Institutional Ethnography: An Emerging Approach for Health and Nursing Research

IntroductionInstitutional ethnography (IE) is a critical form of social inquiry founded by Dorothy Smith. Institutional ethnography can be described as a "Marxist-feminist, reflexive-materialist, qualitative method of inquiry" (Hussey, 2012, p. 2). Since Smith's early writings during the 1970s, IE has continued to be shaped and developed by Smith along with a growing group of well-respected researchers and theorists from North America and, increasingly, other parts of the world. Institutional ethnography publications listed on Scopus have more than doubled for each five year period from 1990, to a total of 184 in August, 2014. Institutional ethnography is now being used across a wide diversity of disciplines, including health, social work, law and justice, and education, because of its relevance to exploring and making visible the relationship between the everyday activities and experiences of people, and the institutional construction of the social world. The term institutional ethnography explicitly connects an emphasis on the structures of power - institutions - with the everyday practices and experiences of people at the local level - ethnography (Appelrouth & Edles, 2011).This paper introduces IE as a valuable research approach for health and nursing in New Zealand and adds to previous articles on methodology published in this journal. The theoretical underpinnings of IE as an alternative sociology, and the key concepts of the ruling relations and experiential knowledge in the everyday world are described. Finally, a brief overview is provided of how IE is being used for research on nurse practitioners in rural primary health care.Dorothy Smith (b. 1926), a Canadian sociologist and feminist activist, began her work developing an alternative sociology during the second-wave of the contemporary women's movement in the 1960s and 1970s. She has been described as "a worldrenowned Marxist feminist scholar and activist and a formidable intellect" (Carroll, 2010, p. 9). Her work in founding IE stemmed from what Smith described as the disjuncture she experienced early in her career between being a sociologist in a male dominated and gendered institution, and a single mother of two young children (Smith, 2005). She objected to the ways that traditional positivist sociology categorised people into designated groups, including housewives and single mothers, and then sought to explain their activities, behaviours, or their culture. She believed that this generated ideology not knowledge, and served further to perpetuate oppression and discrimination, particularly for women (Smith, 1974, 1990a). She identified that her own experience and knowledge of her everyday life was disconnected from the official or authoritative representations of her world and work as a sociologist (Bisaillon, 2012). However, as her work progressed Smith updated her terminology from a sociology for women to that of a sociology for people clearly signalling that we must begin our understanding of the social world from the experiences or standpoint of people as they go about their everyday lives (Smith, 2005).Today, Dorothy Smith still holds a position as professor emerita at the University of Toronto, as well as adjunct professoratthe University ofVictoria, British Columbia, where she continues to develop IE with scholars and students from across the world.Institutional ethnography: An alternative sociologyInstitutional ethnography is an alternative sociology. It describes how the social world is (ontology), the knowledge required to understand our social world (epistemology), and how we go about collecting that knowledge (methodology). The key premise of IE is that our social world, and our everyday activities in it, are controlled and coordinated textually and discursively by the institutional or ruling relations of our society. The web of ruling relations is produced by the ruling apparatuses that are "those institutions of administration, management, and professional authority, and of intellectual and cultural discourses, which organise, regulate, lead and direct contemporary capitalist societies" (Smith, 1990b, p. …