A Foucauldian perspective on electronic nursing documentation
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This paper aims to demonstrate the relevance of Michel Foucault’s work for revealing how electronic nursing documentation is enmeshed in processes of power. Applying Foucault’s concept of biopower, provides a critical perspective on the increasing use of artificial intelligence and the commodification of patient data, outlining how these may undermine person-centred care and health equality. Arguing that nurses should take a leadership role in shaping the future of technology in healthcare, this paper suggests that Foucault’s concepts of counter-conduct, counter-discourse and care of the self, invites nurses to imagine how they can move from being agents of biopower to agents of rebellion.
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References
Alhammad, N., Alajlani, M., Abd-alrazaq, A., Epiphaniou, G., & Arvanitis, T. (2024). Patients’ perspectives on the data confidentiality, privacy, and security of mHealth apps: systematic review. Journal of Medical Internet Research, 26, e50715. https://doi.org/10.2196/50715
American Academy of Pediatrics Committee on Coding and Nomenclature. (2020). Pediatric coding basics : an introduction to medical coding. American Academy of Pediatrics.
Asempah, E., & Wiktorowicz, M. E. (2023). Understanding HPV vaccination policymaking in Rwanda: a case of health prioritization and public-private-partnership in a low-resource setting. International Journal of Environmental Research and Public Health, 20(21), 6998. https://doi.org/10.3390/ijerph20216998
Ashuri, T., & van Voorst, R. (2024). Networked biopower: personalized healthcare in a datafied world. Information, Communication & Society, 1–18. https://doi.org/10.1080/1369118X.2024.2442411
Bakhoum, N., Gerhart, C., Schremp, E., Jeffrey, A. D., Anders, S., France, D., & Ward, M. J. (2021). A time and motion analysis of nursing workload and electronic health record use in the emergency department. Journal of Emergency Nursing, 47(5), 733–741. https://doi.org/10.1016/j.jen.2021.03.007
Bauer, J. C., John, E., Wood, C. L., Plass, D., & Richardson, D. (2020). Data entry automation improves cost, quality, performance, and job satisfaction in a hospital nursing unit. The Journal of Nursing Administration, 50(1), 34–39. https://doi.org/10.1097/NNA.0000000000000836
Campanella, P., Lovato, E., Marone, C., Fallacara, L., Mancuso, A., Ricciardi, W., & Specchia, M. L. (2016). The impact of electronic health records on healthcare quality: a systematic review and meta-analysis. The European Journal of Public Health, 26(1), 60–64. https://doi.org/10.1093/eurpub/ckv122
Campbell, E. (2010). Narcissism as ethical practice? Cultural Sociology, 4(1), 23–44. https://doi.org/10.1177/1749975509356752
Campbell, M. L., & Rankin, J. M. (2017). Nurses and electronic health records in a Canadian hospital: examining the social organisation and programmed use of digitised nursing knowledge. Sociology of Health & Illness, 39(3), 365–379. https://doi.org/10.1111/1467-9566.12489
Chan, S. C. C., Neves, A. L., Majeed, A., & Faisal, A. (2024). Bridging the equity gap towards inclusive artificial intelligence in healthcare diagnostics. BMJ, q490. https://doi.org/10.1136/bmj.q490
Dedalus. (2024). Dedalus digital transformation in healthcare choosing an electronic patient record (EPR) system for your organisation . https://www.dedalus.com/uki/wp-content/uploads/sites/7/2023/01/DigitalTransformationinHealthcare.pdf
Dillard‐Wright, J. (2019). Electronic health record as a panopticon: A disciplinary apparatus in nursing practice. Nursing Philosophy, 20(2). https://doi.org/10.1111/nup.12239
Dreyfus, H. L. , & Rabinow, R. P. (2013). Michel Foucault: beyond structuralism and hermeneutics. Routledge.
