| This research explores the nature of work, work relations, and work environments for ten (10) registered nurses in seven (7) Alberta acute care hospitals. Participants practised in one or more clinical areas including orthopaedics, cardiac or general systems intensive care, neurosciences, operating room, recovery room, diagnostic care, burns, general or cardiovascular surgery, trauma, and labour and delivery. In the study, technology was defined both as the machines, treatments, and products of the health care industry and as characteristic patterns of thinking, relations, and comportment that surface in our daily work. Technology theory and knowledge of ecological restoration were successively used to analyse the nurses' accounts.;In the nurses' accounts of their work, practice settings with a preoccupation for short-term "efficiencies" were also ones where an overall environmental degradation was described. Narrow targets of quicker discharges, more procedures, and "just in time" staffing were frequently pursued despite significant adverse consequences for patients' and practitioners' overall health and well being. Recurring instances were cited where adequate patient monitoring, clinical decisions, scheduling of staff, maintenance of sufficient equipment and supplies, error management, and/or communications and coordination between areas were neglected in order to get more immediate although often unproductive tasks "done". In contrast, participants described a smaller number of practice settings as more supportive of good nursing care. These settings exhibited attributes such as valuing the retention of experienced nursing expertise, consistent presence of unit level clinical leadership, respectful and democratic work relations, consultative redesigns, and error management that was transparent and improvement oriented.;The association between deteriorated or denatured nursing care and degraded work environments parallels several concerns in the field of ecological restoration, where similar technological tendencies threaten efforts to recover and sustain the ecological integrity and health of damaged lands. Knowledge from the nurses' accounts, technology theory, relational ethics, and ecological restoration is synthesised to develop recommendations in the inter-related areas of relations, resistance, and response. Principles of ecological and ethical integrity are used to identify structures, processes, and relations that support good nursing care and the critical questioning of automatic technological practices. The aim of suggested reforms is to foster individual and system-wide capacities for adaptive, self-organising, and self-correcting practices that heal in a complex, biotechnological world. The use of root cause analysis with sentinel events, early warning systems for emerging health technologies, and interdisciplinary projects in research, education, and practice are examined as potential exemplars of healing practices that incorporate principles of ecological and ethical integrity, and areas of further research are proposed. Additional reforms are outlined under the interconnected categories of knowledge development, critique and synthesis of new knowledge, dissemination and practice of what we learn, feedback on knowledge applications, and democratic systems design in health care. |
