The Concept of Influence - A Short Analysis

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The concept of influence is the topic analyzed in this paper. What makes somebody do this or not do that? What influences people to prioritize their health and wellbeing? Is influence consciously or subconsciously conveyed, and is it verbal or nonverbal? There are many disciplines that highlight influence in their literature and application to practice, however, influence is also similar to many other terms and concepts. This paper defines and sets apart influence from other like-terms, and also descriptively defines influence and how it relates to nursing. Within the healthcare paradigm attributes including teamwork, holistic caring, and empathy are demonstrated by nursing and serve as a role-model for others. For the purposes of this analysis, by discretely defining influence in the context of nursing, we can bring awareness and light to the empowerment nurses provide patients with to care for themselves.

This analysis follows the Walker and Avant concept analysis method. As so, the characterization of influence along with a model case, antecedents and consequences, empirical referents, and relevance to service based learning regarding influence are described.

A thorough review of the literature relating to the concept of influence, within nursing and also within other disciplines has provided supporting evidence and clarity to this concept analysis. Many self-help books concerning communication, business, networking, and education use the concept of influence as a verb (an action) producing a positive or negative variance. Following includes the characteristics used to define the concept of influence.

Characterization

Communication includes both verbal and nonverbal cues and can be consciously or subconsciously conveyed. And as such, influence can come from words or gestures, and the sender/receiver may be aware or unaware of its expression (Sayler, 2010). Defining characteristics of influence are not limited to but may include the following elements: attitude, receptiveness, self-esteem, background knowledge, emotion, and character (Mortensen, 2008). Preceding influence is the current state of the person (baseline), which is a combination of who he/she is and compound nature of his/her past experiences. This notion is supported by the literature as follows, "King emphasized that each person's perceptions were unique and valid, and contributed to the knowledge on which the person based his or her actions." (Clarke, Killeen, Messmer & Leibold, 2009).

Role-modeling can be a characteristic example of an influential person or idea. Many times, children grow-up to demonstrate and practice similar traits and traditions as they experienced during their upbringing. Traditions are in essence the result of cultural or familial influence. Giving gifts to each other during Christmas or Hanukkah is an example of cultural influence. Partaking in the Eucharist is a result of religious influence. Another illustration expressing influence, or the result of influence, is a painting or work of art. Picasso had many different periods of time where his work was influenced by varying things, such as his blue period, rose period, and cubism period. Additionally, a person's values and perspective can influence the way he/she dresses and behaves in public. Role-modeling as an apprenticeship is the teacher influencing the student through showmanship and practice. Similarly, the purpose of influence in the nursing profession is to empower others to take responsibility for their health, and demonstrate the importance of teamwork, empathy, and holistic caring.

Similar terms but distinct from influence include: persuasion, reinforcement, provoke, impact, encourage, manipulate, and motivate to list a few. Influence, in general, is neutral by itself. This separates it from other concepts such as persuasion, encouragement, and motivation which take a more positive tone in nature. The concept of provocation acts similarly to a negative aggravation, and sometimes similar to a negative catalyst. Unlike a catalyst such as an enzyme, which does not affect the outcome but merely speeds up the process to the outcome, influence has the ability to affect the outcome. This ability also applies to persuasion, reinforcement, and manipulation. As an example, a student is required to get a Tdap prior to admission. This student knows that he must be vaccinated in order to attend, so any past knowledge tells him there is not an option to choose whether or not to get the vaccine. Thus knowing did not influence, but merely reinforce what he knew. However, past experience and a fear of needles may influence his trepidation and procrastination of when and where he goes to get the shot. Therefore, unlike these similar but separate terms, influence does not take a purposeful approach to effect change.

A purposeful approach is something that comes with the intention to sway an outcome one way or another. Although influence can be used to persuade, or even manipulate, influence alone is unconcerned with its degree of impact. Consequently, most similar to influence is impact, however, impact has a greater effect on the outcome, and influence has a greater effect on the choice leading to the outcome. Moreover, meaning that for every notable degree of impact there must precede a notable degree of influence. For this analysis, every choice made has something that added to the selection of that choice, and this determining change shows empirical evidence of influence. Mortensen describes successful influence as, "Development of your influential presence will enable you to build, motivate, and empower others to take action" (2008). Influence furthermore, relates to the nursing profession in two ways. First, nursing is a trusted profession, and so has a greater impact on others provided by modeling nurses' behavior, attitude, and actions. Secondly, nursing exhibits the values of empathy, true caring, and real teamwork. An example is the nursing moto "ADPIE", which implements working with the patient to individualize care and plan outcomes realistic to the patient's lifestyle. All the while, nursing serves to empower and influence others to work together and prioritize health.

Model Case

A Hispanic patient who rarely goes to the doctor comes in for a required physical for insurance and is diagnosed with hypertension. The patient is from a culture that does not seek care until absolutely needed and also a culture oriented around meals. The nurse is assigned teaching the patient about hypertension management. The goals are for the patient to return for follow-up, to take his medication, and adhere to a DASH diet. Whether or not he is truly receptive to the nurse's teaching can be dependent on influence. As stated by Mortensen on empathy, "The ability to see through the eye of another creates long-term influence. When people know that you can see what they see, feel what they feel, and hurt the way they hurt, then they will be willing to be influenced by you." (2008). The patient is more comfortable and less intimidated by the nurse than he is with the physician. His understanding of nurses to be honest and caring contributed to (influenced) his positive attitude and receptivity.

The nurse takes into account the culture of the patient (background knowledge) and the relation to ADLs, and in such a way approaches with an empathetic attitude and the grit to form a working plan with the patient. Her approach positively influences the patient to be receptive to her teaching, as opposed to be overwhelmed and tune-out. The team approach of the nurse to apply the physician's orders in a practical way with the patient and his lifestyle, empowered the patient to care for himself by taking his medication, returning for follow-up, and adjusting his diet. Without the support and help of the nurse, he may or may not have followed the physician's advice. But with her support he was enabled (influenced) to appropriately apply the physician's advice, despite his background and past experience.

