Torbjørg Meum

The Pendulum of Standardization

Cooperation and collaboration are generally an inherent part of everyday practice, and particularly among nurses. However, the technologies that support these practices are still inadequate. In this study, we present and discuss the use of classifications in nursing practice, and highlight the collective re-construction of classifications that emerge over time. Specifically, we study how the negotiation between global classifications and local practice takes place with long-term use, and depict this dynamic interaction as a pendulum movement. Furthermore, we characterize this standardization as a collective re-construction grounded in everyday practice. This paper contributes to the body of research on this topic by doing the following: (i) characterizing the process of standardization as a pendulum movement; (ii) drawing out theoretical perspectives for standardization as a collective, emerging accomplishment; (iii) stating the practical implications of our perspective. Finally, we compare the local adjustment (local classifications) discussed in this study with social classifications (social tagging), and suggest how social classification may lead to increased flexibility in the use of classifications.

How does nursing staff perceive the use of electronic handover reports? a questionnaire-based study

Following the implementation of electronic nursing records in a psychogeriatric ward, we examined nursing staffs attitudes and perceptions to the implementation of an electronic handover routine. A web-based anonymous and secure questionnaire was distributed by e-mail to all nursing staff at a psychogeriatric ward at a university hospital. Most respondents were satisfied with the electronic handover, and they believed they managed to keep informed by the new routine. The simultaneous introduction of a morning meeting, to ensure a forum for oral professional discussion, was a success. A minority of staff did not fully trust the information conveyed in the electronic handover, and a significant proportion expressed a need for guidance in using the system. Staff that had a high level of trust in written reports believed these saved time, had little trouble finding time and a place to read the reports, and were more positive to the new handover routine.

The interplay between global standards and local practice in nursing

PURPOSE The paper assesses the extent, form, and transformation of global nursing classifications (NANDA) in a nursing practice during a period of 5 years. METHOD A longitudinal case study was used to trace implementation, adoption and use of nursing classifications as an integral part of an electronic nursing module. A mixed method of data collection was used, including semi-structured interviews, observation and document analysis. RESULTS A surprisingly high proportion of nursing diagnoses was consistent with the global standard, in spite of a gradual increase of user-generated concepts. This is elaborated more thoroughly through a co-constructing perspective, emphasizing how the global standard and the practice mutually shaped each other over several years. CONCLUSION Standardization is an iterative process that is performed in close relationship with practice. The mutual interrelation between formal classifications (NANDA) and local practices are co-constructed in a dynamic interplay that evolves over time. In such a process, the use of local classifications and local strategies can be a means to bridge the gap between these two extreme points.

'Sound of silence'-changing from an oral to a computer-mediated handover

In this article, we study the change from oral to computer-mediated handover among nurses in the psycho-geriatric ward at the University Hospital of Northern Norway. We explore what issues are at stake when introducing written handover to a particular nursing practice. At the core of nursing documentation is the electronic care plan, and we discuss its role and interplay vis-à-vis the other information sources in the ward. Furthermore, we examine the inherent tension between the increased pressure (among nurses) to document on the one hand, and the need to discuss patient issues first on the other. Finally, we discuss how the use of the care plan, video-projector and the newly established morning meeting collectively served as a basis for a new and better collaborative setting for the nurses.