Introduction
Empowerment is an essential element of multiple modern theories in nursing. However, despite its growing popularity, the lack of proper understanding of the concept has led to its misattribution and misidentification in a practical setting (Slatyer, Coventry, Twigg, & Davis, 2016). The following paper provides a comprehensive analysis of the concept of empowerment, as presented in the interpersonal theory. The analysis is based on the findings from the scholarly literature and backed by the examples of relevant cases from nursing practice.
Definition of Empowerment
The most suitable definition of empowerment can be found in Peplau’s interpersonal theory. The latest version of the theory defines empowerment as the readiness of the patients to discuss terms of health care delivery, identify and fully comprehend their health needs, and share responsibilities with the providers in the decision-making process (Hosieni, Ravari, & Akbari, 2017). As can be seen, it is possible to view empowerment as a method of seeking autonomy from healthcare professionals and actively participate in the process. The promotion of empowerment is among the most important objectives of professional nursing activities.
Literature Review
As was mentioned above, the concept of empowerment has gained significant adoption in several nursing theories. However, it is important to note that its role is not universally agreed upon, leading to a variety of interpretations by different authors. In addition, its impact on the quality of health care is debated by some theorists.
The concept was initially introduced in what is now known as the interaction theories of nursing, with Peplau’s interpersonal theory being one of the examples. According to the theorists, the patient first appears in the healthcare setting as a recipient of care without the means of participation (Hosieni et al., 2017). The goal of the nursing practitioners is, therefore, to equip the patients with the necessary tools and knowledge to shift from a passive observer to an active participant. For instance, nurses are expected to provide the individuals with knowledge regarding their condition and the skill to apply it in a practical setting. In addition, nurses should provide emotional support, which would promote the described knowledge application. Once the patient becomes sufficiently autonomous, it is possible to consider the relationships between them and the nurse a success.
Dorothea Orem proposed a similar view on empowerment but points to the importance of acknowledging the systemic component (Slatyer et al., 2016). According to Orem’s viewpoint, the success of patient outcomes depends on their ability to shift from dependence on healthcare providers to a self-care approach. The shift is facilitated through access to resources rather than nurses’ capacity for patient involvement and, therefore, relies on healthcare systems and the organization of facilities.
In modern literature, the concept of empowerment is used primarily in the context of chronic conditions that pose no immediate threat to patient health and well-being. It is evident that in many cases, patient involvement does not provide sufficient relief. However, it is still considered by many experts a major variable in the treatment process. For example, according to the study by Chen, Wang, Lin, Hsu, and Chen (2015), empowerment plays an important role in the treatment of type 2 diabetes.
The results of the study suggested that the addition of a patient empowerment program reduces the mortality among the individuals impacted by the condition (Chen et al., 2015). The gradual shift towards online interactions between patients and healthcare professionals, as well as the incorporation of smart tools and instruments into the treatment process, also allows for the creative use of the empowerment concept. A study by Tang, Funnell, Sinco, Spencer, and Heisler (2015) evaluated the efficiency of a comprehensive empowerment program that included status reporting, medication intake logging, diet monitoring, and communication with the professional consultant. The obtained results identified the viability of the described approach.
At this point, it is necessary to point out that the results above were obtained from patient populations with conditions that require significant individual engagement in order to achieve the desired result. Simply put, the interventions in question were highly compatible with the concept of empowerment. Therefore, it is reasonable to expect that in the situation where such alignment is absent, the results would be less prominent. Due to this fact, some of the results demonstrated by the studies show little to no effect of empowerment. For instance, a systematic review by Kuo, Lin, & Tsai (2014) demonstrated several inconsistencies and gaps in understanding pertinent to the field.
Specifically, a significant proportion of the articles used as sources of data contained significant methodological flaws, undermining the validity of the results. Perhaps more importantly, the aggregated results of the studies did not produce a convincing picture of empowerment as a core component (Kuo et al., 2014). Finally, it is apparent that the interventions described in the source materials differed significantly in content and implementation process, further diluting the relevance of the results. One of the possible reasons for such lack of specificity is the vagueness of the concept. According to the analysis by Barr et al. (2015), empowerment is defined in a wide variety of ways and through a number of sufficiently unique terms. In other words, despite the evident potential, the concept of empowerment remains relatively poorly defined in the academic domain, leading to a number of practical issues.
Attributes of Empowerment
As was mentioned in the previous sections, communication is one of the key elements of successful empowerment. Thus, the commitment to stakeholders is required for a successful intervention. Considering the systemic nature of empowerment suggested by Orem, it is possible to include the access to organizational resources in the definition. In other words, collaboration is the first major attribute of the concept. The second attribute is a shared vision, which is required for aligning the efforts of nurses with those of the patients. By specifying the objectives, it is possible to increase the effectiveness of the actions. The third attribute of empowerment is the dynamic shift of responsibilities.
Over the course of the interpersonal interaction, the increase in patient autonomy is expected to be accompanied by the respective decrease of the significance of the health care professional. When executed appropriately, this shift is beneficial for both the patients and the nurses. Finally, the fourth attribute is the readiness to accept responsibility (Hosieni et al., 2017). In order to participate in the decision-making process, the patients must be ready to face the consequences of their actions. This attribute is arguably one of the most significant barriers to the effective application of empowerment in practice.
