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.

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.

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For more than 30 years, a negative "off-peak effect" on patient outcomes has been associated with weekend and/or nighttime hospitalization in more than 25 diagnostic groups. Descriptive studies have verified the presence of this off-peak effect on patient outcomes but have done little to explain its cause. Institutional ethnography is a promising method for describing challenges nurses encounter and deal with on off-peak shifts and for exploring how those challenges arose in institutions designed to avoid such outcomes. The authors discuss their research and suggest a number of steps that nurse administrators might take to enhance their knowledge for handling off-peak challenges in their hospitals.

This article draws on a body of research conducted by the author over the past ten years on the social organization of nursing work. It explores questions surrounding nurses' contemporary labor process control and its meaning for nurses' professionalization and proletarianization. Both are dynamic processes, changing as public administration of the Canadian health care system changes and as nurses are successful in winning more complete self-regulation. Nurses are currently being articulated more and more securely to dominant ideas of public sector management through textually mediated technologies. Nurses find new upwardly mobile careers and challenging, responsible, and more respected work. However, as the generation of objective information for professional accountability, cost-accounting, and managerial decision-making becomes unified in computerized patient information systems, producing and using such information becomes a central and determining core of everyday nursing work. It organizes nurses into a "managed" practice of patient care, contradictory for them in many ways. Outstanding among these contradictions is a new professionalized standpoint of cost-efficiency that subordinates nurses' traditional interests and grounding of their work in the standpoint of care.

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Researchers attempting to improve knowledge for policy making look to intersectionality to theorize the important, yet poorly understood constitutive elements of people's lives and experiences. As argued here, certain epistemological and ontological issues, while much debated, remain a problem in intersectional and other social research. This paper introduces Dorothy E. Smith's analytic approach, institutional ethnography, arguing that its use avoids reliance on categories that objectify people and, instead, explicates the social relations that rule people's knowing and doing. In institutional ethnography, people are understood to conduct and experience their lives within discursively organized social relations, coordinating their activities with institutions and the political economy, more broadly. Addressing how the latter implicates policy-oriented activism, an illustration from research in healthcare is used, demonstrating how in accounting empirically for 'what actually happens', an institutional ethnography makes visible the relations of knowing that link research subjects and researchers, too, into an institution's ruling purposes.

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