”The struggle for good numbers”

Nursing staff’s work on electronic health record of patient vital signs

Abstract

In 2013 electronic data-registration was implemented in the Danish health system.This means that nursing staff are to register patients’ vital signs on computers that automatically calculates whether patients are in the process of developing critical illness, and defines after how many hours the measurement of vital signs are to be repeated. Existing medical research argue that the measurements of patient’s vital signs promotes identifi cation of morbidity, but it does not necessarily prevent mortality. The political argument is, however that electronic health measurements reinforces qualifi ed and cost-effective healthcare for patients. In consequence, data-registration has become an increasing focus for hospital managers i Denmark. This article presents an institutional ethnographical inquiry of nursing staffs electronic health measurements of patients’ vital signs in a Danish hospital. It analyzes the nursing staff’s interactions with electronic systems and points out how the introduction of these systems may lead to unintended consequences. In the empirical data for this article, the practice of producing health data, is verbalized by a nurse as: ”The struggle for good numbers”. In busy, overcrowded medical units “good numbers” indicate that patients are not critically ill, and that nursing staffs should not repeat measurements of patients’ scores until after 12 hours. The article show how individual nursing staff aims to construct good numbers in order to create favorable working conditions in their busy work life. The article thus discusses how the ambitions of cost-effective electronic-health monitoring of patients have implications for nursing staff’s work-lives and work-arounds regarding electronic health measurements of patient’s vital signs.