Exploring the Concept of Power in a Nursing Context, Essay Example

Although malapropisms are often humorous in people’s quotidian lives, within scholarly and professional spheres they cause much perplexity and uncertainty. Confusing words utilized in the scholarly literature often negatively impacts research methodology and the construction of theory (Walker & Avant, 2010). Indeed, so-called buzzwords are frequently pervasively and indiscriminately utilized in the literature, although empowerment is the most frequently cited concept (Pilkington, 2010). Indeed, empowerment is often cited when discussing the provision of patient care and/or within didactic purposes. Empowerment within nursing contexts derives from so-called word potency. The concept of power must be clarified with regards to its utilization by nurses within the healthcare system. Katrina et al. (2013) contends that comprehending the power concept is of rudimentary significance to comprehend what word empowerment actually means in addition to all of its assumptions and connotations. This paper thus aims to evaluate the concept of nursing power, which germinates from root word potency in addition to assessing its application (Pilkington, 2010). By examining various fictional scenarios, the construction of theory based on the model proffered by Walker & Avant (2010) can be conveyed to enhance the knowledge about and understanding of the concept of power within nursing contexts. Indeed, words retain intrinsic potency, although the transmission of power can be quite illusory.

Nurses retain an immense amount of power within their profession whether or not they are aware of that fact. Individuals who possess an immense amount of expert knowledge translates into them wielding power, and nurses often utilize their superior knowledge when they are take care of patients who are less informed about their medical condition. This theme often appears in any research study about nursing power in various contexts. Expert knowledge, however, is gained gradually and through a protracted period of time, and it can also be quite a cumbersome process for nurses, which Benner (1984) ascertained in her landmark study on nursing power. Patients often expressed their gratitude towards nurses who they perceived as possessing expert knowledge as a member of the medical profession. Qualitative studies have also demonstrated that patients have many expectations with regards to the healthcare they receive and that they are more fond of the nurses who are effective communicators and highly knowledgeable. As such, nurses must be cognizant of the reality that power does exist, and all human beings are capable of procuring and exerting it. The potentiality of power in people takes place in the ontological phases along a continuum ranging from the power to be and violence, although there are many other phases along the continuum that are noteworthy. On the negative end of this power continuum are violence and aggression, which is utilized for individuals to dominate others.

Conversely, self-assertion and self-affirmation are situated at the positive end of the power spectrum, which are helpful in the analysis of nursing power from the perspective of Walker & Avant’s (2010) model. It should be noted that aggression can also be used as a corollary model for Walker & Avant’s models in a very attenuated manner. It is important for nurses to comprehend the notion of elusive power and how it pervades all human interactions within a society. From this vantage point, it is clear that nursing constitutes an important social activity. As such, if nurses effectively wield elusive power, patient care will be enhanced and far more efficacious as long as they transmit their knowledge to less informed patients. Nursing students will also benefit from expert nurses who engage in the transference of knowledge to them when developing interpersonal and clinical dexterity within clinical contexts.

Power within society AT-Large

It is unequivocal that power pervades all of society and not just in the nursing profession. Extant literature apportions various sources to power, and power is categorized according to both context and subject. As such, researchers ascertain so-called power holders within communication contexts, the fluidity of power embedded in particular relationships, variable or constant total power within the sociological arena, and ultimately, traditional charismatic, or legal power that functions as a political maneuver in the field of sociology (Weston, 2010). The perception of power embraces divergent terminology linked to the concept itself in addition to the application, according to extant research, within society. According to several researchers, in society there is a variable totality of power that reflects both the latency and capacity to be adapted to different environments, which transpire amidst personal growth and development. Within this context, humans assume a relatively passive role and thus they must acquiesce to orders given at the behest of a paternalistic overlord. Other researchers allot the constant totality of power which relies on the status or class of persons in addition to the manner in which an individual can procure power via resistance to a superior or more potent personality (Weston, 2010). These two conflicting parties of power underscore the degree of how trenchant power is and permeates society in addition to how power is viewed through various contexts and prisms (Larsson et al., 2011). There are several levels of power from a management perspective in addition to how nurses can exert their own power, including these seven distinct types of power: information, persuasion, coercive, legitimate, expert, and antecedent. While these various classifications germinated out of various philosophies, they are nonetheless traits that are pertinent to the nursing profession in addition to society at-large when they are exercised.

