N U R SI N G T H E O R Y A N D C O N C E PT D E V E L O P M E N T O R A N A L Y SI S

Technology and humane nursing care: (ir)reconcilable

or invented difference?
Alan Barnard RN BA MA PhD MRCNA
Lecturer, School of Nursing, Queensland University of Technology, Australia

and Margarete Sandelowski RN PhD FAAN

Professor, School of Nursing, University of North Carolina at Chapel Hill, USA

Submitted for publication 23 June 2000

Accepted for publication 22 December 2000

Correspondence: BARNARD A. & SANDELOWSKI M. (2001) Journal of Advanced Nursing 34(3),

Alan Barnard, 367±375
School of Nursing, Technology and humane nursing care: (ir)reconcilable or invented difference?
Queensland University of Technology,
Aim(s) of the paper. This paper questions the validity of a boundary presumed to
Victoria Park Road,
exist between technology and humane care. It argues the need for reconciliation of
Kelvin Grove Campus,
Queensland 4059,
presumed tension(s) between technology and person focused care and the need to
Australia. reconsider our ways of understanding the relations between technology and nursing.
E-mail: a.barnard@qut.edu.au Background/rationale. Recent scholarship in the social sciences related to repro-
ductive and imaging technologies and emergency resuscitation are examined and
arguments are presented that question the appropriateness of a humanist view that
emphasizes technology on the nonhuman and nonnatural side of a human/
nonhuman, nature/arti®ce divide. It is argued that what determines experiences
such as dehumanization is not technology per se but how individual technologies are
used and operate in speci®c user contexts, the meanings that are attributed to them,
how individuals or cultural groups de®ne what is human, and the organizational,
human, political and economic technological system (technique) that creates
rationale and ef®cient order within nursing, health care and society.
Conclusion. The paper concludes by asking whether the commonplace appeal to
resolve tensions between humane care and technology has erroneously highlighted
technology as the reason for impersonal care, and encourages re-examination of the
relationship(s) between technology, humane care and nursing practice.

Keywords: technology, humane care, touch, technique, nursing practice, humanism,

theory

beings, with creating the alienation between self and body,

Introduction
A commonplace in nursing (although not exclusive to it) is to
portray medical technology as a `culprit in contemporary
health care' (Timmermans 1998a, p. 435). We nurses (and
others) have variously charged medical technology with the
dehumanization, depersonalization, and objecti®cation of
patients and of nursing care: that is, with depriving patients
of their individuality, subjectivity, and dignity as human
and with separating nurses from their mission to care. Some
nurses (Allan & Hall 1988, Green 1992, Mann 1992, Cooper
1993, Calne 1994) have linked dehumanization with clinical
environments characterized by standardization, the too pal-
pable and audible presence of machinery and equipment, and
by the treatment of patients as extensions of that machinery.
A thematic thread in the nursing literature critical of tech-
nology is that technology/scienti®c cure is paradigmatically

Ó 2001 Blackwell Science Ltd 367

 A. Barnard and M. Sandelowski
opposed to touch/humane care and thus is at odds with the
practice and even moral imperatives of nursing (Braun et al.
1984, Gadow 1984, Sandelowski 1988). In this literature, the
organized and ef®cient world of technology prevails over the
particular and spontaneous world of people, and functions to
undermine expressions of caring. Medical technology is here
juxtaposed with the nursing `culture of caring' (Fox et al.
1990). Indeed, the positioning of nursing/care against tech-
nology/cure has been a key device by which some have sought
to establish the distinctive professional identity of nursing
and the `narrative and symbolic boundary' between nursing
and medicine (May & Fleming 1997).