Druedahl, L. C., & Kälvemark Sporrong, S. (2024). Patient perspectives on data sharing (pp. 51–67). https://doi.org/10.1007/978-981-99-6540-3_4
European Commission. (2025). European health data space regulation (EHDS). https://health.ec.europa.eu/ehealth-digital-health-and-care/european-health-data-space-regulation-ehds_en
Evans, B., & Colls, R. (2009). Measuring fatness, governing bodies: The spatialities of the body mass index (BMI) in anti‐obesity politics. Antipode, 41(5), 1051–1083. https://doi.org/10.1111/j.1467-8330.2009.00706.x
Evans, J. D., Crooks, V. A., & Kingsbury, P. T. (2009). Theoretical injections: On the therapeutic aesthetics of medical spaces. Social Science & Medicine, 69(5), 716–721. https://doi.org/10.1016/j.socscimed.2009.06.040
Ferryman, K., Cesare, N., Creary, M., & Nsoesie, E. O. (2024). Racism is an ethical issue for healthcare artificial intelligence. Cell Reports. Medicine, 5(6), 101617. https://doi.org/10.1016/j.xcrm.2024.101617
Foth, T. (2013). Understanding ‘caring’ through biopolitics: the case of nurses under the Nazi regime. Nursing Philosophy, 14(4), 284–294. https://doi.org/10.1111/nup.12013
Foucault, M. (1980). The history of sexuality: Interview. Oxford Literary Review, 4(2), 3–14. https://doi.org/10.3366/olr.1980.002
Foucault, M. (1982). The subject and power. Critical Inquiry, 8(4), 777–795. https://doi.org/10.1086/448181
Foucault, M. (1999). Discourse and truth: the problematization of parrhesia (six lectures given by Michel Foucault at the University of California at Berkeley, October– November 1983 (Ed. J. PEARSON 1985), compiled from tape-recordings and re-edited in 1999. Available at: http://foucault.info/documents/parrhesia/.
Foucault, M. (2002). The order of things: an archaeology of the human sciences. Routledge.
Foucault, M. (2003). The birth of the clinic: an archaeology of medical perception. Routledge.
Foucault, M. , Senellart, M., Ewald, F., Fontana, A., Davidson, A. I., & Burchell, G.
. (2009). Security, territory, population: lectures at the College de France, 1977-78 (Pbk. ed.). Palgrave Macmillan.
Gastaldo, D., & Holmes, D. (1999). Foucault and nursing: a history of the present. Nursing Inquiry, 6(4), 231–240. https://doi.org/10.1046/j.1440-1800.1999.00042.x
Georges, J. M., & Benedict, S. (2008). Nursing Gaze of the Eastern Front in World War II. Advances in Nursing Science, 31(2), 139–152. https://doi.org/10.1097/01.ANS.0000319564.68760.04
Gonçalves, F. G. de A., Souza, N. V. D. de O., Zeitoune, R. C. G., Adame, G. F. P. L., & Nascimento, S. M. P. do. (2015). Impacts of neoliberalism on hospital nursing work. Texto & Contexto - Enfermagem, 24(3), 646–653. https://doi.org/10.1590/0104-07072015000420014
Green, K., Asthana, S., Ponce-Ponte, O. J., Downey, J., & Watson, J. (2025). Collecting and sharing person-centered AI clinical cummaries across frailty services provided by the National Health Service and voluntary, community, and social enterprise: protocol for a co-design and feasibility study. JMIR Research Protocols, 14(16), e68511. https://doi.org/10.2196/68511
Heartfield, M. (1996). Nursing documentation and nursing practice: a discourse analysis. Journal of Advanced Nursing, 24(1), 98–103. https://doi.org/10.1046/j.1365-2648.1996.15113.x
Henderson, A. (1994). Power and knowledge in nursing practice: the contribution of Foucault. Journal of Advanced Nursing, 20(5), 935–939. https://doi.org/10.1046/j.1365-2648.1994.20050935.x
Holmes, D., & Gastaldo, D. (2002). Nursing as means of governmentality. Journal of Advanced Nursing, 38(6), 557–565. https://doi.org/10.1046/j.1365-2648.2002.02222.x
Hunt, L. M., Bell, H. S., Baker, A. M., & Howard, H. A. (2017). Electronic health records and the disappearing patient. Medical Anthropology Quarterly, 31(3), 403–421. https://doi.org/10.1111/maq.12375
Johnson, E., & Carrington, J. M. (2023). Revisiting the nursing metaparadigm: Acknowledging technology as foundational to progressing nursing knowledge. Nursing Inquiry, 30(1). https://doi.org/10.1111/nin.12502
Jones, C. , & P. R. (1998). Reassessing Foucault : power, medicine and the body. Routledge.
Khalid, N., Qayyum, A., Bilal, M., Al-Fuqaha, A., & Qadir, J. (2023). Privacy-preserving artificial intelligence in healthcare: Techniques and applications. Computers in Biology and Medicine, 158, 106848. https://doi.org/10.1016/j.compbiomed.2023.106848
Liaschenko, J. (2000). The moral geography of care work. Home Care Provider, 5(4), 126–128. https://doi.org/10.1067/mhc.2000.109234
Lilja, M., & Vinthagen, S. (2014). Sovereign power, disciplinary power and biopower: resisting what power with what resistance? Journal of Political Power, 7(1), 107–126. https://doi.org/10.1080/2158379X.2014.889403
Lorenzi, D. (2023). Foucault, governmentality, and the techniques of the self. In W. Walters & M. Tazzioli (Eds.), Handbook on Governmentality (pp. 22–37). Edward Elgar Publishing.
