Introduction
The changes occurring in the health sector has been one of the main concerns of health professionals and researchers. Due to the changes of the demographics and health status of patients along with the current technological advances, it has been assumed that the old strategies used could no longer suffice for the current global health concerns. Thus, it is necessary to consider revisions and improvements when it comes to the advancements of medical technology along with the other issues related to the implementation of certain interventions and promotion of the fundamental goals of health development (United Nations Development Program, 2006).
One of the factors that greatly contribute to the hierarchy and structure in the field of health policy is power dynamics. Power has been defined as the degree of control given to particular sections and representatives of the society over particular resources such as material, human, financial, and even intellectual resources. Different sectors in the society achieve a certain source of power in the individually or socially by having control of the abovementioned resources (VeneKlasen & Miller, 2006; Pettit, 2012).
Currently, the concept of power is not considered as absolute but dynamic and relational. It is usually associated in the social, economic, and even political relations apparent between individuals and organizations in the society. In the field of health care and health policy, one of the main concerns when it comes to power dynamic is the unequal distribution of power among some individuals and groups. It has been acknowledged that the degree of power given to an individual or a particular group is dependent on the different types of resources they can control and handle (VeneKlasen & Miller, 2006; Pettit, 2012).
An individual possesses power by engaging in a dynamic relationship with other individuals and stakeholders; however, the degree of power an individual possesses mainly depends on the individual’s nature of relationship which tends to be associated with the characteristics of the individual and the situations or positions where they are assigned. Thus, despite the numerous types of power, there are only two basic types to be considered namely personal power and position power. Personal power is dependent on the characteristics of an individual such as respect, skills and expertise, and general likability. On the other hand, position power is dependent on the position or job status of an individual within a society or an organization. Position power is bounded by the rules and regulations of the society or of the organization (Akioyamen, 2014).
In the field of health care, nurses are considered to be stakeholders in the development and implementation of health policy because they work alongside with other teams or groups. Thus, it is necessary for the stakeholders to be aware of their power to be able to use this in the development and implementation of new interventions and strategies that can aid in the current problems of the society. Additionally, they should also be able to take note of the power dynamics in their institutions to empower and encourage them when it comes to the various decision-making processes. In the relationship between nurses and patients, it can be claimed that nurses have more power than the patients because of the former’s access and knowledge of the healthcare system and privileged information. However, this power dynamic is not apparent because nurses tend to be reluctant to acknowledge and exert this power. In line with this, this paper aims to critically appraise the power dynamic that exists during interprofessional collaborations especially when developing interventions or projects associated with vaccinations among selected populations. Additionally, it also aims to demonstrate the application of legitimate and illegitimate power which affects the outcomes of the health policy (McDonald, Jayasuriya, & Harris, 2012).
Description of the Power Dynamic
The dynamics in power is mainly apparent during collaborations among different health professionals. Most of the time, nurses collaborate with physicians, researchers, educators, and medical specialists to be able to compile information and devise a plan that can improve the current status of health care in their respective institutions. These collaborations tend to result to conflicts and disagreements because of the overlapping of different roles and the boundaries of respective roles. The absence of the shared decision-making process is also a concern because it leads to inefficiency when it comes to the development and implementation of various health interventions and strategies. Conflicts and disagreements during interprofessional collaboration suggest a presence of power and authority issues within the organization. During interprofessional collaborations, other professionals tend to initiate conversations more because they have higher positions and power than other professionals. The presence of this type of power dynamics in the health sector limits the participation and contributions of other health professionals especially in terms of the brain storming process (McDonald, Jayasuriya, & Harris, 2012).
According to the study of Ponte, et al. (2007) entitled “The Power of Professional Nursing Practice- An Essential Element of Patient and Family Centered Care”, nurses tend to view their power according to personal experiences and experiences of other colleagues. Additionally, it was revealed that majority of the nurses believed that their power is dependent on one’s own knowledge, expertise, and skill set in terms of the different important aspects in the nursing practice such as technical, analytical, and interpersonal aspects. Among these, it has been observed that the expertise and skillset of nurses tend to be directed solely on the patients and the relatives of the person they are attending to. These findings support the claim that the collective power of nurses tend to be dependent of the various actions, behaviors, and personality of nurses as an individual (Komatsu &Yagasaki, 2014; Peltomaa, et al, 2012).
