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ensue. This is especially true in the ''softer" areas of care. Social-psychological care giving is one of the areas where this dilemma is prominent. For example, NIC lists as nursing interventions "anticipatory guidance" and "mood management"preparation for grief or surgery. Difficult though these are to capture in a classification scheme, one much more difficult is ''humor." How can one capture humor as a deliberate nursing intervention? Does sarcasm, irony, or laughter count as a nursing intervention? When do you stop? How to reimburse humor, how to measure this kind of care? No one would dispute the importance of humor, but it is by its nature a situated and subjective action. A grey area of common sense remains for the individual staff nurse to define whether some of the nursing interventions are worth classifying. |
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There are continuing tensions within NIC between just this kind of common sense and abstracting away from the local to standardize and compare, while at the same time rendering invisible work visible. Nurses' work is often invisible for a combination of good and bad reasons. Nurses have to ask mundane questions, rearrange bedcovers, move a patient's hand so that it is closer to a button, and sympathize about the suffering involved in illness. Bringing this work out into the open and differentiating its components can mean belaboring the obvious or risking being too vague. |
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One of the battlefields where comparability and control appear as opposing factors is in linking NIC to costs. NIC researchers assert that the classification of nursing interventions will allow a determination of the costs of services provided by nurses and planning for resources needed in nursing practice. As the nurse above says, nursing treatments are usually bundled in with the room price. NIC is used in the development of nursing health care systems and may provide a planning vehicle for previously untracked costs. As we shall see, NIC can also be problematic for nurses. Like any other classification scheme that renders work visible, it can also render surveillance easierand it could in the end lead to a Tayloristic dissection of the tasks of nursing (as the NIC designers are well aware). So-called unskilled tasks may be taken out of their hands and the profession as a whole may suffer a loss of autonomy and the substitution of rigid procedure for common sense. |
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As in the case of the ICD, there are many layers of meaning involved in developing and implementing nursing classification. NIC might look like a straightforward organizational tool: it is in fact much more |
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