Abstract
The paper contributes to the conceptualisation of "integrated care" in heterogeneous work practices. A dynamic perspective is developed, emphasising how integrated care is malleable, open, and achieved in practice. Furthermore, we explore the role of nursing plans in integrated care practices, underscoring the inherent difficulties of building one common infrastructural system for integrated care. Empirically, we studied the implementation of an electronic nursing plan in a psychiatric ward at the University Hospital of North Norway. We conducted 80 hours of participant observation and 15 interviews. While the nursing plan was successful as a formal tool among the nurses, it was of limited use in practice where integrated care was carried out. In some instances, the use of the nursing plan even undermined integrated care. Integrated care is not a constant entity, but is much more situated and temporal in character. A new infrastructural system for integrated care should not be envisioned as replacing most of the existing information sources, but rather seen as an extension to the heterogeneous ensemble of existing ones.
Highlights
The health care sectors in all Western countries are profoundly fragmented across technical, organisational and professional boundaries
We explore the role of nursing plans in integrated care practices, underscoring the inherent difficulties of building one common infrastructural system for integrated care
Empirically, we studied the implementation of an electronic nursing plan in a psychiatric ward at the University Hospital of North Norway
Summary
The health care sectors in all Western countries are profoundly fragmented across technical, organisational and professional boundaries. Nurses are often referred to as the ones ‘‘who weave together the many facets of the whealth carex service and create order in a fast flowing and turbulent work environment’’ w20x Their associated tool, the nursing plan, is bound to play a key role in strategies for integrated care: wThe nursing plan’sx primary purpose is to ensure the individuality and continuity of care («) When documentation is accurate, individual, pertinent and up-to-date, it promotes consistency and effective communication between nurses and the other team members involved in care. One explanation may be that the ‘‘nursing process is thought to be time-consuming to document’’ and its value was questioned w25x Both the contested nature of integrated care and the (not yet fulfilled) potential of nursing plans in contributing to coherent care for patients serve as a basis for our empirical investigation and analysis
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