Even those of us who espouse the existence of a harmony
between technology and care (Ray 1987, Bosque 1995,
Locsin 1995, Walters 1995, Ozbolt 1996, McConnell 1998)
have assumed a rapprochement between two separate and
potentially irreconcilable entities (Sandelowski 1997). For
many of us technology is still something nurses must work
with, work around, or work hard to make compatible with,
or supportive, nursing care. To this end, we have encouraged
each other to develop an ethical awareness, in order to
2 temper the effects of technology (Ray 1987, McConnell
1998), including the `dissonance' that it engenders (Purnell
1998).
Yet as we will propose in this article, recent scholarship in
the social sciences has called into question the tension
presumed to exist between humane care and technology:
between a `paradigm of relation' and a `paradigm of control'
(Hawthorne & Yurkovich 1995, p. 1090). Indeed, the tension
between `touch' and `technology' as `two paradigms of patient
care' (Gadow 1984), and the positioning of nursing between
the `humanistic' and `technologic frameworks' (McConnell
1998, p. 26), may re¯ect better a certain social construction of
humane care and technology, rather than any essential
difference between them. Recent scholarship suggests a more
complicated relationship, as what any technology is at any
moment in time is increasingly understood to depend on the
eye of the beholder, the hand of the user, and the technological
systems that in¯uence integration and use.
In this paper, we argue that technology is not necessarily
opposed to humanized care, but rather is often speci®cally
and deliberately enrolled in the service of that care. In
addition, we suggest that the continued polarization of
technology and humane care may comprise a discourse that
is more in the service of maintaining a distinctive professional
identity than of improving nursing care. The paper seeks to
highlight an alternative approach to understanding the
relations between technology and nursing and to discuss
critically whether there is necessarily an irreconcilable tension
between technology and humane care.
368 Ó 2001 Blackwell Science Ltd, Journal of Advanced Nursing, 34(3), 367±375
Contested terrain
In sharp contrast to the humanist depiction of technology on
the nonhuman side of the human/nonhuman divide is the
postmodern challenge to all `troublesome dualisms' (Balsamo
1997, p. 133), including nature/culture, person/object, female/
male, and human/nonhuman (both animal and machine).
Although it is common to categorize technology as nonhuman,
pacemakers and arti®cial joints implanted in living human
beings, genetic engineering, and arti®cial intelligence systems
regularly confront us with the reality of and potentiality for
living artifacts and vital machines (Channell 1991). These
cyborg `emblem(s) of postmodern identity' (Balsamo 1997,
p. 32) blur the line between animate and inanimate, and
human and machine (Haraway 1991).
Long conceived in Western medicine as if they were
machines (Lupton 1994), human bodies have actually
become `technological artifacts' (Oldenziel 1998, p. 181) as
new media/medical technologies have made these bodies
more `plastic', `bionic', `interchangeable', and `virtual'
(Williams 1997). Body parts (for example, kidneys, hearts,
gametes) are now used as `therapeutic tools' (Hogle 1996). In
the case of organ transplantation, these `personalized' and
`objecti®ed' body parts challenge existing notions of a uni®ed
embodied self (Sharp 1995, p. 361). Corpses, experimental
animals, fetuses, and brain-dead-but-otherwise-alive organ
donors confound and contest humanistic notions of person
vs. object, natural vs. arti®cial, and living vs. dead (Casper
1994, Ohnuki-Tierney 1994, Pickstone 1994).
(Casper 1994, pp. 307±308) located the fetus `at the
margins of humanity': in the `spaces between ááá (the) concep-
tual dualism' of human/nonhuman. Technological innova-
tions in diagnosis and treatment have contributed to the
marginality of the fetus. No longer solely a divine or natural
creation, the contemporary fetus is a technologically `carp-
entered' entity (Ihde 1979, p. 118): a `synthesized' product
(Duden 1993, p. 8) and `engineered construct of modern
society (Duden 1993, p. 4). Contested objects, such as the
fetus, exemplify the disappearance of the last great divide:
that is, they exemplify the effacement of what Mazlish (1967)
referred to as the `fourth discontinuity' between human and
machine. Indeed, biomedical technologies, in particular, are
the contested sites and even the `fault line' where such entities
as nature and culture, person and object, and human and
nonhuman meet, mingle, and regularly transgress traditional
boundaries (Casper & Koenig 1996, p. 525).
