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the need to make administrative care visible is not as urgent as the need to differentiate nursing as a hands-on clinical discipline. Although the nursing researchers are aware that the boundaries among direct, indirect, and administrative care are not firm, administrative care was not part of the first two editions of NIC. This dilemma about the encoding of administrative work points to a practical limit on the visibility-discretion tradeoffs. To fully abstract from the local, everything must be spelled out; to avoid resistance from nurses and nursing administrators, some specifications for work must be left implicit. What is left implicit becomes doubly invisible: it is the residue left over when other sorts of invisible work have been made visible (Strauss et al. 1985, Star 1991c; Star and Strauss 1999). Where claims are made for the completeness of an accounting system, that which is not accounted for may be twice overlooked. This is noted here as both a formal and a practical challenge for classification designers and users. |
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The tension between visibility and discretion became apparent when several group members noted that the classification is strongperhaps too strongwithin the nursing specialties of the system's developers such as the complex physiological domain. It is still underdeveloped in other nursing areas, however, such as community health and social-psychological nursing. Social-psychological care giving is one of the areas where the control-visibility dilemma is very difficult to grasp. As noted, NIC lists "humor" as one nursing intervention. How can one capture humor as a deliberate nursing intervention? Does sarcasm, irony, or laughter count as a nursing intervention? How to reimburse humor; how to measure this kind of care? No one would dispute its importance, but it is by its nature a situated and subjective action. Since NIC does not contain protocols and procedures for each intervention, a grey area of common sense remains for the individual staff nurse to define whether some of the nursing activities can be called nursing interventions or are worth charting. This same grey area also remains for more clinical interventions such as "cerebral edema management" or "acid-base monitoring."
40 But because the classification is modeled after a clinical model of nursing, the team felt it easier to define and include those more clinical interventions. |
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The borderland between professional control and the urge to make nursing visible is fraught with difficult choices and balances not only in the interventions themselves but also in the decisions underlying NIC. Team members recalled discussions where interventions were so |
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