J. TECHNICAL WRITING AND COMMUNICATION, Vol.

38(4) 301-329, 2008

INFORMATION TECHNOLOGIES AS DISCURSIVE AGENTS: METHODOLOGICAL IMPLICATIONS FOR THE EMPIRICAL STUDY OF KNOWLEDGE WORK

JASON SWARTS North Carolina State University, Raleigh

ABSTRACT

Work activities that are mediated by information rely on the production of discourse-based objects of work. Designs, evaluations, and conditions are all objects that originate and materialize in discourse. They are created and maintained through the coordinated efforts of human and non-human agents. Genres help foster such coordination from the top down, by providing guidance to create and recreate discourse objects of recurring social value. From where, however, does coordination emerge in more ad hoc discursive activities, where the work objects are novel, unknown, or unstable? In these situations, coordination emerges from simple discursive operations, reliably mediated by information and communication technologies (ICTs) that appear to act as discursive agents. This article theorizes the discursive agency of ICTs, explores the discursive operations they mediate, and the coordination that emerges. The article also offers and models a study methodology for the empirical observation of such interactions.

INTRODUCTION It takes only a few moments of watching a surgeon or a pilot fly a jetliner to recognize those performances as astonishingly complex and coordinated uses of information. The activities are too complex to be performed by a single person, because no single person could be adequately aware of and able to perform all of the smaller tasks from which the overall task arises. Yet pilots fly
301 2008, Baywood Publishing Co., Inc. doi: 10.2190/TW.38.4.b http://baywood.com

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and surgeons operate because it is possible to distribute the cognitive and physical effort required to carry out those tasks [1-3]. Qualitatively different although very much related, activities such as designing tractor gears, writing patent applications, writing quality assurance reports, and other information-centric knowledge work requires similar kinds of cognitive distribution [4, 5]. The latter examples of distributed work are of interest because of their focus on writing and discourse and the objects made from it: gear designs, patents, and assessments of quality. Each object is the product of a distributed discursive effort. An assessment of quality may not be written by a single author nor written from a single source of information, but may instead be the emergent product of information fragments that originate with both human (engineers, field technicians) and non-human (machine interfaces, testing instruments) sources [6-9]. The fragments may be held together firmly in a familiar genre form or tentatively by the cognitive efforts of those who use the information. The resulting discursive objects then help coordinate larger activities (e.g., designing a tractor, filing a patent, issuing an air quality permit). This article examines the mechanisms of distributed discursive activity, in particular, how people rely on information and communication technologies (ICTs) for supporting simple uses of information from which larger, coordinated uses arise. A central pillar of this argument is that ICTs change the amount, availability, and form of information to support location-specific forms of uptake (i.e., conversion of information into actionsee [10, p. 39]). So common are these functions that users frequently interact with ICTs, although perhaps unconsciously, as if they were discursive agents, whose simple (and not so simple) manipulations of information help create the conditions for coordinated discursive activity to emerge. After first arguing why we have and should look at ICTs as discursive agents, I then model how to examine the discursive functions of technology, using an example from veterinary medicine. I conclude with an outline of the implications for the empirical study of such knowledge work. Before discussing distributed discursive activity and the role of ICTs, we need to understand the role of coordination in distributed activities and how complex coordination emerges from simple coordination. ICTs, I will argue, assist with simple coordination. Distributed activities are comprised of simpler, coordinated actions oriented to the same outcome [1, pp. 178-228]. Yet while we may experience an activity like surgery as a single, unified activity, it is actually comprised of a series of coordinated goal-directed actions, such as scheduling, billing, and lab work that may take place outside of the operating theater. These actions are then comprised of a series of much simpler interactions between people, their technologies, and information. People direct attention, recognize patterns in machine outputs, interact with equipment, and so forth. This breakdown of activity into goal-oriented actions and into simple operations is a

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framework [11] that is common to many activities [12-16]. More importantly, this framework allows us to see where people focus attention. For familiar activities, people may remain focused at the level of activity or actions (i.e., a goal-oriented outcome), allowing their tacit knowledge to guide work at the operational level (i.e., the steps of carrying out an activity). For those focused at the operational level, it may be difficult, as the saying goes, to see the forest for the trees. Regardless, successful actions are built upon successful operations and conditions in which operations are coordinated to fulfill task goals. Complex discursive activities can also be described in this same manner, as Swales [17, pp. 136-166] has famously done in his explication of introductions to academic essays. The focus of investigation in this article is coordination of discursive activities. Genres and their aggregate repertoires [18], systems [19], and supportive ecologies [9] greatly assist in coordinating recurring discursive activities. However, this article considers the means by which coordination emerges when the object of discursive activity is novel, unknown, or unstable. If genres tend to assert top-down coordination [20, 21] how can we account for and study coordination that emerges from disparate, technologically-mediated discursive actions? This kind of coordination builds out of simple discursive operations (e.g., reading displays, comparing figures, etc.) that, in themselves, do not have any particular discursive aim, only discursive potential [22]. The results of these operations accumulate, organize, and emerge as discursive actions. Throughout the article, I refer to these as micro-discursive operations. In information-mediated knowledge work, these micro-discursive operations are not inherently coordinated with one another; they are distributed throughout the environment, across people, technologies, texts, space, and time. Yet to add up to a discursive action, some effort at coordination must be exerted.1 Policies, user guides, training sessions, systems of management, shared theories, systems of nomenclature, and so on all serve as mechanisms of coordination [7, p. 301]. Values associated with these discursive artifacts are often captured in the genres and in the interfaces and outputs of the technologies that people interact with [8, pp. 59-111]. Looking at these genres (e.g., feasibility reports and evacuation plans) and technologies (e.g., blood pressure machines and automotive diagnostic tools) we see information organized into familiar forms, creating recognizable discursive objects for coordinating work activities. Scholarship in the field is rich with studies of genre or aggregates of genres as coordinating mechanisms [18, 19, 23] that profoundly influence the ways users understand the objects of their work [e.g., 24-27]. Genres are associated with social action and those who use them understand them to be reflective of community values. Users recognize genres as intentional,

The use of the passive voice here is intentional, as I mean to suggest that the agent bringing about coordination is too complex for expression in the active voice at this point.

