Power in Nursing

Power has been a concern to all living beings – humans and animals – since the beginning of time. Nursologists have been sensitive to power issues at least since Florence Nightingale’s time. It is likely, however, that power has different meanings for different people, including those who hold positions associated with power and those who regard themselves as subjected to power and may think they are powerless.

Very specific meanings of power are evident in a nursology theory developed by Elizabeth Barrett and a nursology theory developed by Peggy Chinn. Elizabeth Barrett developed the theory of power as knowing participation in change. This theory focuses on power-as-freedom, which contrasts with power-as-control. Barrett (2010) explained that power-as-freedom comes from and is associated with participating knowingly in life changes.

Peggy Chinn developed the theory of peace and power. This theory focuses on peace-power, which contrasts with power-over. Chinn (2018) explained, “This theory provides a framework for individuals and groups to shape their actions and interactions to promote health and well being for the group and for each individual, using processes based on values of cooperation and inclusion of all points of view in making decisions and in addressing conflicts.

My interpretation of these theories is that both emphasize power as a beneficial attribute that enables the individual or group to thrive and evolve, as opposed to power as a detrimental attribute that often prevents others from thriving and evolving. But what, I wondered, are meanings of power held by other nursologists?

St. Mary’s College Campus (from http://www.st-mary.ac.jp/about/)

Therefore, I invited graduate students at St. Mary’s College School of Nursing in Kurume, Japan, where I am a visiting professor, to share their meanings of power. I asked the students to respond to two questions:

How do you define power?
How does power affect what you think and do as a nursologist

The students’ responses are given here. I am indebted to Eric Fortin, who is a faculty member at St. Mary’s College School of Nursing, for translating the students’ responses from Japanese to English. (See notes below for more information about St. Mary’s College School of Nursing)

How do you define power?

Yukari Shitaki wrote: Power is generally defined as authority, motive power, energy, and so on. In nursing, I think that there are many things that are demonstrated through relationships among people, such as manpower, empowerment, and power augmentation, which improve technical skills and abilities. In addition, I think that the way people, whether individuals, groups, or society at large, perceive that power changes according to the situation at any particular time. Therefore, for me, power is defined as the force in the fellowship among people that produces synergistic effects and is further demonstrated through the interactions among them.

Kiyoko Tanaka wrote: We as nursologists work to maintain and promote human health, prevent health problems, create an environment that promotes health, and share and resolve issues related to the destruction of the natural environment and the deterioration of the social environment. In contrast, nursology is caring and has the power to realize and maintain a peaceful human society by fulfilling its role

Yoko Hashimoto wrote: In Japan, some nurses work in the government as licensed nurses and are involved in devising national policies. Many other nurses are involved with patients and local residents in hospitals and communities. Nurses see problems and other issues in their daily practice. Therefore, as nurses, we are working to improve the quality of nursing to solve these issues. I believe that nurses consider motivation and the ability to improve the quality of nursing to be power

Risa Fujimoto wrote: I think that nursologists’ power can be defined as action. As nursologists, everything should be done for the patient. It is very important to possess the ability to do something useful for people and to act on and realize what we want to do, including even little things. I also think that studying at graduate school may be the first step that will lead to having the power of a nursologist.

Saki Higashi wrote: The power of a nursologist for me is defined as the ability to constantly grow from the soul and to spread that around to others. I categorize power into three aspects. The first is the core, the second is influences absorbed from one’s surroundings, and the third is action. The core is latent and spiritual and includes one’s thoughts on nursing. The aspect of power that is absorbed from one’s surroundings is the power that can exert influence and that can be taken in from all external stimuli such as patients and other staff through one’s experiences of being a nursologist. Action is the aspect of power that derives from what has been cultivated up to now, including from the first and second aspects, and it works by giving back what has been absorbed from others through one’s practice and by diffusing one’s own power to those around us. Power is not always constant, but fluctuates; and power, although being influenced by others, also gives of itself and continues to grow.

How does power affect what you think and do as a nursologist?

