Lecture: Power, Corporations And Culture PDF

LECTURE: POWER, CORPORATIONS AND CULTURE NSB 102: MODULE 4, PART 2 DR AUDRA DE WITT Acknowledgement of Traditional Owners In keeping with the spirit of Reconciliation, we acknowledge the Traditional Owners – the Jagera and the Turrbal peoples of the land where QUT now stands and recog...

LECTURE: POWER, CORPORATIONS AND CULTURE NSB 102: MODULE 4, PART 2 DR AUDRA DE WITT Acknowledgement of Traditional Owners In keeping with the spirit of Reconciliation, we acknowledge the Traditional Owners – the Jagera and the Turrbal peoples of the land where QUT now stands and recognise these places have always been places of teaching and learning. We pay our respects to their Elders past and present, and acknowledge the important role Aboriginal and Torres Strait Islander peoples continue to play within the QUT community www.reconciliation.qut.edu.au  Social construction of Medical and Nursing 1 knowledge Nursing Regulations relating to power, principles 2 of collaboration, partnership and cultural safety Organisations, workplace culture, policies and 3 culturally safe health care Social Construction of medical knowledge Knowledge can be defined as : is NOT neutral Simply a “mode of thought” Influenced by many things eg. society, culture, views etc Use of antibiotics have saved millions of lives But at times it has been overused What has been the result? Examples of Developments in Medicine 1870 – Germ theory of disease established (Robert Koch & Louis Pasteur) 1879 – First Cholera vaccine developed 1882 – First Rabies vaccine developed (Louis Pasteur) 1955 – First Polio vaccine developed (Jonas Salk) 1964 – First Measles vaccine developed 1975 – CAT-scans invented (Robert Ledley) 1978 – First Test tube baby is born 1980 – Smallpox is eradicated 1983 – HIV – virus that caused AIDS identified 1996 – First clone – Dolly the Sheep 2006 – First cancer vaccine Source: https://www.datesandevents.org/events-timelines/10-history-of-medicine-timeline.htm  Power Can have various meanings …. ‘to structure the possible field of action of others’ (Foucault 1982, p 341) Power-knowledge – one does not exist without the other Power is a relationship not a thing – term ‘balance of power’ shows that power in a relationship shifts and is dynamic  Power in Medicine “The capacity of scientific medicine to influence social action is the defining characteristic that makes scientific medicine an active focus of exercising power over society. Its monopoly in providing health services turns scientific medicine into a guardian (gatekeeper) of sickness and health, life and death” Source: Alexias, G. (2008). Medical discourse and time: authoritative reconstruction of present, future and past. Social Theory & Health, 2008, 6, (167–183).  Australia’s ‘Dr Death’ In 2005, events at Bundaberg Base Hospital made media headlines worldwide due to the actions of general surgeon, Dr Jayant Patel, often referred to as ‘Dr Death’ in the media. He has been linked to numerous deaths of patients under his care, and many more cases of patient mistreatment and negligence have been alleged (Dunbar et al. 2007; Thomas 2007). After being convicted of three counts of manslaughter and given a seven-year jail sentence, and serving two years in prison, in 2012 Dr Patel successfully appealed his convictions and had them overturned by the High Court of Australia, which ordered a retrial. The first retrial found him not guilty, and the second retrial resulted in the jury failing to reach a verdict related to grievous bodily harm (Elks 2013a; 2013b; Wordsworth 2013; Taylor 2015). In November 2013, Dr Patel did plead guilty to four counts of fraud in relation to dishonesty obtaining registration and employment in Queensland. He was sentenced to two years in jail for fraud, which was wholly suspended, and the Director of Public Prosecutions in Queensland where the offences had taken place, decided not to pursue any other charges (Taylor 2015). The Patel case exposes the systemic problem of medical dominance and the difficulty in challenging the clinical autonomy of doctors. Of particular concern was the fact that ‘whistle-blowers’ had to turn to politicians and the media to have their concerns addressed. The case also demonstrates the reluctance of juries and public authorities to sentence and jail members of the medical profession, compared to other members of the health profession, because of the status and power they hold in society. Source: Germov, J. (2018). Second Opinion: An Introduction to Health Sociology Case study - Thoughts? What was your first impressions about the case on “Dr Death”? What did you think about how our society views doctors? What do you think about the ‘power’ they hold in society? Any other thoughts? Social Construction of nursing knowledge  Florence Nightingale where it all began According to Ulrich and colleagues [2010, p. 2] Nightingale ‘…discussed ethical duties of confidentiality, communication, and the centrality of meeting patients' needs’. See NIGHTINGALE, F. (1860) NOTES ON NURSING What it is, and what it is not New York. D. Appleton and Company. Available at http://digital.library.upenn.edu/women/nightingale/nursing/nursing.html Development of Nursing in Australia - summary Nursing services developed late 19C. Services provided mainly by charity organisations – sick-care & welfare Focus – hygiene and morals. No formal training in hospitals. Informal training not always supported by hospital management (except if on hygiene, order and discipline). Many doctors did not see need for nurses to be trained – except for menial work, patient hygiene and other patient care Power struggles between senior nurses, doctors and hospital management to have control over nursing. Change was slow Germov, J. 92016). Second opinion. An introduction to health sociology. Oxford university press Development of Nursing in Australia – summary 2 Victorian Trained Nurses Association 1902 – the 1st Australian nursing organisation. Nursing register & journal – UNA, United Nurses Association Nurses needed to sit exams to be a member, and if passed could practice in relevant state Early nursing organisations - many doctors held senior positions in nursing eg chairperson, editorship of nursing journals - medical bias dominated nursing editorial content & for improved pay & work conditions Nursing Registration Boards established – Qld 1912, other states in the 1920s. Hospitals were responsible Germov, J. 92016). Second opinion. An introduction to health sociology. Oxford university press Development of Nursing in Australia – summary 3 Nursing – seen as ‘women’s work’ based on gendered social processes Doctors also working on professionalization strategies – excluded women from entering medical profession & limiting