Power acquired by different individuals can either be legitimate or illegitimate. The legitimacy of power is necessary to obtain the trust and cooperation of workmates and subordinates. It has been revealed that legitimacy can provide the “cushion of support for authority” due to the fact that having a legitimate power means that the powerful individual has been conventionally accepted by subordinates. Various studies revealed that the appraisals in legitimacy of power is fundamental when it comes to the acceptance or rejection of the existing power differences among individuals and groups. Additionally, these appraisals are considered to be determining factors of the differences in power when it comes to an individual’s thoughts, feelings, and even actions. On the other hand, illegitimate power is a source of difference in power which can have a negative impact in the working relationships between the person involved and other workmates. According to the studies and theories in justice, workmates or subordinates will experience anger when faced with a perceived unfair or unjust treatment (Hennes, Ruisch, Feygina, Monteiro, & Jost, 2016).
Despite these theories that reveal the rejection of power without adequate explanation, there are currently two lines of research which are actively proposing the tendency of individuals to accept pseudo-explanations or illegitimate explanations for differences in power. One of these researches is the study conducted by Langer, et al. (1978) which revealed that uninformative, placebic explanations and reasons are already enough for obtaining compliance among workmates and subordinates. The results of the study revealed that individuals are motivated to work and cooperate with the person in power provided that the reasons for the power was legitimate and rational. Additionally, the perspective of system justification also hypothesized that individuals have the tendency to actively engage in the legitimation of the social reality up to the point of justifying personal positions of power or powerlessness. Thus, it has was concluded that individuals use cognitive and memory functions to look beyond the facts and information provided in determining the legitimacy of the power (Hennes, Ruisch, Feygina, Monteiro, & Jost, 2016).
The power dynamics that exist during interprofessional collaborations can impact the health policy outcome in terms of the legitimacy or illegitimacy of the power. When developing new interventions associated with the improvement of vaccination rates among a selected population, interprofessional collaboration is necessary because there are several tasks that can be designated to different professionals. For example, the provision of detailed facts and information about the current statistics of vaccination rates can be done by nurses and health researchers. On the other hand, the development of interventions and strategies can be led by public health professionals and advisers. Physicians and other administrative staff can also provide guidance when it comes to gathering different professionals and initiating group discussions during decision-making processes. As mentioned earlier, conflicts and miscommunications may occur because of the power dynamics that exist within the group. When the power of the health professionals who lead the group discussions is legitimate, other health professionals will have trust and confidence on the ability of the leader to lead the group. Additionally, this trust allows other health professionals to share their insights regarding the interventions and suggestions on the innovations that aim to improve the health status of individuals. On the contrary, the presence of illegitimate power within the group can lead to mistrust and judgments which can eventually act as a barrier towards the improvements in the health policy analysis and decision-making process of the implementations of various interventions and strategies (McDonald, Jayasuriya, & Harris, 2012).
Reflection on the Power Dynamic
Changes in the macro, meso, and micro system levels of healthcare can be dependent on the different driving and restraining forces. Driving forces are defined as elements and factors that are responsible for the promotion or progress of changes in the system. On the other hand, restraining or static forces are elements or factors that negate the progress or promotion towards change. Restraining or static forces simply act as opposing elements of change (Sutherland, 2013). According to the study conducted by Suhonen, Välimäki, and Leino-Kilpi (2009) entitled “The driving and restraining forces that promote and impede the implementation of individualized nursing care: a literature review”, the main categories that can describe and identify the restraining and driving forces of change include: (1) personal characteristics of nurses; (2) enhancement of skills; (3) ethical issue; (4) delivery and interventions related to nursing care; (5) characteristics of patients; (6) organization and structure at work; (7) staffing; (8) group dynamics and teamwork; and (9) leadership and management styles (Suhonen, Välimäki, & Leino-Kilpi, 2009).
The above-mentioned categories can act as a driving or restraining force. For example, the characteristics of nurses can either promote or negate the advances towards change in terms of health policy. If a nurse is optimistic, critical, and cooperative during the process of policy analysis and brainstorming, progress and promotion can be attained because nurses with these characteristics actively participate in group discussion to encourage accurate and efficient inputs on the status of patient care. On the contrary, when a nurse is unenthusiastic, uncooperative, and passive, progress and change on the micro, meso, and macro levels are unattainable because there is stakeholder who is not actively participating in group discussions. This can lead to inaccuracies when it comes to diagnosing the main problems of the different health strategies and interventions (Suhonen, Välimäki, & Leino-Kilpi, 2009).
The next categories (skills enhancement and ethical issue) act as a driving force (the former) and restraining force (the latter). Skills enhancement act as a driving force that impact the power of nursing because obtaining additional trainings and other skill enhancement programs can provide nurses with legitimate power. Enhancement of skills can encourage nurses to actively participate in policy analysis in the micro, meso, and even macro levels because they are competent and are back up by their training and skills records. It has been acknowledged that the participation of nurses in these events is considered to be advantageous because of the knowledge and experience of nurses when it comes to patient care. On the other hand, the ethical issues can act as restraining force when it comes to the changes in the health care sector. Ethical issues limit the scope of changes and improvements that health professionals can tackle. It is important to consider these ethical issues to ensure that the benefits always outweigh the risks involved in certain advancements (Suhonen, Välimäki, & Leino-Kilpi, 2009).
