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Over the years many innovative applications in information technology have failed due to insufficient consideration of the projected users. When developing new information infrastructures, however, the scope of usage is murky. Users may not know, prior to experience, what they want from the new system and how they will use it. The success of France's Minitel Rose is a prime example where, much to the designers' surprise, personal and pornographic messages and not official information sold the system (Taylor and Van Every 1993). As noted in chapter 3, the work of being a classical Greek scholar has changed with the advent of the Thesaurus Linguae Graecae. The ability to produce concordances on the fly makes previous laborious library work, which had to be carried out over two or three continents, the work of a few minutes. This means that new kinds of questions may, indeed must, be asked of the material the researcher is looking at (Ruhleder 1995). Secretaries now do much less copy typing and professionals do morethe result of a pincer movement between the development of new management philosophies and new information technology. New infrastructures do more than support work that is already being done. They change the very nature of what it is to do work, and what work will count as legitimate. |
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In this sense, NIC is an actively developing infrastructure. It is fed into a clinical decision support system, directs nurses on which activities to perform, and becomes part of hospital accounting systems. It lays claim to a professional territory for nursing; used as part of ongoing research and teaching programs, current nursing interventions (fluctuating at present) become stabilized. Since research is built around these categories, a feedback loop is set up that stabilizes the current set. (A similar set of events were seen in the development of the international classification of diseases (ICD) in chapter 4.) Political, cultural, ethical, social, religious, economic, and institutional factors each play a role in NIC's development. Thus, for example, the definition of stillbirth has been a site of conflict among states with different religious constituencies; and epidemiologists argue that it is still highly variably diagnosed depending on the beliefs of the attending physicians. Similar coding problems have been documented in the case of AIDS and its associated illnesses, especially during the early 1980s (see Verghese 1994 for a wonderfully compassionate physician's view of the situation). |
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With NIC, as with the ICD, apparently precise, measurable qualities often prove much fuzzier when looked at closely. And yet as classification systems they present knowledge in a form that is transportable |
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