Indeterminacy and technicality revisited: how medicine and nursing have responded to the evidence based movement

Abstract

In 1970 sociologists Jamous and Peloille proposed that occupational work could be understood as a combination of technical activity and indeterminate judgement and that the professions were characterised by high levels of indeterminacy relative to technicality. They argued that groups with low status or on the fringes of powerful professional groups were more likely to promote technically based reform, whereas elites were likely to resist with assertions of indeterminacy. Subsequent writers claimed that their notion of the indeterminacy/technicality ratio was more useful in analysis of professional ideology than in examinations of work content. During the 1990s the evidence based movement exerted a strong influence within the healthcare professions. Medicine and nursing responded in ways that reflected their differing status; however, both reactions included assertions that evidence based practice (EBP) could not take into account the subtle expertise required in daily clinical decision making. This paper argues that Jamous and Peloille's theories about technical reform and professional elites can help to explain responses to EBP. EBP was initially promoted by a relatively low-status speciality of medicine while nursing, as an emerging profession, has shown more enthusiasm for its activities being formalised in a technically based fashion.

Professional autonomy in 21st century healthcare: Nurses’ accounts of clinical decision-making

“…They predicted that a study of how these two types of decision-making affected work would empirically identify ‗genuinely' professional occupations because professional work would feature a high proportion of indeterminacy relative to technicality -their so-called 'I/T ratio'. Their work has been drawn on in recent studies of the medical and nursing professions though their ideas have been applied more to studies of professional rhetoric than decision making in practice (Atkinson et al, 1977;Traynor, 2009). Looking at professional rhetoric it is possible to argue that groups like medicine or nursing face a dilemma.…”

Psychiatric Hospital Nursing Staff's Experiences of Participating in Group-Based Clinical Supervision: An Interview Study

“…The nurses worked within an institutional context characterised by high levels of uncertainty and anxiety, and their professional decision-making was indeterminate rather than technical (Jamous & Peloille, 1970;Traynor, 2009). In many situations, professional decision-making was based on the nurses conforming to social norms for reflection and action, rather than clear-cut technical decision-making (Hamilton & Manias, 2007).…”

Professional practice in contested territory: Child health nurses and maternal sadness

“…Yet occupational groups, including nursing, have resisted the dominance of medicine and distinguished themselves as health professionals. Nursing is thus situated as an emerging profession within health care delivery (Jamous & Peloille, 1970;Traynor, 2009). Nursing's separation from adjacent professions through its recognition of an exclusive knowledge base is part of a dynamic process that Gieryn (1983) described as 'boundary work'.…”