practices of other health workers including midwives and nurses ‘Medical profession had to manage nursing in order to control it’ even though ‘nursing has never seemed to pose any threat to the power of medicine in Australia’ Late 1800s public health movement gained momentum. Nurses working in PHC entering a different culture compared to ‘real nursing’ in hospitals A little bit (more) of health sociology relating to theories of professions and gender in nursing Trait theory – identifies qualities and attributes that distinguish professionals from other occupational groups Professions are established and operate within social structures where power is dynamic ‘All professions employ power to create and control their market of professional services by surrounding their knowledge in mystique to promote their self-serving social status & prestige’ – eg medical profession Germov, J. 92016). Second opinion. An introduction to health sociology. Oxford university press More health sociology! Gender – social construct – based on norms, values and perceptions of roles of men and women in society Present in all parts of life – constructed by gender divisions and stereotypes and shape oganisation structures, institutions and the labour market In medicine – wanted to exclude women – based on belief that women were second class status, stereotype of womens roles and sutability science vs caring roles. Now this has of course changed. Eg women in medicine, science, men in nursing etc Power in Nursing Hierarchy within nursing - ‘Lady nurses’ – from middle class who could afford to pay premiums to enter into nurse leadership positions compared to ward nurses Nurse organisations reluctant to be involved in industrial action – dominated by matrons and medical profession Hospital matrons developed power – alignment with medical profession. Perceived high status from close working relationship Reluctant to ‘push’ for better training & working conditions – didn’t want to ‘rock the boat’. Med profession approval - sense of security & reflected status – trade off for tough working conditions Nursing regulations relating to power, principles of collaboration, partnership and cultural safety Figure 1: Registered Nurse Standards of Practice, NMBA 2016 Code of Conduct for Nurses – NMBA, 2018 ‘sets out the legal requirements, professional behaviour and conduct expectations for all nurses, in all practice settings, in Australia. It describes the principles of professional behaviour that guide safe practice, and clearly outlines the conduct expected of nurses by their colleagues and the broader community Code of Conduct, 2018 The ICN Code of Ethics for Nurses Elements of the Code 1. Nurses and patients or other people requiring care or services 2. Nurses and practice 3. Nurses and the profession 4. Nurses and global health The ICN Code of Ethics for Nurses provides ethical guidance in relation to nurses’ roles, duties, responsibilities, behaviours, professional judgement and relationships with patients, other people who are receiving nursing care or services, co-workers and allied professionals. The Code is foundational and to be built upon in combination with the laws, regulations and professional standards of countries that govern nursing practice. The values and obligations expressed in this Code apply to nurses in all settings, roles and domains of practice Organisations, workplace culture and policies and culturally safe health care  Organisations, workplace culture and policies and culturally safe health care The Cultural safety in health care for indigenous Australians monitoring Cultural Safety Framework framework assess how well we are Culturally respectful achieving cultural safety in the health health care services system for First Nation Australians Patient experiences with care Access to health care services  Cultural Safety in Health Care Framework 1 Module 1: Culturally respectful health care services Between 2013 to 2020: the rate of Indigenous medical practitioners employed in Australia increased from 234 to 494 (from 31 to 57 per 100,000) the number of Indigenous nurses and midwives employed in Australia increased from 2,434 to 4,610 (324 to 535 per 100,000). Cultural Safety in Health Care Framework 2 Module 2: Patient experience of health care In 2018–19, 91% of Indigenous Australians aged 15 and over in non-remote areas reported that doctors always/often showed respect for what was said. In 2018–19, of the 243,663 Indigenous Australians who did not access health services when they needed to, 32% indicated this was due to cultural reasons, such as language problems, discrimination and cultural appropriateness. In 2020, 22% of Indigenous Australian adults or their families reported being racially discriminated against by doctors, nurses and/or medical staff in the last 12 months. Cultural Safety in Health Care Framework 3 Module 3: Access to health care services Indigenous Australians waited longer to be admitted for elective surgery in 2019–20 than non-Indigenous Australians—50% of Indigenous patients were admitted for elective surgery within 49 days, compared with 38 days for non-Indigenous patients. In 2019, the potentially avoidable mortality rate for Indigenous Australians was 222 per 100,000. The Indigenous age-standardised rate was over 3 times that for non- Indigenous Australians (323 and 98 per 100,000 respectively). In closing … Health professionals, play a significant role in improving outcomes by ensuring they provide a high standard of culturally safe and respectful care. As nurses, the largest health workforce, there is a lot we can do on a day-to-day basis to improve this ‘statistics and figures’ – remembering that behind these statistics and figures that we often see, are real people, like you and me! References Foucault. (1982). The subject and power Germov, J. 92016). Second opinion. An introduction to health sociology. Oxford university press History of Medicine Timeline: https://www.datesandevents.org/events-timelines/10-history-of-medicine-timeline.html NMBA (2018). The Code of Conduct for Nurses https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/professional-standards.aspx Nightingale, F. (1860) NOTES ON NURSING What it is, and what it is not New York. D. Appleton and Company. Available at http://digital.library.upenn.edu/women/nightingale/nursing/nursing.html Registered Nurse standards for practice: https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/registered-nurse- standards-for-practice.aspx The ICN Code of Ethics for Nurses. 2021 https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/professional-standards.aspx The Cultural safety health care framework. https://www.aihw.gov.au/reports/indigenous-australians/cultural-safety-health-care-framework/contents/summary