Disparities in Health and Health Care, Research Paper Example

Introduction

Firmly embedded within the current healthcare system, nurses encounter first-hand issues within healthcare settings related to quality in conjunction with performance gaps. Nursing executives retain the power and agency to influence both public and organizational policies if they utilize their sources of power in an effective manner. Legitimate power within context of nursing is the power nurses incur through their status as effective and sound caregivers in addition to the critical role that nurses play within the current healthcare system. Illegitimate power within the healthcare industry refers to any coercive or divisive power that endeavors to manipulate and force via the utilization of punishment a change in the healthcare system. This type of use of power is quite destructive and will not foment dedicated healthcare professionals in any field, especially in the field of obstetrics. Nurses always have a power base in which they can transform a particular vision they have of healthcare into reality vis-a-vis legitimate clinical power, charismatic clinical power, extended clinical power, and their informational clinical power. Because of these various facets of power that they have, nurses also have discretionary coercive power in which they are placed in a legitimate position to punish others merely because they have the power to do so. Within the field of obstetrics, illegitimate power is most poignantly felt at the micro level because not all clinicians treat their patients in a positive manner. Because many girls do not receive an adequate education on issues related to on reproductive health, many girls participate in unsafe reproductive behaviors. It is the duty of a nurse working for Planned Parenthood to effectively educate their patients rather than conveying threats about unsafe practices.

The purpose of this paper is the examine the elements of the power dynamic within practice settings and understand how both legitimate and illegitimate power can potentially impact health from the perspectives of sociopolitical factors, stakeholders, and interested parties when applied to the field of obstetrics. Nurses are aware that without power, no action will follow (Hakesly Brown & Malone, 2007). The nurse/patient dyad operates within a political, clinical, and organizational power base that has evolved over time. As a result, nurses have played a critical role in how patients have received healthcare whether positive or negative, and using their various bases of power, they have endeavored to enhance the quality of care that patients receive.

Description of Power Dynamic

Power—both legitimate and illegitimate—is required in order to transform a certain vision into reality, and this can only transpire through sharing and collaboration because only by sharing it with others and others buying into such a vision can an effective and healthy partnership commence and be sustained (Malone, 1996). Indeed, a vision that lacks a power base, and there action, constitutes a hallucination.  The very concept of power within  healthcare settings is more complex and multidimensional then it seems, and the various perspectives of power that a nurse is involved in must be explored in order to get a more nuanced understanding of the power dynamic in clinical settings.  Relevant power perspectives to the nursing profession and the clinical relationship between patients and nurses include clinical, informational, charismatic, legitimate, extended, organizational, and political clout. Each of these types of power will be considered prior to reflecting on how such power translates into certain healthcare settings such as in obstetrics.

At the very core of nursing and what nurses engage in is clinical power, and patients are critical components within this power perspective. Moreover, they make significant contributions to a nurse’s clinical power base since they are the ones who grant nurses this power.  This partnership and interdependence fomented between  patients and nurses thus create this power, which impacts healthcare organizations at the micro and macro levels (Malone, 1996). Indeed, healthcare organizations such as hospital seek to extract the most optimal care for their patients, which relies on the clinical relationships and power bases therein. A subset of a nurse’s clinical power is the informational clinical power they possess because of the quotidian interactions with patients. As such, by nature informational clinical power goes in many directions and is created via examining, talking, listening, intervening, reviewing , discovering, and physically being together in the same exam room with a patient (2007). Nurses and patients constantly exchange information with one another far more than any other partnership within the healthcare industry, as the nurse acts as the conduit between physician and patient, and an advocate in certain situations with other healthcare officials. Nurses in hospital settings are with patients sometimes seven days a week for twenty four hours a day. Nurses also can offer patients an integrated and holistic approach to healthcare that can include various members of the community, including significant others, friends, colleagues, family members, and the community at large. As a result, nurses are given the information that can be shared with stakeholders. Informational clinical power that nurses are endowed with thus becomes a potent mechanism in the entire healing process. Ultimately, it redefines the contours of the entire healthcare process on an idiosyncratic basis.

