Nurses, Clients and Power

Nurses General Nursing

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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

The medical professionals, whether it be nurses or doctors ARE NOT IN CONTROL. It is the patients body and they decide what happens, noone else. I have a list of procedures that I will never consent to and if any medical person goes against this regardless of the consequences, they will be in court so fast for battery and will also be making an appearance in front of the medical disciplinary council. I expect doctors to advise me what they think would be the best course of action and to discuss all the options. They will NEVER tell me what I am going to have done

Specializes in ER.

GEDPAR:

For the record, I spent five years in this corporate world you speak of, I NEVER worked as hard as the laziest (yes there are plenty of them) nurses I have met in the years I have been a nurse. I never sweated. I took lunches at lunch time and used the restroom when I wanted. I never held people's lives in my hands.

I also got paid better: 75k a year to sit at a desk in a pretty suit and type away as a paralegal. Last year, I made 37k according to my tax return and I worked holidays, weekends and sweated it out in my scrubs while abusive ungrateful people verbally abused me (and a few people even thanked me for saving their lives: go figure!)

As for your assertion that the healthcare system is running great and your insurance is fabulously covering whatever care you deem appropriate as a consumer, I think this is more than just a bit idealistic. The MDs and RNs that attend to you have their own licenses and make decisions based on their duties as a licensed professional because this is how they provide their income. Your insurance coverage is less so important to us when faced with the potential loss of our licenses. The insurance and hospital conglomerates squeeze their profits for wall street from all of us, including the RN staffing grid.

As for your assumption that nurses should simply leave the bedside if they don't like their jobs, they do. They do it in droves. By year ten after their licensure, 75% or so have left the hospital in favor of outpatient jobs that provide better hours/work schedules, more job satisfaction and frankly, less stress. As another "consumer" mentioned, we are in this together. If you want experienced professional nurses taking care of you, you are going to have encourage your local favorite "business" to retain excellent nursing experienced staff.

The medical professionals, whether it be nurses or doctors ARE NOT IN CONTROL. It is the patients body and they decide what happens, noone else. I have a list of procedures that I will never consent to and if any medical person goes against this regardless of the consequences, they will be in court so fast for battery and will also be making an appearance in front of the medical disciplinary council. I expect doctors to advise me what they think would be the best course of action and to discuss all the options. They will NEVER tell me what I am going to have done
Yiyayiya,This post is two years old. You keep posting how you will refuse all these procedures and how you will take medical personel to court for battery. I hope you don't end up at the hospital where I work. Yes patients do have the right to refuse....but why show up at a hospital and refuse care? Doctors don't order tests and procedures to torture people.

I think overt power would be abusive. I am persuasive.. someone with a raging infection who needs an IV but doesn't want it,, an elderly woman who doesn't want her brief changed is sitting in excoriating diarrhea..I don't see anything wrong with persuasion when you're trying to prevent further injury. We do have to control the agenda .. we can be friendly and have a conversation, but who can stand around for 25 minutes listening to a story about Uncle Joe's Civil War coin collection? I can't really do that so I listen to what I can and appropriately change the subject so that I get on to what must be done..I'm sorry but these folks who think terms of endearment are wrong are way off base.. using them with sarcastic or condescending tones is WRONG.. If I think someone is a sweetheart, and I say it in a comforting tone and mean it,, that makes them feel cared for..I don't treat people like a child but when you're sick and feel helpless a nice word here and there said with kindness makes a patient know they are not another burdon you must deal with..I know this from extensive experience being the patient..I find this study weird to be honest.. it's not a power trip to be a nurse, for me anyway..

Yiyayiya,This post is two years old. You keep posting how you will refuse all these procedures and how you will take medical personel to court for battery. I hope you don't end up at the hospital where I work. Yes patients do have the right to refuse....but why show up at a hospital and refuse care? Doctors don't order tests and procedures to torture people.

Zofran, I often laugh at these people both out loud , not in front of them. Some patients refuse procedures because they disagree with them , do not htink bennifits outweigh risks, or any reason really. That is okay with me. THe ones I laugh at are the ones who are very angry and RUDELY AND LOUDLY REFUSE EVERYTHING, but you better have their pain meds ready, and do a bath when they want, even though they can wash themselves. I think some of them think I care what they refuse, I absolutely do not care. let them do what they want. most nurses I know are glad when they have someone refusing everything since it is less work, however these types tend to be the ones you spend most time with at their own demands

