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The role of locally-designed organizational artifacts in supporting nurses' work: and ethnographic study on the wards

Alessandra Talamo, Barbara Mellini, Barbara Barbieri


Introduction: This paper aims to describe how nurses’ planning and coordination work is performed through the use of locally designed tools (i.e., diaries, planners, reminders, and organizers). These tools are investigated as the materialization of organizational work, thus offering a complementary perspective on nursing practice to that proposed by the professional mandate and supported by official artifacts in use.

Method: Ethnographic study.

Results: By analyzing locally designed artifacts, the rationale that enables nurses to make the flow of activities work is highlighted and explained. Evidence is provided by a description of how nurses’ tacit knowledge is reified and embedded into objects produced by the nurses themselves. Implications for the design of digital systems supporting nursing practice are discussed.

Conclusion: The analysis of these artifacts has allowed an understanding of practices used by the nurses to manage the workflow in the wards.

Keywords: locally designed artifacts, organizational artifacts, nursing, ethnography.

Il ruolo dei “Locally Designed artifacts” nel lavoro infermieristico: uno studio etnografico in reparto

Introduzione: il presente contributo si propone di descrivere le funzioni di alcuni strumenti “locally designed”, non sostenuti istituzionalmente, che supportano il lavoro quotidiano degli infermieri nei reparti ospedalieri. Questi strumenti, concepiti come artefatti organizzativi, possono essere considerati come “prodotti” del lavoro degli infermieri per la gestione del reparto nella sua complessità organizzativa. Tali artefatti sono dunque in grado di offrire una diversa prospettiva circa le pratiche lavorative degli infermieri in reparto, che potremmo definire “complementare” rispetto a quella “tradizionale” proposta dal mandato professionale degli infermieri (centrata sulla relazione di cura con il paziente) e sostenuta da artefatti istituzionali (es. la cartella clinica).

Metodo: studio etnografico.

Risultati: i risultati, discussi alla luce dell’Activity Theory, hanno evidenziato la necessità di sviluppare un nuovo dialogo in merito al lavoro degli infermieri in reparto, che tenga conto delle reali attività svolte, per la progettazione di nuovi strumenti organizzativi a supporto delle medesime.

Conclusioni: l’analisi di questi artefatti ha consentito, da una parte, l’emergere delle logiche e dei significati co-costruiti e attribuiti al “fare” organizzativo, dall’altra la comprensione delle prassi di cui si avvalgono gli infermieri per gestire i flussi di lavoro in reparto.

Parole Chiave: artefatti “locally designed”, artefatti organizzativi, professione infermieristica, etnografia.

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Riferimenti bibliografici

Aiken, L., Clarke, S., Sloane, D., and Sochalski, J. (2001). An international perspective on hospital nurses’ work environments: The case for reform. Policy, Politics, and Nursing Practice, 2(4), 255-263.

Allen, D. (1997). The nursing–medical boundary: a negotiated order. Sociology of Health and Illness, 19(4), 498–520.

Allen, D. (2001). The Changing Shape of Nursing Practice: The Role of Nurses in the Hospital Division of Labour. London: Routledge.

Allen, D. (2002). Time and space on the hospital ward: shaping the scope of nursing practice. In D. Allen and D. Hughes (Eds.) Nursing and the Division of Labour in Health Care (pp. 23–51). Basingstoke: Palgrave Macmillan.

Allen, D. (2004). Re-reading nursing and re-writing practice: towards an empirically based reformulation of the nursing mandate. Nursing Inquiry, 11(4), 271–283.

Allen, D. (2014). Re-conceptualising holism in the contemporary nursing mandate: from individual to organisational relationships. Social Science & Medicine, 119, 131–138.

Atkinson. P., Coffey, A., Delamont, S., Lofland, J., and Lofland, L. (2001). Handbook of Ethnography. London: Sage.

Bardram, J. (1998). Collaboration, coordination and computer support: an activity theoretical approach to the design of computer supported cooperative work (doctoral dissertation). Aarhus University, Denmark.

Bardram, J. (2000). Computer Supported Cooperative Work (CSCW), 9(2), 157–187.

Bardram, J., and Bossen, C. (2005). Mobility work: the spatial dimension of collaboration at a hospital. Computer Supported Cooperative Work (CSCW), 14(2), 131–160.

Bertelsen, O. W., and Bodker, S. (2003). Activity Theory. In Carroll, J. M. (Ed.). HCI Models, Theories, and Frameworks. Morgan Kaufman Publishers, San Francisco, pp. 291-324.

Bjorn, P., and Hertzum, M. (2011). Artifactual multiplicity: a study of emergency-department whiteboards. Computer Supported Cooperative Work (CSCW), 20(1&2), 93–121.