With the recognition of the `traf®c' between entities once
thought of as having inviolable borders (Casper & Koenig
1996, p. 526), technologies, like people, are now conceived of
as having agency, biographies, lives, lifecourses, histories,
 Nursing theory and concept development or analysis
language, idiosyncratic quirks, inclinations (Ihde 1979,
Wiener et al. 1979, Cowan 1983, Rothenberg 1993, Callon
1995, Orr 1996, Prout 1996, Timmermans 1998a), and
`known propensities for perverse or benign behaviour' (Orr
1996, p. 89). In contemporary social studies of science and
technology, and especially evident in studies framed in actor-
network theory, both human and nonhuman actors act.
Agency is no longer conceived as the sole privilege of human
beings.
The `ontological extension of human agency' (Timmer-
mans 1998a, p. 427) to nonhumans is said to occur through
`delegation'', whereby devices `substitute for ± stand in for
and hold the place of ± the actions of people' (Timmermans
1998a, p. 428). For example, Prout (1996) used actor-
network theory to show how the metered dose inhaler can
be usefully seen as a means of delegating biomedical work.
The inhaler was given the clinician's work of controlling the
dose of medication delivered to the patient, even as the
inhaler itself was placed in the hands of patients. The
autonomy of the patient was extended, but it was also limited
as the inhaler regulated the dose the patient could receive.
The device thus offered simultaneously more control that was
personal to patients while maintaining traditional medical
control over them.
The actor-network view of humans and nonhumans as
analytically (as opposed to morally) similar (Prout 1996,
p. 215), and its emphasis on acts, not actors, contrasts with
dualistic and deterministic accounts of technology as alien to
human beings and as stable causes of effects (Barnard 1996).
As (Timmermans 1998a, pp. 435±436) argued, critics using
`technological deterministic arguments dislodge technological
innovations from their performance contexts'. Such argu-
ments preclude us from seeing how technologies, like people,
simultaneously act, but are also `acted upon' (Timmermans
1998a, p. 436): that is, how the human and the technological
mutually constitute each other (Prout 1996) and thus cannot
be understood as entities apart from each other. Indeed, the
one is in the other, as opposed to the one (that is, the
technological) existing exclusively as Other to the human
3 (Gadow 1984).
Moreover, technological deterministic arguments preclude
us from seeing that what technologies are depends on the
historical, social, and cultural (including gender) contexts in
which they act and are acted upon: how the `potential and
power of a technological device to shape an interaction is not
pregiven but is realized in practice' (Timmermans 1998b,
p. 148). A stethoscope is what it is physically. But even more
importantly, the stethoscope is also what it becomes in a
speci®c user context; the stethoscope is, among other things,
an instrument of diagnosis, an extension of the ear, a symbol
Ó 2001 Blackwell Science Ltd, Journal of Advanced Nursing, 34(3), 367±375
Technology and humane nursing care
of science, and a bid to a higher social status (Sandelowski
2000).
Technology in the service of personhood
While technological determinists assume a pre®gured stable
cause of effects, humanists assume a pre®gured stable self.
This essential self is at the heart of prevailing notions of
agency, identity, and person-hood. Several recent ethnog-
raphies challenge both of these ideas, emphasizing the
changing meanings of technology and the changing identities
technologies invoke (Timmermans 1996). In these ethnog-
raphies, technologies are shown to foster person-hood and to
further humane caring.