Nurses possess legitimate clinical power, which is derived from their position as a registered nurse or nurse practitioner and/or their credentials. For example, in the United Kingdom, the most important credential to have in order to garner the most legitimate clinical power is the Nursing and Midwifery Council (NCM) registration, which grants the practitioner who has it the authority to provide patients with competent and safe care (Waldau, 2010). Indeed, all patients have the right to access to safe and competent healthcare. In some instances, the Department of Health is seeking to diminish the role of some nursing officials with less credentials while others argue against implementing constraints that hinder a nurse’s capacity to self regulate.  Legitimate power, from the perspective of a patient, comes from the implementation of an ethical framework that is accepted and delineated in an organization’s professional code of conduct, which valorizes the patient. Patient care always comes first, and nurses obtain legitimate power from this premise. The Patient’s Charter which is implemented in the United Kingdom is the first organization document that addressed this issue. Other professional bodies can also articulate the proper protocol with regards to the rights of patients in certain arenas. Healthcare research using patient case studies, for example, has very strict protocols in place. Patient pressure groups have germinated over the past few years in order to be active in various specialties. Both professionals and the public have made concerted efforts to raise money for various enterprises such as heart health and cancer research. Such activities engage in family members as well as the community because causes such as Lupus or Cancer has affected everyone in one way or another.

As an advocate for the patient and conduit between the patient and physician as well as other important stakeholders, the nurse must have the ability to inspire, which is known as charismatic clinical power. Charisma refers to one’s enthusiasm and confidence in one’s own abilities as well as in patients, family members, and colleagues. As such, it is of paramount importance that the nurse conveys a fervor and joy for the profession because of the healing and caring aspect (Malone, 1996). Such ardor and passion can spread to others and truly impact medical personnel in ways that are not quantifiable, thereby enhancing the overall environment therein. For example, some research points to the significance of ward sisters as positive role models who act as cultural barriers for an entire medical team in the ward in order to deliver the best and highest quality healthcare that is patient-centered. Nurses are cognizant of the fact that patients and their families themselves can serve as inspirations to nurses and other medical personnel in the how they approach life-altering situations.

Extended clinical power is based on the notion that providing quality healthcare is a collaborative rather than an individual endeavor. If the nurse is the only health provider, the caring would manifest with the cooperation, collaboration, and support of the various stakeholders involved (Waldau, 2010). This type of power confronts the various challenges involved with shift work and being a part of medical teams that are multidisciplinary in nature. Thus, nurses must be  able to communicate with others well and acknowledge that nurses have limitations and can rely on others for help.

A complicated interplay of diverse power forces including as health-related behaviors, physical environment, and access to and quality of healthcare greatly impact human health and any and all health outcomes yielded. Social and economic environments that people grow, inhabit, learn, and work    in collectively dictate various health quality in addition to health outcomes. Structural socioeconomic and political inequalities play an integral role in deciding whether or not someone can afford to look to obtain healthcare, especially for socioeconomically disadvantaged individuals, minority women who are pregnant and lack the funds and/or the education  about where to get health, and many other groups (Baldwin, 2003). Socioeconomic determinants of health include a family’s or individual’s income, employment status, support they get from the family, level of education, and community involvement and support. Sociopolitical factors that impact human health and health outcomes are both at the societal and individual levels in addition to power relations between various groups. Discrimination predicated on race and gender and the redistribution of wealth are two types of this kind of socio-political factor. Democratic principles related to accountability in healthcare, fairness, and informed consent are also socio-political factors at the societal level. At the individual level, patient-related outcomes including quality of life, work opportunities, social integration, and family/marital life. Nurses retain political power through community advocacy, as they must act as advocates for their patients by putting pressure on political lawmakers at the micro and macro levels to ensure that patient care and safety is enhanced.

Clinical, political, and organizational clout remain critical for nursing, especially since it is still a predominately female profession in while male leadership foments a certain type of culture within the field. The cognizance and ability to effectively deploy various types of power does not eradicate the necessity for nurses to have emotional intelligence (Malone, 1996). There remains blaring flaws within the healthcare system due to prevalent prejudicial attitudes towards female minorities within the field of obstetrics. As such, the nursing power dynamic can further be explored and reflected on within this field of choice in order to elucidate changes that need to be made in the near future to enhance the delivery of healthcare services today.

Reflection of Power Dynamic

Nurses have power at the micro and macro levels, which enables them to act as integral members of a healthcare team, especially within the field of obstetrics. Indeed, their role as socio-political advocates for their patients means that they must be actively engaged in the political process in a  way that enhances healthcare and patient-care and safety. The legislative process and healthcare lobbying from a nursing perspective is important to understand as  component of this power dynamic in which they can enact meaningful and tangible change. . Discerning how a personal opinion is bolstered and informed by nursing research sheds light on the various intricacies of the legislative and political processes and how nurses can effectively lobby for pressing healthcare issues related to certain specialties or the healthcare system as a whole. Writing letters to congress is one way to accomplish this. For example, many registered nurses working in hospital care settings have sent letters to their local or state congress members advocating for the implementation of strict, and concrete nurse-patient ratios in order to yield more optimal health outcomes (Hertel, 2012). California is the only state that has passed policies that have implemented strict regulations, and the results were staggering regarding how many less preventable deaths, illnesses and readmittances California had as a result (Hertel, 2012, p. 3). Billions of dollars in unnecessary healthcare was saved, which has prompted nurses in states such as New York to push for the support and passage of similar initiatives.

