Power imbalance between nurses and patients: a potential inhibitor of partnership in care

Abstract

The Patient's Charter identifies the need for nurses to respect patients' rights to influence their care, and contemporary nursing practice advocates that nurses work in partnership with patients. Hence nurses are encouraged to share their power and facilitate empowerment in their patients by giving them information and support. However, the literature indicates that nurses are not very successful in making patients feel empowered to make informed decisions. This study, conducted in 1998, provides some answers as to why this may be the case. The aim of the study was to explore and describe nurses' and patients' views regarding partnership in care in hospital. Using the grounded theory approach, participants were drawn from four hospitals in Western Australia. A purposive sample of 33 nurses and 32 patients were interviewed in-depth. Participant observation was also conducted and field notes were written. The interviews were transcribed verbatim and analysed using the constant comparative method. The findings showed that nurses viewed involving patients in care as requiring them to give patients information and to share their decision-making powers with them. With the exception of a few, the majority of nurses were unwilling to share their decision-making powers. This created a situation of power imbalance with subsequent little patient input. Factors identified included nurses' beliefs that they "know best", the view that patients lacked medical knowledge and the perceived need for nurses to hold onto their power and maintain control. If nurses and patients are to work as partners, it is important that nurses make every effort to equalize the power imbalance. One way to do this is for nurses to share and give information to patients readily and to be open in their communication with them.

What contributes to abuse in health care? A grounded theory of female patients? stories

“…Henderson (2003) identifies three factors which strongly contribute to this power imbalance. First, nurses' belief that they "know best".…”

Nurses’ responses to expert patients: The rhetoric and reality of self-management in long-term conditions: A grounded theory study

“…Whilst there is a growing acknowledgement within nursing literature that patient expertise within chronic illness not only should be promoted (Hughes, 2004) but also acknowledged (Fox, 2005, Wilson, 2002, research suggests that there is some resistance from nurses towards the notion of active self-managing patients (Henderson, 2003, Thorne et al, 2000. However, within the policy context of the expert patient and self-management there has been little previous research in the UK exploring nurses' responses towards active and informed patients.…”

“…The nurse specialists had confidence in their empirical knowledge which not only formed part of their decision making process but was also shared in an egalitarian manner with patients (Henderson, 2003).…”

Patient participation from the perspective of staff members working in spinal cord injury rehabilitation

“…Organizational impediments, such as lack of time and resources, have been reported as common barriers [21][22][23].…”