|Please read the case “Power Distance Consequences” and analyze the following questions.
1. How do we see “cultural differences such as attitudes toward [Hofstede’s] power distance, individualism or collectivism, uncertainty avoidance, and masculinity or femininity influence people’s perceptions about competent behavior” in this case? Please focus your discussion on the dimension(s) that you perceive to be relevant to this case.
2. What responsibility did the student nurse (or a less powerful employee) have to advocate for the patient based upon the information she overheard? What should the student nurse do?
3. What responsibility does the charge nurse (a supervisor-type employee) have to advocate for the patient to Dr. Topoli based upon the new information from Dr. James, the professor?
4. How can junior staff and other professional personnel discuss intimidation by senior, more powerful leaders? How can people come to better understand power distance in the general culture as well as the work culture?
Power Distance Consequences: Authoritarian Doctor, Silent Student Nurse
|This case emphasizes the cost of remaining silent as well as how powerful people are sometimes not
open to communication from others.
|Nursing student Gayathri Gupta, an international medical student from India, was troubled over the
case of Rachel Laurel, a 23-year old patient who had been diagnosed with stage IV laryngeal cancer.
Laurel had just started law school at a major university where she was a very brilliant, dedicated
student. Her treating physician, Dr. Topoli, had weighed all the possible options and concluded that if he
operated on Laurel, the consequences could include brain damage, blindness, hemorrhage and, worst-
case scenario, an untimely death. The doctor discussed these scenarios with the parents and the
patient, and they agreed on palliative care (care to minimize pain without invasive treatment) and Laurel
signed a Do Not Resuscitate (DNR) form.
|Since this was a teaching hospital, Dr. James, a medical professor, came in one morning accompanied by
her students. She used Laurel’s case as the example in order to explain the condition of the patient and
the pathophysiology of cancer to his students. Upon looking at the MRI scans, Dr. James thought that
the tumor was operable and the patient could walk away cancer free after the procedure and
|Nursing student Gupta had heard Dr. James discussing Laurel’s case, and she followed up with Professor
James. Gupta asked in-depth questions about the procedures and treatment. From Dr. James’ answers,
Gupta began to understand that Laurel might have a chance to survive and even become cancer free.
|During this time, Laurel’s family had slowly been coming to terms with the fact that their daughter was
dying, and they just wanted to make her happy. Concerned, Gupta informed the charge nurse about the
conversation with the professor, and the nurse agreed with Gupta.
|At the hospital level, this facility was a prime candidate to adopt a communication and care strategy
known as Patient-and Family-Centered Care (PFCC) which presents all options to the patients, and then
let the patient decide what is best for him or her. PFCC focuses on the patients, families, and the
healthcare staff as the co-decision makers in the patient’s care. The traditional, hierarchical, vertical
model of care has care and control moving downward from physicians to nurses to other specialists and
then to patients and families. In this model, patients and families lose much of the control over their
medical care. PFCC focuses, instead, on changing an ingrained, vertical centric culture into a more
horizontal culture and patient centric system (Barker, 2015).
|Unfortunately, two days later patient Laurel stopped breathing, but, after resuscitation, she was able to
breathe again. This brief reprieve at life made Jones think that maybe this was her opportunity to do
something to help the patient. Gupta discussed Laurel’s case again with the charge nurse, who told
Gupta that she, as the charge nurse, had hinted to Dr. Topoli about the possible alternatives mentioned
by Dr. James, but Dr. Topoli did not care to listen. Gupta was acutely aware that no one dared question
Topoli’s judgment because he was the most experienced oncologist at the hospital. It seemed to be an
unwritten rule that no one questioned Dr. Topoli’s decisions. Gupta understood enough about power
distance to know that she would not succeed in overcoming Dr. Topoli’s case management decisions.
The treating doctor’s judgment prevailed, and Laurel died two weeks later.