Power in the nursing profession

A large corpus of nursing literature frequently cites renown French philosopher Michel Foucault, who wrote abundantly on power constructs and associations in addition to discursive frameworks that are applicable to power structures. Foucault’s various associations and definitions range from reproduction, gender, and sexuality to prison, rape, and murder (Daly et al., 2014). Such a sweeping range of power is analogous to the power that is present within the context of nursing: exploitative power, competitive power, manipulative power over others, and integrative power (Daly et al., 2014). Foucault’s conceptions address how power relations undergird the experiences of nurses in the workplace in a variety of ways. He conceptualized power as an amalgam of disciplinary techniques that often envelops nurses, thereby underscoring that power does not necessarily have to be discussed as a repressive entity. There are productive components of power, and Foucault’s discussion of where power lies conveys a cogent approach to empowering nurses and retains the capacity to alter nursing practices via loci of resistance. The quality of the nursing profession can thus be enhanced   as intimated by Foucault’s power concepts and associations. In conjunction with the ontological phases in the real world, these power concepts can be appropriated both to society as well as to nursing. Power is differentiated in nursing literature as collegiality power and nursing synergy; power over rather than power to; productive or restrictive power; affable instead of forcefully harsh power; and subtle or overt potency (Daly et al., 2014). The variable totality of power in conjunction with the ontological power element in various relationships within nursing contexts. Power thus can be defined as the potential in all persons, and depending on how an individual wields this power determines whether or not the material will manifest or not. As such, power retains the capacity to propel or impede change, which reveals that there are two different components involved: the potentiality of power and the power as an actuality (May, 1974, p. 99. as cited by Daly et al., 2014). As such, actual power forms the basis for nurses to set goals and the achievement and successes in patient care. The  potentiality of power is most optimally comprehended when nurses grant patients some power utilizing both integrative and nutritive facets of power.

Nurses who relinquish their power enable patients, families of patients, and/or junior medical personnel to share the power, which takes place when power is disseminated among the actors whom the nurse interacts with. The nurse thus retains the capacity to empower others with regards to how to effectively manage their health conditions and enhance their overall lives. Goal-setting takes place in all social sectors, albeit for economic growth and development or patient recovery (Daly et al., 2014). This notion is most evident upon examining various scenarios that effectively showcase the heuristic construction of concept and theory proffered by Walker & Avant (2010).

Scenarios of various types of power in nursing context 

The following scenarios highlight the various uses and dimensions of power and the empirical referents therein. Each scenario described is predicated on the positional and expert power within the individual who possesses the power, and it will be evident that nurses use power in a variety of ways that could resulted in the empowerment of the power recipient or not. The first case study demonstrates how integrative power can facilitate the emancipate the dependent party within healthcare contexts. The second scenario exemplifies how exploitative or competitive power cinches the individual who is involved. Nurses can wield their power through effective communication and the dissemination of information to the patient, which enables power to pervade. The power recipient is empowered because of the enhancement of their competency, thereby enabling the individual to live an autonomous life.

Scenario One: Paradigmatic Case

Nurse Andy was rendered expert in her pedagogical approach as well as in her nursing dexterity. A patient named John was recently diagnosed with Diabetes Mellitus, which means that the patient would be dependent on insulin for the rest of his life. Andy was assigned to the new patient, and while treating John, she instructed a junior nurse for didactic purposes and told the patient to ask the junior nurse any probing questions he had. The junior nurse repeatedly stressed the significance that John keep a stringent meal schedule in addition to insulin regiment while caring for him. Because of how ubiquitous diabetes is at the community level, the junior nurse conveyed to John that it would be impractical to depend on community nurses. In addition, John was instructed to keep careful track of the administration of insulin as the nurse demonstrated very precisely and slowly so that the patient internalized the process. John then showed his ability to self-administer the drug step by step. First he took the insulin out of the bottle using a small syringe and eliminated the air bubbles from the site of injection. Nurse Andy supervised the activities going on throughout the demonstration. The junior nurse had encouraged the patient to pose any questions, so he gained some level of theoretical knowledge. After a series of demonstrations of the patient’s capacity to self-administer the insulin, the patient gained competence once he was able to self-administer with little supervision and rendered apt to do so.