Agency through objecti®cation
Cussins (1996, 1998) challenged the humanist notion of a
stable self appropriated by technology and the humanist
argument that these selves required protection from techno-
logical `objecti®cation to ensure their agency and authenti-
city' (1996, p. 575). She especially wanted to confront the
longstanding humanist tradition of viewing objecti®cation as
alienating and technology as `usurping selfhood's (1996,
p. 576), and a speci®cally feminist tradition of viewing
infertile women as `paradigmatic of the objecti®ed patient'
(1998, p. 167). Not wanting `to deny the subjugating and
disciplining effects of many technologies', Cussins instead
sought to `question whether ... objecti®cation per se (was)
antithetical to personhood's (1998, p. 167). Cussins found
infertility clinics `rich sites' for answers to this question: that
is, for an `examination of agency and the ontological
commitments that go with it' (1998, p. 169).
Cussins concluded that the infertile women she observed
often asserted themselves through objecti®cation. As she
interpreted their experiences with assisted reproductive tech-
niques, there was no one infertility patient, who exempli®ed
the saved or victimized patient objecti®ed by technology,
but rather there existed at different times various kinds
of active participants pursuing agency by means of objecti-
®cation.
Cussins used the term `ontological choreography' to refer to
the multiplicity of selves evident in infertility work, whereby a
woman is at one time and in one place a generic patient, and at
other times and places a set of ovaries and follicles on an
ultrasound screen, a vagina and cervix on speculum exam-
ination, or a satis®ed or dissatis®ed consumer of medical
services. By permitting and even requiring these ontological
variations to multiply, reproductive technologies offered
women new options for achieving a long-term desired self:
that is, to be a mother. Indeed, as Cussins proposed, women
369
A. Barnard and M. Sandelowski
did not allow themselves to be treated passively like objects in
order to comply with medical protocols, but rather they
complied actively to permit themselves to be treated like
objects in the interests of achieving a long-range desired self.
Women actively participated in several kinds of objecti®ca-
tion, including `medical operationalization', by which a
woman is `rendered into multiple body parts', `naturaliza-
tion', by which many of a woman's social roles are made
irrelevant while her body becomes an object of experimenta-
tion and manipulation, `bureaucratization', by which only her
status as a generic infertility patient is made relevant, and by
`epistemic disciplining', by which a woman becomes an
informed consumer of infertility services (1998, pp. 187±189).
Cussins (1998) proposed that not only did women's selves
vary, but also their perceptions of their own objecti®cation as
operating for or against their long-range self. A woman might
say that a procedure objecti®ed her after failing to get
pregnant by it, but evaluate the same procedure more
positively when she achieved pregnancy. Yet, as Cussins
(1998) argued, these judgements were not simply re¯ections
of changes in any one woman's perception according to
outcome, but rather of different `subject(s) of discourse'
(1998, p. 191); for one of these subjects, treatment entailed
retaining properties of personhood while for the other, it did
not. Moreover, the care of women was personalized by
objecti®cation, because objecti®cation allowed a failed proce-
dure to be separated from a failed body/self. That is, it
allowed a woman and those caring for her to see a failure to
achieve conception, not as her failure (I/she cannot get
pregnant), but rather as an organ failure (my/her fallopian
tubes block conception) or technical failure (the embryos did
not implant). This `synedochal's (1998, p. 176) relationship,
by which an isolated body part or function comes to stand for
a particular patient and by which instruments `acquire
properties of personhood in virtue of which they ®x, bypass,
or stand in for stages in a woman becoming pregnant' (1998,
p. 192), allowed women's subjectivity to be maintained. Only
in cases of `synedochal breakdown', where `rupture (1998,
p. 190) occurred between the long-range self and these
variously objecti®ed selves did feelings of alienation or
dehumanization emerge.
Accordingly, as Cussins' work illustrated, there is no
necessary tension between technology and self, nor techno-
logically-engendered alienation between body and self. (Van
Manen 1998, p. 16) observed that an `objectifying view of a
patient's body is not in itself a dehumanizing activity'. As he
proposed:
The physical body is the form in which our lived body can show itself
as object. It is only when the relation between physical body and lived
370
body is broken that we may speak of an alienated corporeal
existence.
