Transforming Work Practices in a Complex Environment

Nursing work is intertwined with a number of technologies. This paper explores the work practices in a pediatric intensive care unit, and discusses some possible directions for introducing new technologies. Work in intensive care is approached as a set of complex and networked practices that are characterized by dynamism and reflexivity of situated action. We observed how, in the intensive care unit, the emerging issues and complexity of organizational action are anticipated with situational adaptability and self-ordering of action. Although the nurses are capable of adapting to rapidly changing situations, at the same time, the nursing practices are bounded by the situational rationalities, such as the information available on the patient. With new technologies, we see several opportunities for change in time-place arrangements, in coordination and communication practices, and in information sharing practices. The roles and tasks of the various actants may reformulate, and thereby possibly their skills and professional identities as well. All of this will take place when work practices, new technologies, and care processes are negotiated and made irreversible through the actions of the participants.