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Since nursing has grown into a remarkable profession and discipline across the whole world, there has been growing concern with delineation of its theory base. The development of theory is one of the most important tasks facing nursing today. Concepts are the basic foundation of theories. Concept analysis is not only an excellent way for analyzing information in preparation for theory construction, but also results in operational definition as well as a list of defining features and antecedents. The strength of any theory that guides a particular discipline is anchored on the quality of concept analysis. Empowerment is one of the most familiar concepts used in various professions and specialties. An analysis of the empowerment concept can help in understanding patient empowerment (Walker & Avant, 2019). This paper aims to explain the concept of patient empowerments as well as its implication in the nursing profession using Florence Nightingale’s Environmental theory. The defining attributes, antecedents and consequences, empirical referents, construct cases as well as theoretical application of the empowerment concept are also discussed

Definition/ Explanation of Patient Empowerment Concept

The concept of empowerment is normally employed in various contexts. In the healthcare sector, the expression is used as a guiding basis for different health promotions as well as a strategy for management of chronic health conditions. However, in as much as there is a broad consensus on the importance and the multidimensional nature of empowerment, a universally accepted definition of empowerment, its operationalization as well as dimensions does not exist, giving rise to numerous measures of empowerment (Camerini & Schulz, 2015). According to McAllister et al. (2012) the concept of empowerment conceives a patient as a self-determining agent with some degree of control over his or her life. Small et al. (2013) define empowerment as a process as well as outcome arising from the interaction or communication between a healthcare professional and a patient involving sharing of resources over information regarding a particular illness, which enhances a patient’s self efficacy, coping abilities, ability to effect change over his or her condition and feeling of control.

Literature Review

Paulo Freire, in his philosophy of emancipatory education, made the earliest references to the empowerment concept. He saw empowerment as a response social inequality as well as oppression (Nouri & Sajjadi, 2014). Later the concept of empowerment was explored within critical social theory, rural economy, community psychology and gender study, before being explored in the health education and promotion disciplines (Bravo et al., 2015). Camerini and Schultz (2015) assert that irrespective of the discipline in which the concept of empowerment is used, the expression contains a variety of definitions, meanings as well as interpretation of the term empowerment, thereby transforming it into a multidimensional concept.

One of the key features of the concept, when considered from psychological perspective, is that empowerment is a feature of the community and not of an individual. Various authors differentiate between the concept of empowerment and other concepts like personal agency, autonomy, self determination, self regulation, self efficacy and personal control, all of which have generally equivalent meanings. The latter features are individual attributes, but a person can only talk of empowerment if these concepts affect the community. This can happen when an individual actively participates in a community or an organization (Christens, 2013).

The application of the concept of empowerment in the field of health is, however, diversely used and still contested. In the beginning it was adopted as the foundation of health promotion but later on used as means of increasing patient autonomy as well as participation in decision making activities related to their health (Cerezo, Juve-Udina & Delgado-Hito, 2016). Today, with the rising cases of chronic diseases, the empowerment concept started to be used a strategy for ensuring that patients do not only participate in, but also take responsibility in their healthcare to improve health outcomes as well as control health expenditures (Castro et al,. 2016).

Defining Attributes of Empowerment Concept

The defining attributes of empowerment in healthcare are related to what happens within an individual as well as between individuals. These include mutual and supportive relationship, self determination, and knowledge.

Mutual and Supportive Relationship

Relationship nourishment is important for the patients, their family members and health care providers. An empowering process calls for an engagement that is combined with the nourishing as well as interactive relationship founded on mutual trust and respect. Authenticity, encouragement, active listening, equality, acknowledgment and communication are essential elements of an empowering relationship, as it implies that everyone’s feelings plus experiences are not only important, but of equal value (Browning, 2013). Relationships empowerment may help patients, their family members and nurses to mobilize necessary resources to manage the existing challenges (Fitzpatrick, Campo & Lavandero, 2011).

