The role of locally-designed organizational artifacts in supporting nurses' work: an ethnographic study on the wards

INTRODUCTION: This paper aims to describe how nurses' planning and coordination work is performed through the use of locally designed tools (i.e., diaries, planners, reminders, and organizers). These tools are investigated as the materialization of organizational work, thus offering a complementary perspective on nursing practice to that proposed by the professional mandate and supported by official artifacts in use. METHOD: Ethnographic study. RESULTS: By analyzing locally designed artifacts, the rationale that enables nurses to make the flow of activities work is highlighted and explained. Evidence is provided by a description of how nurses' tacit knowledge is reified and embedded into objects produced by the nurses themselves. Implications for the design of digital systems supporting nursing practice are discussed. CONCLUSION: The analysis of these artifacts has allowed an understanding of practices used by the nurses to manage the workflow in the wards.

An Organizational Perspective to the Creation of the Research Field.

The aim of the paper is to contribute to the definition and analysis of the "access to the field" (Feldman et al. 2003) through an inter-organizational perspective. The paper discusses a case study on the access of a researcher to a hospital department where both organizations and actors are shown as actively constructing the research site. Both researcher and participants are described in terms of work organizations originally engaged in parallel systems of activity. Dynamics of negotiation "tied" the different actors' activities in a new activity system where researcher and participants concur to the effectiveness of both organizations (i.e., the research and the hospital ward). An Activity Theory perspective (Leont'ev 1978) is used with the aim of focusing the analysis on the activities in charge to the different actors. The approach adopted introduces the idea that, from the outset, research is made possible by a process of co-construction that works through the development of a completely new and shared work space arising around the encounter between researchers and participants. It is the balance between improvised actions and the co-creation of "boundary objects" (Star and Griesemer 1989), which makes interlacement possible between the two activity systems. The concept of "knotworking" (Engeström 2007a) is adopted to interpret specific actions by both organizations and actors intended to build a knot of activities whereby the new research system takes place.