Luan, Z., Zhang, Z., Gao, Y., Du, S., Wu, N., Chen, Y., & Peng, X. (2023). Electronic health records in nursing from 2000 to 2020: A bibliometric analysis. Frontiers in Public Health, 11. https://doi.org/10.3389/fpubh.2023.1049411
McGregor, S. (2001). Neoliberalism and health care. International Journal of Consumer Studies, 25(2), 82–89. https://doi.org/10.1111/j.1470-6431.2001.00183.x
Michl, G., Paterson, C., & Bail, K. (2023). ‘It’s all about ticks’: A secondary qualitative analysis of nurse perspectives about documentation audit. Journal of Advanced Nursing, 79(9), 3440–3455. https://doi.org/10.1111/jan.15685
Momenipour, A., & Pennathur, P. R. (2019). Balancing documentation and direct patient care activities: A study of a mature electronic health record system. International Journal of Industrial Ergonomics, 72, 338–346. https://doi.org/10.1016/j.ergon.2019.06.012
Montero, Á. G. (2024). Diary writing as a queer technology of the self: David Vilaseca’s Els homes i els dies. Interalia: A Journal of Queer Studies, 93–111. https://doi.org/10.51897/interalia/JGYB1108
Moreno‐Mulet, C., Valdivielso‐Navarro, J., Miró‐Bonet, M., Carrero‐Planells, A., & Gastaldo, D. (2025). Transgressive acts: Michel Foucault’s lessons on resistance for nurses. Nursing Philosophy, 26(1). https://doi.org/10.1111/nup.70008
Mosqueda-Díaz, A., Vílchez-Barboza, V., Valenzuela-Suazo, S., & Sanhueza-Alvarado, O. (2014). Critical theory and its contribution to the nursing discipline. Investigación y Educación En Enfermería, 32(2), 356–363. https://doi.org/10.17533/udea.iee.v32n2a18
Octaviano, A. T. B., Baac, M. B. G., Selso, T. B. S., Estoya, E. A. V, Buena, Z. M. E., Hinlo, H. K. L., Gernale, L. A. M., Hesido, S. A., & Pacaol, N. F. (2024). Artificial intelligence vis-à-vis Foucault’s medical gaze: implications for healthcare, public health, and prison. Journal of Public Health, 46(3), e544–e544. https://doi.org/10.1093/pubmed/fdae106
Papadimos, T. J., & Murray, S. J. (2008). Foucault’s “fearless speech” and the transformation and mentoring of medical students. Philosophy, Ethics, and Humanities in Medicine, 3(1), 12. https://doi.org/10.1186/1747-5341-3-12
Pennington, M. (2023). Foucault and Hayek on public health and the road to serfdom. Public Choice, 195(1–2), 125–143. https://doi.org/10.1007/s11127-021-00926-6
Perron, A. (2013). Nursing as ‘disobedient’ practice: care of the nurse’s self, parrhesia, and the dismantling of a baseless paradox. Nursing Philosophy, 14(3), 154–167. https://doi.org/10.1111/nup.12015
Perron, A., Fluet, C., & Holmes, D. (2005). Agents of care and agents of the state: bio‐power and nursing practice. Journal of Advanced Nursing, 50(5), 536–544. https://doi.org/10.1111/j.1365-2648.2005.03432.x
Perron, A., Rudge, T., Blais, A.-M., & Holmes, D. (2010). The politics of nursing knowledge and education. Advances in Nursing Science, 33(3), 184–195. https://doi.org/10.1097/ANS.0b013e3181e093bc
Petersen, A. R. , & Bunton, B. R. (1997). Foucault, health and medicine. Routledge.