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as designed to shape information into forms that are valued. In this sense, Cooren [28] argues, people see texts as agents in the production of discourse. They exert an influence that helps users both understand an activity, the actions of which it is comprised, and the operations required for carrying out those actions. Genres create coordination by helping users produce discursive objects that have a known shape and recurring situated value. But what of those discursive objects that are more emergent, of unknown shape and dynamic content, drawn from a variety of sources? Here, coordination may be achieved inductively, built up from simple discursive operations with and via texts and technologies that create discursive building blocks and nudge a mediated form of uptake. The idea that ICTs, like texts, have the status of agents in the production of discourse has circulated in the literature of the sociology of science for some time [29-34]. Technologies are purposeful; they are designed by someone, and being designed, they embody the values and actions of the designers. The extent to which we recognize those values and identify with them influences the perceived value of those technologies [35] such that conflicting views of those technologies can lead to uncoordinated work practices. The coordinating and mediating influence of ICTs that concerns us is to be found more at the level of simple interactions. Our interactions with these technologies, Latour argues, are pre-scripted [31]. There are successful and unsuccessful ways to interact with technologies that correspond to the values and politics of the spaces where those technologies are found. Since many of our technological interactions are simple ones, we are often only dimly aware of the politics we are complicit in maintaining. We may not recognize that the form of information may reinforce a hierarchy of expertise regarding who can use that information. We may not see that the openness2 of an interface shapes the organization of team efforts. Latours example is of a door closer that: a) replaces the human action of opening and closing a door; and b) embodies the human motivation to close doors after they have been opened. By design, people can only interact with door in a limited number of ways, and these interactions reinforce a social order. Where automatic door closers are in use, our interactions with doors are very simple: we walk toward them and the doors open. When we leave, the doors close. We participate in a social order that values closed doors by stepping away from the sensor, making our cooperation with maintaining order a simple technological interaction of the type that we likely perform countless times in a day. The same is true of our interactions with ICTs, which mediate how we produce, share, and work with information. Many technologies fragment the activities that they afford in sum by turning those activities into a series of simple operations (e.g., pushing buttons when

Meaning how visible the interface is to onlookers.

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illuminated, reading numbers on a machine display), and yet this is not a problem because simplification is what we expect from our technologies. Technologies that get in the way and draw attention to themselves prevent users from focusing on the activities that they wish to achieve with their assistance. Still, this does not absolve us of the responsibility to consider how technologies mediate the production of discourse on the basis of their design. If these simple interactions, as I will demonstrate, help create coordination, we ought to consider how. In some situations, such study could reveal ways that ICTs mediate discourse that results in systematic problems of coordination. To study these interactions empirically, however, we need a methodology that accounts for the agential role of technology. As a backdrop for considering these methodological issues, I will analyze a simple exchange between a veterinary student and members of the anesthesia team on which she was working.3 SITE OF STUDY For a period of six months, I shadowed veterinary students as they carried out work related to different rotations during a year of clinical study. For example, while shadowing a student on a cardiology rotation, I sat in on a patient consultation and on a round of cardiac testing. For anesthesia, I followed the students from the moment their patients were anesthetized, through the procedures, and up until the patients were revived. For each observation, I collected data from numerous sources. I recorded conversations throughout the observation. I made notes about the arrangement and types of technological resources. I took copies of reference materials (those not containing patient-specific information). For each session, I made notes about the ways that the students and their colleagues interacted with the technologies. I looked for evidence that the technologies were performing some discursive function that helped create opportunities for cooperative activity, the joint assessment of a patients condition. My observations are verified through post-observation interviews that I conducted with each student. I do not intend for this analysis to comment in great detail on the organization of discursive activity at the veterinary hospital. Instead, my purpose is to show a relatively simple interaction between a veterinary student, an anesthesia technician, and a clinician as they attempted to assess a dogs condition while under anesthetic and determine what (if any) countermeasures were needed to stabilize the dogs condition. After first presenting the interactions between the three people involved and offering a surface-level interpretation of how these members achieved a coordinated understanding of the dogs condition, I then offer a deeper analysis of contributions made by ICTs.
Data from an ongoing study of veterinary students on clinical rotations and the information technologies that they use.
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DISCURSIVE NEEDS IN ANESTHESIA Under the right circumstances, patients can yield up vast amounts of information [36] to veterinarians. Different specialties may be interested in different kinds of information: the appearance of the stomach lining, the patients neurological state, temperature, or treatment history. Each piece of information derives from the patients physiological state or experience and is manufactured by technologies such as ultrasounds, CT scans, blood pressure cuffs, and stethoscopes. Each technology generates information by converting information about patients from one form (e.g., physical and auditory) to another (e.g., numerical and pictorial) that is better suited to the discourse in which that information will be taken up. Take the example of CT scans. Not only does a CT scan make the invisible visible, it makes the patients interior available to anyone within sight of the display, and who has the expertise to interpret the sliced images. It also allows onlookers to see conditions that might only be indirectly suggested by other diagnoses. To facilitate these uses, patient information must be prepped for uptake. Information generated about the patient at one moment in time may have lasting value and should be recorded in a durable medium to be accessible at some future point. Transferring physical and experiential information into numbers, observations, and images helps preserve it, yet this synchronic picture of the patients health may not be sufficiently informative. For some medical tasks, a diachronic picture of the patients health is more appropriate. Information mediating such work puts data points into plots, aggregates, and other combinations. Patient information must also be available to the right people in the right form. Changes in a patients physiological state must be converted into conditions that can be treated, or drug side effects that can be counteracted. Such transformations allow information about a patients physical condition to be coordinated with other knowledge bases. At the veterinary hospital, animals are anesthetized for a variety of reasons, including procedures that require the patients to be still. In the scene that follows this section, Janet, a fourth-year veterinary student, is caring for a dog brought in for a CT scan and a CSF tap. Early on the morning of the procedure, Janet visited the patient to administer a sedative prior to intubation. After medicating and anesthetizing the patient, Janet, an anesthesia technician, and a clinician inserted a breathing tube and then connected the patient to a host of equipment, including a ventilator, a blood pressure monitor, a heart monitor, and an anesthesia vaporizer. These technologies delivered anesthetic and oxygen; they monitored the patients vital signs, and reported back a continuous stream of information that Janet recorded, every few minutes on the anesthesia record (see example in Figure 1). These texts and technologies were accompanied by others, including Janets classroom notes, the patients chart, the doctors orders, and a PDA on which Janet had access to drug formularies, dosage calculators, and other references.

