Counting practice: the impact of information systems on community nursing

The act of collecting data is not neutral, it exerts an influence on the activity it is intended to reflect. This paper examines three basic assumptions which underpin the collection of information for minimum data-sets from community nurses, and suggests that influence has the potential to drive practitioners towards a model of practice which is fundamentally flawed. The paper criticizes the use of a single episode of care as the base unit of activity in a long-term, continuing service. It argues that the focus on single individuals as recipients of a service is inappropriate for family- or community-based nursing. Further, it challenges the idea that the complex, multi-faceted and compound interactions encompassed within community nursing practice can be separated into single activities to be counted or measured. It concludes that identified deficiencies in the information systems stem from an inadequate base of theoretical knowledge, and not from personal failings on the part of managers or their staff. It warns that the inappropriate basis for collecting information may promote insensitive and ineffective community nursing practice.