Towards critical medical practice : nursing practice and an EMR system

A focus on critique as a form of theory within critical management studies (CMS) and critical information systems research (CISR) leads to concerns about the impact of critique on the transformation of practice and about the active role of practitioners. The emphasis on theory also prevents insight into the heterogeneous nature of critical practices. This paper develops a posthumanist approach to critique. A case is analysed where an electronic medical record (EMR) information system is introduced in a hospital. The focus is on tracing the effect of this system on the work of nurses. It is shown how the system entails the marginalisation and reduction of the professional expertise and knowledge of nurses. Where critical theories are able to identify, analyse and evaluate the forms and extent of this marginalisation, the focus in this article is on the ways in which the nurses enact a reality that is different from the one prescribed by the EMR. The differential enactment of reality is achieved through a heterogeneous assemblage that consists of various agents such as nurses, computer workstations, paper and meetings. The practice of the nurses is defined here as a material form of critique. It is not the traditional form of critique which articulates and evaluates the embedded ideologies, but one which enacts a reality that could be seen as emancipatory. It is concluded that the focus on the heterogeneous nature of critical practices creates the conditions for a more sustained form of critique