Electronic health record as a panopticon: A disciplinary apparatus in nursing practice

Abstract

Working through the nights as a senior staff nurse in shock/trauma critical care, I gradually realized that I was ensnared in a complex web of expectations and behaviours, with the electronic health record a constant presence, both intrusive and surreptitious. The electronic health record seemed to take on a life of its own, a person behind the curtain. As patients grew sicker, the record grew more insistent, firing off endless reminders, prompts and commands. The electronic health record housed orders for the nurse to execute at the same time as it demanded feeding; extracting data from patients like flour from grist. All the while, the electronic health record monitored and recorded, quantifying the actions of nurses as they care for their patients. These actions are then transformed into discrete, minable data points that go on to construct a map of the patient experience, capturing vital patient information. This transformation also becomes an audit trail for nurses' behaviours, surveillance in absentia. The ghostly tentacles of managerial discipline emanate from AbstractThe specific arrangements of power/knowledge that characterize nurse interactions with the electronic health record form a panopticon. As health care moves into the 21st century, sophisticated technologies like the electronic health record shape the terrain of professional possibilities. The longer it is in use, the more it is possible to excavate the inherent disciplinary function of electronic health record. A panopticon is a generalizable, replicable apparatus of power that cultivates discipline when similar behaviours are desired from a group of people. This paper traces the arrangements of power/knowledge that characterize nurse interactions with the electronic health record rooted in a trauma critical care setting. Examining the apparatuses of power/knowledge enforced through panopticism in nursing makes the invisible visible. This in turn enables nurses to address the intended and unintended consequences of the electronic health record. If nurses are to effectively shape the direction of their own futures and the future of health care, nurses will need to unpack the invisible techniques of power such as the electronic health record as a panopticon. In the process of building a visible identity, contextualizing nursing knowledge to better care for patients on the one hand and understand the relationships of power that limit us on the other, nurses are neither apolitical nor powerless. Considering the dialectic of power/knowledge in the healthcare setting helps to illuminate spaces to recharacterize nursing, reveal the contributions and knowledge of nurses, and consolidate the professional power of nurses to affect meaningful change and self-governance in the healthcare setting. K E Y W O R D Scontrol, Foucault, knowledge, nursing, panopticon, power

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