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singular and demarcated as to warrant inclusion, but they ended up not being included. For example, "leech therapy" was not accepted as an intervention in the first edition of the classification system, although there was enough research literature to support this intervention as typical nursing in many parts of the world. This strategic choice was a response to a prior history of nursing classifications not being taken seriously. It was feared that the mention of leech therapy, with its folk and medieval associations, would provide a red flag for critics (compare this situation with virus classifications discussed in chapter 2). It was introduced into the second edition, when the Iowa intervention team believed that they had sufficiently demonstrated their credentials. Also the advanced statistical analysis of the validation studies was located in what the design team members typified as "common sense." One could have a reliability coefficient of .73, but if it did not respond to a visible or controllable enough nursing reality, it became an outlier, a nonresult, or resulted in a residual category. As with all statistical analyses, a link with theory and practice must precede testing or the results are meaningless. |
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In other cases, the criteria for inclusion and control are themselves contested. One research member confided in an interview that her intervention was rejected because it was not supported with research evidence. Her plan was to first publish a paper about the intervention in a research journal and then resubmit the intervention for consideration with her own reference as research evidence. |
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In these examples, the goal of making as much visible as possible clashes with what should remain taken for granted. The nursing researchers temper their quest to make nursing visible with the image of what nursing is or should be about. Again, there is no final answer or algorithm but a complex balance of experience and rules. Common practice, contingency, and legitimacy temper visibility. |
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Control, Discretion, and Reliability |
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There is a continuing tension within NIC between abstracting away from the local and rendering 'invisible work' visible. Nurses' work is often quintessentially invisible for a combination of good and bad reasons. Nurses have to ask mundane questions, rearrange bedcovers, move a patient's hand so that it is closer to a button, and sympathize about the suffering involved in illness (Olesen and Whittaker 1968). |
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