Concept Analysis: Oppression of Nursing in the Workplace
SAMPLE PAPER
Introduction
The concept analysis topic is: Oppression in the nursing workplace. Several managers in the clinical settings of my hospital environment unanimously identified an increase in inhibited behavior followed by aggressiveness of on duty nurses. Oppression applies to all of humanity so the concept was narrowed to that of nurses in the workplace because prolonged oppression in nursing is a detriment to patient safety. According to Martin, Stanley, Dulaney, and Pehrson (2008), prolonged oppression leads to frustration when members in work groups are not able to adequately express concerns about the systems confronted. When expression is thwarted, employees direct frustration toward each other resulting in tension and further conflict in the workplace (Martin; Leos, 2008). Unexpressed feelings slip out as passive aggressive behavior that is covert or seemingly indirect (Martin, Leos). Workers receiving these violent acts become victims and internalize feelings which result in lowered self esteem, sense of value and powerlessness that, if continued, furthers a cycle leading to poor job satisfaction, retention of nurses and patient safety (Leos, 2008; Martin, Roberts, 2000).
Evolution of Oppression
A definition of oppression was investigated and discovered through literature review in disciplines of nursing, sociology, psychology, philosophy and anthropology. Oppression dates back to 300 B. C. from ancient philosophers such as Aristotle and Plato from 300 B. C. who believed in a natural hierarchy of oppression from rulers of society and wrote of oppression as a naturally occurring phenomenon (Cudd, 2006). Oppression exists in all of nature not exclusively to people (Cudd). In the 1900s, oppression definitions shifted from the natural tendency of humanity to an act of dominance over another through views expressed by Karl Marx (Cudd). More recently oppression was discussed in the United States in 1960 during the feminist movement. According to Thobaben (2007) and Leos (2008), aggressiveness, or lateral or horizontal violence as it is known in the literature, has been in the research for 25 years. Aggressive behavior has been gaining attention in recent years likely due to the changing dynamics in health care such as regulation, media stereotypes, technology, evidence base practice, and short staffing to name a few (Gordon, 2005). In 1990 varying forms of violence is attributed to institutional downsizing affects on nursing and today with the growing health care crisis (Cudd; Martin, et al., 2008; Trauchert, 2008).
Definitions of Oppression
As a starting point in understanding the concept of oppression in the nursing workplace, the general definition of oppression was sought in Webster’s New World Dictionary (1991) which defined oppression as a feeling of being weighed down as with worries or problems or a mental and physical stress. American Heritage Dictionary of the English Language (2006), an on-line dictionary source had three definitions of oppression. The first definition was the act of oppressing, followed by an arbitrary and cruel exercise of power or something that oppresses and lastly, a feeling of being weighed down in mind and body. WordNet (2006), another on-line dictionary source defined oppression three ways also. First was the act of subjugating by cruelty as in the tyrants’ oppression of people, followed by the state of being kept down by unjust use of force and lastly, the feeling of being oppressed. Similarities in the general use of the concept of oppression were found in these three sources. Literature review is required to further define the concept and identify attributes.
Aim of Analysis
The purpose of this analysis is to determine defining attributes of oppression in the nursing workplace. Oppression is an ancient phenomenon requiring the need to understand the concept for use today, to gain insight in the dynamics of the individual and the workplace and to understand effects of oppression as it applies to nursing. Literature review is useful in determining attributes to understanding the dynamics of oppression.
Literature Review
In general terms, the attributes of oppression found in the literature were powerlessness resulting from dominance. Many scholars did not define the concept directly, but developed the idea through the varying uses of the term. The concept of oppression in the nursing workplace was used implicitly and explicitly (Matheson & Bobay, 2007). Implicit forms of oppression were defined as internal dynamics of the individual responding to the explicit forces of oppression which were interconnected with emotions and feelings of individuals (Thesen, 2005).
