Hierarchy and traditional roles such as doctor to nurse, nurse to student, genders, patient to nurse/doctor are some of the relationships which come to mind when thinking of power in a hospital setting. For this post we are looking at Michel Foucault and the theory of the relationship between power and knowledge. Thinking about power can be insightful to consider all other parties who may be effected by planned change and to ensure equality ensues.
According to Foucault, power is everywhere, in relationships, learning and shapes people’s behaviour. Foucault’s theory states that “knowledge is power” (1998, pg.93).
“Knowledge linked to power, not only assumes the authority of ‘the truth’ but has the power to make itself true. All knowledge, once applied in the real world, has effects, and in that sense at least, ‘becomes true.’ Knowledge, once used to regulate the conduct of others, entails constraint, regulation and the disciplining of practice” (Foucault 1977, pg. 27).
The metaphor for power discourse is the panopticon according to Foucault (see image below). The panopticon allows one guard to view and control hundreds of prisoners, the prisoners have no way of knowing when they are being observed, which places all power to one person. The armed forces, schools, factories, technology and hospitals are all modern disciplinary power settings where a form of power, where no bars, chains, and heavy locks are necessary for domination to occur.
Power Play in Nursing
The relationship of the educator and student in nursing highlights the potential healthcare hierarchical regime. Students can be undergraduate or postgraduate (meaning they are employed professionals), all which may create power play within the educator-student relationship in the process of completion of appraisals or assessments. The stakes are high, as success for a student could mean their first job or ongoing employment for the postgraduate student. Is the structure in hospital set up to allow speaking up and junior staff to question care?
Clutterbuck (2004) highlights the locus of power in mentoring relationships and, that mentors should work with mentees to increase empowerment and the independence of mentees. Clutterbuck (2004) states mentors should respond to mentees’ developmental needs, and the mentee should accept increasing responsibility for managing the relationship. Employment, hierarchy, culture and ‘speaking up’ are all likely power constraints.
“Adult educators talk emphatically of empowerment as a process through which adult learners find their voices and develop the self-confidence to take control of their lives” (Brookfield, 2001).
Keywords: power; Foucault; panopticon.
Brookfield, S. (2001). Unmasking power: Foucault and adult learning. Canadian journal for the study of adult education, 15(1), 1-23.
Clutterbuck, D. (2004). Everyone needs a mentor: Fostering talent in your organisation (4th Ed.). Chartered Institute of Personnel and Development: London.
Foucault, M. (1977). Discipline and Punishment. London: Tavistock. [Goodreads blurb]
Wikipedia (2016) Michel Foucault