Book Review

Canada and the United States

By examining technology and its influence on professional boundaries, Margarete Sandelowski opens wide the dissonance between nursing's highly gendered foundation as a caring profession and its search for legitimacy through science and technology. Sandelowski effectively argues that although technology enlarged and blurred professional boundaries between nurses and physicians, perhaps bestowing a false sense of elevated status in the process, nurses entered into a Faustian bargain that sustained their invisibility in the health care system. Although nurses harnessed technology in the hospital and in fact, made possible the introduction of much of the technology used in today's hospitals, the "discursive practices" around these technologies deskilled nursing and further devalued "true nursing."

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Sandelowski structures her argument both chronologically and through conceptual case studies based on patient-care artifacts and particular nursing specialties. Much of her focus rests on the first four to five decades of American nursing (roughly 1890 to the 1940s), although she briefly extends her analysis to the present. Oxygen therapy, the thermometer and stethescope, and "X-Ray" and operating room nursing are some of the exemplars Sandelowski analyzes in wonderful detail. In fact, this book provides one of the first detailed historical treatments of the particulars of nurses' work with the equipment of patient care. The intricacies of ensuring that patients remained warm and dry while undergoing oxygen therapy in a tent-like apparatus not only create a vivid picture of the treatment but also illuminate the complex undocumented decision making nurses used to care for the patient. The book's strength is in the details: they provide a foundation for Sandelowski to support her argument that technology helped sustain nurses' invisibility, because most of the work nurses took on in management of the technology was of low status, and unstated in the medical record or other patient care documents.

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