I think overt power would be abusive. I am persuasive.. someone with a raging infection who needs an IV but doesn't want it,, an elderly woman who doesn't want her brief changed is sitting in excoriating diarrhea..I don't see anything wrong with persuasion when you're trying to prevent further injury. We do have to control the agenda .. we can be friendly and have a conversation, but who can stand around for 25 minutes listening to a story about Uncle Joe's Civil War coin collection? I can't really do that so I listen to what I can and appropriately change the subject so that I get on to what must be done..I'm sorry but these folks who think terms of endearment are wrong are way off base.. using them with sarcastic or condescending tones is WRONG.. If I think someone is a sweetheart, and I say it in a comforting tone and mean it,, that makes them feel cared for..I don't treat people like a child but when you're sick and feel helpless a nice word here and there said with kindness makes a patient know they are not another burdon you must deal with..I know this from extensive experience being the patient..I find this study weird to be honest.. it's not a power trip to be a nurse, for me anyway..

Exactly, it is the OPPOSITE OF A POWER trip for the most part. I think some patients are too ignorant, or perhaps have they are really savy, and do not understand that legally we HAVE TO EXPLAIN what will happen shoudl they refuse a treatment. I always start off by saying something it is absolutely your choice, but i do have to explain the rational for the order, risks/bennifets. Some people get angry that even that is explained as they believe, your explanation for why a bolus might be ordered for a bp of 80/40, is just you ascerting your power and attempting to coerce them into a procedure/medication. ugh

Specializes in Med/Surg, Academics.
Yiyayiya,This post is two years old. You keep posting how you will refuse all these procedures and how you will take medical personel to court for battery. I hope you don't end up at the hospital where I work. Yes patients do have the right to refuse....but why show up at a hospital and refuse care? Doctors don't order tests and procedures to torture people.

I too know that yiyayiya's post is two years old, but I agree with zofran's statement 100%. As we all know, nursing calls refusal of procedures that could potentially be life-saving, or at least life-improving, a "knowledge deficit." While all patients should have input into their treatments and/or procedures, I've encountered enough patients in my short career that simply don't understand what is happening to them. However, that may be also the failure of communication to the patient from the healthcare team. Sometimes, it's not.

I had one patient recently who said, "I came in for x condition, and they are all focusing on my heart." While it's true that his main complaint was unrelated to his heart, his heart condition took priority. He was refusing a life-saving, very common medical intervention. While caring for him, I thought I would give it a go on providing patient education. What I discovered is that he was totally in denial, no amount of education would convince him that some of his presenting symptoms (unrelated to his presenting complaint) were due to his heart condition. Based on time correlations with treatments, he was convinced that his diarrhea caused his other symptoms, simply because when the diarrhea went away, his LE edema got better. He simply couldn't reconcile that he was being treated for two conditions at once.

I agree, they dont, but by the same token I will never allow people randomly poking instruments into me such as endoscopes, catheters, etc. I expect to have ALL the options explained to me, not just the one the medical professionals feel are the most convenient for them then I will decide what if any treatment to accept.

Specializes in Neurosciences, cardiac, critical care.
I think overt power would be abusive. I am persuasive.. someone with a raging infection who needs an IV but doesn't want it,, an elderly woman who doesn't want her brief changed is sitting in excoriating diarrhea..I don't see anything wrong with persuasion when you're trying to prevent further injury. We do have to control the agenda .. we can be friendly and have a conversation, but who can stand around for 25 minutes listening to a story about Uncle Joe's Civil War coin collection? I can't really do that so I listen to what I can and appropriately change the subject so that I get on to what must be done..I'm sorry but these folks who think terms of endearment are wrong are way off base.. using them with sarcastic or condescending tones is WRONG.. If I think someone is a sweetheart, and I say it in a comforting tone and mean it,, that makes them feel cared for..I don't treat people like a child but when you're sick and feel helpless a nice word here and there said with kindness makes a patient know they are not another burdon you must deal with..I know this from extensive experience being the patient..I find this study weird to be honest.. it's not a power trip to be a nurse, for me anyway..

Agree 100%!!!! And bravo on "Uncle Joe's Civil War coin collection" - we must have the same patient! :lol2::yeah:

Specializes in Neurosciences, cardiac, critical care.
cb-rn:

I don't think we disagree as much as we think.....

This post was started from a quote supporting patient modesty, and you seem to support choice. I commend that: you may think it is common but it actually is not. Now these are the discussions potential patients and caregivers need to have!

I have to agree with cb-rn - this attitude really is not common. It might seem common among the population of nurses that is represented on this forum, but allnurses members & regular posters are by no means common at my workplace. I have so much respect for most of the members here and their dedication to the nursing PROFESSION and their integrity in representing their opinions while maintaining an open mind.

Quite a few of the nurses that I work with are focused on not having to do anything extra during their 12 hours at work.

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