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a new generation of information technology; it provides strategic resources for clinical nursing practice rather than just support for various nursing tasks. (Zielstorff et al. 1993, 1). |
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This speaks to the progressive denial of process and continuity through the segmentation of nursing practice into activity units. Many argue that to "speak with" databases at a national and international level just such segmentation is needed. The fear is that unless nurses can describe their process this way (at the risk of losing the essence of that process in the description), then it will not be described at all. They can only have their own actions remembered at the price of having others forget, and possibly forgetting themselves precisely what it is that they do. |
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Some nursing informaticians have chosen rather to challenge the existing memory framework in the medical organizations they deal with. They have adopted a Batesonian strategy, responding to the threat of the new information infrastructure by moving the whole argument up one level of generality and trying to supplant data-driven categories with categories that recognize process on their own terms. Thus the Iowa team pointed to the fact that women physicians often spend longer with patients than male doctors; however, these physicians need to see patients less often as a result. The female physicians argue that just such a process-sensitive definition of productivity needs to be argued for and implemented in medical information systems so that nursing work be fairly represented (IIP 6/8/95). They draw from their tacit (because unrepresented) reservoir of knowledge about process to challenge the data-driven models from within. |
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Within this strategy the choice of allies is by no means obvious. Since with the development of NIC we are dealing with the creation of an information infrastructure, the whole question of how and what to challenge becomes very difficult. Scientists can only deal with data as presented to them by their information base just as historians of previous centuries must rely heavily on written traces. When creating a new information infrastructure for an old activity, questions have a habit of running away from one. A technical issue about how to code process can become a challenge to organizational theory and its database. A defense of process can become an attack on the scientific world-view. Susan Grobe, a nursing informatician, has made one of the chief attacks on the NIC scheme. She believes that rather than standardized nursing language, computer scientists should develop natural language processing tools so that nurse narratives can be |
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