|
|
|
|
|
|
|
operating within a well-defined information infrastructure subtended by classification systems. In this process, the decision of whether to opt in to an infrastructure, with its attendant memory frames and modes of forgetting, or to stay out of it is of great political and ethical import. We first follow this set of arguments through with a case study of the development of NIC and then broaden the discussion out to more general considerations of classification and memory. |
|
|
|
|
|
|
|
|
Nursing Classifications and Organizational Forgetting |
|
|
|
|
|
|
|
|
Nursing is particularly interesting with respect to forgetting. Nursing work has traditionally been invisible, and its traces removed at the earliest opportunity from the medical record. In general, the nursing profession has not been able as an institution to draw on an active archived memory. Rather, nursing has been seen as an intermediary profession that does not need to leave a trace; in accord with traditional gender expectations, nurses are "on call" (Star and Strauss 1999). As nursing informatician Castles notes, citing Huffman on medical records management, "the nursing records are the first to be purged from the patient records; there is thus no lasting documentation of nursing diagnoses or nursing interventions and no method of storage and retrieval of nursing data" (Castles 1981, 42). |
|
|
|
|
|
|
|
|
There was a primal act of clearance in the very establishment of NIC. By clearance we mean a complete wiping away of the past of nursing theory in order to start with a clean slate (we draw here on Serres' (1993) work on clearance and origins in geometry). The nurses said that until now there had been no nursing science and therefore there was no nursing knowledge to preserve. One nursing informatician ruefully noted: "It is recognized that in nursing, overshadowed as it is by the rubrics of medicine and religion, no nurse since Nightingale has had the recognized authority to establish nomenclature or procedure by fiat. There are no universally accepted theories in nursing on which to base diagnoses, and, in fact, independent nursing functions have not yet gained universal acceptance by nurses or by members of other health professions" (Castles 1981, 40). Nursing, it was argued, had until now been a profession without form; nothing scientific could be preserved. There was no way of coding past knowledge and linking it to current practice. A conference was held to establish a standardized nursing minimum data set (information about nursing practice that would be collected from every care facility). It found that "the lists of |
|
|
|
|
|