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Figure 1. A sample of a veterinary anesthesia record [37].

Janets duties were to move the dog between procedures and monitor his state of anesthetization and general state of health. The anesthesia technician and the clinician, both assisted in between supervising other student-led cases. The anesthesia technician and clinician were generally aware of how each of the cases were progressing, but still relied on each student to apprise them of any changes in the patients condition. An overall goal of the interactions between anesthesia students and the other members of the anesthesia team was to create a coordinated understanding of the patients condition. Although there are common ways to express condition, each condition is potentially unique. A coordinated understanding of the condition and any measures needed to improve or maintain it builds out of simple

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exchanges of information. Patient condition is a discursive object, an ad hoc arrangement of patient information supporting an assessment of good or poor condition, continually revised as new information is generated. Deciding on the patients condition, however, is not always easy, as many different factors, including the length of the procedure, patients prior medical history, and combination of anesthetics given can influence how one assembles and interprets the physiological information. To illustrate these difficulties and to see how one can make empirical observations of coordination arising from discursive operations, I will consider a scene of anesthesia work where such coordination was achieved. First is an analysis of the coordination at the level of spoken discourse:
Anesthesia Technician: Yeah, his drugs are hitting him pretty hard. I guess thats whats worrying me. Hes probably not going to take much to . . . yeah, not much Thio[pental] at all. Not much to give his pressures too. So well just have to really be careful on that. ... Anesthesia Technician: Um, you might want to turn it [vaporizer delivering anesthetic] down a bit. Janet: Okay. (unintelligible). Anesthesia Technician: Yeah, exactly. Lets run it on one and four. Alright? ... Janet: [To the clinician], his pressures a little low Clinician: Sos his heart rate Janet: Yeah. Um. Should I draw *** [anesthetic countermeasure] Clinician: Um, what are we doing with this guy? CT Technician: (unintelligible) [type of scan] Clinician: but as far as any other procedures? CT Technician: I have no idea. Janet: Plus or minus CSF tap. Clinician: Um, yeah I would give it [anesthetic countermeasure]. Its probably a little low for a unintelligible. Janet: Yeah, hes 112 [heart rate?]. Clinician: Thats fine. Janet: Does it have to be given any particular way? Like . . . Clinician: Like? Janet: Like back flow? Clinician: Intravenously. Janet: Okay. His heart rates already jumped up to 114 from like 112. Down and back. Much higher now. And his pressures already jumped up to 80 from like 55. ... Janet: [To the clinician], so, the pressure went up, but only temporarily. And its continuing to drop now, where the last reading says like 47. Clinician: Okay, so theyre just about done. Right? Janet: Yeah, so is that going to be okay?

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Clinician: Whats the vaporizer on? Janet: What? Clinician: Whats the vaporizer on? Janet: Um, probably two. I can put it down to one and a half. Clinician: Yeah. Janet: It was only on two for the way over [to the prep room] Clinician: Okay. Well be done soon, so I think wake him ups going to be the answer. Janet: Okay.

From the start of this patients case, Janet and the technician could tell that the patient was more sedated than would normally be expected prior to intubation. Where dogs would normally be awake and looking around, this dog appeared nearly comatose, stirring only when touched. The technician warned Janet that the patient would not need much additional anesthetic (Thiopental) in order to be ready for the procedures. Nor would they need to set the vaporizer quite as high for delivering additional anesthetic during the procedures. There was at least some initial concern that any additional anesthetic would adversely affect the patients pressures, and so Janet was cognizant of that potential effect. Once in the CT room, the patients blood pressure started to drop, along with his heart rate. In preparation for this potentiality, Janet had prepared an injection of the anesthetic countermeasure, which would bring the dogs blood pressure and heart rate back up. The only danger in giving this medication was that by bringing the patients pressure and heart rate up, the patient may start to revive from the anesthetic. Janet called over the clinician, who agreed with Janet that the dogs vitals were low enough to merit intervening, especially since there was still another procedure to take place. The countermeasures had the intended effect, but only temporarily, as the patients condition again deteriorated. By this time, the only procedure remaining was a CSF tap, after which the patient would be revived. The clinician determined that while Janets assessment was accurate, the patient did not require another dose. Instead, the two decided that the dogs condition was good enough for the time remaining in the procedure. The only measure necessary was to turn back the flow rate of the vaporizer. The purpose of the interaction was for Janet, the anesthesia technician, and the clinician to agree on the state of the patients condition. Together and at different points during the scene, the team members negotiated and jointly built a sense of the dogs condition as a stable-enough discursive artifact that allowed them to agree on an action to take, follow through on that action, and then monitor any resulting changes in the patients condition. Condition was negotiated on the basis of patient information rendered up by physical observations of the situation and by quantitative observations made by the monitoring equipment. Yet there is more to the negotiation and coordinated approach than is evident at the level of spoken discourse. There are many small

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discursive interactions that both reveal, structure, and organize information to afford its use in the construction of that dogs condition. Janet and all of the members of the anesthesia team treated the technologies around them as discursive agents, participants in the construction of a sense of the patients health. These technologies made information about the patient visible and put it in a valued form. Moreover, these technologies also changed the manner of information uptake; they changed how and when the information was available. They determined the form and the quantity of information. They altered the ways in which that information was made visible to those in the room. This is the discursive role that the technologies played, and if we layer in a consideration of the technologies supporting the interactions described above and look at how the participants interacted with them, we can see more precisely how members of the team created a coordinated and actionable account of the patients condition. TECHNOLOGIES AS DISCURSIVE AGENTS Before discussing the discursive functions, it is important to note that the technologies are not acting as discursive agents in the sense that they are speaking with any rhetorical intent. Even so, it is easy enough to perceive things this way, as the members of the anesthesia team often did. On many occasions, for instance, members of different anesthesia teams would make comments like: the blood pressure monitor is telling us that his pressure is too low. Of course, the blood pressure monitor is not telling anyone anything and it is certainly not telling anyone that the pressure is too low. Rather, the agency attributed to these technologies is in the way that they influence the participants ability to gather and interpret information and to convert that information into action. In a re-analysis of the same scene from above, I consider four discursive functions: transformation, dis/aggregation, broadcast, and relay. While I discuss these discursive functions separately, in practice, the functions overlap. Transformation Instances when information of one type is converted into another are acts of transformation. Technologies serving this function reduce the labor required to take information available in one form and convert it into others that may be scaled differently, expressed in different units, or may be semantically connected to other discourses. In anesthesia, people rely on transformative technologies when information about a patients condition require translation into terms or units by which the patients condition can be more readily assessed. For example, a scale transforms a patients weight into pounds, and conversion software on a PDA transforms pounds to kilograms. Each step is a transformation of information across representational states. These small transformations result in a number that can be plugged into fluid rate calculators.