The nurse worked with the patient to modify his daily routine, not forcing him to take on a whole new lifestyle. She influenced through encouragement, positivity, empathy, and by listening to the patient. According to scholars of Imogene M. King, "In King's view, as part of goal-setting and transaction, patients have to be involved in their care. They [nurses and patients] are goal-directed and from a King perspective the nurse does not force ideas on others." (Clarke, Killeen, Messmer, & Leibold, 2009).

Antecedents

Antecedents can be a person, thing, or idea; positive or negative or the same. The freedom of choice allows influence to exist. If every decision was set in stone so to speak, there would be no application of influence, as it would not effect it anyways. Imagine the butterfly effect when thinking of the mass amount of variables that can influence. A state of flux provides an opportunity for the influence of organization. Uncertainty, spirituality, adaptation, power, and limit of control, all provide an environment open to influence. Visualize a two-part system, where one is the receiver of the influence (variable "X"), and the other is the influence of the receiver (variable "Y"). There might be many variables in the environment that can influence "X", however, the only variable that effects the direction of "X" is "Y". So what is it that selects "Y" as the variable out of many to effect "X"? The answer is "X". Because "X" is the deciding factor, "Y" is something that can only add to the direction of "X" (true: x + y = z, false: x + y = xy).

An additional predecessor is role-modeling, which serves as the base of the influence. This means for someone to have a role model, there must be someone to model after. Also, one's values and beliefs antecede one's actions. Respectively, this is seen in nursing theories which guide research and practice. Adopting a nursing theory, such as the theory of comfort, will influence which interventions the nurse implements. Alternatively, cultures and traditions can serve as a continuous model influencing future customs and practice. In healthcare, there are various cultures that influence a patient's participation in such things as blood transfusions or dietary intake.

Consequences

The consequences of influence are not always expressed immediately (short-term), there could be an idea planted that does not take effect until much later or unless repeated (long-term) (Mortensen, 2008). Nonetheless, the consequences of influence are many times the result of emotion, including trust or fear, and their degree of impact relates to the preexisting emotion. For example, someone who was raised in a home with parents happily married may have less fear of commitment and more excitement towards developing a relationship of her own. When faced with the choice to commit to a marriage, her attitude will be hopeful and happy. Since she was positively influenced by her past and current attitude, her marriage should also be a positive experience. However, the consequence is also subject to influence from other variables in the environment, perhaps, though not directly related. Continuing with the example above, her continuance of a happy marriage will also be influenced by her husband's character, attitude, actions, and receptivity of her.

Empirical Referents

As influence can be short-term or long-term, empirical evidence is difficult to quantify and qualify. One questionnaire, the Quiet Influence Quotient, is a tool that rates one's character in relation to that person being influential (Kahnweiler, 2013). The QIQ qualifies and quantifies elements of mindfulness in communication such as listening, body language, writing, and thoughtful responses that contribute to one's degree of influence.

Another way to measure the degree of influence is surveys. Surveyors can ask consumers if their experience was positively or negatively influenced by the customer service representative, and whether this influenced their perception of the service (short-term) and if they intend to return again soon (long-term). These measurements can identify where improvement is needed, and thus contribute to future service. However, this really just evaluates the quality of influence (did it help or not). Advertising can now be tailored to personal preference, thus more effectively influencing one to shop here or there (Davis, 2006). For example, while checking-out at the grocery store, coupons relating to one's purchases are printed with the receipt to encourage future purchases. If able to monitor the degree of returning to purchase the discounted product, one could measure the marketing influence.

To quantify influence would be to establish differing degrees of influence, perhaps by saying first degree influence is the object directly acting upon the receiver of influence. And second degree influence is something like, "a" influenced "b" to do something that influenced "c" to produce "d". Another potential way to quantify influence is to rate the degree of impact, which is the product of influence. But this would necessitate the measurement of variation of the choice prior to the influence, which is unknown. So for this to work, one would have to assume a standard for the direction of impact prior to the influence. Standards that create notable change can be measured as influential, however, the degree of influence would depend on the variables concerning that which is the object of influence. For example, standards influence policy and legislation, such as scope of practice (Weiss & National Research Council, 2001). Relating to the model case, staying true to character influences patient receptiveness, which can be accounted for by amount of return follow-ups and measured by reduced hypertension.

Relevance

Catholic Charities health fairs is my assigned community-based service learning (CbSL) site. We see people without insurance or access to health care. The concept of influence in nursing provides guidelines to approach the patients we serve in a positive manner and individualize care to influence positive outcomes.

References

Clarke, P. N., Killeen, M. B., Messmer, P. R., & Leibold, S. C. (January 01, 2009). Imogene M. King's scholars reflect on her wisdom and influence on nursing science. Nursing Science Quarterly, 22, 2, 128-33.

Davis, H. (2006). Google advertising tools. Sebastopol, Calif: O'Reilly.

Kahnweiler, J. B. (2013). Quiet influence: The introvert's guide to making a difference. San Francisco: Berrett-Koehler Publishers.

Mortensen, K. W. (2008). Persuasion IQ: The 10 skills you need to get exactly what you want. New York: AMACOM/American Management Association.

Sayler, S. (2010). What your body says (and how to master the message): Inspire, influence, build trust, and create lasting business relationships. Hoboken, N.J: John Wiley & Sons.

Weiss, I. R., & National Research Council (U.S.). (2001). Investigating the influence of standards: A framework for research in mathematics, science, and technology education. Washington, D.C: National Academy Press.