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requirements of the information infrastructure. In her study of nursing information systems in France, Ina Wagner speaks of the gamble of computerizing nursing records, "Nurses might gain greater recognition for their work and more control over the definition of patients' problems while finding out that their practice is increasingly shaped by the necessity to comply with regulators' and employers' definitions of 'billable categories'" (Wagner 1993, 7). Indeed, a specific feature of this "thought world" into which nurses are gradually socialized through the use of computer systems is the integration of management criteria into the practice of nursing. Wagner continues: "Working with a patient classification system with time units associated with each care activity enforces a specific time discipline on nurses. They learn to assess patients' needs in terms of working time."
45 This analytic perspective is shared by the Iowa nurses. They argue that documentation is centrally important; it not only provides a record of nursing activity but also structures the activity at the same time: |
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While nurses complain about paperwork, they structure their care so that the required forms get filled out. If the forms reflect a philosophy of the nurse as a dependent assistant to the doctor who delivers technical care in a functional manner, this is the way the nurse will act. If the forms reflect a philosophy of the nurse as a professional member of the health team with a unique independent function, the nurse will act accordingly. In the future, with the implementation of price-per-case reimbursement vis-à-vis diagnosis related groups, documentation will become more important than ever. (Bulechek and McCloskey 1985, 406) |
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As the NIC classification has developed, observes Joanne McCloskey, the traditional category of "nursing process" has been replaced by "clinical decision making plus knowledge classification." And in one representation of NIC that she produced, both the patient and the nurse had dropped entirely out of the picture (both were, she said, located within the "clinical decision making box" on her diagram) (IIP 6/8/95). A recent book about the next generation nursing information system argued that the new system: |
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cannot be assembled like a patchwork quilt, by piecing together components of existing technologies and software programs. Instead, the system must be rebuilt on a design different from that of most approaches used today: it must be a data-driven rather than a process-driven system. A dominant feature of the new system is its focus on the acquisition, management, processing, and presentation of "atomic-level" data that can be used across multiple settings for multiple purposes. The paradigm shift to a data-driven system represents |
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