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Transformed information also acquires other characteristics that afford distributed and coordinated uses of information. Transformative technologies multiply the amount of available information, producing variants of the same information in different forms. The transformed information is also then more fluid, as it can be taken up into a larger variety of discourses that may rely on the same information but in different forms. Dis/Aggregation Another bundle of related discursive functions is aggregation and disaggregation. Technologies can take multiple streams of information and connect them in meaningful arrangements. A heart monitor may transform the physical sensation of a beating heart into a number, but the anesthesia record aggregates multiple readings in a line chart that shows increasing, decreasing, or stable values. Aggregators create discursive objects that afford work- specific uses and interpretations, which is to say that they also serve transformation functions. When data points come together, the points remain the same, but what emerges from them is an aggregate discursive object that is not wholly present in any one piece of data. As in the case of the anesthesia record, aggregators often require information to be transformed prior to aggregation. Units of information must be complementary and the modes (e.g., numerical, pictorial, auditory) must be compatible. The counter-function to aggregation is disaggregation, the splitting of discursive objects into multiple data streams. Sometimes the found form of information does not serve the needs of all users. Technologies like the anesthesia record can then take a complex discursive object and split it into useful pieces of information that other users may recruit into other discourses. For example, a blood pressure machine disaggregates overall heart function into pulse and into systolic and diastolic blood pressures. The anesthesia record disaggregates the condition of anesthetization into the anesthetics delivered, their amounts, and times of delivery. Aggregation and disaggregation alike change the form of access, which may favor or disfavor the use of that information by people with different training and expertise. Broadcast Broadcast technologies make private information public, by distributing to all within range. Broadcast technologies replace the effort needed to deliver information and make it continuously available. As with the dis/aggregation technologies, broadcast technologies can have transformative functions. For example, a heart monitor measures a patients heart rate and transforms those readings into numbers in order to broadcast that information to people at a distance or to those who are unable to take their own readings. The number is continually

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updated and broadcasted, which affords the creation of an aggregated, real-time account of changes in the patients vital signs. A broadcast technologys influence on uptake is that when information is more shareable, coordination may become easier to achieve because more people have access to the same information. Relay A function related to broadcasting is relaying, which differs in that information is broadcasted across time and place and requires the use of technologies to receive that information. A broadcast technology operates in real time and within the confines of a particular place where that information is to be used. Although not exclusively true, people who inhabit the same physical place are often engaged in the same, similar, or complementary activities. That is, the assumption is that broadcasters send out information to those who have compatible uses of that information and who require no technological assistance to receive it, whereas relay technologies do. Information that is relayed crosses boundaries of place, as facilitated by mobile, networked technologies, may be taken up into discourses the author had not anticipated. Relaying technologies also broadcast across boundaries of time. Information that was broadcast at one moment may travel through a network and be retrieved minutes, days, or years later. Information conveyed through relay technologies retains evidence of its discursive origins, of other information with which it has held company [38]. To the extent that users are aware of those origins, they may be prompted to apply an associated interpretive frame. For instance, a technology that makes interactive tissue and cell slides helps users apply information that would normally require the mediation of a microscope in settings where no microscopes are available or where they would be impractical to use. The relay technology would allow the user to think like a microscope. We can see this discursive function and the others at play through a re-analysis of the anesthesia scene considered earlier. RE-ANALYSIS WITH MEDIATING TECHNOLOGY Janet and her colleagues distributed their efforts to assess the patients condition over their locally available ICTs. They offloaded to the technologies small-scale discursive responsibilities for generating, transforming, aggregating, broadcasting and relaying information about their patient. These micro-discursive operations helped create the ground for coordinated assessment. These operations often occurred in rapid, overlapping succession, appearing to be as simultaneous as the coordination that resulted. To carry out the analysis, I will again recount the scenario, but I will divide it up to intervene with narrative analysis of the technological interactions. A supplemental summary of the discursive functions performed by the available technologies is included in Appendix A. To assist in

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this analysis, I have included, in curly braces, the technologies that the participants attended to while speaking. Intubation
Anesthesia Technician: Yeah, his drugs are hitting him pretty hard. I guess thats whats worrying me. Hes probably not going to take much to . . . yeah, not much Thio[pental] at all. Not much to give his pressures too. So well just have to really be careful on that {anesthesia record, syringe}.

This remark begins the interactions in which members of the anesthesia team decided that the patient was potentially having an adverse reaction to the anesthesia, as indicated by an abnormally low heart rate and blood pressure. The source of the problem was the amount of anesthetic that the dog had been given and its apparent tolerance for the sedatives delivered in the pre-medication phase. In the above remark, the technician started with a physical observation, that the patient was more sedated than would be expected. The objective at this stage was to anesthetize the patient more fully, so that a breathing tube could be inserted. The first issue to negotiate was to decide how much more sedated the patient needed to be. Prior to this point, the technician had looked at the anesthesia record, on which Janet had written the amount of anesthetic delivered. The anesthesia record relayed information about the sedative and the conditions under which it was delivered. In other words, the paper on which Janets pre-medication actions had been written, conveyed information across time and the genred form of the anesthetic record helped shape that information into a form that was useful during the intubation. The record also transformed the dogs apparent state of anesthetization into a quantitative amount of sedative that produced the effect. The dosage allowed the technician to determine how sedated the dog actually was, by comparing that dosage to a normal dosage range for a dog of that size. She determined that the dog had not been overdosed, but that it was instead simply hit hard by the drugs. In the moments prior to the technicians arrival, Janet had reached the same conclusion, by relying on her PDA to access a drug formulary, which relayed to her a range of adverse effects associated with the sedatives along with a dosage calculator for verifying the dose. Already, Janet and the technician were able to start off with the same interpretation of the dogs condition. The syringe full of Thiopental, which was within sight of both, then broadcasted information about Janets intentions for the second stage of anesthetization, or so it seemed. Janet had drawn up the maximum amount of Thiopental that she thought they might need for a dog of this size, weight, and age. She had done so while waiting for the premedication sedatives to take effect. Because the syringe was clear and had units of measurement printed on the outside, the technician saw that a maximum dose had been drawn. This information prompted her warning that the patient would not need that much. Janet had drawn up the maximum amount, but did not necessarily intend to use all

