Using artifacts for practices tuning and performance refining. The Nursing Record artifact between affordance and agency: A case study.

Introduction: The paper addresses the role of organizational artifacts in mediating the tacit, implicit and informal knowledge embedded in working practice, routines and taken-for-granted activities. Analyzing organizational artifacts offers the possibility to explore the relationship between affordance and agency in the workplace. Methods. Nowadays, healthcare contexts are forced to engage in ongoing organizational change. The plurality of actors that inhabit health care services cope with pressures for reorganization and are often challenged to update their operational systems. The paper describes an action research which took place in an (Italian public) hospital during a reorganization aimed at changing the paradigm of healthcare delivery. The contribution highlights the main phases of the intervention, focusing on the revision process of the Nursing Record as crucial artifact. Results. Participants tried to make the Record easier, clearer, closer to the patient condition and more connected to the Medical Record. The new Record needed to be effective in identifying the diagnosis, the therapeutic problems and solutions for each patient, and the correct evaluation system requested. Changing the Record, moreover, entailed a professional accountability both as social responsibility for own daily activity and as responsivity to the relational and transactive processes in which practitioners are engaged. Conclusions. Artifacts can be seen as mediating objects that spread knowledge and meanings, thus founding the cooperative actions and the possibility to share working cultures. In this direction, the paper proposes new research paths for inquiring situated experiences of transformative agency and and discusses innovative methodological options for developing training interventions.