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interpreted. Grobe argues for the abandonment of any goal of producing "a single coherent account of the pattern of action and beliefs in science" (Grobe 1992, 92). She goes on to say that "philosophers of science have long acknowledged the value of a multiplicity of scientific views" (92). She excoriates Bulechek and McCloskey, architects of NIC, for having produced work "derived from the natural science view with its hierarchical structures and mutually exclusive and distinct categories" (93). She on the other hand is drawing from cognitive science, library science, and social science (94). Or again, a recent paper on conceptual considerations, decision criteria, and guidelines for the Nursing Minimum Data Set cited Fritjof Capra against reductionism, Steven Jay Gould on the social embeddedness of scientific truth, and praised Foucault for having developed a philosophical system to ''grapple with this reality" (Kritek 1988, 24). Nurse scientists, it is argued, "have become quite reductionistic and mechanistic in their approach to knowledge generation at a time when numerous others, particularly physicists, are reversing that pattern'' (ibid., 27). And nursing has to find allies among these physicists. "Nurses who deliver care engage in a process. It is actually the cyclic, continuous repetition of a complex process. It is difficult, therefore, to sketch the boundaries of a discrete nursing event, a unit of service, and, therefore, a unit of analysis. Time is clearly a central force in nursing care and nursing outcomes. Nurses have only begun to struggle with this factor. It has a centrality that eludes explication when placed in the context of quantum physics" (ibid., 28). The point here is not whether this argument is right or wrong. It is an interesting position. It can only be maintained, as can many of the other possible links that bristle through the nursing informatics literature, because the information infrastructure itself is in flux. When the infrastructure is not in place to provide a seemingly "natural" hierarchy of levels, then discourses can and do make strange connections among themselves. |
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To not be continually erased from the record, nursing informaticians are risking either modifying their own practice (making it more data driven) or waging a Quixotic war on database designers. The corresponding gain is great, however. If the infrastructure is designed in such a way that nursing information has to be present as an independent, well-defined category, then nursing itself as a profession will have a much better chance of surviving through rounds of business process reengineering and nursing science as a discipline will have a firm foundation. The infrastructure assumes the position of Bishop |
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