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an observation that "the subject of recordkeeping has probably never been discussed at a convention without some agitated nurse arising to ask if she is expected to neglect her patients to write down information about them . . ." (Martin and Scheet 1992, 21, echoing a 1917 source). And Joanne McCloskey, one of the two principal architects of NIC notes that "the most convincing argument against nursing service or Kardex care plans is the absence of them. Although written care plans are a requirement by the Joint Commission for Hospital Accreditation and a condition for participation in Medicare, few plans are, in fact, written" (McCloskey 1981, 120). In her study of the ICD, Ann Fagot-Largeault (1989) notes the same reluctance on the part of doctors to spend time accurately filling in a death certificate (itself a central tool for epidemiologists) when they might be helping live patients. Thus there is, in Engeström's (1990a) terms, a block between internal memory and external memory. Because representational work takes time, those filling out forms systematically erase the complex representations that they hold in their heads in favor of summary ones. In the case of the ICD, there are many complaints about the quality of data, due to the overuse of general disease terms or "other'' categories. In the case of a computerized NIC, nurses are sometimes suspected by the NIC implementation team of using the choices that appear before them on a screen (which they can elect with a light pen) rather than searching through the system for the apt descriptor (IIP 6/8/95). |
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One of the main problems of nurses is that they are trying to situate their activity visibly within an informational world that has factored them out of the equation. It has furthermore maintained that they should be so excluded, since what nurses do can be defined precisely as that which is not measurable, finite, packaged, or accountable. In nursing theorist Jenkins' terms, "nurses have functioned in the post-World War II era as the humanistic counterbalance to an increasingly technology-driven medical profession" (Jenkins 1988, 92). Nursing informaticians face a formidable task. They have tried to define nursing as something that fits naturally into a world partly defined by the erasure of nursing and other modes of invisible and articulation work. This is parallel with technicians who seek new ways of writing scientific papers in a way that their work is acknowledged, and yet neither the nature of scientific truth nor its division of labor remains intact. |
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Sometimes the nurses are driven for these reasons by their own logic to impeach medical truth. At other times they challenge orthodoxy in organization science, or they seek to restructure nursing so that these |
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