The other categories mentioned above can act as both driving and restraining force. These categories can act as driving forces that can impact the power of nursing when there are sufficient and appropriate health interventions and strategies, when the characteristics of the patients are receptive and positive, when there is an organized structure at work, when the staffing at the institution is sufficient, when there is a coordinated dynamics and teamwork at work, and when the leadership and management styles promote and encourage collaboration among health professionals. However, the opposite of these categories can act as restraining forces because they would serve as barriers in improving the power of nursing and in promoting changes in the health policies and interventions of institutions in the micro, meso, and macro system levels of health care (Suhonen, Välimäki, & Leino-Kilpi, 2009).
During interprofessional collaborations for the development of innovations and strategies, the characteristics of the professionals as well as the availability of the resources are considered to be important factors that can either act as driving or restraining forces. In the micro and meso levels of health care, it is easier for nurses to interact and reach out to patients to help improve the vaccination rates within the particular population. However, it is harder for improvements to take place at the macro system of health care because a bigger number of health professionals are needed to collaborate to attain improvement in vaccination rates in the macro level. Thus, it is important to properly address the power dynamics that exist among the professionals to establish a positive working atmosphere and an organized structure that allows open discussions and brain-storming processes (Suhonen, Välimäki, & Leino-Kilpi, 2009).
Conclusion
Power dynamic is a term that can be applied in the different sectors of governments and health institutions. Thus, it is necessary to consider that different problems and benefits that can arise from the power dynamics present at a particular institution. In the field of health care, it is important to consider the legitimacy of power to ensure that professionals are capable of initiating and sustaining improvements and changes in the health policies and strategies associated with patient care. In totality, it is important to consider the different restraining and driving forces that can impact the power of health professionals to point out possible areas of improvement. Additionally, possible problems may be prevented by taking note of the categories that may negate or promote changes in power dynamics and health policies (VeneKlasen & Miller, 2006; Pettit, 2012).
References
Akioyamen, L.E. (2014). Power in Individuals Groups, and the Nursing Profession: An Exposition. International Journal of Nursing Student Scholarship 1: Article 1.
Hennes, E.P., Ruisch, B.C., Feygina, I., Monteiro, C.A., and Jost, J.T. (2016). Motivated Recall in the Service of the Economic System: The Case of Anthropogenic Climate Change. Journal of Experimental Psychology: General 145(6):755-771.
Komatsu, H. and Yagasaki, K. (2014). The Power of nursing: Guiding patients through a journey of uncertainty. European Journal of Oncology Nursing 18(4): 419-424.
Langer, E., Blank, A., and Chanowitz, B. (1978). The Mindlessness of Ostensibly Thoughtful Action: The Role of “Placebic” Information in Interpersonal Interaction. Journal of Personality and Social Psychology 36(6): 635-542.
McDonald, J., Jayasuriya, R., Harris, M.K. (2012). The influence of power dynamics and trust on multidisciplinary collaboration: a qualitative case study of type 2 diabetes mellitus. BMC Health Services Research 12(63).
Peltomaa, K., Viinikainen, S., Rantanen, A., Sieloff, C., Asikainen, P., and Suominen, T. (2012). Nursing power as viewed by nursing professionals. Scandinavian Journal of Caring Sciences 27(3): 580-588.
Pettit, J. (2012). Empowerment and Participation: bridging the gap between understanding and practice. New York, NY: United Nations Headquarters.
Ponte, P.R., Glazer, G., Dann, E., McCollum, K., Gross, A., Tyrell, R., Branowicki, P., Noga, P., Winfrey, M., Cooley, M., Saint-Eloi, S., Hayes, C., Nicolas, P.K., and Washington, D. (2007). The Power of Professional Nursing Practice—An Essential Element of Patient and Family Centered Care. The Online Journal of Issues in Nursing 12(1).
Suhonen, R., Välimäki, M., and Leino-Kilpi, H. (2009). The driving and restraining forces that promote and impede the implementation of individualized nursing care: a literature review. International Journal of Nursing Studies 46(12): 1637-1649.
Sutherland, K. (2013). Applying Lewin’s Change Management Theory to the Implementation of Bar-Coded Medication Administration. Canadian Journal of Nursing Informatics 8(1).
United Nations Development Program. (2006). UN Millennium Project. Retrieved from http://www.unmillenniumproject.org/documents/maternalchild-chapters1-2.pdf [Accessed on 25 Jul 2016]
VeneKlasen, L. and Miller, V. (2006). Dynamics of Power, Inclusion, and Exclusion. Nonprofit Online News Journal: 38-56.