Implicit uses of the term from literature most commonly related oppression to the lack of power or powerlessness resulting in and from poor self-esteem, marginalization, submission, and subordination
(Daiski & Richards, 2007; Deegan, 1980; Manojlovich, 2007; Matheson & Bobay, 2007; Roberts,
1983). Daiski & Richards (2007) considered empowerment as opposite of the oppressed individual. Continued powerlessness led to internal feelings of low self esteem defined as low value or self worth which one accepts which results in internal conflict (Roberts, 2000). Most scholars consider marginalization as one going along with the majority or taking on characteristics valued by society or the dominant party to become accepted or gain power (Daiski & Richards; Roberts; Thesen, 2005). Even nurse administrators have become marginalized by identifying with physicians who are perceived as the dominant group (Freire, 1994). Roberts (2000) believed that oppression was a result of inability to obtain control over personal identity because of one’s own internalized belief of inferiority resulting in self hatred. Eventually the inability to challenge the unequal powers within a group leads to one who loses identity through assimilation, a point in which one is marginalized (Roberts, 1983). Thesen (p. 48) described oppression as “the antithesis of reciprocal empowerment which curtails self-determination, perpetuates social injustice, and suppresses the voice of vulnerable individuals.” Roberts (2000) referred to subordinate behavior when nurses took on undesirable tasks or roles delegated by the dominant group.
Cox (1991) claimed that submissive behavior was exhibited by control from external forces.
Explicit uses of the term oppression found in the literature center on dominance or power over the one who is oppressed. Understanding explicit forms of oppression is important because these acts induce oppression. The literature defined dominance as either intentional or unintentional. Sometimes this dominance is an unbeknownst judgment due to long standing and tolerated patterns of societal values which are imposed on another (Matheson & Bobay, 2007). Forms of dominance commonly mentioned in literature were exploitation, alienation, and varying strengths and forms of verbal or physical violence (see Appendix). Exploitation was defined as occurrences when nurses are taken for granted or deceived for another’s gain (Peter, Macfarlane, & Pallas, 2003). Interestingly, 2 scholars referred to marginalization explicitly as the peripheralization of one based on their identity, association, experience and environment or being removed from a useful part of society (LeBlanc, 1997; Northway, 1997). This definition of marginalization strongly resembles alienation where by a nurse does not feel like part of the group and is moved to the fringes of the group due to differences from society and peers (LeBlanc, 1997; Manojlovich, 2007; Trauchert, 2008; Freire, 1994). Miller (2008) describes this phenomenon as one where individuals are prevented from mutual participation in a relationship. Lastly, violence was described and deemed as the strongest dominating act used to release pent up stress or achieve power resulting from prolonged suppressed frustration and self-hated (Roberts, 2000).
The centers of power and oppression are ever shifting within groups and within societies and all members play the role of the oppressed or the oppressor at some point (Cudd, 2006; Daiski, 2007). Power and oppression are opposing forces constantly shifting the centers within a group because power is desired by all members of society with each individual always positioning oneself to attain what is perceived as a higher level (Cudd; Daiski & Richards). The occurrence of oppression is a normal phenomena existing in all living beings and is merely a dynamic which requires management (Cudd).
Defining Attributes
Defining attributes are a cluster of contributing factors that are the most frequently associated with the concept being researched (Walker & Avant, 1995). Many attributes for oppression in the workplace were found in the literature with the most frequently occurring chosen for this paper (see
Appendix). Implicit attributes identified were: (a) powerlessness; (b) low self esteem; (c) subordinate; (d) marginalization. Explicit attributes were: (a) domination; (b) exploitation; (c) alienation; (d) violence. Implicit and explicit both contribute to the phenomenon of oppression.
Model Case
A young black nurse starts her first job in a telemetry unit. Her preceptor and coworkers are experienced white males and females. The young nurse was frightened because of difficulty with a past clinical instructor in her last rotation of school which was on a telemetry unit and she barely passed. On arrival her name was not on the staffing roster and the team did not know she was a new hire. Report ensued without making all the assignments clear to her. After report, she sat at the desk to read charts when a doctor on the unit arrived to see his patient. The new nurse offered her chair as he approached but hesitated before offering to get another nurse. The doctor threw the chart, said he was in charge, could get information without her and then looked for another nurse. The other team members started laughing when the doctor commented that the new nurse dropped the chart. The new nurse moved to be near the team and laughed with them. The nurse manager arrived without awareness of the situation. She saw the new nurse with the team and was pleased that everyone was accepting the newly hired nurse. This model case contains all the attributes of oppression identified in the literature.
