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A favorite metaphor of NIC members to describe their task is to make the invisible work visible. As the layers of complexity involved in its architecture reveal, however, a light shining in the dark illuminates certain areas of nursing work but may cast shadows elsewhere: the whole picture is a very complex one. NIC is at once an attempt at a universal standardized tool with a common language; at the same time, its development and application is proceeding via managing and articulating the local and particular. It is in that sense a boundary object between communities of practice, with a delicate cooperative structure (Star and Griesemer 1989). At the same time, it is balanced in a given workflow and historical period that makes it a potential target for control. The fact that NIC researchers are carefully involving a huge web of nurses and nursing researchers and building slowly over time, with revisions, is key to this process. The conservation of work inscribed in the static list of concepts and activities that form a classification system will be inserted into a field of ongoing practices, negotiations, and professional autonomy disputes. These practices and the political field in which they occur form the architecture of intimacy, manageability, and standardization. The local and macro contexts of the classification system and its attendant practices determine in the final instance the extent of the displacement of nursing work. In classification systems, differentiation and dedifferentiation emerge as a continuous and negotiated accomplishment over time. The same lesson holds for the organization of nursing work through NIC as for the coordination of medical organizations of all kinds through the ICD as discussed in chapter 4: it is not a question of mapping a preexisting territory but of making the map and the territory converge. |
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