By Ministry of Information Photo Division Photographer [Public domain], via Wikimedia Commons
This poses a challenge when you are trying to implement electronic record systems to support the practice of nursing. Electronic systems respond well to lists and tables, check boxes and drop down lists. This is why electronic record systems meet our needs in terms of risk assessment and listing things but perhaps are less well able to respond to the more complex and less visible work of nurses.
Traditionally software systems are created based on what could be called ‘user requirements’. But if the users can’t clearly articulate what they need, then the developers will struggle to respond. In my experience nurses can describe a risk assessment form and probably paper forms they use but really struggle to describe the more complex aspects of what they do. The result? System developers develop task based record systems that drive nurses towards the less complex work and fail to record the more complex and less visible work of nurses.
The work by Davina Allen – The invisible work of nurses: hospitals, organisation and healthcare (2014) – should start us to think more about how we describe the complex work we do but it’s a challenging conversation – complex and abstract and we are often too busy to engage. Allen says: ‘Nurses, it is argued, can be understood as focal actors in health systems and through myriad processes of ‘translational mobilisation’ sustain the networks through which care is organised.’
Perhaps it’s time to look again at the models of nursing we build systems on. Nursing care planning doesn’t do it for me, again it drives us to simplify and describe what we do merely as a set of tasks. Perhaps natural language processing is likely to offer more to nurses than we might think and we should engage with the developers of these type of solutions and resist the drive towards solutions that push us towards over simplification.
I would argue that not everything we do can be entered as structured text of check boxes. If we do this pushes us towards task based thinking. We need better than this if we are to really recognise what nursing really is and build the electronic record systems nurses deserve.
Allen, Davina Ann 2014. The invisible work of nurses: hospitals, organisation and healthcare. New York: Routledge.
anniecoops 
Thought provoking piece once again Anne! Only this afternoon I had a conversation with a developer about clinical content development who said ‘ oh you mean a checklist?’ No I didn’t mean a checklist – your blog describes perfectly the difficulties articulating care delivery & decision making in practice
Great article Anne, “invisible work” is a big problem in public perception of what nurses do. Users may not know what they need but excluding them leads to a system/service they cannot use. All stakeholders need to be involved in the conversation and sometimes all it takes is a facilitator to create the opportunity. Patients Know Best in the UK have a great system from admission to self management, it allows nurses more time to concentrate on their patients instead of stacks of paperwork and creates an environment of positive communication for all involved in healthcare, nurses, consultants, GP’s, alternative health and patients. Rachel