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"preparation and delivery of narcotic analgesics into the epidural space;" another common one, "cough enhancement," groups activities designed to help respiration. |
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The Iowa NIC researchers built up their system of nursing interventions inductively. They created a preliminary list that distinguished between nursing interventions and activities, then nurtured a large grassroots network of nursing researchers.
5 This group narrowed the preliminary list of interventions to the original 336 published in NIC and further validated them via surveys and focus groups. Different interventions were reviewed for clinical relevance, and a coding scheme was developed. The classification system grew through a cooperative process, with nurses in field sites trying out categories, and suggesting new ones in a series of regional and specialist meetings. Since 1992 the nurses have added over 50 interventions to their original list. We attended a number of these meetings, and interviewed many of the nurses involved. |
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Caring work such as calming and educating patients, usually done by nurses, often cuts across specific medical diagnostic categories. The NIC investigators use their list of interventions to make visible and legitimate the work that nurses do. The idea is that it will be used to compare work across hospitals, specialties, and geographical areas, and to build objective research measures for the outcomes. NIC, although still relatively young, promises to be a major rallying point for nurses in the decades to come. Before NIC, much nursing work was invisible to the medical record. As one nurse poignantly said, "we were just thrown in with the cost of the room." Another said, "I am not a bed!" The traditional, quintessential nurse would be ever present, caregiving, and helpfulbut not a part of the formal patient-doctor information structure. Of course, this invisibility is bound up with traditional gender roles, as with librarians, social workers, and primary school teachers. |
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But as with the ICD, classifying events is difficult. In the case of NIC, the politics move from a politics of certainty to a politics of ambiguity. The essence of this politics is walking a tightrope between increased visibility and increased surveillance; between overspecifying what a nurse should do and taking away discretion from the individual practitioner. |
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When discretion and the tacit knowledge that is part of every occupation meet the medical bureaucracy, which would account for every pill and every moment of health care workers' time, contradictions |
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