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Operating within the space of erasure that is at once home for them and a threat to their continued existence, the nurses in Iowa have thought long and hard about the politics and philosophy of classifying their activities so that they fit into the hospital's potential memory. They do not want to flip over from being completely invisible to being far too visible. They have decided to name their tasks, but not to name too much at too fine a grain of detail. To this end they have adopted their own practice of continuing partial erasure (where they limit the nature and scope of erasure) for three reasons: |
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From within the exercise of the profession of nursing, to recognize local differences and protect local autonomy (so central to the nursing self-image) while providing the necessary degree of specification for entry into the world of potential memory. They have decided to specify only down to the level of interventions, but to leave the subcategories of activities as relatively fluidseveral possibly contradictory activities are subsumed under a single intervention (see figure 7.1 for example). |
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From within the hospitals of which nursing constitutes one administrative unit, to protect the nurses from too much scrutiny by accountants. It is harder to set off aspects of nursing duties and give them to lower paid adjuncts if that work is relatively opaque. The test sites that are implementing NIC have provided some degree of resistance here. They argue that activities should be specified so that, within a soft-decision support model, a given diagnosis can trigger a nursing intervention of a single, well-defined set of activities. As Marc Berg (1997b) has noted in his study of medical expert systems, such decision support can only work universally if local practices are rendered fully standard. A key professional strategy for nursingparticularly in the face of the ubiquitous process to reengineeris realized by deliberate nonrepresentation in the information infrastructure. What is remembered in the formal information systems resulting is attuned to professional strategy and to the information requisites of the nurses' take on what nursing science is. |
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From an information systems perspective, to ensure that information does in fact get recorded on the spot. There is a brick wall that such systems encounter when dealing with nurses on the hospital floor. If they overspecify an intervention (break it down into too many constituent parts), then it will be seen as an NSS classificationone that is too obvious. The project team sees the classification scheme as having to be very prolix at present; but when the practice of nursing itself is fully standardized, some of the words will be able to wither |
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