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Much of the medical literature on patient compliance explores why patients fail to follow practitioners' instructions. This paper explores perspectives on 'compliance' expressed in online discussion groups for kidney patients. Discourse analysis was used to investigate how contributors conceptualise knowledge and the role of the renal patient. In the discussion groups, patients were sometimes seen to have better understanding of the details of their illness than some practitioners, a focus born of inhabiting their situation and therefore having more at stake. Some patients set themselves the task of supervising their own care, double checking the work of practitioners. This did not threaten biomedical knowledge, but these counter-discourses challenge professional boundaries by making it the prerogative of patients to obtain biomedical knowledge. I explore issues of surveillance and frustration, and the potential usefulness of patients' overseeing their own safety, while flagging the potential plight of less 'empowered' or motivated patients. [ABSTRACT FROM AUTHOR]

This paper explores the impact of restructuring, conducted under the auspices of new public sector management, on the delivery of hospital based nursing care. Alderfer's model of 'overbounded' and 'underbounded' systems is used to analyse the way in which the organisation and delivery of nursing care has changed. Nursing was traditionally organised in an overbounded system which nevertheless focussed clearly and primarily on the provision of excellence in patient care. Recent research and examples from case law illustrate how nursing has moved into an underbounded system, where lines of authority and accountability are crossed and blurred. This can lead to practices of 'responsible subversion' which leave nurses feeling dissatisfied, guilty and marginalised. New management models are required to address the multiple and competing authority relations and imprecise, incomplete and overlapping role definitions. [ABSTRACT FROM AUTHOR]