Browsing by Subject "Datafication"

Apotti is an electronic health record system (EHRs) used in the Uusimaa region of Finland. The system is based on structured records which aims to maximize the collection of big data, which is expected to bring long-awaited solutions for our health care system suffering from structural funding and efficiency issues. As such, Apotti reflects the paradigm of datafication, which means quantifying social reality into data to be later used in value-making purposes. However, the endeavors gaining benefits from big data might be problematic from the point of view of nursing, that is hard, if not impossible to quantify due to its multidimensional nature, which also operates beyond visible performance. For this reason, there is a tension between the datafication paradigm and nursing practice in a more data-driven health care system. In this thesis, I explore this tension by examining the experiences of Finnish nurses using the Apotti system. The material of this thesis consists of eight in-depth interviews of nurses using the Apotti system, collected during the year 2023. The analysis was done using theory-guided content analysis. As a theoretical framework, Hartmut Rosa’s theory of social acceleration is used. According to the theory of social acceleration, the essence of modernity is acceleration, consisting of technical acceleration, acceleration of social change and the acceleration of pace of life. Rosa’s theory suggests that accelerated life leads to an alienated relationship with the world, as modern subjects seek to do more in absolute numbers but end up doing qualitatively worse. Rosa also uses care work as an example of an alienated relationship: caretakers do not encounter the patient on a reciprocal basis anymore, but the patient is fragmented into discrete pieces of parameters on which the health care staff focuses on under constant pressures of being effective. Accelerated life, according to Rosa, roots back to the ethos of controllability which seeks to dominate the surrounding reality by technological and scientific processes. As such, for both datafication and controllability, value creation is linked to how successfully the surrounding reality becomes exploitable for humans. The analysis consists of three parts, starting with handling time scarcity in nursing practice. Datafication is linked to this in two ways: firstly, doing the EHRs is not a minor, but major work task in nursing practice. Secondly, as value and meaning assimilates with data, work that does not show in the data starts lacking crucial evidence of its existence, leading to an accelerating data mill with increased amount of mandatory data work. The second part of the analysis elucidates the “invisible” work of nurses not shown in the data. In this part, challenges related to the nature of structural records against the nursing practice are also scrutinized, as well as more profound problems related to data collection and uncritical use of data. In the third part of the analysis, the medication process in Apotti is examined. Even if the medication process in Apotti is rendered as rock solid as possible, by shifting the focus away from nurses own judgement to technological procedures that are never flawless and often very complex, new hazards to medication safety emerge. This thesis discusses how Apotti, being a technological solution for time scarcity in the health care sector, has not decreased time scarcity, but instead by changing the social reality of nurses has resulted into an opposite outcome with increasing demands raising from datafication. Nevertheless, nurses hold resistance to these demands by actively maintaining more holistic relationship with patients by focusing on the human behind the parameters representing a human and prioritizing patient care over data work. The main contribution of this thesis is showing the limits to quantitative data in representing and guiding nursing practice, which should be acknowledged when health care sector becomes more data-driven. As nursing is being quantified regardless of being a profession that seems hard if not impossible to define in quantitative manners, qualitative research is also needed to elucidate essential work that remains in the shadows of quantification.