Concept Analysis Summary
In summary the concept of oppression is an ancient natural phenomenon studied for over 2000 years by scholars and today continues as an engaging and perplexing topic. Everyone seems to feel and participate in oppression and dominance but few people actually recognize it or talk about it. After extensive research, a time came when decisions needed to be made about which attributes applied to nursing oppression in the workplace. Oppression is implicit and explicit with many facets, some being uniquely identified by researchers as Manojlovich (2007) who referred to oppression as the deskilled worker and Cudd (2006) and Peter et al. (2003) who referred to suffering from one’s own failings or acts of others as the cause of oppression.
The opposite poles in power were powerlessness and dominance with the most frequently occurring force described being marginalization (see Appendix). Scholars defined it in different ways but one definition outweighed the other; that less powerful people take on the characteristics of the dominant group to gain power (Roberts, 2000; Cox 1991). Cudd (2006) discussed the center of power as ever shifting. It can be seen as a dance with each artist moving in position on stage to create a story.
Violence is difficult to research due to its diversity and multiple forms from slight innuendos to physical violence (Leos, 2008). Lateral violence in the form of nonverbal communication is often unnoticed and is damaging as it occurs between peers or to lower ranking workers resulting in erosion of the work environment (Leos). I believe that oppression and dominance require management before it consumes the workplace. Without managing this phenomenon nurses experience a reduction in job satisfaction and retention which can be detrimental and costly to organizational stability and patient safety (Leos).
One excellent research study compared nurses to school teachers by Daiski and Richards (2007) who reported parallels between the two professions. I saw gaps in research studies on nursing work environments and only 1 study was found on nurse oppression caused from managers and administrators. None were found on oppression caused by physicians, but articles were found identifying them as oppressors to nurses. A plethora of articles identified the powerlessness of nursing and that empowering nurses is the solution. I found success stories or studies on environments where nurses were successfully empowered.
The concept of oppression has been studied for a long time, is developed and ready for use by nurse leaders and instructors who could coach nurses in the work place on managing dominating forces constructively and to believe in their abilities of empowerment. I believe that empowerment of the nursing profession requires promotion with emphasis on nursing attributes such as knowledge, caring and the need for growth through organizational and political activities to reduce the invisibility of nursing. Miller (2008) emphasizes the need for mutual empowerment within relationships among women and men. More research studies of oppression are needed in actual work environments where nursing is performed. More studies on types of oppressors in the work environment and oppression in a stable versus and unstable organization and one of great cultural diversity are needed. Master’s students in nursing and researchers need to focus on these types of studies and nurse leaders and educators need to teach and coach methods of empowerment to nurses. I could be an instrumental role model, educator and advocate for management of oppression in the nursing workplace in my organization. Health care provider awareness of oppression is a good starting point for our future in nursing.
References
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Appendix
Oppression of Nursing in the Workplace
| Author/Attribute | Powerless Overpowered Low power Reciprocal power | Low Esteem/ value or worth | Exploitation | Martinalization | Submission/ Subordinate Passive | Deskilled | Alienated/ Overlooked / Invisible | Domin- ated | Suffer- ing | Violence |
| Matheson/ Bombey | | | | | | |||||
| Manojlovich | | | | |||||||
| Peter/ Macfarlane/ O’Brien | | | | | | | | |||
| Cudd | | | | | | |||||
| Rather | | | ||||||||
| Thompson | | |||||||||
| Tauchert | | | | | | |||||
| LeBlanc | | | | |||||||
| Thesen | | | | | ||||||
| Carpenter | | | | |||||||
| Daiski | | | | |||||||
| Martin | | | | | | |||||
| Northway | | | | |||||||
| Roberts | | | | | | |||||
| Scarry | | |||||||||
| Leos | | | | | ||||||
| Thobaben | | |||||||||
| Roberts (1983) | | | | | ||||||
| Roberts (2000) | | | | |||||||
| Miller | | | | |||||||
| Gordon | | | | |||||||
| Cox | | | | | ||||||
| Deegan | | | |
