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The idea of computerized care-plans, as put forward in nursing research, is to strengthen the focus on nurses' own preplanned nursing "projects." Like "the autonomous profession," nurses are seen as setting apart time for specialized activities, irrespective of ad-hoc-demands . . . the reality of computerized care planseven when nurses themselves have a voice in their developmentmay lag far behind this idea, given the authority structures in hospitals. With management focusing on care plans as instruments that may help them with their legal and accreditation issues, and nurses having to continue documenting their work on the KARDEX and other forms as well, care plans cannot unfold their potential. (Wagner 1993, 12) |
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Once designed, a classification system is therefore not a black box before it becomes part of nursing practice. The designers' balancing act needs to continue on every ward of every hospital. |
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Professionalization, Classification Systems, and Nursing Autonomy |
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Since the focus of the NIC is on making nursing visible, along with balancing out control and comparability, it is interesting to compare the strategies chosen by the NIC researchers to fully professionalize nursing to the range of strategies discussed by Abbott (1988, Hughes 1970) in The System of Professions. Abbott puts the struggle for jurisdiction in a central place, and his model of "the cultural machinery of jurisdiction" (Abbott 1988, 59) characterizes professional work in terms of diagnosis, treatment, inference, and academic work. The very words are drawn from the medical profession; staking out a jurisdictional claim within that profession is particularly difficultwhat is specific in a "nursing diagnosis" that differentiates it from "medical diagnosis?" He does not describe any other case where a central tool has been the creation of a classification system. Yet within the medical system as a whole, having access to one's own classification has long been a control strategy. Kirk and Kutchins (1992), for example, discuss jurisdictional disputes between the ICD and the DSM, and they show convincingly that the DSM became a tool for a particular theory of psychiatry, empowering more physiologically based models at the expense of psychological models. |
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To gain equity with the medical profession (where they have often been seen as subordinate), nursing research is an important aspect of legitimization. In turn, classification of work is a cornerstone of this research. Nursing classification creates the possibility of equivalence on the research end. Because nursing had long been defined as the |
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