Nurses, Clients and Power

[Anxious Patient]

There's a discussion going on at a bioethics blog dealing with patient modesty. The discussion went a little offcourse with an interesting subtopic called "Nurses, Clients and Power". I wonder if you agree if the types of power listed are used by nurses when dealing with patients.

The Powers:

1. Overt Power --Nurses "openly giving orders or making decisions without consulting patients." There was often a shared assumption between patient and nurse that the nurse will be in control. "Thus we can see that overt power is not simply a matter of making people do things against their will. In many cases, patients interpreted nurses' open power as legitimate, and willingly went along with it."

2. Persuasion -- Nurses "cajoling patients to do things that they originally did not want to do. This often involved negotiation. The "nurses' position within the organization of health care gives them a pegged position in the negotiating process."

3. Controlling the Agenda -- This was the most common method nurses used. In this case "the exercise of power is very subtle and comes in the form of manipulation." The nurse appeared to give the patient a choice by asking questions, but the questions were constructed in such a way that, "in reality, patients have little choice but to go along with" the agenda.

4. Terms of Endearment -- This was the most subtle form of power nurses used -- based upon "displays of affection." In other words, treating the patients similar to the way a parent would treat a child.

The study is not a definitive example of how power works within health care -- but as just one example of how power can be studied within the hospital culture.

The source material:

Chapter 8 "Nurses, Clients and Power" by Martin Johnson, in the book Sociology as Applied to Nursing & Health Care by Mary Birchenall et. al.

A. Hewison (1995) "Nurses power in interactions with patients" in the Journal of Advanced Nursing 21: 75-82. The nurses studied were working with the elderly.

The discussion was here:

blog topic: Patient Modesty and Caregivers

http://bioethicsdiscussion.blogspot.com/2009/03/patient-modesty-volume-12.html#c6253700032823945852

poster's entire comment:

http://bioethicsdiscussion.blogspot.com/2009/03/patient-modesty-volume-12.html#comments

[Tait, MSN, RN]

I don't feel I fit in any of those categories. Where is the Mutual Respect category?

:)

Tait

[Blee O'Myacin, BSN, RN]

Or the educating to promote self care category?

[Ahhphoey]

I have done each one of these categories at some point or another, but cannot solely classify myself as any one of them. I think situations can dictate how the nurse can and should help the patient. Different patients require different tactics. I have never and will never try to convince the patient to do something that they are just totally against for whatever reason, but I will try to convince them that some parts of their treatment regime are necessary for the healing process. In the end, it is still their decision to say yes or no and once that decision is final, I can only accept it. I would not feel good about accepting it, though, if I haven't done my job of fully educating and advocating for the patient beforehand.

[llltapp]

I have used every single one of those strategies lol. Although, the terms of endearment strategy was mostly used to cajole the drunks who were throwing things at me to sit down before we strapped em down :)

[MoopleRN]

I think a big component of the nursing care I give my patients is reminding them that they are the boss of their care. I let them know I understand they may feel how they've lost a lot of their privacy/independence. I also emphasize that they still are in charge of their care and they can absolutely refuse a med/tx or whatever (and discuss the consequences of that choice).

We don't have the time (unless we make it... at the expense of other things that need getting done) to sit down and spell all that out as much as we'd like. When we do make that time, however, it's been my experience that the time taken was very well spent.

[Ruffles 1]

I agree with MoopleRN, the patient is the boss of their own care. I try not to make someone do something they don't want, but I do explain the conseuqences of refusing and we have sometimes made them sign a form for refusal of certain care.

[GEPDAR]

In reference to the book "Nurses, Clients and Power" in part I do not think it just means the direction or the empowerment of a patients health. It also means the day to day interactions of any nurse with any patient which would include nurses working in private practice, floor, or a surgical nurse. A great example of a female nurse with a Foley catheter kit walking into the room of a male patient and that patient is embarrassed or even says is there a male nurse who can do this?

1. Usually the patient is never told that he might be getting the Foley.

2. Usually the nurse will just say I have done this a thousand times or I have seen it a thousand times or you have nothing I have not seen before. Classic example of what the book is talking about disregarding the patients feelings in order not to disrupt the routine because the routine of that nurse is more important then the patients feelings. The same goes for a male patient being prepped for surgery. I do understand every nurse is not like that but there are more situations like that then not. Do we all know a nurse like that, do you not think that is a bully tactic?

[cb_rn]

I absolutely agree to the patient's right to refuse any tx or med they want however why are you in the hospital if you are going to refuse everything?

& regarding #3...we were taught almost that exact phrase in nursing school to effectively manage time. Would you rather xxx or xxx? I'm sorry, I have 7 patients, if you want to walk and have your shower before 5pm then you have to pick one or the other now. This is not the Hilton, it is a hospital. You can sleep until noon if you would like but do not get angry when my CNA can not give you a bed bath the moment you wake up. We will be happy to get to it as soon as possible, please be patient with us.

[RNperdiem, RN]

Sometimes you have to use a little persuasion to get a post-op patient to use their incentive spirometer or get out of bed.

[advo-kate2]

"I absolutely agree to the patient's right to refuse any tx or med they want however why are you in the hospital if you are going to refuse everything?"

Respectfully: Going the the hospital and maintaining the rights and priviledge to own your own body are not mutually exclusive. We are not asking for a lot. We simply want the ability to say "if this needs to be done, I would feel more comfortable with the same gender." Simple. All who post here regardless of career would expect the same rights out of a medical setting. We expect the same within.

We are all overworked, short staffed and underpaid. But we can not lose sight of respecting people's choices about their own body, no matter what we do for a living.

[GEPDAR]

"Would you rather xxx or xxx? I'm sorry, I have 7 patients"

This is where the medical profession goes wrong, who fault is it that you have 7 patients certainly not the patients fault and I suggest you take that up with your employer. Are insurance is paying regardless if you have one patient or thirty. Maybe your employer could stop advertising on every billboard, magazine, or radio spot in your town claiming how there personal care out shines anyone of the hospitals in town. No hospitals are not hotels however it is a competitive business and the patient is the customer, and nurses choose to be nurses and if you can not handle the multi-tasking I suggest you become a junior high school nurse. STOP BLAMING THE PATIENT AND ACTING LIKE YOU ARE ALWAYS DOING THEM A FAVOR, YOU ARE JUST DOING THE JOB YOU SIGNED UP FOR. Doctors and nurses must stop telling the world how busy they are, the whole world is as busy as they are. Are nurses not aware corporate America has been downsizing for the last decade and most are doing the job of three employees? If other profession complained how busy they where to the customer they most likely would be fired. I understand some patients may be more difficult to deal with then others but I also deal with difficult customers everyday and the difficult customers also insure my family eats at night.