Legitimation through visual objecti®cation
A special case of objecti®cation, and a key feature of
contemporary health care, is the increasing turn to an
image-based reality. Health care is now a `panoply of
``screens''' (Williams 1997, p. 1047) by which the natural is
purportedly made visible. Technological images (for
example, X-rays, sonograms, computerized tomography
and magnetic resonance pictures) have created the `inside
body', a body conceived to be the body as it really is: that is,
not the outside body that clinicians routinely engaged prior to
the 20th century and the `blind old days' of medicine (Simon
1999, p. 141).
In the ultimate exemplar of technological objecti®cation,
the patient is not the `corporeal' person in the bed or on the
examining table, but rather the `hyperreal' re-presentation of
that patient on screen in the form of a rhythm strip, black and
white picture, colourized image, or digital or other display
(Williams 1997). Arguably, these images `stand in for
patients with more life than the ``real'' thing' (Simon 1999,
p. 157). Indeed, both clinicians and patients themselves now
look to screens to ®nd out how well or close to death a
patient is (Robillard 1997). Clinicians now treat `bad strips',
not sick patients (Cartwright 1998, p. 249).
Yet as Rhodes et al. (1999) discovered in their study of
patients with chronic back pain, `visual objecti®cation of
the body' often sustained patients' subjectivity by helping
them to legitimate their suffering. By offering these
patients, who had nothing to show for their pain, visual
proof of its cause, visual technologies conferred on them
the `power of the visible' in a culture that increasingly
de®nes the real as the seen. For patients suffering from
ambiguous diseases like chronic back pain, these technolo-
gical images become meaningful as `visual representation(s)
of the truth of pain' (Rhodes et al. 1999, p. 1192).
Moreover, these patients seemed to derive a vicarious
pleasure from the sensuous pleasure their physicians
experienced while gazing at and analysing these images.
For them, there was a `satisfying visualization of the
correspondence between objective ®nding and subjective
pain' (Rhodes et al. 1999, p. 1201).
In contrast, for patients for whom no such visual proof of
their pain existed, these technologies were meaningful as
undermining their claims to pain. These patients experienced
these technologies as alienating because they not only `dele-
gitimized' their pain, but also fragmented their selves.
Reinforcing the Cartesian split between body and mind,
visual technologies, in cases where no visual proof of pain
Ó 2001 Blackwell Science Ltd, Journal of Advanced Nursing, 34(3), 367±375
Nursing theory and concept development or analysis
existed, supported the notion that `what is not clearly body ...
(becomes) only mind' (p. 1201).
Technology as humanized nature
In addition to sustaining subjectivity, technologies may also
enhance nature. Central to critiques of the modern way of
birth and death is the view of technology as at odds with an
idealized nature (Eakins 1986, Davis-Floyd 1992). In these
critiques, natural birth and natural death are romantically
conceived as painless, digni®ed, satisfying, and even beau-
tiful. Natural birth and death are seen to be events in the
`lost' but recoverable past preceding their medicalization, the
key component, cause, and effect of which is technological
intervention (Harvey 1997). Indeed, the technological inter-
vention at the heart of medicalization is seen to be `emblem-
atic of inhumane and unnatural death' and birth (Seymour
1999, p. 692).
Yet there is nothing natural about either birth or death, as
natural childbirth and dying, and the human bodies central to
both, are highly social entities. Indeed, nature is itself a
cultural artifact, as people in different cultures have continu-
ally (re)de®ned and (re)created nature (Lock 1996). In many
Western countries, dead is now `dead enough' (Franklin
1996, p. 684) legally and morally to extract and use body
parts as `therapeutic tools' (Hogle 1996). Dead is not an
absolute category, but rather a `negotiable terrain' (Franklin
1996, p. 684). Moreover, a natural death, when de®ned as a
painless death, is frequently achieved with pharmacological
and technological intervention.