Socioeconomic factors that affect individuals who reside in socioeconomically disadvantaged communities abound and often yield poor health outcomes due to the lack of available resources in those locales. These disparities translate into a general lack of access to necessary reproductive services within the field of obstetrics for pregnant mothers. Many young teenagers in these neighborhoods become pregnant because they lack the knowledge about safe sexual behaviors. One such scenario is that a teenage mother who does not engage in proper prenatal care will most likely give birth prematurely to a baby that is severely underweight due to the fact that the young mother most likely was raised in a household that frequently ingested high-fat meals that contained little to no vegetables and fruits consumption. Moreover, substance abuse and domestic violence was most likely ubiquitous and unrestrained, and the young mother was forced to work in a minimum wage job that lacked any health benefits. As such, the young mother lacked access to any adequate family planning services, and Planned Parenthood has been stripped of its funding so one was not available in a local place, which is why she carried through an unplanned pregnancy without taking any prenatal vitamins or knowing how her eating and lifestyle habits would affect her newborn in the future. The young mother was constantly exposed to second-hand smoke because her father smoked a pack a day. When her pregnancy test tested positive, the young mother wanted to obtain obstetrical services in order to end the pregnancy early, but there were no clinics that offered such services available nearby or near the public transportation spots in her town. As a result, the young mother suffered from several pregnancy-related problems prior to  the premature birth of her baby. This scenario demonstrates how together socioeconomic and sociopolitical factors impact who has adequate access to health education and obstetrics services and who does not. Often, the socioeconomically disadvantaged, poor communities made up of non-white families who cannot afford necessary healthcare are the ones who suffer. Such disparities in the allocation of resources perpetuate this cycle, which is why nurses and socio-political advocates for their patients must use their power at the community level to enact change, especially since reproductive health has emerged as such a contentious and important issue in the national conversation within political discourses.

Conclusion

Quality of care in healthcare settings is profoundly significant to both nurses, patients, and various stakeholders.  The existing patient/nurse relationship is the product of an amalgam of  organizational, clinical, and political power paradigms that have evolved according to epochal exigencies. The importance of this partnership on the quality of healthcare, especially with respect to the power bases that are required, cannot be discounted or ignored in a discussion of the power dynamic within health care settings. A  nuanced analysis of this power dynamic and its idiosyncrasies and impact on various stakeholders, interested groups, and policy process reveals how impactful a nurse is at the micro and macro levels because of the legitimate power they wield. Healthcare systems should graft various elements of this dynamic into their systems in order to enhance healthcare for both patients and nurses. The patient-nurse transaction should be characterized by competent and compassionate healthcare that enhances rather than denigrates the quality of healthcare at the strategic, policy, organizational, and operational levels.

References

Baldwin, D., (2003). Disparities in health and health care: Focusing efforts to eliminate unequal burdens. Online Journal of Issues in Nursing, 8(1).

Hakesley-Brown, R., Malone, M. (January 31, 2007)  “Patients and Nurses: A Powerful Force” OJIN: The Online Journal of Issues in Nursing. Vol. 12 No. 1

Hertel, R. (2012). Regulate patient staffing: A complex issue. Health Care Reform & Issues in   Nursing, 21(1), 3-7.

Los Angeles County of Public Health. (2013). Social determinants of health: How social and economic factors affect health. County of Los Angeles Public Health. Retrieved  October 9,             2015  from http://publichealth.lacounty.gov/epi/docs/SocialD_Final_Web.pdf

Malone, B. (1996). Shared visions & hallucinations: Acquiring a taste for chaos. Canadian Operating Room Nursing Journal, 14(2), 29-35.

Roussel, L. (2011). Management and leadership for nurse administrators. United States: Jones  & Bartlett Publishers.

Waldau, S. (2010). Creating organizational capacity for priority setting in healthcare using a bottom-up approach to implement a top-down policy decision. University Medical Dissertations. Retrieved October 9, 2015 from http://umu.diva-portal.org/smash/get/diva2:353707/FULLTEXT01.pdf