Knowledge

Knowledge and access to information are essential requirements for all parties involved in healthcare, whether patient, family members and care providers. The quality of information as well as the context in which it is conveyed should influence the level to which it empowers an individual. For a patient and his or her family members, information can lead to adequate awareness of a particular situation as well as sense of coherence. Individuals must personalize and adapt information for their own needs. Mutual exchange of information is the beginning of the empowerment process. For nurses, exchanged experiences from colleagues, lectures and seminars are crucial source for professional development (Fitzpatrick et al., 2010).

Self Determination

This can be experienced when a person is involved in important processes, met with respect, truly listened to and taken seriously. Regarding critically ill patients, self determination is nothing but a process of enablement rather than relinquishing or retaining of power. It comprises of the opportunity to contribute if an individual is willing and able, alongside having the possibilities. This includes, for instance, sharing decisions and making informed choices as well as entrusting one’s health to care providers. Next of kin in healthcare experiences involvement by getting informed as well as having the chance to follow the development process. Regarding healthcare providers, the congruence between professional and personal goals as well as values underpins self determination plus involvement (Hauck, Quinn Griffin & Fitzpatrick, 2011).

Antecedent & Consequence of Empowerment Concept

Antecedents are the events which must happen before the occurrence of a concept (Walker & Avant, 2019). There are limited resources that describe antecedents to patient empowerment, but motivation is one of the most common antecedents to empowerment. This implies that deep unconscious patients cannot experience empowerment. Motivation and will are key requirements for the empowerment process to happen. Motivation is nothing but the driving force that provides purpose to human behaviors, which operate at both the conscious as well as the subconscious levels. Without motivation and will the behaviors cannot occur. Consequences are the elements that happen as a result of a concept (Walker & Avant, 2019). For instance, empowerment can result in decreased level of strain. An empowered patient has the necessary knowledge, skills and knowledge to overcome distressing situation such as ill health, and difficult tasks.

Empirical Referents

Walker and Avant (2019) refer to empirical referents as the classes of phenomenon which by their presence alone demonstrate the occurrence of a concept itself. Empirical referents help in determining the existence of a concept and how to measure it. Currently, there is no definite instrument used for measuring empowerment in patients under critical care, even though there are several measurement instruments used in other contexts. For instance, Walker and Avant (2019) indicate that the Patient Empowerment Scale was constructed to help with measuring patient empowerment as well as disempowerment in care environments that cater for older people. Anderson et al.’s Empowerment Scale is another instrument normally used to examine psychological empowerment on patients with chronic illnesses.

Construct Cases

Model Case

Josephine was visiting her son in the intensive care unit, who 5 days ago was involved in a car accident that resulted in multiple rib fractures, several leg fractures and lung contusion. Josephine sat quietly next to her son sobbing about her son’s wellbeing. The attending nurse understood Josephine’s anxiety and told her that the orthopedist was the one in a better position to tell whether or not the patient could walk again. The nurse called the orthopedist on Josephine’s request to explain the situation. The orthopedist respondent and they walked together to one of the meeting room. Josephine explained her concerns and the orthopedist explained to her about the fractures as well as the operation and promised her that in as much as it would take some time, the patient would surely walk again. Josephine felt relieved and went back to sit next to her son, Jacob.

After some time, it was time to turn Jacob and prepare his bed. The attending nurse asked Josephine if she would like to stay or leave the room, to which she said she would want to stay. She asked if there was something she could do for her son, to which the nurse said that she would be of great support jus by sitting next to Jacob and holding his hand. If she wanted anything else she could bathe his face as well as lubricate his mouth. The nurse showed Josephine how to do this. The nurse asked Josephine about Jacob’s interests and when she said that he loves country music, the nurse promised to bring a CD player if Josephine brought Jacob’s favorite album. In the evening when Josephine went home she felt increased strength and felt she was in a better position to help Jacob in his recovery.

