Nurses’ knowledge and deliberations crucial to Barcoded Medication Administration technology in a Dutch hospital: Discovering nurses’ agency inside ruling

Abstract

This article shows how Barcoded Medication Administration technology institutionally organizes and rules the daily actions of nurses. Although it is widely assumed that Barcoded Medication Administration technology improves quality and safety by reducing the risk of human error, little research has been done on how this technology alters the work of nurses. Drawing on empirical and conceptual strategies of analysis, this qualitative study used certain tools of institutional ethnography to provide a view of how nurses negotiate Barcoded Medication Administration technology. The approach also uses elements from practice theory in order to discern how technology operates as a player on the field instead of being viewed as a 'mere' tool. A literature review preceded participant observation, whereby 17 nurses were followed and data on an orthopaedic ward were collected over a period of 9 months in 2011 and 2012. Barcoded Medication Administration technology relies on nurses' knowledge to mediate between the embedded logics of its design and the unpredictable needs of patients. Nurses negotiate their own professional logic of care in the form of moment-to-moment deliberations which subvert the ruling frame of the barcoded system and its objectified model of patient safety. The logic of Barcoded Medication Administration technology differs from the logic of nursing care, as this technology presumes medication distribution to be linear, even though nurses follow another line of actor-bound safety practices that we characterize as 'deliberations'.

An integrative literature review and critical reflection on nurses' agency

“…Meanwhile, other researchers addressed the idea of agency as a capacity for action. This included forms of action embodied in the voice that nurses deploy in social interactions with other healthcare professionals (Caronia & Saglietti, 2018 ), in nurses' practices enacted in the healthcare organizations where they work (Boonen et al, 2020 ; Chulach & Gagnon, 2016 ; Goodman, 2017 ; Hardcastle et al, 2005 ; Nairn & Pinnock, 2017 ; Nairn, 2009 ; Williams et al, 2016 ) or in nurses' political and ethical consciousness of the complex web of power they are entangled in and the practices within which they are engaged (McMillan & Perron, 2020 , 2021 ; Perron, 2013 ).…”

“…Agency appeared in the literature reviewed addressed by some researchers as a concept that was detached from its theoretical or philosophical foundations (Attree, 2005 ; Boonen et al, 2020 ; Caronia & Saglietti, 2018 ; Pecanac & Schwarze, 2018 ). However, most of the researchers of the studies included structured and supported their claims in a theoretical framework that undergirded their thinking with regard to how they understood and planned to explore a topic of interest and how this topic was intertwined with the idea of agency.…”

“…This researcher discussed nurses' constraints over their own professional accountability, responsibility, authority, autonomy, control, influence and power, and voice and choice, in their relationship with nurses' perception of nursing care quality. In Boonen et al ( 2020 ), the idea of agency was also used in its relationship with the structure to explore how technology influences and organizes nurses' practices, discourse, and knowledge around the use of medication administration technologies in healthcare organizations. Therefore, this idea was applied by the authors in the clinical context and only mobilized to ensure patient safety.…”

Social acceleration, alienation, and resonance: Hartmut Rosa's writings applied to nursing

“…Nurses strive to provide the best possible patient care despite the contemporary forces affecting them and the working conditions in which they practice. To this end, they enact their political agency in an attempt to challenge the institutional status quo that keeps them static in healthcare organizations (Attree, 2005; Boonen et al, 2020; Chulach & Gagnon, 2016; Goodman, 2017; McMillan & Perron, 2020; Perron, 2013). Rosa's works on resonance may contribute, in this sense, to explore alternative forms of being‐in‐the‐world for nurses and alternative forms of the institutional order nurses inhabit (Rosa, 2019).…”

Documenting patient risk and nursing interventions: record audit

“…16 In contrast, a system unable to capture and communicate nursing processes can force nurses to create 'workarounds' which involve documentation outside of the formal system. 17,18 These workarounds reflect a failure of the documentation system to accurately reflect the nursing process and support nurses' work. In addition to service and care inefficiencies the authors argue that such workarounds prevent organisational learning about nursing work, 19,20 the long-term consequences of which are negative impacts on the quality and safety of patient care.…”