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of it. It is unclear if the technician saw the sticker that Janet had added to the syringe to mark of how much of the total volume she actually intended to deliver. Adjusting the Vaporizer
Anesthesia Technician: Um, you might want to turn it [vaporizer delivering anesthetic] down a bit. {monitoring equipment, 4 anesthesia vaporizer} Janet: Okay. (unintelligible) {monitoring equipment} Anesthesia Technician: Yeah, exactly. Lets run it on one and four. Alright? {monitoring equipment}

At this point, Janet and the technician had administered enough of the Thiopental to enable them to proceed with the intubation and to hook up the patient to monitoring equipment that included a heart monitor, a blood pressure monitor, a ventilator, and an anesthesia vaporizer. The primary objective at this point was to ensure that the patients vital signs would be visible to all members of the team. When properly arranged, the high-contrast displays could be read from a distance and through the protective glass of the CT observation room. Since, for obvious reasons the team members could not ask the patient about his condition, the monitoring equipment took measurements of physiological signs given by the patients body. While the team could palpate the patient as needed, the monitoring equipment would maintain a constant update needed to see changes in his vital signs. In these cases, the monitoring equipment replaced a significant amount of labor by broadcasting that information. The monitoring equipment helped make the information less private by moving it out of the patients body and into recognizable symbolic form. While not the only discursive technology present, the monitoring equipment served very important and diverse functions for mediating access to and use of patient information. In addition to broadcasting information and holding it in place, the equipment also transformed information across representational states. The equipment transformed physiological information about the patient into data the team members could interpret (although not without complication) in ways that were potentially more reliable and constant than checking the same vitals by hand. The team members could then compare these numbers with known acceptable ranges for animals of that patients size and weight. These numbers gave the technician some indication of how much anesthetic needed to be given continuously in order to both keep the patient anesthetized and to keep his vitals at an acceptable level. Based on a simple comparison of the broadcasted numbers to acceptable ranges, the technician determined that the
Note that all of the monitoring equipment was clustered together and kept either on the patient's gurney or on stands which accompanied the gurney. Because all of the monitoring equipment was kept together, I could not always discern when any one piece of technology was used, although the accompanying dialogue often gives strong indications.
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current vaporizer setting would deliver too much anesthetic. Seeing the same numbers, Janet understood the technicians request to be a comment on how the anesthetic would affect the patient over the course of both procedures. The monitoring equipment also served another critical function in that they both disaggregated and aggregated information about the patient. To say that the patient looked as if he had been hit hard by the anesthetic is an assessment based on seeing an aggregate of available physiological and visual data (e.g., breathing, color, and reactions to touch). The monitoring equipment disaggregated such observations into multiple variables (e.g., pulse, blood pressure, blood-oxygen levels) that were then given numerical expression. At the same time, the monitoring equipment also physically aggregated these figures by keeping them all in roughly the same physical location. This physical proximity invited quick comparison of different outputs as in the moments that followed. CT Scan Monitoring
Janet: [To the clinician], his pressures a little low. {anesthesia record, monitoring equipment} Clinician: Sos his heart rate. {anesthesia record, monitoring equipment} Janet: Yeah. Um. Should I draw *** [anesthetic countermeasure]. {anesthesia record, monitoring equipment} Clinician: Um, what are we doing with this guy? {CT screen} CT Technician: (unintelligible) [type of scan]. Clinician: but as far as any other procedures? {CT screen} CT Technician: I have no idea. Janet: Plus or minus CSF tap. {anesthesia record} Clinician: Um, yeah I would give it [anesthetic countermeasure]. Its probably a little low for a unintelligible. {anesthesia record, monitoring equipment} Janet: Yeah, hes 112 [heart rate?]. {monitoring equipment} Clinician: Thats fine. {monitoring equipment} Janet: Does it have to be given any particular way? Like . . . {syringe, monitoring equipment} Clinician: Like? Janet: Like back flow? Clinician: Intravenously. Janet: Okay. His heart rates already jumped up to 114 from like 112. Down and back. Much higher now. And his pressures already jumped up to 80 from like 55. {monitoring equipment, anesthesia record}

Janet intended to draw the clinicians attention to the patients low blood pressure. Looking at those figures, the clinician was also able to see that the patients heart rate was low, a result of the disaggregation of relevant data into separate data streams. Both pieces of information were essential to determining the patients condition and their close proximity in the bank of monitoring equipment made a quick comparison relatively effortless. The close proximity of these

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technologies kept various representations of the patients condition present and reinforced their collective importance to the discursive activity of assessing condition. The monitoring equipment also helped articulate information that could be aggregated with other pieces. Because the equipment was always on, it provided a constant stream of real-time measurements. Upon recording these outputs onto a graph printed on the anesthesia record, Janet could see a trend of improvement or deterioration. The anesthesia record also aggregated other pieces of information, including the number of drugs given, the amounts, and the schedule of procedures to be performed. The anesthesia record helped relay information about the other procedures in which the patients condition would be a factor. The clinician asked what was planned for the patient, indicating that he wanted to know how long the dog needed to be under anesthesia. Janet retrieved this information from the anesthesia record and noted that he was scheduled for a CSF tap, a relatively short procedure. Because the clinician was also within view of the CT scan results coming back and broadcasted on the CT technicians screen, he had some sense of how far along the scan had progressed. As we learn later, the clinician was attempting to determine how much longer the dog would be under anesthesia. If the dog was to be revived within a short amount of time, then that might lead to one course of action. Because the patient was to undergo another procedure, the clinician determined that the patients condition was poor enough to merit use of a countermeasure. From simple comparisons of numbers on the monitoring equipment and time estimates taken from the visible progress ofthe CT scan and from the schedule, relayed by the anesthesia record, the clinician and Janet were able to coordinate a common understanding of the patients condition and then take action. CSF Tap Monitoring After delivering the countermeasure, the results of Janets actions were immediately transformed into numerical information, which she read off of the monitoring equipment. She saw that the heart rate jumped to 114 from 112 and that the pulse came up to 80 from 55. The previous figures, she had preserved in the anesthesia record, which relayed them to her from a point in the past. In their aggregate, graphed form, the improvement in heart rate and blood pressure was obvious. Finally, at the start of the second procedure:
Janet: [To the clinician], so, the pressure went up, but only temporarily. And its continuing to drop now, where the last reading says like 47. {anesthesia record, monitoring equipment} Clinician: Okay, so theyre just about done. Right? {anesthesia record, monitoring equipment} Janet: Yeah, so is that going to be okay? {monitoring equipment} Clinician: Whats the vaporizer on? {vaporizer}

