful scripting of these visible forms of practice, managers and nurses together work to exclude the local knowledge of patients and of nurses regarding experiences of living with chronic illness. Recommendations are offered for managers and nurses who seek to develop more autonomous roles for nurses: roles that require the inclusion of people's own knowledge of how they live at home with their chronic illness.