Devices & Desires: Gender, Technology, and American Nursing (review)

Margarete Sandelowski. Devices & Desires: Gender, Technology, and American Nursing. Studies in Social Medicine. Chapel Hill: University of North Carolina Press, 2000. xvii + 295 pp. Ill. $45.00 (cloth, 0-8078-2579-4), $19:95 (paperbound, 0-8078-4893-X).

This book merits an extended review within a longer essay, where it could be measured against other important recent works in nursing history,¹ or related books in history of medicine,² or the two great 1980s monographs on the history of the American hospital.³ In a standard scholarly review, though, there is little point in doing more than describing its contents and adding that it is a first-rate book that anyone interested in health care should be familiar with.

Devices & Desires can help set standards for health professionals who wish to use their own experience to illuminate historical issues. It is rooted in nursing practice and nurse education, but its reach is broad. Not merely a book on nursing and technology, it is a work on the political, social, economic, and cultural ramifications of the relationship between the two. Its first chapter starts with the notion of the nurse herself as a technology, "the doctor's hand," a worker whose instrumental value lies in her accessibility to those of higher social status in their work. This theme reappears throughout the book and is complicated as nurses are shown as technological innovators, curmudgeons, and--most interestingly--partners. In this last role, which Sandelowski links to Donna Haraway's conception of the "cyborg," the nurse must confront her relationship with technology most directly.

In the remainder of chapter 1, Sandelowski orients the reader to what she hopes to demonstrate (about nursing, about gender, and about technology) and the types of sources she has utilized. Chapter 2 is a crash course in technology studies, and as such, in twenty-two pages, it is superb. Chapter 3 explores the evolving relationship between the nurse and her tools during the low-tech period that ended with World War II, and the establishment of nursing as primarily a hospital-based activity. Chapter 4 concentrates on nurses as "the physician's eyes," examining the nurse herself both as tool in visualization, and as user of artifices designed for visualization. Particularly useful in this chapter is Sandelowski's discussion of nursing as a way-station in the descent of clinical thermometry into a household practice. Chapter 5 enters the "high-tech" era, and addresses issues of de-skilling, job categories subordinate to nursing, and the nature of care and caring. Chapter 6, the final chapter based in empirical work, is a magnificent study of fetal monitoring and the cultural context in which it has evolved. Sandelowski concludes by revisiting the nursing/technology relationship and the question of how technology has affected the traditional distinction between the diagnostic and therapeutic work of the physician, on the one hand, and the caring work of the nurse, on the other.

It would be nit-picking to criticize this book for its omissions, except for the peculiar absence of any allusion to race. Given the segregated structure of American nursing (other than public health nursing) before World War II, and the relative ease with which the profession integrated during the high-tech era, Sandelowski should have at least asked whether race may have had an impact on the nursing/technology relationship. This is even more significant because so many nursing functions (from fundamental aspects of patient care, like bathing or changing bedpans, to diagnosis-related work such as taking vital signs) have devolved to subordinate jobs held by proportionally more people of color.

Margarete Sandelowski is a fluent writer and an erudite and sensitive scholar who successfully interjects pertinent discussions of difficult theoretical questions into narratives based on empirical findings. Her book demonstrates an understanding of the work of both nurses and historians. She has evidently assimilated the bodies of knowledge known as nursing...