Nature is also culture in the case of natural childbirth.
Early 20th century American women and clinician advocates
of the Twilight Sleep, by which women were heavily sedated
during labour and delivery, promoted drugs as allowing a
natural birth to occur. Indeed, births without drugs were
considered to be unnatural. In contrast, the key feature of the
mid-20th century American Natural Childbirth Movement
was its antitechnological stance: drugs and surgery were seen
to interfere with a natural birth (Sandelowski 1984). In other
studies, patients have often conceived of technology as
operating in the service of nature (Calnan & Williams
1994). For example, infertile couples have described assisted
conception as natural because nature allowed it to succeed,
because it simulated natural conception, because the preg-
nancy, birth, and child that followed it were themselves
natural processes and entities, and because it allowed them to
become natural parents. For these couples, natural equaled
normal, moral, and technological (Sandelowski 1993).
Technology can thus be conceived in two contradictory
ways: as humanizing and `humanized nature' (Pfaffenberger
1988), or as an entity or force opposed to nature. Moreover,
Ó 2001 Blackwell Science Ltd, Journal of Advanced Nursing, 34(3), 367±375
Technology and humane nursing care
it is not technology per se that renders birthing and dying
unnatural and inhumane, but rather technologies contribute
to situations that make possible such events to be conceived
and lived as either natural or unnatural, and humane or
inhumane, as these terms are de®ned by a person or culture in
a speci®c moment in time. Whether birthing woman or dying
patient, individuals `choose and combine elements of their
preferred natural event from a range of potentially contra-
dictory sources (Seymour 1999, p. 693). `What is natural is
man's (sic) arti®ce' (Fletcher 1988, p. 44). Human beings
create technologies and thereby the nature that technologies
reveal, alter, and even (as in the case of a baby conceived by
in vitro fertilization) make possible.
A technological but digni®ed death
Timmermans (1998b) illustrated this phenomenon well in his
ethnographic study of resuscitation technology. Timmermans
challenged the prevailing assumption, largely derived from
cases of chronic illness, that medicalized or technological
interventions undermine digni®ed death in all cases, specif-
ically, in cases of sudden death. He argued that even with all
its problems and excesses, resuscitation technology addressed
a distinctively western reluctance to accept death. By taking
away some of the suddenness of sudden death, resuscitation
technology gave relatives and friends time to come to terms
with the death of their loved ones, allowed them a sense of
control over the inevitability of death, and offered them the
consolation that everything possible had been carried out to
avert it. In the case of sudden infant death, resuscitation
efforts, which were often initiated even when there was no
hope of reviving the infant, helped parents make sense of a
senseless death. These bene®ts were emphasized in cases
where relatives were allowed to witness or participate in the
resuscitation effort (Timmermans 1997). As Timmermans
proposed, resuscitation technology served as a cultural ritual
facilitating the passage from life to death. By providing an
opportunity to prepare for impending death, the technology
naturalized and `digni®ed death' (Timmermans 1998b).
From difference to paradox: from technology
to technique
Although postmodern views of technology challenge its
separation from the human and the natural, nurses are
among many groups who still adhere to a humanist view of
technology on the nonhuman and nonnatural side of the
human/nonhuman, nature/arti®ce divide. We still depict
ourselves as the bridge spanning the divide between tech-
nology and humane health care. We have thereby claimed
professional ownership of the space between technology and
371
 A. Barnard and M. Sandelowski
patient, and the responsibility for maintaining humane care
in technological environments (e.g. Ray 1987, Gordon 1992,
4 Cooper 1993, Halm & Alpen 1993, Pelletier 1994). Dwelling
in this space, we see ourselves as the mediators between two
seemingly irreconcilable and disparate forces.