Bodker, S. (1991). Through the Interface - A Human Activity Approach to User Interface Design. Lawrence Erlbaum Associates, Hillsdale (NJ)

Button, G., and Sharrock, W. W. (1995). Practices in the work of ordering software development. In A. Firth (Ed.) Negotiations in The Workplace: Studies of Language in the Workplace. New York, NY: Pergamon, pp. 159–180.

Button, G., and Sharrock, W.W. (1997). The production of order and the order of production. In J. Hughes, W. Prinz, T. Rodden, and K. Schmidt (Eds.) Proceedings of the Fifth European Conference on Computer Supported Cooperative Work. Dordrecht, Netherlands: Kluwer Academic Publishers, pp. 1–16.

Currie G., Finn R., and Graham M. (2010). Role transition and the interaction of relational and social identity: new nursing roles in the English NHS. Organization Studies, 31(7), 941–961.

Dingwall, C., and Allen, D. (2001). The implications of healthcare reforms for the profession of nursing. Nursing Inquiry, 8(2), 64–74.

Dingwall, R., Rafferty, A. M., and Webster, C. (1998). An Introduction to a Social History of Nursing. London: Routledge.

Duke, K. (2002). Getting Beyond the “Official Line”: Reflections on Dilemmas of Access, Knowledge and Power in Researching Policy Networks, Journal of Social Policy 31(1): 39–59.

Duranti, A. (1992). Etnografia del Parlare quotidiano. Roma: NIS.

Engeström, Y. (1990). Learning, Working, and Imagining: Twelve Studies in Activity Theory. Helsinki: Orienta-Konsulit.

Engeström, Y. (1993). Developmental studies on work as a test bench of activity theory. In S. Chaiklin and J. Lave, (Eds.) Understanding Practice: Perspectives on Activity and Context. Cambridge: Cambridge University Press.

Engeström, Y. (1995). Objects, contradictions and collaboration in medical cognition: an activity-theoretical perspective. Artificial Intelligence in Medicine, 7(5), 395–412.

Engeström, Y. (2007). From communities of practice to mycorrhizae. In J. Hughes, N. Jewson and L. Unwin (Eds.), Communities of practice: Critical perspectives. London: Routledge, 41–54.

Engeström, Y., Engeström, R., and Vähäaho, T. (1999) When the center does not hold: The importance of knotworking. In Hedegaard M, Chaiklin S. and Jensen U. J. (Eds.) Activity theory and social practice: Cultural-historical approaches. Aarhus: Aarhus University Press.

Engeström, Y., Miettinen, R., and Punamaki, R. (1999). Perspectives on Activity Theory (Learning in Doing Social, Cognitive and Computational Perspectives). Cambridge University Press, Cambridge.

Gerson, E. M., and Starr, S. L. (1986). Analyzing due process in the workplace. ACM Transactions on Office Information Systems, 4(3), 257–270.

Goodrick, E., and Reay, T. (2010). Florence Nightingale endures: Legitimizing a new professional role identity. Journal of Management Studies, 47(1), 55–84.

Halverson, R. (2003). Systems of practice: how leaders use artifacts to create professional community in schools. Education Policy Analysis Archives, 11(37).

Halverson, R., and Zoltners, J. (2001). Distribution across artifacts: how designed artifacts illustrate school leadership. Seattle, WA: The American Educational Research Association Conference.

Harris, J. (1997). Surviving Ethnography: Coping with Isolation, Violence and Anger, The Qualitative Report, 3(1), 1–13.

Heath, C., and Luff, P. (1992). Collaboration and control: crisis management and multimedia technology in London Underground control rooms. CSCW Journal 1(1), 69–94.

Heath, C., Svensson, M. S., Hindmarsh, J., Luff, P., and Vom Lehn, D. (2002). Configuring awareness, Computer Supported Cooperative Work (CSCW), 11(3), 317–347.

Hill, S. (2004). Doing Collaborative Research: Doing what Feels Right and Makes Sense, International Journal of Social Research Methodology. 7(2), 109–26.

Hill, M. C. (2006). Representin(g) Negotiating multiple roles and identities in the field and behind the desk, Qualitative Inquiry. 12(5), 926–949.

Hunt, S. A. (1984). The development of rapport through the negotiation of gender in field work among police. Human Organization, 43(4), 283–294.

Iley, K. (2004). Occupational changes in nursing: the situation of enrolled nurses. Journal of Advanced Nursing 45(4), 360–370.

Johnson, M., Cowin, L. S., Wilson, I., and Young, H. (2012). Professional identity and nursing: contemporary theoretical developments and future research challenges. International nursing review, 59(4), 562-569.

