Department of Public Health, Aarhus University, Aarhus C, Denmark.
Nurs Inq. 2023 Jan;30(1):e12499. doi: 10.1111/nin.12499. Epub 2022 May 10.
Historically, recordkeeping has been an essential task for health professionals. Today, this mandatory task increasingly takes place as digital documentation. This study critically examines problem constructions in practical documents on digital documentation strategies in Danish municipal healthcare and how these problem constructions imply particular solutions. A document analysis based on the approach presented in Bacchi's "What's the problem represented to be?" was applied. Forty practical documents in the form of guidelines, strategies, and quality control documents were included. The analysis uncovered three problem representations: lack of coherence between health services in a complex healthcare system, lack of assessable data for management and political prioritization, and inefficiency in the healthcare system. The proposed solution is a digitalized and standardized practice that transforms recordkeeping in the municipalities. However, municipal healthcare is at risk of being fragmented due to digital documentation's focus on the organizational management of health with task-oriented practices supplied by an anonymous health professional. We find that digital documentation functions as an organizational micromanagement approach that assigns the health professional a subject position as an employee acting according to the organization's framework rather than the profession's normative framework.
从历史上看,记录保存一直是卫生专业人员的一项基本任务。如今,这项强制性任务越来越多地以数字文档的形式进行。本研究批判性地考察了丹麦市立医疗保健中数字文档策略的实际文件中的问题构建,以及这些问题构建如何暗示特定的解决方案。应用了基于 Bacchi 的“所代表的问题是什么?”提出的方法进行文档分析。包括 40 份以指南、策略和质量控制文件形式的实际文件。分析揭示了三种问题表现:复杂医疗体系中卫生服务之间缺乏一致性、管理和政治优先事项缺乏可评估数据以及医疗体系效率低下。建议的解决方案是将市政记录保存转化为数字化和标准化的实践。然而,由于数字文档侧重于通过面向任务的实践对卫生进行组织管理,并且由匿名卫生专业人员提供,因此市立医疗保健有被分割的风险。我们发现,数字文档作为一种组织微观管理方法,将卫生专业人员分配到一个员工的主体地位,根据组织的框架而不是专业的规范框架行事。