Dr Howard Karl Butcher creates this opportunity for a critical dialogue on classification systems in his letter commenting on my Current Controversies in Critical Care column titled “Designing Formal Classification Systems to Better Articulate Knowledge, Skills, and Meanings in Nursing Practice” (September 2004;13:426–430). In this response to Dr Butcher’s thoughtful letter, I hope to clarify points of misunderstanding and extend the dialogue. The thesis of the column is that every classification system designed for indexing and retrieving records and communicating and documenting nursing work creates a particular view of practice. The particular view of practice that spawned the classification system has an inner logic. With continued use, that inner logic becomes reified and increasingly invisible as the classification system becomes a taken-for-granted understanding and approach to practice. The column warns that practitioners must be astute and critical of the...

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