Empowerment Antecedents and Consequences
The main antecedent of empowerment is an alignment of views between a patient and a healthcare professional. This alignment needs to be established by the nurse upon the encounter with the patient and can be based on the existing values and knowledge (Hosieni et al., 2017). In the case where these are considered insufficient, new information can be offered until the agreement is reached. Once the alignment is achieved, the patient actively engages in the treatment process, gaining gradually more confidence and autonomy. Thus, the latter can be considered the main consequence of empowerment. It should be understood that in a strict sense, absolute autonomy is practically impossible. Therefore, the readiness of the patient to engage in the healthcare process is the most important determinant of the consequence.
Empowerment Empirical Referents
The first referent that can be used for the measurement of empowerment is the decision-making capacity. Within the framework of Peplau’s theory, this referent can be determined by the relevance of the information communicated from the nurses to the patients and the ability of the latter to apply the received information to real-life situations. In the case where empowerment is achieved on a structural level, the assessment would also involve the review of instruments and tactics offered by the providers (Slatyer et al., 2016). Both measurements can be performed with the help of standardized instruments and approaches. The second referent is opportunity actualization. In order to apply the received knowledge, the patients need to have a certain degree of confidence, which can be boosted by nursing actions and is measurable through qualitative data collection tools.
Empowerment Construct Cases
A model case for empowerment application would be a scenario where a nurse would interview the patient upon admission and clarify the technicalities of the treatment, which would constitute the defining attribute of collaboration. Next, the nurse would lay out the benefits of participation in treatment, and explain the benefits of individual monitoring techniques, establishing the attribute of shared values. Finally, a nurse would familiarize the patient with means of communication (e.g., the hotline), establishing two-directional relationships. In this situation, the patient is expected to become gradually more autonomous, or, in Peplau’s terms, less dependent on the professional assistance.
A borderline case would be the scenario where the patient, who is appropriately instructed on the possible adverse effects of treatment, decides to proceed with the procedure but expresses dissatisfaction with the quality of services once the expected effects are observed. In this situation, the necessary information is available, but the patient is not ready to take responsibility for the decision. Thus, the absence of a single attribute undermines the effectiveness of empowerment.
Finally, an example of a contrary case would be a scenario where the information available to the patient is insufficient for the independent inquiry, only the technical details of treatment are provided, and the nurses are either unable or reluctant to communicate. Since none of the required attributes are present, the alignment does not occur, and the patient remains fully dependent on the healthcare provider.
Theoretical Application of Empowerment
The analysis above is important for two reasons. First, it identifies the intersection points between it and the most relevant theories in nursing practice, which is useful for incorporating it in a real-life setting. By extension, it offers a list of attributes and referents, providing the means of measuring the effects of its inclusion. Second, the analysis identifies several important issues in the field, such as the lack of precise definitions and established frameworks for its application (Slatyer et al., 2016). Thus, it improves the theoretical knowledge on the subject and outlines viable directions for further research.
Conclusion
In Peplau’s theory, empowerment is defined as the readiness of the patients to discuss terms of health care delivery, identify and comprehend health needs, and share responsibilities with the nurses in the decision-making process. Despite the growing acceptance, the effects of empowerment demonstrate significant potential for enhancement of the healthcare process. In addition, it may be useful for establishing trust with the patients and decreasing the workload across the advanced practice nursing as well as my selected specialty track.
References
Barr, P. J., Scholl, I., Bravo, P., Faber, M. J., Elwyn, G., & McAllister, M. (2015). Assessment of patient empowerment-a systematic review of measures. PloS One, 10(5), 1-24.
Chen, M. F., Wang, R. H., Lin, K. C., Hsu, H. Y., & Chen, S. W. (2015). Efficacy of an empowerment program for Taiwanese patients with type 2 diabetes: A randomized controlled trial. Applied Nursing Research, 28(4), 366-373.
Hosieni, F., Ravari, A., & Akbari, A. (2017). The effect of communicating with patients using Peplau model on patients’ satisfaction with the provided nursing cares at the cardiac intensive care unit. Iran Journal of Nursing, 29(104), 36-45.
Kuo, C. C., Lin, C. C., & Tsai, F. M. (2014). Effectiveness of empowerment‐based self‐management interventions on patients with chronic metabolic diseases: A systematic review and meta‐analysis. Worldviews on Evidence‐Based Nursing, 11(5), 301-315.
Slatyer, S., Coventry, L. L., Twigg, D., & Davis, S. (2016). Professional practice models for nursing: A review of the literature and synthesis of key components. Journal of Nursing Management, 24(2), 139-150.
Tang, T. S., Funnell, M. M., Sinco, B., Spencer, M. S., & Heisler, M. (2015). Peer-led, empowerment-based approach to self-management efforts in diabetes (PLEASED): A randomized controlled trial in an African American community. The Annals of Family Medicine, 13(1), 27-35.