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Janet: What? Clinician: Whats the vaporizer on? {vaporizer} Janet: Um, probably two. I can put it down to one and a half. {vaporizer} Clinician: Yeah. {vaporizer} Janet: It was only on two for the way over [to the prep room] Clinician: Okay. Well be done soon, so I think wake him ups going to be the answer. {monitoring equipment} Janet: Okay. {monitoring equipment}

At the start of the CSF tap, Janet had moved the patient back to the anesthesia prep room and was continuing to monitor his condition. She noticed, however, that the patients blood pressure had again started to drop. Responding to Janets question, the clinician looked at the anesthesia record to update his understanding of the patients schedule, in case any further procedures had been ordered after an ophthalmology team had reviewed the results of the CT scan. The record did not show any additional procedures, which meant that following the CSF tap the patient would be revived. Responding to Janets implicit question about the patients condition, the clinician appeared to conclude that although he could see that the patients heart rate and blood pressure had again dropped, the best approach was to wait until the patient was to be revived. Layering in the local ICTs helped articulate the ways that coordination present at the level of spoken discourse was afforded by subtle micro-discursive operations supported by the texts and technologies. The simple interactions between people and ICTs and their subsequent mediated interactions with each other underscores the role that ICTs play in creating coordinated discursive activity. The remainder of this article attempts to outline methodological implications for empirical investigations of these mediating effects. METHODOLOGICAL IMPLICATIONS: STUDYING MEDIATED DISCOURSE The first methodological consideration when undertaking an empirical study of mediated discourse is choosing an object of study. Following Kaptelinin, I suggest adopting the functional organ, a functionally integrated, goal-oriented configuration of internal and external resources [39, p. 50] as the object of study. To illustrate, instead of saying that Janet is the object of this study, the object is instead Janet and all of her mediating technologies, which become extensions of her ability to fulfill her professional responsibilities. In this case, the monitoring equipment is inseparable from any analysis of what Janet does to monitor the patients condition. From a practical standpoint, studying a functional organ requires the researcher to start with a research subject but then look outward to the technologies and their physical and virtual environments. Such a shift in research focus makes empirical studies far more complex; however, even this complexity can be managed through

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a multi-tiered approach to the collection and analysis of data. While my particular area of concern is the micro-discursive operations facilitated by ICTs, I will step back for a moment to discuss an analytic framework in which my methodological recommendations fit: Clay Spinuzzis concepts of the macroscopic, mesoscopic, and microscopic levels of analysis [8, pp. 25-58]. At the macroscopic level of analysis, our attention goes to culturally-and historically-situated activities as well as to the environments supporting them. The culture and history of these activities, broadly defined, will be captured in the design of spaces where those activities take place. Important sources of data include patterns of traffic flow, the ways walls are used to create public and private space, the ways walls create disciplinary spaces (e.g., rooms for clinical pathology, for radiology, for anesthesia, etc.), and the lines of sight allowing people sharing a space to see each others work. The cultural and historical significance of these activities will also be captured in the histories and designs of the technologies found there. The technologies may be designed to create information that is specific to the discursive activities typically supported in a given space, helping users understand the discourses that they enact. The mesoscopic level is the level of actions. Here we begin to see circumscribed tasks that are attributable to people who may appear principally responsible for carrying them out. Actions such as identifying a set of symptoms, estimating damage on a vehicle, or reading a street sign appear to be more limited in scope, but they are integral parts of larger activities (e.g., diagnosing an illness, writing an insurance settlement, or providing driving directions). People are assisted in these actions by technologies and other discursive artifacts that help guide that activity toward pre-scripted ends. Spinuzzi argues that many of the mediating qualities associated with the macro and mesoscopic levels are captured in genres and in the interfaces of technologies, which he argues have considerable impact on operations at the microscopic level. At this level, we are looking through the ecologies that define the character of any discursive activity, through the discursive actions by which those activities are carried out, and to the simple discursive operations underneath. Certainly genres of information impose downward coordination on many activities. Knowledge of the kind of discursive object one wants to create can clearly guide how one interacts with information. But when the discursive object is not clear, when no genre explicitly guides its creation, and when the object is fashioned from streams of data that are distributed physically and cognitively, I suggest that we should look at the discursive agency that people tacitly attribute to their technologies. This perspective takes us further toward a consideration of the semantic potential [22] of information technology as mediators of discursive action. Each of these levels describes activity in successively richer detail. Although I have separated them here, they are integrated in analysis. In order to understand why Janet makes numerical notations on a sheet of graph paper, one must

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understand that doing so is part of the process of tracking vital signs, which is part of administering anesthesia. Each level helps explain what is happening on other levels. Consideration of activity at these levels suggests different research questions and objects of study, as outlined in the following table (Table 1). Employing these levels of analysis to anesthesia, we see that it breaks down into a variety of discursive actions, such as intubation, monitoring vital signs, and tracking patient condition. Members of the anesthesia team accomplish these tasks with the assistance of available texts and technologies, which help them structure and organize available information so that it can be readily used. These discursive actions then break down into simpler micro-discursive operations such as reading equipment displays, comparing sets of numbers, and making hash marks or simple notations on graph paper, which help create basic conditions for coordination.