Nurse Andy was able to provide patient care while also teaching him the skill of self-administration, and she concurrently taught the junior nurse how to effectively communicate with the patient in a two-way manner, which is an important nursing technique. Through this experience, the patient was becoming more prepared prior to being discharged. Upon discharge, John only had to sign the necessary paperwork without any significant problems to go home. John’s medical condition remained stable because he was fittingly prepared to supervise his own healthcare. The junior nurse used the encouragement of nurse Andy in order to perfect an important nursing technique, and her teaching skills were honed as she prepared the patient for his ultimate discharge. Various attributes can be gleaned from this particular scenario related to the ideal utilization of power through the ontological phases of power in real world settings. The nurse was able to effectively communicate and share her expert knowledge and power to enhance the capacity of the patient who procured power via self-affirmation and confidence to competently manage his own health care. As such, all involved parties—the nurse, the patient, and the junior nurse–underwent the diffusion of nutritive and integrative power. Through effective communication, sound sharing of information, and competent teaching methods, the patient was empowered in his own self-assertion and competency. The junior nurse also bore witness to a sound methodology for how to empower patients in their own capabilities to manage their care. Variable power needs, when applied correctly in work settings, can enhance the skills and empowerment of both the junior nurse and the patient.

Scenario #2: Contrary Power Example

Nurse George was a nurse who had previously worked in middle management in the outpatient nursing department for over three decades. He was knowledgeable about how the department operated in all of the functioned carried out therein. Despite his knowledge about the human and technical resources, he was overlooked for a job in upper management within the department, as a junior official was favored even though the junior worker was less experienced and lacked the dexterity for the job. Although George planned to retire soon, he was antagonistic towards his fellow collegues, especially when he was forced to collaborate with junior officials. Moreover, he did not share his empirical knowledge out of jealousy, refusing to actually teach any junior members of the nursing staff in order to preserve his own power. As such, George exploited any situation he was put in for teaching junior staff, exerting as much effort as possible to ensure that the junior staff does not gain any knowledge from him. This antagonistic situation frustrated members of the junior staff, which propelled many to inquire about a transfer to a different department. When George retired, he was left alone with his own knowledge and simmering resentment about the entire situation. The lack of effective communication and power sharing with junior officials posed various difficulties and difficulties in the department. This situation took a protracted period of time to ameliorate as a result.

The negative use of power evident in this case study evinces various attributes that underscores how the erroneous utilization of power does not serve to benefit any of the actors involved at the organizational level. It is unequivocal that competency within the nursing profession is a nuanced attribute at the micro and macro levels. Potentiality can be ascertained within the positional power of an expert like George, which failed to be disseminated and thus adversely affected the other parties involved in the scenario.

References

Daly, J., Speedy, S., & Jackson, D. (2014). Contexts in nursing. United States: Routledge.

Katriina, P., Sari, V., Anja, R., Christina, S., Paula, A. and Tarja, S. (2013). Nursing power as viewed by nursing professionals. Scandinavian Journal of Caring Sciences, 27, 580–588.

Larsson, I.E., Sahlsten, M.J.M., Segesten, K., & Plos, K.A.E. (2011). Patients’ perceptions of nurses’ behavior that influence patient participation in nursing care: A critical incident study. Nursing Research and Practice.

Pilkington, F.B. (2010). Exploring the concept of power in a nursing context. Nursing Science Quarterly, 23(17).

Walker, L. O & Avant, K. C. (2010). Strategies for theory construction in nursing (5^th ed.). Upper Saddle River, NJ: Prentice Hall.

Weston, M.J. (2010). Strategies for enhancing autonomy and control over nursing practice. OJIN: The Online Journal of Issues in Nursing, 15(1).