Our claims to ownership of the divide between technology
and patient imply not only our alignment with the human,
but also our belief that we can control technology. Moreover,
our association with technological knowledge and skill has
been a source of increased prestige and power for nursing
(Barnard & Gerber 1999). Indeed, we have conceived of
technology as the embodiment of both scienti®c progress and
of professional development. Although we have questioned
the impact of technological innovations on nursing practice,
we have accepted technological tasks delegated to us and
turned to technology to advance our profession (Barnard
1999, Barnard & Cushing 2001, Walker 1970, Donahue
1985, Gordon 1992, Castledine 1995). As one nurse
observed:
I think the profession looks more professional and more glamorous
with the technology because there's a lot more of it now in the wards
that nurses use ... People ... outside of the nursing profession, don't
know anything about it. They tend to put nurses up a little bit higher
because they can work all these machines that buzz and they [nurses]
know exactly what to press. They [patients] think they are going to
be blown up or something like that, and they panic. The nurse comes
along and she just saves the day and presses the right button (Barnard
1998, p. 161).
Yet the discourse of difference that nurses have engaged in
concerning technology does not resolve the paradox of
technique that exists in the nursing/technology relationship.
Technique refers to the formation of system comprised of
human, organizational, political, and economic structures,
which are aimed toward the absolute ef®ciency of methods
and means in every ®eld of human endeavor. Several
philosophers of technology have emphasized the importance
of technique over technology (Ellul 1964, Winner 1977,
Mitcham 1994, Feenberg 1999). For them, technique ± not
technology ± has increasingly structured collective behaviour
and in¯uenced individual lives, cultures and professional
perspectives. Many aspects of nursing and health care are
structured in accordance with technical demands arizing
from relationships that develop because of technique, which
emphasize a primacy of means, ef®ciency, and rational
order. Technique does not attend to such phenomena as
individual and cultural difference. The purpose of technique
is to reproduce itself; it is the centre of its own attention.
When we raise issues of individual and cultural differences,
we emphasize the opposite end of technique. The paradox is
372 Ó 2001 Blackwell Science Ltd, Journal of Advanced Nursing, 34(3), 367±375
that the human differences, feelings, and meanings we
identify, categorize, and order can themselves become
technique by virtue of our identifying, categorizing, and
ordering them. When we set about, for example, to invent
protocols for quality care, for teaching caring nursing, or to
achieve natural birth, we facilitate the development of
technique. Although practices such as family presence
during emergency resuscitation allow digni®ed deaths, their
transformation into `best practices' can lead to poorer
practice. Because of technique, there can be over emphasis
on the maximization of ef®ciency, specialization of practice,
and development of conformity and sameness in product,
process, and thought.
Accordingly, it is technique, not technological objects
per se, that we must confront, as we have delegated to
technique the power of decision-making and have relied on
technique for the development of professional status. We
nurses have expressed concern over the impact of technology,
but we have embraced technique. Yet, it is technique that has
made contemporary nursing `technological', not objects,
machines, automata or equipment. Technology has always
been part of nursing. The use of technology now, although it
is more advanced and sophisticated than technologies of the
past, is not a criterion for de®ning contemporary nursing
practice as technological (Barnard 2001).
Conclusion: nursing, technology, and difference
In conclusion, we have in this paper questioned the validity of
a boundary traditionally presumed to exist between tech-
nology and humane care. We have proposed a more compli-
cated view of technology. We have argued that what
determines whether a technology dehumanizes, depersonal-
izes, or objecti®es is not technology per se, but rather how
individual technologies operate in speci®c user contexts, the
meanings attributed to them, how any one individual or
cultural group de®nes what is human, and the potential of
technique to emphasize ef®ciency and rationale order. Like
technology, humane care is itself a socially-constructed
entity. The power any technology exerts derives from how
it acts in any given situation and from its meaningfulness.
Technology is thus not simply or necessarily a paradigm of
care opposed to touch, but rather also an agent and object of
touch. Technology can itself be a humanizing factor, even in
the most technologically intense arenas of health care. The
`duality of technology' (Orlikowski 1992) ± as matter and
meaning ± lies not in its necessary opposition to humaniza-
tion, but rather in its recursiveness: in its existence as both
objective, material force and as a socially constructed and
chameleon-like entity.
