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

Margarete Sandelowski. Devices and Desires: Gender, Technology, and American Nursing.Chapel Hill: University of North Carolina Press, 2000. 322 pp. $45 cloth; $19.95 paper.

Margarete Sandelowski has written an insightful book that explores the conflicted public and self-image of nursing as much as it does the role of technology in the nurse's work.

In Devices and Desires, Sandelowski portrays the identity problems nursing has had since its modern rehabilitation by Florence Nightingale in the mid-nineteenth century. Among them: should nurses be helpers of doctors, as Nightingale defined their role, or independent providers? Should nursing be defined by its unique role in physical attendance, observation, and humanistic engagement of patients, or should nursing seek a wider identity by embracing contemporary problems and needs such as the cost management of patients and hospitals and the rational use of technology?

Her discourse on technology as a shaper of the relationship of nurses to themselves and their profession is carried out brilliantly. She discusses perceptively the generic ways in which people and technology interact, exploring conceptual views of this exchange. She is concerned with the role gender has played in defining social and health professional roles and how this has influenced the place of the nurse in health care. She details the interplay between physicians and nurses and discusses its centrality in defining the nurse's role and self-image. In this exposition she focuses particularly on the nuances of the person-machine relation.

Although technology enlarges human capabilities, it also can limit human capabilities by diminishing the status of those aspects beyond technology's reach. Phenomena that cannot be analyzed through technology are made to seem unimportant. The intellectual and legal authority to use and command technology affects hierarchical relationships and creates professional advantage. This factor in part explains the competition among health professional groups for authority over technologies.

Because it explores how technology is deeply affected by the internal dynamics and external profile of a key health profession such as nursing, this book should prove valuable not only to the academic and practice branches of the health professions, but also to the makers of public policy. As they create incentives for different health professional groups to adopt roles in the health system based on immediate personnel needs or fiscal matters, policy makers should also look at the larger effects of their proposals. The push to create more nurse practitioners from a need to reduce the expense of primary care provision has had a large resonance within nursing that Sandelowski splendidly portrays. It did provide nurses with a new authority to make independent judgments about a person's health and to introduce the humanism characteristic of the nurses' role into the patient-practitioner relationship. But it also furthered the conflict within and outside of nursing about the nurse's role, which introduced new strains into the nurse-physician relationship.

Sandelowski emphasizes too the basic role of the nurse as intermediary. The hospital nurse mediates the care orders of physician to patient, and from the viewpoint of technology has become a machine tender. It is the nurse who applies many of the technologies central to the intensive and ordinary care of the patient. Nurses apply and monitor respirators, give IVs, oversee the administration of drugs, chart the results of and implement the placement of diagnostic monitors, and so forth. High technology health care falls on its face without the nurse. Playing the role of technology intermediary introduces ambiguity about the role of the nurse. This ambiguity is furthered by the various other roles nurses have played and continue to play in the century and a half of development since Nightingale's reform.

Who is the nurse? Is he or she the expert in body care—assuring its nurturance and oversight as it strives to overcome illness? The humane caregiver making constant visits to the bedside to discern...