'What she says she needs doesn't make a lot of sense': seeing and knowing in a field study of home-care case management.

Foucault's preoccupation with the visual, specifically his positing of a sort of 'positive unconscious of vision', offers an entry point for examining data generated through a field study of home-care case management practice. In Foucault's work, our attention is directed not so much to what is seen but to what can be seen and to the effects of practices of knowledge and power in constituting these particular realities. Knowledge emerges as a matter of what it is possible for knowers, for nurses, to see and to say, as well as the conditions that constitute these specific possibilities for seeing and saying in a given context. Given the significance of practices of seeing in case management - seeing clients, seeing situations - examining how possibilities for understanding are constituted through ways of seeing helps us to 'see' the limits of currently possible practice. In the case examined in this paper, these limits constitute a gap between what a client may actually need and what it is possible, in the context of current practice, to provide. To change practice it seems important, if only as a first step, to recognize the constraints of thought in what we see.