Jordan, B. (1996). Ethnographic workplace studies and CSCW. In D. Shapiro, R. Traunmüller, and M. G. Tauber (Eds.) The Design of Computer Supported Cooperative Work and Groupware Systems. Amsterdam: Elsevier Science.

Kaptelinin, V. (2013). Activity theory. In M. Soegaard and D. Rikke Friis (Eds.) The Encyclopedia of Human-Computer Interaction (2nd ed). Aarhus, Denmark: TheInteraction Design Foundation.

Kaptelinin, V., and Nardi, B. A. (2012). Activity Theory in HCI: Fundamentals and Reflections. Morgan and Claypool, Carleton.

Leong, Y. M. J., and Crossman, J. (2015). New nurse transition: success through aligning multiple identities. Journal of health organization and management, 29(7), 1098–1114.

Liberati, E. G., Gorli, M., and Scaratti, G. (2015). Reorganising hospitals to implement a patient-centered model of care: Effects on clinical practice and professional relationships in the Italian NHS. Journal of health organization and management, 29(7), 848–873.

Lundby, K. (2007). Interdisciplinarity and Infrastructure: Mediation and Knotworking in Communication Research, Nordicom Review, Vol. 28, pp. 195–209.

Mellini, B., Giorgi, S., and Talamo, A. (2014), Soglie, scene, spazi e artefatti come strumenti di conoscenza dell’organizzazione, Studi Organizzativi, 97- 125

Mulhall, A. (2003). In the field: notes on observation in qualitative research. Journal of Advanced Nursing, 41(3), 306–313.

Murphy, E., and Dingwall, R. (2001). ‘The Ethics of Ethnography’, in P. Atkinson, A. Coffey, S. Delamont, J. Lofland and L. Lofland (eds) (2001) Handbook of Ethnography. London:Sage.

Nardi, B. A. (1996). Context and Consciousness: Activity Theory and Human-Computer Interaction. Boston, MA: The MIT Press.

Newman, M. (1986). Health as Expanding Consciousness. St Louis, MO: Mosby.

Norman, D. A. (1988). Psychology of Everyday Things. New York, NY: Basic Books.

Parse, R. R. (1981). Man–Living–Health: A Theory of Nursing. New York, NY: Wiley.

Pedditzi, M. L., Nonnis, M., and Barbieri, B. (2013), Doctor-child relationship and burnout risk in pediatrics: A qualitative research. Medico e Bambino, vol. 32(5), pp. 308-312

Reeves, C. L. (2010). A difficult negotiation: Fieldwork relations with gatekeepers. Qualitative Research, 10(3), 315–331.

Sachs, P. (1995). Transforming work: collaboration, learning and design. Communications of the ACM, 38(9), 36–44.

Schmidt, K. (2002). The problem with ‘awareness’: introductory remarks on ‘awareness in CSCW’. Computer Supported Cooperative Work (CSCW), 11(3), 285–298.

Schmidt, K., and Simone, C. (1996). Coordination mechanisms: towards a conceptual foundation of CSCW systems design. Computer Supported Cooperative Work (CSCW), 5(2-3), 155–200.

Scott, S.D. (2008) ‘New professionalism’ – shifting relationships between nursing education and nursing practice. Nurse Education Today, 28(2), 240–245.

Simon, H. A. (1986). The Science of the Artificial. Cambridge, MA: The MIT Press.

Strauss, A. (1985). Work and the division of labor. The Sociological Quarterly, 26(1), 1–19.

Suchman, L. A. (1987). Plans and Situated Actions. Cambridge: Cambridge University Press.

Talamo, A., Mellini, B., Camilli, M., Ventura, S., and Di Lucchio, L. (2016). An Organizational Perspective to the Creation of the Research Field. Integrative Psychological and Behavioral Science, 1–19.

Talamo, A., Mellini, B., Ventura, S., and Recupero, A. (2015). Studying practices to inform design: organizational issues and local artifacts.In Bruni, A., Parolin, L.L. and Schubert, C. (eds), Designing technology, work, organisations and viceversa. Wilmington, Vernon press. pag. 71-113.

Tyler, S. (1986). Post-Modern Ethnography: From Document of the Occult to Occult Document, in J. Clifford and G. Marcus (eds.) Writing Culture. Berkeley, CA: University of California Press, pp. 122–40.

Wall, S. (2010). Critical perspectives in the study of nursing work. Journal of health organization and management, 24(2), 145-166.

Wartofsky, M. W. (1979). Models: Representation and Scientific Understanding. Boston, MA: Reidel.

Watson, J. (1979). Nursing: The philosophy and Science of Caring. Boston, MA: Little, Brown.


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