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Striving for comparability in a standardized language across settings conflicts with the need for visibility within local settings. The nursing intervention architects want their system to be adopted by health care institutions. As a language, its entire vocabulary needs to be available to nursing professionals. Certain institutions, however, will most likely only need part of the NIC taxonomy; for example, nurses in a geriatric hospital would not require "Newborn Care" as an intervention. The results of validation studies with different nursing specialties suggest that between 20 and 80 percent of the terminology would be routinely used by several nursing specialties. This raises the issue of how to limit each institution's modifications. Too much flexibility would obviously undermine the birth of a standard language, but too much control makes a system user unfriendly especially in such a safety critical and busy line of work. As a rule of thumb, the NIC group decided that an institution should adopt the whole classification system at the level of the copywritten interventions, definitions, and labels, but that activity-level descriptions could be modestly changed. Control and enforcement of this rule, however, ultimately rests with the publisher. |
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This central tension between standards on the one hand and local, tailorable systems on the other is a familiar one in information systems (Trigg and Bødker 1994). It remains a tradeoffa tension not resolved by resorting to a lowest common denominator, a universal algorithm, or an appeal to universal positivist knowledge (Star 1992). |
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Visibility: Legitimacy versus Surveillance |
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Comparability rests on the management and mobility of differences and equivalencies across sites. The issue becomes what is local and particular or what do all nurses have in common that can be rendered equivalent across settings and nursing specialties? Then, what does this commonality render invisible? The nursing classification designers employ a definition of nursing interventions as a guideline. "A nursing intervention is any direct-care treatment that a nurse performs on behalf of a client. These treatments include nurse-initiated treatments resulting from nursing diagnoses, physician-initiated treatments resulting from medical diagnoses, and performance of the daily essential functions for the client who cannot do these" (Bulechek and McCloskey 1989, 23). Here, the emphasis is on direct care: that which nurses do to increase the well-being of a patient at the bedside. Direct |
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