Nurses must be aware of their power: a nurse observes a nurse-patient interaction and is left disappointed at the nurse's abuse of her knowledge and, therefore, her power.
|Publication:||Name: Kai Tiaki: Nursing New Zealand Publisher: New Zealand Nurses' Organisation Audience: Trade Format: Magazine/Journal Subject: Health; Health care industry Copyright: COPYRIGHT 2001 New Zealand Nurses' Organisation ISSN: 1173-2032|
|Issue:||Date: Feb, 2001 Source Volume: 7 Source Issue: 1|
|Product:||Product Code: 8043100 Nurses NAICS Code: 621399 Offices of All Other Miscellaneous Health Practitioners SIC Code: 8049 Offices of health practitioners, not elsewhere classified|
I AM currently engaged in a research project that uses critical
theory as a framework for the study. Consequently I find myself immersed
in the concepts of power and control. Looking at the world through this
particular lens, I find evidence of these issues nearly everywhere.
Critical theory has long sought to expose oppressive relationships and many writers present evidence that nurses are an oppressed group, by dint of gender, class and occupation. (1) Unfortunately belonging to an oppressed group can typically lead to the internalisation of the values of the oppressor in the belief this will lead to power and control. (2) This means using power against the people we should be helping.
With these thoughts in mind, it is not surprising the following rather ordinary story impelled me to write about the dynamics I observed. My role as onlooker was heightened because the patient involved was a relative and therefore my observations were positioned altogether outside an active nursing role. I was unable to tell if the health professional was a midwife or a nurse, so for simplicity, I refer to her as a nurse.
My relative was admitted to hospital, febrile and 33 weeks into a pregnancy. She was dehydrated, hot and not completely lucid. She responded quickly to the intravenous (IV) rehydration therapy and began to feel more like herself within a few hours. She remained in hospital for IV antibiotics and ongoing monitoring of the baby in-utero.
I was fascinated to observe how the nurse discussed the plan of care with her. The nurse stood some distance from the end of the bed and quickly ran through a list of abbreviations, familiar to me as a nurse, but clearly unfamiliar to the patient. She referred to the intravenous therapy as the IV, to the urine sample as an MSU, to the observations as BP and "temp", and to the monitoring as CTG.
These are all straightforward abbreviations nurses use in their interactions with other health professionals every day. What surprised me was that the nurse didn't take the time to explain what any of them meant to her patient. Perhaps the nurse assumed the patient would figure it out. But bearing in mind she was unwell, that the nurse spoke from some considerable distance and that the world of health care can be very foreign, it is not surprising my relative returned a blank stare. Elaboration or interpretations were not offered before the nurse left the room.
To me, the power differential was the most striking feature of the exchange. Here is a nurse, endowed with the knowledge necessary for the care of her patient. Here is a patient, anxious to understand what is to become of her. The patient is lying in bed, wearing a hospital nightgown, attached to a bag of IV fluids attached to the bed. The uniformed nurse stands away from the bed, holding the patient notes close against her body. The young mother's impulse is to leave and care for her unborn child and toddler at home, but the fear that without proper care, she might harm her baby, keeps her in the bed. She will stay and listen to this nurse who carries the power to make sense of an otherwise incomprehensible situation.
Whether she intended to or not, this nurse chose to use complex language, thereby creating the impression she is aligned with a powerful group of health professionals. Such language lends weight and authority to her presence and helps to dispel any possibility of a challenge. Combined with her posture--clutching the notes to her body, standing when her patient is horizontal, and maintaining physical distance--the role of gatekeeper is firmly reinforced. "I know all about what's going on and you don't" is the unspoken message this body language can readily convey. Indeed, knowledge is power.
An assumption basic to critical social theory is that certain groups in any society are privileged over others. (3) In a health setting, in nurses easily assume a position of privilege because of their greater knowledge about the institution, the patient's condition and their access to treatment than the patient. They are paid to have this knowledge. Patients come to hospital to benefit from that knowledge. The contract nurses have with their patients is to share that knowledge. What I witnessed exploited that position of privilege over another and I found that offensive. With privilege comes power--power to empower. I realised we all need to be aware of the power we hold in our interactions with patients.
(1) Fulton, Y. (1997) Nurses' views on empowerment: A critical social theory perspective. Journal of Advanced Nursing; 26, 529-536.
(2) Bent, K. (1993) Perspectives on critical theory and feminist theory in developing nursing praxis. Journal of Professional Nursing; 9: 5,296-303.
(3) Kincheloe, J. and McLaren, P. (1994) Rethinking critical theory and qualitative research. In Denzin, N. and Lincoln, V. (Eds.). Handbook of qualitative research. Thousand Oaks, California: Sage.
--Jill Wilkinson, RGON, BN, is a nurse lecturer at Whitireia Community Polytechnic. Her research project for her Masters thesis is about personal safety for district nurses.
|Gale Copyright:||Copyright 2001 Gale, Cengage Learning. All rights reserved.|