Care on Paper

The aim of this project is to consider how a particular kind of document, the nursing record, has developed and been applied in hospital care. The investigation will to a large extent deal with records written on paper, which elicits paying attention to the particular qualities of forms, and charts, as paper-technologies, as well as the bureaucratic practices of reading and writing conducted by nurses. Another central point of departure is to ask how the records have been submerged in the (ongoing) development of ideas about a particular kind of work, and accordingly a certain kind of knowledge about patients, namely nursing. Throughout the tentative time period I propose here increasing attention was put to how ‘nursing knowledge’ could serve as an humane addendum to biomedicine, and as a means to ensure more ‘holistic’ care in the hospital, and beyond.
The medical record, or patient record, is a central tool in 20th century standardisation of health care, regardless of institution/profession. In this study I propose a slightly different vantage point than studies of the record as the ‘epistemological precondition’ of various forms of medical knowledge. For, standardisation and documentation of nursing work has been seen as both an imperative from above, and a vehicle for ‘making scientific’ and ‘making visible’. This entails ideas about how documentation systems render certain kinds of work, and knowledge, visible, and a questioning of what this visibility has entailed, for those who have been subjected to documentation, which in this case involves both nurses and patients in various configurations.
What is central here is the move to create and continuously attempt to standardise a distinct area of health care which is not medicine, but nursing, or care even. The nursing record documents both a certain kind of work, and a particular type of information about patients. I propose to do this by looking into both the processes of standardisation as they appear in state- initiated standardisation bodies responsible for record-keeping systems in health care, and by investigating the more internal debates on documentation and recording in the professional bodies of nurses in the years in question (1940-1990).
I do, however, want to stress that ‘the nursing record’ is a construct at this point, it does not appear in any of the material I have made tentative entries into, but can be understood for the purpose of this text as a plethora of different forms, charts, and notes in which nurses have written about patients. Much of the paper-work carried out by nurses resulted in forms and charts that were treated as temporary and disposable, and some even written with pencil so that the record could be continuously altered.
The project is, at this point, situated within the context of two explicit welfare state building projects, in Sweden and Norway, and allows for a broader questioning of the consequences/technicalities of the material practices of managing and shaping knowledge about citizens through particular formats. The investigation also touches upon practices of recording in early computerized records, and is thus heavily invested in the ramifications, or privileging, of different, and in this case shifting, kinds of formats in the venture to generate, collect, and store knowledge on patients.