Table 1. Research Questions and Objects of Study at Macro-, Meso-, and Microscopic Levels
Macroscopic Question Orientation Activity: culturally and historically defined. Mesoscopic Actions: goal-directed tasks that collectively constitute an activity. Microscopic Operations: simple physical or mental interactions by which actions are carried out. What kinds of information do technologies create (e.g., in mode and form)? Who has access to the technologies? How do the users interact with those technologies (e.g., reading, touching, etc.)? e.g., how does the student use patient information that is collected by touch? Simple observations of habitual technology use. Orientation of technologies to all participants.

Question Types

What kinds of discursive work are these technologies intended to serve? How does the architecture of a room arrange people and information? e.g., how has the anesthesia record evolved over time to support the creation of condition narratives?

In the course of what goal-oriented tasks do people interact with technologies? What discursive functions do users require their technologies to handle? e.g., in service of what information needs do students use local computer terminals?

Objects of Study

Architectural layout of room. Cultural, institutional, and professional histories of support technologies.

User-defined tasks and the sequences of technological, textual, and interpersonal interactions enacted to carry out those tasks.

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Data Collection Case studies performed in naturalistic settings will provide the best study design for witnessing the mediating effects of technology. In some instances, however, quasi-experimentation may be a possibility, assuming that the researcher can ethically exert some control over the kinds of technologies used if not the people who actually use them. The first step in data collection is to identify all of the actors involved in the discursive activity, both human and non-human. Equally important, we must have some understanding of the nature of the relationships between actors, the motivations of human actors, and the design histories of the non-human elements. The level of detail depends on the depth of the claim.
Types of Data

Much of the analysis of discursive activity will be framed by the researchers notes, through which one should attempt to create a rich picture of the environments in which people interact with texts, technologies, and each other. Initially, researchers should gather information about the physical layout of the work spaces. Descriptive notes, sketches, and photographs of these places will provide some information about the lines of sight, public and private areas, places where people congregate, places where information is stored, and movements throughout. Just as the architecture of any building guides users to inhabit and move through it in a particular manner, so too do the spaces in which people work. Make a note of technologies, texts, instruments, and other artifacts that may be present. Note their arrangement in space. From these notes it is possible to perform some macroscopic analysis of the work setting by constructing a map of the networked interactions between humans and non-humans. Figure 2 is a selection from a map showing Janet and the mediated interactions with her patient. The map shows the possible points of connection and routes of connection to the different sources of information. The clinician, for instance, can see all of the monitoring equipment, and the patient. He can also talk to Janet. These are routes to the patient and sources of mediated information about the patient. Maps such as these can be further enriched with information about the cultural, professional, and institutional histories of the technologies in use. What are the precursors to the texts in use? To what other institutional discourses does the information in those texts contribute? What technologies preceded blood pressure machines or CT scans? How are the mediating perspectives of those precursor technologies folded into the new devices, for example, in the way that old typewriter designs are folded into modern keyboard layouts and modern concepts of desktops are carried forward on computer operating systems? These progenitor technologies mediate interaction and information in ways that are compounded [40] in the interfaces of the technologies that the research participants may be using.

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Figure 2. Network of mediating agents in anesthesia.

With notes about the physical layout of the room, we can tell, for instance, if there are areas where a technology might not be visible. If this is the case, it may be important to know if that technology has a broadcast function and if it broadcasts visually, audibly, or both. Take pictures of interfaces and samples of output. The aim is to understand how these technologies create information, represent it symbolically, store it, and share it. It is important to know, for instance, that a blood pressure machine records pressures as systolic and diastolic pressures, that it only provides a moment-by-moment display, and that it shares the information by broadcasting it to anyone within sight of the interface. When these technologies are used, attempt to see how they are used, by whom, under what circumstances, in what order, and in combination with what other texts or technologies? Another type of data to capture is talk. What are the research participants saying, to whom, and when? It is often the case in knowledge work that, to invoke Austin [41], we do things with words. We create work objects out of words [42] and we perform discursive tasks on those objects in consistent ways that can be tracked by analyzing the patterns of language we use to talk about them [43]. To capture what is spoken in addition to information about how participants

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use technologies, audio or video tapes are recommended. By studying talk, we can determine what discursive functions the participants assign to their technologies. At the same time, we should gather information about how people interact with technologies, texts, and other people. Much of this information can be supplied with a researchers descriptive notes. Diligent researchers should, however, annotate their data with additional information about the interactions as they occur. Video obviously provides the same kind of detail, but may be more difficult to transcribe. As seen earlier, I marked the transcript of Janets work with notes about the technologies that she was looking at or directly using. As a result, the transcript not only shows what she was doing with words, but what technologies and texts she was oriented to while performing those actions. A caveat: an outsider is not always the best person to make observations about the kinds of artifacts that may be important to an activity. Researchers should be mindful of their outsider status and attempt to triangulate their data whenever possible. Interviews with participants can fill in some of the gaps, especially when the research participants are allowed to comment on the researchers assumptions and interpretations of the activities observed. I often recount or show a section of activity and then provide an explanation of what I saw happening, encouraging the participant to correct my interpretation. I also ask the research participants to point out technologies, texts, instruments, and other artifacts that they consider to be important. I then give additional attention to these artifacts during the course of my observations. A team-based approach, with both insiders and outsiders on the team may be a worthwhile approach. Another source of triangulation is to make multiple observations of the same participants and of different participants performing the same tasks. Look for ways in which their performances are similar when using the same technologies and texts. Data Analysis The object of analysis when looking at transcripts and notes about a discursive activity are mediated interactions. There are a variety of ways to approach such an analysis, although an inductive approach that attempts to understand actions by looking at the underlying operations may lead to a more precise understanding of the kinds of mediation at work. An inductive approach to data analysis would begin with close readings of the transcripts, from which researchers could identify micro-discursive operations and the discursive actions that arise from them. Data analysis should begin with an inductive approach to coding transcripts of the observations and interviews. These categories of discursive activity should arise from iterative readings of the transcripts. The participants will reveal many of the discursive functions that they attribute to their technologies along with their expectations about the kind of work those technologies contribute.

