power, politics and priviledge in healthcare

Question 1

weberianism

Answer 1

max weber
-(like marx) perceived society to be characterized by conflict and social stratification
-diverged from marx regarding the nature and source of social stratification
-> in addition to class, other factors that contribute to social inequality

Question 2

weber and social stratification

Answer 2

1. property (economic resources)
2. Power (political resources)
3. prestige (social status)

3 p’s of weberianism

Question 3

prestige

Answer 3

-respect, priveleges, honour given to members of particular status groups *
-social class and status groups are closely related, but don’t need to be
-different status groups = differing prestige

Question 4

status group

Answer 4

-based on membership in specific groups (professional, ethnic, religious etc.) in which members share common interests and lifestyles
-membership restricted through a process of social closure

Question 5

status groups in health care

Answer 5

differing prestige linked to differences in :
-skills/expertise
-salaries, working conditions etc.
status groups within status groups

Question 6

social closure *****

Answer 6

the way that power is exercised to exclude outsiders from the priviledges of social membership (in social classes, professions, or status groups)
eg. medecine : keep people out, keep people down -> medical dominance

Question 7

medical dominance****

Answer 7

the term medical dominance refers to the fact that medicine was and to some extent still is, the most powerful profession in the health system. It points to the power the medical profession has, despite its limited numbers, to control its own work, and that of other health workers, and to have influence over health policy, (health resource allocation), and the organization of hospitals

key feature : autonomy

Question 8

physicians (medical dominance)

Answer 8

12% of health professional workforce
-gatekeepers
-driver of health care policy/decision-making

Question 9

4 challenges to medical dominance

Answer 9

1. emergence of the welfare state
2. professionalization of occupations in healthcare
3. increasing heterogeneity in medicine
4. Demystification of medicine (consumer power)

demystification : removal of mystery or confusion surrounding a topic

Question 10

nurses

Answer 10

-the face of contemporary health care
-ambivalent relationship embedded in historical roots

ambivalent : having mixed feelings about smt/someone

Question 11

history of nursing

Answer 11

-religious orders
-military organizations
-female dominated profession

Question 12

florence nightingale (1820-1910)

Answer 12

-founder of modern nursing
-social reformer
-opposed to the women’s movement

Question 13

first nurses training school in canada

Answer 13

1874
st catherine’s ontario
nurses trained to provide service to :
a) patients (hands-on-care)
b) physicians (carrying out their orders)

Question 14

three historical time periods of modern nursing in canada

Answer 14

1. emergence of lay nursing (1870-1930)
2. move to hospital nursing (1930-50)
3. post - WWII changes to nursing (1945-)

Question 15

emergence of nursing as a profession

Answer 15

1908 - Provisional society of the canadian national association of trained nurses
-> licensing of registered nurses (RNs) and creation of registries (status group)
1919 - UBC Nursing
-Unionization

Question 16

changing nature of nursing

Answer 16

emphasis on skills and training (rather than service)
-shift to university training
-changing scope of work/practice
-nurses social power and prestige are in flux
-increasingly specialized and hierarchically organized
-> different types of nurses
-> different types/levels of training
-> different levels of responsibility

Question 17

todays nurses..

Answer 17

42.7% of health care professional workforce
-majority are women, registered nurses (RN) and working in hospitals and institutions
-more than half are aged 40-60 years

Question 18

weberianism and nursing

Answer 18

-increasing emphasis on “rationalization” and efficiency over time
- “rationalization” ***** standardization of social life through rules and regulation (eg. growth of bureaucracy)

Question 19

nature of social life according to weber (pre industrial/modern society)

Answer 19

pre-industrial society
-> characterized by irrationality (belief in magic, supernatural etc.)
-> emphasis on emotions, insight and revelations

modern society
-> characterized by rationality (science, efficiency, laws)
-> emphasis on reason, logic and the intellect

Question 20

consequences of rationalization (pros and cons)

Answer 20

pros
-nurses more organized, efficient, cost-effective, research-based, etc
Cons
Iron cage
mcdonaldization
new managerialism

Question 21

The “iron cage” ***

Answer 21

-rationalization -> people trapped by rules/rationalization
-the squelching of creativity and spontaneity
-the devalutation of emotion and nurturing
-robot-like care

Question 22

mcdonaldization **

Answer 22

-rationalization -> overemphasis on efficiency, uniformity and predictability
-> fast food chain analogy
-> dehumanization

Question 23

new managerialism

Answer 23

-rationalization -> demands of the job intensifying; nurses expected to do more with less time/resources
-continuous scrutiny
-stress and burnout

Question 24

contemporary nursing

Answer 24

-high working conditions and low job satisfaction
-high rates of burnout, absenteeism, injury and turnover
-high rates of on-the-job physical assault and verbal abuse
-ethical dilemmas

Question 25

street nursing in BC

Answer 25

established by bc centre for disease control in 1988
-provincially funded
-follows a ‘harm reduction’ model