Yukari Shitaki wrote: The reason I wanted to raise the level of my expertise was that I strongly believe in the importance of education. In my work environment as a perinatal nursologist, I encounter situations in which induced abortions are easily requested due to undesired, unexpected, or young pregnancies. One of the reasons for this involves the issue of sex education. I have thought about what I could do to change the consciousness of the women in these cases by inculcating in them the value of life and the desire to protect its dignity. It is difficult to face such a problem through one individual’s power alone, so it is necessary to first acquire the ability to judge the essence of one’s role as a professional and to think about what kind of method is possible to implement an action from an educational perspective. I also think it is possible to augment an individual’s power by utilizing the power of a larger group through fellowship with its members, and thereby be better able to put necessary actions into practice.

Kiyoko Tanaka wrote: As a pediatric nurse, I realize that the family is very important in child development. If families cannot fully understand children with developmental disabilities and cannot understand the characteristics of their own children, it will not be possible to support those children, and it will be difficult to expand their possibilities with adequate developmental support. It will also be difficult to improve their future health in connection with possible secondary disabilities. The risk of ruining a healthy life can also develop. Conversely, with regard to the mental health of parents, especially mothers, of children with developmental disabilities, feelings of difficulty in raising these c)hildren have led to depression and reduced self-esteem. Based on this situation, we, as nursologists have the power of specialized knowledge to offer counseling, guidance, and a positive nursing environment for children with developmental disabilities and their families in cooperation with related organizations such as prefectures, municipalities, hospitals, and schools. We can also provide information about services available for children with developmental disabilities and their families so that they can maintain, promote, recover from, and prevent illness. In addition, we believe that such support will promote the health of caregivers, promote a better understanding of children with developmental disabilities, and lead to their healthy development.

Yoko Hashimoto wrote: Japan has had a background of advanced medical care catering to the needs of an aging society having an increasingly long lifespan, and medical care is moving from the hospital to the home. However, there are few nurses who are practicing in the field of home nursing, so evidence in this field is weak and, therefore, has failed to lead to policies. In the future, it will be necessary to conduct research and establish evidence for issues arising from daily practice to provide high-quality nursing in response to social changes. It is difficult to act alone, so it is necessary to become involved with others and to work together. Through the power of nurses, nursing practice will be better visualized, which will hopefully allow it to occupy a more important position among government circles, thus leading to improved nursing and medical care.

Risa Fujimoto wrote: For nursologists, power is the ability to help people by being useful to them. In my clinical experience, I often wondered whether I could really help others or if there was something more I could do for them. Therefore, I decided to undertake graduate study with the goal of improving my knowledge level and nursologists’ practice skills. As a rehabilitation nurse, I want to become a nursologist with a wide range of knowledge and be involved in primary through tertiary stroke prevention. We can only become useful to people by taking action and practicing what we know. However, to take action, we cannot act entirely alone; we need the knowledge and skills of other nursologists. Personally, if I obtain enough knowledge in graduate school, I am confident that I will have to play a role in creating an opportunity for many nursologists to understand the value of nursology. So, I think that that would be one of my responsibilities as a nursologist. As a practitioner, I will keep in my heart and mind what I believe to be useful for people and will work to obtain knowledge and skills so that I can better perform the actions of a nursologist.

Saki Higashi wrote: Power influences my activities as a nursologist. In the future, by incorporating my experiences and various influences from the external environment and applying them to my nursology activities, I am confident that I will not only grow as a nursologist, but also expand my influence to people, regions, countries, and the world at large.

References

Barrett, E. (2010). Power as knowing participation in change: What’s new and what’s next. Nursing Science Quarterly, 23(1), 47-54. doi:10.1177/0894318409353797

Chinn, P. L. (2018, August 23). Peace & Power. Retrieved from https://nursology.net/nurse-theorists-and-their-work/peace-power/

Chinn, P. L., & Falk-Rafael, A. R. (2015). Peace and power: A theory of emancipatory group process. Journal of Nursing Scholarship, 47, 62–69.