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Once a set of discursive actions can be identified and defined in a coding scheme then the researcher can look for instances of that discursive activity throughout. For each instance of the activity, one can catalogue the interactions between people, technology, and texts in order to understand the actions and operations constituting that activity. Where possible, researchers should attempt to compare instances of the same discursive actions mediated by different sources and emerging from different sets of micro-discursive operations to see if the outcome is different. One can use the network map to sketch out the order of interactions or the mediation path that coincides with the discursive act in question. A mediation path shows possible points of re-structuring and re-organizing that information goes through. It is a handful of mediating resources set into temporary coordination to serve an ad hoc discursive goal. If we know that Janet makes notations on the anesthesia record in order to mark changes in a patients condition, it is useful to know (confirmed by observations) that all marks in the anesthesia record are preceded by Janet looking at and reading (confirmed in the interview) the readouts of the monitoring equipment. One can then examine the interactions between Janet and the monitoring equipment to see how these interactions mediate information about the patient and subsequently mediate Janets interaction with the anesthesia record. What we have isolated here is a mediation path (see Figure 3) that influences the enactment of a discursive activity: monitoring a patients condition. The doctor does not see the anesthesia record and so his source of information about the patient is not directly mediated by that text, except in so far as he gets information from Janet, whose interpretation of the patient comes through the anesthesia record, which holds an aggregate representation of blood pressure readings, which are numerical transformations of the patients actual blood pressure. From an analytic standpoint, we can observe the simple interactions that Janet has with the anesthesia record (e.g., filling in blanks, making hash marks, etc.), look at the simple interactions between the anesthesia record and the blood pressure machine (e.g., a recording of the machine display), and finally between the blood pressure machine and the patient (e.g., transformation of actual pressure into a numerical measurement of actual pressure). Through these transformations, Janet is able to support her physical observations of the patient with symbolic information about the patient mediated through the blood pressure machine and the anesthesia record. The clinician can then verify the information he receives from Janet via his reading of the blood pressure machine and his observations of the patient, two information sources to which he does have access. CONCLUSION: APPLYING THE DESIGN Although the technologies used by the members of the anesthesia team were designed to serve useful ends, it is also important to consider the ways that the technologies change information-centric knowledge work in possibly

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Figure 3. Mediation path showing Janets interaction with the patient.

counterproductive ways. Just as these technologies alter the form and distribution of information in useful ways, they also, potentially, negatively impact other work practices by altering both our means of access to information and our ability to use it. Even based on the positive interactions described in this brief study, we can intuit some possible negative outcomes, which when studied in light of the methodological concerns outlined in the second half of this article, present important empirical questions. Transformation technologies convert information across representational states. These states, as Winsor [44] indicates, are associated with different kinds of knowledge and power. When transformational technologies are put into play, especially when they both collect and transform information, one concern is how the transformation opens or closes access to that information. While the transformation might make the information more easily connectable to other streams of information, one needs to consider how others may be using that information and the impact of the transformation on their use. Dis/aggregation technologies can constrain work activities for the same reasons. Instead of transforming information across representational states, aggregation technologies transform by embedding information into units that may

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require a different kind of expertise to unlock or that may speak to one particular use of the information at the expense of others. When information is locked into an aggregate form, some audiences interests will be better served than others. Disaggregation has a similar effect, requiring users to assemble their own discursive objects from separate streams of data. Broadcast technologies have the impact of making private information public. In some situations it is useful to have information broadcast in an accessible form. Those receiving the information can apply it to their own ends and work independently. An unintended result may be that work relationships are altered, information-sharing and information-processing relationships may be changed. Publicly available information also enables supervision and surveillance. What are the effects of these changes on discursive activity? Relay technologies facilitate the transfer of information across place and time. They ensure that useful pieces of information can be called up and applied in a variety of settings. However, many relay technologies are not sensitive to context. They are not aware of the ways that information becomes useful as it is shared among people, texts, technologies, and other streams of information in a specific context and moment. The content itself may be unnecessarily constraining or, worse, misleading and uninformative. Regarding both the positive and negative qualities of interacting with technologies as discursive agents, the point is the same: these technologies have prescriptions that are designed into their functionality and their interfaces. Where this issue concerns us is when these technologies are increasingly used to mediate knowledge work. When people start to interact with their technologies as discursive agents, responsibility must begin to shift to those who are critically equipped to assess the value and future design directions of these tools. Thus, a secondary purpose of this article has been to discuss the methodological imperatives associated with studying these effects. By studying the discursive functions of ICTs and observing their mediating impact on discursive activity, we may see how successful coordination is afforded by ICTs. Perhaps more importantly, in situations where coordination fails, an analysis like that discussed in this article may point to the systemic ways that ICTs contribute to the problem.

APPENDIX A: Summary of ICT Discursive Functions in Anesthesia Scenes Transformation Anesthesia record transformed patients apparent state of anesthetization into a quantitative amount of sedative Syringe broadcasted information about Janets intentions for the second stage of anesthetization Dis/Aggregation Broadcast Relay Anesthesia record relayed information about the sedative Drug formulary relayed a range of adverse effects and dosages

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Intubation

Adjusting the Vaporizer Monitoring equipment transformed physiological information into numerical data Monitoring equipment was physically aggregated in space. Monitoring equipment broadcasted patient information in highcontrast displays. Monitoring equipment disaggregated observations into multiple variables Monitoring equipment supplied information that could be aggregated (i.e., information in compatible forms) Results of countermeasure transformed into numbers on the monitoring equipment Anesthesia record aggregated readings in a line chart CT scan results broadcasted on the CT technicians screen

CT Scan Monitoring

Anesthesia record relayed information about the other procedures.

CSF Tap Monitoring

Previous figures relayed via the anesthesia record.

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Other Articles On Communication By This Author

Swarts, Jason, Together with Technology: Writing Review, Enculturation and Technological Mediation, Baywood, Amityville, New York, 2007. Swarts, Jason, Mobility and Composition: The Architecture of Coherence in Non-Places, Technical Communication Quarterly, 16:3, 2007. Swarts, Jason, Coherent Fragments: The Problem of Mobility and Genred Information, Written Communication, 23:2, 2006. Swarts, Jason, Textual Grounding: How People Turn Texts into Tools, Journal of Technical Writing and Communication, 34 :1, 2004.

Direct reprint requests to: Jason Swarts Dept. of English North Carolina State University Campus Box 8105 Raleigh, NC 27695 e-mail: Jason_Swarts@ncsu.edu