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Knowledge, technology and nursing: The case of NHS Direct

Management Centre of the University of Leicester, gerard.hanlon{at}kcl.ac.uk

Tim Strangleman

Working Lives Research Institute, London Metropolitan University, t.strangleman{at}londonmet.ac.uk

Jackie Goode

Jackie.goode{at}nottingham.ac.uk

Donna Luff

School of Health and Related Research at the University of Sheffield, d.luff{at}sheffield.ac.uk

Alicia O’Cathain

Medical Care Research Unit, University of Sheffield, a.ocathain{at}sheffield.ac.uk

David Greatbatch

School of Education at the University of Nottingham,Centre for Developing and Evaluating Lifelong Learning (CDELL), Institute for Research into Learning and Teaching in Higher Education (IRLTHE), _dg{at}greatbatch-associates.co.uk

NHS Direct is a relatively new, nurse-based, 24-hour health advice line run as part of the UK’s National Health Service (NHS). The service delivers health advice remotely via the telephone. A central aspect of the service is the attempt to provide a standard level of health advice regardless of time, space or the background of the nurse. At the heart of this attempt is an innovative health software called CLINICAL ASSESSMENT SYSTEM (CAS). Using a number of qualitative methods, this article highlights how the interaction between the nursing staff and this technology is key to the service. The technology is based on management’s attempt to standardize and control the caller-nurse relationship. Thus the software can be seen as part of an abstract rationality, whereas how it is deployed by nurses is based on a practical rationality that places practice and experience first and sees the technology and protocols as tools.

Key Words: autonomy • forms of rationality • NHS Direct • nursing • objectivity

Human Relations, Vol. 58, No. 2, 147-171 (2005)
DOI: 10.1177/0018726705052179


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