Nursing theory and concept development or analysis
The problem of technology for nurses may thus lie less in
technology itself than in the choices we and our patients
make about what is humane, natural, and digni®ed care. As
we have proposed, we all choose and combine elements of
our own preferred humane, digni®ed, or natural event from a
range of potentially contradictory sources. A digni®ed death
might thus entail a `low'- or `high'-technology presence. The
resolution of this problem is, in part, to ascertain and honor
these varied choices.
Alternatively, the problem of technology for nurses may lie
less in technology itself than in the discourse of difference
(Burbules & Rice 1991) surrounding technology. (Ellul 1990,
p. 130) argued that we often experience what is opposite to a
prevailing discourse. Professional discourses, paradoxically,
often re¯ect opposing realities; that is, more talk of freedom
often means there is less freedom, more talk of respect, less
respect, and more talk of humane care, less humane care.
Accordingly, by emphasizing the difference between touch
and technology, we may be focusing on differences that either
do not exist, or do not matter, and thereby diverting
ourselves away from differences that do. A question that
we must answer is whether the discourse of difference
surrounding technology is preventing us from recognizing
the technique that can undermine humane care?
Another key question for nursing is `whose interests are
being furthered or protected' (Munro 1997, p. 4) by main-
taining the distinction between technology and humane care.
Indeed, this distinction exempli®es `difference-in-use' (p. 19)
by which divisions are exploited to achieve certain ends. We
nurses have engaged historically in the `labour of division and
identity' (p. 5), seeking to de®ne nursing in part by claiming
difference from medicine and the things with which it is
culturally associated: namely, technology. For nurses, as for
others seeking identity and power through difference, there is
`no vision without division' (p. 10); division allows nurses to
see (themselves) and to be seen. The appeal to difference
(between technology and humane care) is itself a technology ±
an `artifact' (p. 4) ± by which we have sought to make `visible'
our contributions to health care (Gordon 1991, p. 93).
But we nurses have yet to examine the `effects that ¯ow
from the presence of difference' (Munro 1997, p. 19). That is,
for example, whether and how the distinction between
technology and humane care serves our patients or nursing
in an era when divisions that once seemed `®xed and
fundamental' now appear increasingly `precarious and arbi-
trary' (p. 3). Indeed, for nurses, who comprise a social group
that has never established fully a separate and secure identity,
it is the abandonment of divisions ± not the divisions
themselves ± that may seem precarious and arbitrary.
Ó 2001 Blackwell Science Ltd, Journal of Advanced Nursing, 34(3), 367±375
Technology and humane nursing care
Accordingly, the question of whether to maintain or to
abandon the distinction between technology and humane
care is not a simple one to answer, as it confronts us with the
core issues of professional position and power, and of the
politics of difference. We have to ask ourselves: What
differences will we `choose' (Burbules & Rice 1991, p. 400)
to maintain? Does maintaining a distinction between tech-
nology and humane care reinforce or undermine gender and
other stereotypes and prejudices concerning nursing? Such
distinctions have often entailed essentializing both nursing
and technology, or minimizing the differences or diversity
within these categories and thereby reinforcing stereotyped
notions of them (Sandelowski 1997). Indeed, the idea of
difference has itself become essentialized; rather than reifying
it, difference is better conceived as in constant interaction
with sameness. Whether two entities are viewed as different,
or the same, is a matter of changing cultural evaluation
(Burbules & Rice 1991). Does difference contribute to or
detract from the goals of equality or privilege (Barrett 1987)
for nursing? As (Barrett 1987, p. 35) observed, `sites of
difference are also sites of power'. Finally, we must ask
ourselves whether the appeal to difference settles any differ-
ences for us concerning nursing, technology, and the humane
care of our patients?
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