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

Devices and Desires: Gender, Technology, and American Nursing. By Margarete Sandelowski. Chapel Hill: University of North Carolina Press, 2000. Pp. xvii+295. $45/$19.95.

Nursing has long posed a provocative test case for arguments about work and technology. For more than a century, nursing has been reshaped by technological innovation; since World War II, nurses have increasingly been identified with the formidable array of machines at the bedside. In contrast to classic cases of de-skilling, new technologies of diagnosis and treatment have not turned nurses into machine tenders or rendered their work superfluous. Instead, health-care technology has more often demanded new skills and knowledge, and increased the time involved in patient care. Nonetheless, Margarete Sandelowski argues, nurses have been repeatedly thwarted in their efforts to use technical expertise to enhance their professional standing.

Devices and Desires opens with two chapters of scholarly apparatus, invoking legions of other scholars and quoting from secondary sources in every other sentence. The reader struggles in vain to locate Sandelowski's subject and argument in this overly detailed recapitulation of approaches to the history of technology. In chapter 3, though, Sandelowski hits her stride. What follows is a compelling analysis, presented with clarity and conviction, of the fraught relationship of nursing and technology. Early on, nursing took place mostly in patients' homes, and its technology involved familiar household objects that nurses turned to the uses of patient care. New diagnostic technologies transformed both nursing and medicine, and influenced the expansion of hospital-based care. Sandelowski argues persuasively that nurses shaped and enabled this transition: "Nurses made hospitals more hospitable, not only to patients but also to the new devices and device-mediated techniques that became the sine qua non of medical practice. Nursing was the soft technology that allowed physicians to use the new hardware of diagnosis" (p. 94).

Sandelowski goes from strength to strength in chapters that build on her careful and perceptive analyses of key technologies. Her discussions are subtle and rich, combining a detailed understanding of technology as material culture and a social historian's grasp of the relations of power and inequality that organize the division of labor. From the late nineteenth century until World War II, new technologies such as clinical thermometry and diagnostic X rays, as well as laboratory work, expanded nurses' roles as the "physician's eyes." New technologies made medicine and nursing more interdependent, but in an unequal division of labor the result was the loss of a distinctive nursing identity: "the diagnostic revolution in medicine diminished the importance of nursing by subsuming it under medicine" (p. 97).

In the 1930s and 1940s, intravenous therapy had the same effect. After World War II, and at an accelerating pace since the 1960s, "surveillance technologies" have reorganized medical protocols and patients' experience of health and disease. The nurse's traditional role of"watchful care" took on new meanings as technologies such as electronic fetal monitoring offered increased access to the body. Already at the bedside of laboring women, nurses were crucial in using continuous fetal monitoring; in some ways, the devices validated their role as skilled observers, and the cachet of esoteric technology improved the status of obstetrical nursing. But machine monitoring also imposed new barriers between nurse and patient.

Sandelowski takes nurses to task for not maintaining and defending a clearer commitment to "true nursing," that is, the promotion of health and the care and comfort of sick persons. The ranks of nurses were often divided internally about the meaning of their work and the value of new technology, and nurses themselves were too ready to abandon "the embodied intimacies of true nursing for the instrumentally mediated intimacies of medicine," as Sandelowski writes of nurse practitioners (p. 189). But given the relentless sex segregation of nursing and the power of a preexisting division of labor controlled by physicians, Sandelowski may be too hard on nurses. Her own case histories point to another conclusion: that...