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Juvé Udina ME. ATIC: 30 años construyendo conocimiento enfermero y autonomía profesional. Metas Enferm sep 2022; 25(7):3-6. Doi: https://doi.org/10.35667/MetasEnf.2022.25.1003081970
Maria Eulàlia Juvé Udina
Autora de ATIC. Doctora por la Universidad de Barcelona. Enfermera Ejecutiva Instituto Catalán de la Salud. Jefe de Grupo de Investigación en Enfermería del Instituto de Investigación Biomédica de Bellvitge (España).
Contact email: email@example.com
Versión en Español
The sentence by Socrates (470 BC) “The secret of change is to focus all your energy not in fighting the old but in building the new” shows the spirit of these three decades devoted to the building, validation, implementation and expansion of the ATIC* Terminology and nursing knowledge tools. This year 2022 is also the 15th anniversary of their first implementation in daily practice, and 10 years from the publication of the process and its validation results (1). The history of this language system, its use and utility in nursing practice at hospitals, sociosanitary centres and Primary Care, as well as all the scientific production that it has allowed generating, have been documented and published over these years; therefore, I will use this chance offered by Metas de Enfermería to share some considerations which have also been part of this journey.
Dogmas are systems of thought which include beliefs considered absolute certainties, that cannot or should not be questioned. In the case of the nursing profession in Spain, there are some widespread dogmas regarding models, theories, the process of care provision, and language systems. These were captured, for example, in the sentence “We nurses must use a single language system, because that is the only way to communicate and compare us”; and even in 2019, this appeared with the following headline in La Vanguardia newspaper: “Experts advocate for standard Nursing languages vs. the one in Catalonia” (2); this headline represents an oxymoron in itself, because ATIC is a standardized language. With respect for other opinions, for three decades I have questioned these dogmatic approaches, not only from a philosophical, ethical and theoretical philosophy but also practical, looking through my eyes during my years of work as a practice nurse. Whether naïve or not, it was evident to me back in 1992 that the world was starting to turn towards digitalization, information systems and artificial intelligence, that we nurses had a basis of theoretical and methodological knowledge tools, such as the Data, Information, Knowledge and Wisdom model (3,4), and that if we played our cards adequately, this could allow us an advantageous collective position in decades to come. When I read the article in La Vanguardia back in 2019, I regretted the way in which we nurses continued losing opportunities once again, because in my opinion different languages are enriching for everybody. As in other occasions, I suggest reading La ciencia empieza en la palabra (“Science begins with the word”) (5), which was published by Dr. Gutiérrez from the University of Salamanca in 1998, and I recommend the so-called experts to analyse the case of the medical profession, where more than 100 language systems are used. Maybe because our physician colleagues discovered a long time ago that in order to train and practice their profession they need to understand and manage over 150,000 concepts, and that no single language system collects the disciplinary knowledge completely.
The Nursing profession keeps on losing opportunities, and not only due to the gender gap and glass ceilings. We nurses keep on losing opportunities because the way in which we generate our own mantras, articulate our collective discourse and the single “formal” language advocated for by some, are limiting our ability to achieve a position in the world, timely and correctly. A profession that, despite generating major scientific evidence, is mainly anchored in dogmas and beliefs of the last century, self-imposes low ceilings to its members, which limit growth, creativity, innovation and disciplinary advance, and which ostracizes those nurses who raise questions or resist accepting that “you have to do it like this because it has always been done like this”.
The discrepancy in our individual and collective view of the world is not an exclusive problem of the nursing profession. The bias in the view that we all have of the world in which we live is clearly demonstrated in the papers by the epidemiologist Hans Rosling and can be confirmed in the Gapminder website (6). In this sense, as explained by Harari in his book Homo Deus (7), data are the petrol of the 21st century, and dataism is the prevailing ideology in our days, with data and information flows as the essential corpus to create and use artificial intelligence algorithms in the transition of our species from Homo Sapiens to Homo Deus.
On the other hand, one of the usual and more furious criticisms to ATIC (or its author) throughout this past decade has been that ATIC is used under licence. It is considered bad manners to speak about money, but I guess that there is an exception when we need to talk about money. Well, let’s talk about it. You will understand that, in my opinion, the knowledge provided by ATIC, the data model behind it, the different instruments that have demonstrated its utility, the effort, economic investment and personal time that it has represented, as well as my professional and personal renunciations during these 30 years, should have a monetary value equivalent to the investment made in the terms expressed. However, I am most concerned and challenged about this ceiling to the right of a woman to have her work rewarded in a fair and equal manner, a ceiling that is shown in the salary gap, but again also self-imposed by dogmas in our own profession, as if it were inexplicable or unthinkable that a female nurse could earn a living with her job, or that we must keep a submissive attitude and accept that nursing knowledge and services should not be addressed from an economic perspective. All this is a challenge for me, and I think that it should be a challenge for all of us. I am fortunate to have known and worked with a high number of nurses throughout my 35 years in Nursing, but you can count with the fingers in your hands the number of entrepreneur nurses, or nurses who have been able to work and support themselves without depending on an employer, public or private institution or organization, or nurses who have been able to create jobs for other nurses or professionals through their work. Please excuse my boldness, from my point of view this is not a purely economic matter, it is a matter of equal opportunities and social justice, which does not contradict at all my professional vocation or my wish and aim to contribute to placing our profession in the position where it belongs.
The ATIC architecture is currently structured into over 25,000 concepts which shape its terminology, a system of archetypes, hundreds of thousands of relationships which form its ontologies, a model of indicators for care management, a classification system for patients by levels of care intensity, based on the weight of the primary nursing diagnosis, and other tools in development. I celebrate these 30 years since the creation of ATIC and these 15 years of its coming out. I celebrate its successes and achievements, its failures, strengths and weaknesses, because they are part of my life and professional history. I celebrate that, regardless of slights, repeat omissions, destructive criticism, unfounded rumours and daring opinions, ATIC is still going forward almost 11,000 days after that first day; and I also celebrate that today the pen is still mightier than the sword. I invite all those who already know it to come celebrate with me and to continue examining its different aspects in depth. And to those who don’t know ATIC, I invite you to discover it.
Today and always, I thank Metas de Enfermería for its work, plurality and rigour, with which it contributes to spreading knowledge and generating professional autonomy; and I hope that we can celebrate together its 25th anniversary next year. Greetings to all of you.
- Juvé Udina ME. ATIC. Aticcare [sede web]. [citado 2 jun 2022]. Disponible en: http://aticcare.peoplewalking.com/
- La Vanguardia. Expertos abogan por lenguajes de enfermería estándar frente al de Cataluña. lavanguardia.com [internet] 2019. [citado 2 jun 2022]. Disponible en: https://www.lavanguardia.com/vida/20191019/471056743079/expertos-abogan-por-lenguajes-de-enfermeria-estandar-frente-al-de-cataluna.html
- Nelson R, Joos I. On language in nursing: From data to wisdom. PLN Vision 1989 (Fall): 6.
- Graves J, Corcoran S. The study of nursing informatics. IMAGE: J Nurs Scholarship.1989; 21(4):227-31.
- Gutiérrez B. La ciencia empieza en la palabra. Análisis e historia del lenguaje científico. Barcelona: Ediciones Península; 1998.
- Gapminder. Herramientas gratuitas para una visión del mundo basada en hechos. [internet]. [citado 2 jun 2022]. Disponible en: https://www.gapminder.org/
- Harari YN. Homo Deus. Breve historia del mañana. Barcelona: Editorial Debate; 2016.