Enabling Patient Empowerment

Enabling Patient Empowerment

What is empowerment?Process which enables individuals/groups to

fully access personal/collective power, authority and influence, and to employ that strength when engaging with other people, institutions or society

is not giving people power, people already have plenty of power, in the wealth of their knowledge and motivation, to do their jobs magnificently. We define empowerment as letting this power out – Blanchard

What is empowerment?a social process of recognizing promoting

and enhancing people’s abilities to meet their own needs, solve their own problems and mobilize the necessary resources in order to feel in control of their own lives… a process of helping people to assert control over the factors which affect their health -Gibson

Patients and empowermentemerged as nursing has directed its ethical

focus to advocacy for patients.Adherence to principles, particularly respect

for persons, autonomy, justice and beneficence, makes it incumbent upon nurses to involve patients in making decisions about their health and care

Negotiating within a system that has traditionally placed decision making authority and power primarily within the hands of physicians requires skills, support, and a strong sense of personal empowerment.

Patient empowerment is both a process and outcome in which

nurses have an active involvement

Nurses and Patient Empowerment•We cannot empower another, as that would strip them of their ability to choose.

•nurses can serve as enablers of the process

•Enabling the empowerment process requires a paradigm shift away from the paternalistic attitude of knowing what is best for the patient. Instead, we recognize and accept that patients are essentially responsible for their own health and have ability to discern what they need, make decisions and direct their own destinies

People may need information and support in order to make decisions

Attitudes of Nurses That Enable Empowerment•learn to surrender their need for control, developing instead attitudes of collaboration and mutual participation in decision making.

•make a commitment to being with patients as they struggle with their questions and issues and seek meaning in the process

•accept decisions made by patients and families, even when they are different from what the nurse might do or suggest.

Nursing Knowledge and Skills Necessary for Enabling Empowerment

•Awareness of the development of values and their impact on choices allows nurses to be clearer about their own perspectives, so as to foster integrity and avoid imposing personal values on others

•Knowledge of social, cultural, political, economic and other forces affecting a person’s options and health choices is essential.

…Empowerment is interactiveeffective communication is necessary for

facilitating empowerment

ability to listen with our whole being and to trust intuitive as well as intellectual understanding is important

…Empowerment is interactive

•Reflective listening allows us to help people to recognize their own strengths, abilities and personal power

•Active listening helps people develop awareness of root causes of problems and to determine their readiness to take action for change

If it is determined that the patient does not want to be empowered, nursing interventions need to be provided in a style of empowerment rather than control

This means approaching patients with an attitude of trust in their abilities to know, at some place within themselves, what they need, and to incorporate behaviors such as offering choices about aspects of care over which they can have control.

•Having opportunities and resources necessary for understanding and changing our world is part of the empowerment process

• Nurses must have knowledge of factors affecting a patient’s health and health care decisions in order to help provide or share the necessary resources.

• Such as knowledge includes awareness of patient and family values and decision making style; cultural context; social, political and economical influences on our options; and health care constraints. We also recognize that individual responsibility for health is necessarily tempered by social and environmental factors

Accdg. To GibsonNurses need to focus health promotion efforts on

macro social level, attending to conditions that control, influence and produce health or illness in people. Efforts as individuals, within professional organizations and within communities, aimed at providing access to health care for all provide base support for empowerment

Nurses must approach patients as equal partners. Skillful collaboration and negotiation, which incorporate power sharing and mutually beneficial interactions, enable empowerment. Relinquishing professional power returns to the patient.

Enhancing Patient Capacity for Decision Making

•Empowerment originates in self esteem; is developed through love a sense of connectedness, responsibility, and opportunities of choice; and is supported through perceived meaning and hope in life.

•Helping patients to know who they are facilitates empowerment. The process of self discovery enables patients to decide what they want to do based on appreciation of who they are

the patient’s empowerment to make decisions comes from the deepest understanding of the self

require facilitating a patient’s self awareness on many levels. Such as:

identifying personal values, sources of those values, where and with whom they feel

connected where and how they experience control

in life.

Locus of control •beliefs about the ability to control events in our life

internal locus of controlPeople who believe that they are able to influence or control things that happen to them

external locus of controlpeople who feel that forces outside of themselves direct or rule their lives, whether these be generalized forces such as fate o other persons who are perceived as more powerful

Persons who are internally motivated are more likely to perceive themselves as having power to make choices and control their lives, and be motivated to make necessary changes.

Those who are externally motivated tend to be more fatalistic, expecting their lives to be controlled by powerful others, and less likely to enact personal power.

Barriers to Empowerment

not everyone wants to take the risks and assume that responsibility that empowerment demands.

Paternalistic attitudes within the health care system have fostered reliance on health care providers to determine what patients need for health.

patient lack of knowledge of resource strategies that promote empowerment, dependency, apathy, mistrust and being labeled by staff

limitation of resources, control of knowledge about options, locking people into traditional roles and expectations, social labeling that stereotypes and devaluates certain people or behaviors, and restriction of access to resources

Fostering Patient EmpowermentWe can facilitate empowerment in others

by being role models of self-empowerment

•the ability to make choices regarding their health, and other areas of their lives, is basic empowerment

•Patients need to given an opportunities for choice regarding small as well as major decisions.

there needs to be participatory decision making, involving collaboration and negotiation, in all areas of health care

Connelly suggest that choosing implies having both freedom and the courage to choose from different options. Support is an important part of the encouraging process.

Support…

Having at least one or other person who supports a choice made or stance that a person takes enhances the likelihood

that the person will follow through on the decision.

Empowered atient The Szabos' story began in 2004 when she was in labor with

Michael. Complications arose and doctors at Page Hospital feared the baby wasn't getting enough oxygen, and so they performed an emergency Caesarean section.

"I'm grateful for that C-section," Joy says. "It saved Michael's life." Two years later, Szabo had a successful, uncomplicated vaginal

delivery with son Daniel at the same hospital. She assumed she could have a vaginal birth this time too, but, she says, a month ago her doctor told her Page Hospital had changed its policy and she'd have to have a C-section.

Studies have shown VBACs carry with them an increased risk of a uterine rupture compared with births in women who've never had a C-section, but the risk is less than 1 percent, according to the American College of Obstetrics and Gynecologists.

The results of a uterine rupture can be devastating: The baby could die or have permanent brain damage.

"I know there's a risk with a VBAC, but we think the risks of surgery are worse," Joy Szabo says. C-section risks include breathing problems for the baby and infections and bleeding for the mother, according to the Mayo Clinic.

"And I don't want to have to recover from surgery when I'll have four children at home, at least not voluntarily," says Joy.

After their discussion with their doctor, the Szabos made an appointment to speak with Page Hospital's CEO, Sandy Haryasz. When the couple told her about their desire for a vaginal birth, they say Haryasz would not budge, even telling them she would get a court order if necessary to ensure Joy delivered via C-section.

"I was a bit flabbergasted, because that seemed rather extreme," Joy says. "I'd already had a VBAC at Page and it went fine. And if something happened, I know they can do an emergency C-section, because they did one for Michael."