Raab, R., Küderle, A., Zakreuskaya, A., Stern, A. D., Klucken, J., Kaissis, G., Rueckert, D., Boll, S., Eils, R., Wagener, H., & Eskofier, B. M. (2023). Federated electronic health records for the European Health Data Space. The Lancet Digital Health, 5(11), e840–e847. https://doi.org/10.1016/S2589-7500(23)00156-5
Ramezani, M., Takian, A., Bakhtiari, A., Rabiee, H. R., Ghazanfari, S., & Mostafavi, H. (2023). The application of artificial intelligence in health policy: a scoping review. BMC Health Services Research, 23(1), 1416. https://doi.org/10.1186/s12913-023-10462-2
Ramos Toescher, A. M., Barlem, E. L. D., Tomaschewski Barlem, J. G., Castanheira, J. S., & Rocha, L. P. (2021). Moral distress among nursing professors: The exercise of parrhesia. Nursing Ethics, 28(4), 543–553. https://doi.org/10.1177/0969733020952109
Ronquillo, C. E., Peltonen, L., Pruinelli, L., Chu, C. H., Bakken, S., Beduschi, A., Cato, K., Hardiker, N., Junger, A., Michalowski, M., Nyrup, R., Rahimi, S., Reed, D. N., Salakoski, T., Salanterä, S., Walton, N., Weber, P., Wiegand, T., & Topaz, M. (2021). Artificial intelligence in nursing: Priorities and opportunities from an international invitational think‐tank of the Nursing and Artificial Intelligence Leadership Collaborative. Journal of Advanced Nursing, 77(9), 3707–3717. https://doi.org/10.1111/jan.14855
Rony, M.K.K., Parvin, M.R., Ferdousi, S. (2024). Advancing nursing practice with artificial intelligence: Enhancing preparedness for the future. Nurs Open, 11(1).https://doi.org/10.1002/nop2.2070
Rose, L. M. (2012). Legally public but privately practiced: Segregating the lactating body. Health Communication, 27(1), 49–57. https://doi.org/10.1080/10410236.2011.568999
Sandset, T., Villadsen, K., Heggen, K., & Engebretsen, E. (2023). Discipline for pleasure: a new governmentality of HIV prevention. BioSocieties, 18(1), 102–127. https://doi.org/10.1057/s41292-021-00257-1
Shaw, D., & Scully, J. (2024). The foundations of influencing policy and practice: How risk science discourse shaped government action during COVID‐19. Risk Analysis, 44(12), 2889–2905. https://doi.org/10.1111/risa.14213
Shaw, J. (2012). The birth of the clinic and the advent of reproduction: Pregnancy, pathology and the medical gaze in modernity. Body & Society, 18(2), 110–138. https://doi.org/10.1177/1357034X10394666
Slawomirski, L., Lindner, L., de Bienassis, K., Hashiguchi, T. C. O., Haywood, B.K., Steentjes, M., & Oderkirk, J. (2023). Progress on implementing and using electronic health record systems: Developments in OECD countries as of 2021. https://www.oecd.org/content/dam/oecd/en/publications/reports/2023/09/progress-on-implementing-and-using-electronic-health-record-systems_f6c2a59a/4f4ce846-en.pdf
Smith, J. B., Willis, E., & Hopkins‐Walsh, J. (2022). What does person‐centred care mean, if you weren’t considered a person anyway: An engagement with person‐centred care and Black, queer, feminist, and posthuman approaches. Nursing Philosophy, 23(3). https://doi.org/10.1111/nup.12401
Starfield, B. (2011). Is patient-centered care the same as person-focused care? The Permanente Journal, 15(2), 63–69. https://doi.org/10.7812/TPP/10-148
Stein, C. (2011). The birth of biopower in eighteenth-century Germany. Medical History (Pre-2012), 55(3), 331–337.
Stoler, A. L. (1995). Race and the education of desire: Foucault’s history of sexuality and the colonial order of things. Duke University Press.
Strand, N. H., Mariano, E. R., Goree, J. H., Narouze, S., Doshi, T. L., Freeman, J. A., & Pearson, A. C. S. (2021). Racism in pain medicine: We can and should do more. Mayo Clinic Proceedings, 96(6), 1394–1400. https://doi.org/10.1016/j.mayocp.2021.02.030
Straw, I., & Wu, H. (2022). Investigating for bias in healthcare algorithms: a sex-stratified analysis of supervised machine learning models in liver disease prediction. BMJ Health & Care Informatics, 29(1), e100457. https://doi.org/10.1136/bmjhci-2021-100457
Thompson, L. (2008). The role of nursing in governmentality, biopower and population health: Family health nursing. Health & Place, 14(1), 76–84. https://doi.org/10.1016/j.healthplace.2007.05.001
U.S. Department of Health and Human Services. (2022). Addressing health worker burnout. https://www.hhs.gov/sites/default/files/health-worker-wellbeing-advisory.pdf
Villadsen, K. (2023). Goodbye Foucault’s ‘missing human agent’? Self-formation, capability and the dispositifs. European Journal of Social Theory, 26(1), 67–89. https://doi.org/10.1177/13684310221125350
Zaharijević, A., & Urošević, M. (2024). Resistance as desubjectivation in Foucault. Philosophy & Social Criticism. https://doi.org/10.1177/01914537241284544
Zaidi, Z., Bush, A. A., Partman, I. M., & Wyatt, T. R. (2021). From the “top-down” and the “bottom-up”: Centering Foucault’s notion of biopower and individual accountability within systemic racism. Perspectives on Medical Education, 10(2), 73–75. https://doi.org/10.1007/S40037-021-00655-Y
Zhang, X.-Y., & Zhang, P. (2016). Recent perspectives of electronic medical record systems. Experimental and Therapeutic Medicine, 11(6), 2083–2085. https://doi.org/10.3892/etm.2016.3233