Three essays on power dynamics within China’s community nursing system

Abstract

This doctoral thesis investigates the power dynamics within China’s community nursing system through three interpretative case studies. Grounded in French and Raven’s typology of social power, the initial study categorises the diverse manifestations of power and elucidates the contextual constraints of power faced by community nurses. This analysis highlights the need for initiatives aimed at empowering nurses, thus harnessing untapped power reserves to more effectively meet the needs of patients. The second study employs Rosabeth Kanter’s theory of organisational power to explore how community nurses, acting as street-level bureaucrats, manage and utilise power resources within their professional environments. This inquiry exposes significant disparities in access to power and underscores the role of interpersonal relationships in shaping the structures of organisational power. It also provides a framework for understanding the dynamics of power among grassroots policy implementers who operate within both formal and informal job structures, with a particular focus on equity considerations. The third study, informed by Michel Foucault’s concept of biopower, examines the profound influence of community nursing on health promotion at both the individual and population levels. It identifies three specific community nursing services that epitomise biopower approaches to health promotion, characterised by their persuasive, constructive, and evidence-based methods. These services align with the core principles of biopower. This study offers a conceptual framework that underscores the significant impacts of community nursing services on health promotion at the primary care level. The integration of French and Raven’s typology of social power, Kanter’s theory of organisational power, and Foucault’s concept of biopower enables a comprehensive examination of the structural, interpersonal, and ideological forces shaping community nursing in a Chinese context. This tripartite approach provides a layered understanding of how power operates within the community healthcare system and offers a pathway towards reforms that enhance both nurse empowerment and patient care. This thesis asserts that understanding and restructuring power dynamics are essential steps towards not only enhancing the professional stature and effectiveness of community nurses but also improving the overall primary healthcare infrastructure.