Abstract
We present an institutional ethnography of hospital-based psoriasis day treatment in the context of evaluating readiness to supplement services and support with a new web site. Through observation, interviews and a critical consideration of documents, forms and other textually-mediated discourses in the day-to-day work of nurses and physicians, we come to understand how the historical gender-determined power structure of nurses and physicians impacts nurses’ work. On the one hand, nurses’ work can have certain social benefits that would usually be considered untenable in traditional healthcare: nurses as primary decision-makers, nurses as experts in the treatment of disease, physicians as secondary consultants, and patients as co-facilitators in care delivery processes. However, benefits seem to have come at the nurses’ expense, as they are required to maintain a cloak of invisibility for themselves and for their workplace, so that the Centre appears like all other outpatient clinics, and the nurses do not enjoy appropriate economic recognition. Implications for this negotiated invisibility on the implementation of new information systems in healthcare are discussed.
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Acknowledgements
Dr. Winkelman is recipient of a post-doctoral fellowship from the Institute for Health Services and Policy Research of the Canadian Institutes for Health Research (CIHR) and from the CIHR Strategic Research Program in Health Care, Technology and Place (HCTP) at the University of Toronto. This research project was conducted with financial support from the Canadian Dermatology Foundation (CDF).
The authors acknowledge the following contributors to the research project: Ms. Tari Shear (research associate), Dr. Neil Shear (co-principal investigator), Dr. Patricia McKeever (editorial review), and most significantly, the nurses, staff and physicians at The Centre.
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J. Winkelman, W., V. Davis Halifax, N. Power is Only Skin Deep: An Institutional Ethnography of Nurse-Driven Outpatient Psoriasis Treatment in the Era of Clinic Web Sites. J Med Syst 31, 131–139 (2007). https://doi.org/10.1007/s10916-006-9048-6
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DOI: https://doi.org/10.1007/s10916-006-9048-6