This case demonstrates all the defining attributes of empowerment. Josephine acquired the knowledge she needed, and the nurse enabled her to develop the skills to be helpful to her son. Her self determination was demonstrated by her desire to get involved in her son’s care. Also, she had a mutual and supportive relationship with the nurse and felt power within herself.

Borderline Case

A borderline case contains most of the defining features of a concept but varies substantially in one of them. For instance, Ryan is an experienced and skillful nurse who really enjoys his job. But today he feels sad and powerless. For the past 1 week he has been taking care of Leon, a 67-year-old man who underwent surgery for lung cancer. He has metastases in the liver and has been on a ventilator for the past 3 days. Three days ago, he contracted pneumonia and showed signs of sepsis. Leon was a positive and active patient, but in the recent past days he has been putting a sad face and trying to move his mouth asking for help. Yesterday, Leon sat next to Leon holding his hand when he told him that he does not want to live anymore.

Now Leon seems to have ileus and the physician has decided to perform another operation to determine if there was a mistake during the last operation. Before this operation, Leon has to get 2 units of blood and a new venous catheter. Leon feels that these would cause him unnecessary pain as he is too sick to have any chance of recovery. Leon’s son, Dan, is very sad and says that it is too painful to see his father suffering. Leon comforts his son and says that he understands that it is hard for him. He feels sad that Ryan is only having his woes prolonged rather than allowing him to have a dignified death. In this case, even though Leon has acquired the knowledge and skills as well as established good relationship with Ryan, he lacks self-determination and power within himself, as he does not feel that he is doing well

Contrary Case

Katherine was being cared for in the intensive care unit after complicated cervical cancer operation. One day she woke up when the nurse said he was going to help her with her morning cleanliness. The patient did not have enough sleep during the night because a great deal of noise in night caused by a new patient. Katherine felt tired and asked the nurse if he could extend the morning routine by two hours to have more sleep. The nurse told her that it was the hospital’s policy to clean rooms at that particular time. He removed Katherine’s bed sheets, helped her bathe and asked another nurse to make the bed and turn Katherine over to the left side. Katherine experienced that the nurse turned her over in a painful and rough way. She felt sad as well as powerless. Two hours later another nurse came and took blood samples using Katherine’s arterial cannula. She said that she had to take new test because the previous one had deteriorated. Katherine wondered if there was anything that could be done to improve her situation but was very tired to ask. She felt like giving up. In this case Katherine did not get any knowledge about her problem and what could be done to help her situation. She lacked any skills on how to manage her hygiene and the relationship between her and the nurse was not mutual. Also, she lacks power within herself.

Theoretical Application of Empowerment

In healthcare environment, empowerment gives patients the appropriate support, education as well as resources to decide the methods of maintaining their health. Florence Nightingales indicates that environment plays a crucial role in service delivery in healthcare. According to Nightingale, if healthcare professionals modify a patient’s environment in accordance to the cannons of environment, they can help patients restore their usual health. The major cannons include light, cleanliness of rooms, beds and beddings, ventilation, noise, taking food as well as personal cleanliness (Pirani, 2016). Empowerment is the support towards enabling people and groups to participate in decision making as well as actions related to their health (Walker & Avant, 2019). Based on Nightingale’s Environmental theory, nurses can empower patients to take control of and participate in decisions related to their healthcare. For instance, unclean room is one important factor than affects patient’s health. Nurses can use the empowerment concept to enlighten their patients their patients that they should open the windows for air circulation and sunlight which is beneficial for recovery. Most patients do not open window believing that dust from outside is more harmful to their lives. However, it is important to let them understand of the adverse health impacts caused by dust from inside the room (Pirani, 2016).

Conclusion

This concept analysis reveals that the concept of patient empowerment includes numerous essential components that healthcare professionals must be aware of and get ready to facilitate. Even though the concept of empowerment is sparingly applied in healthcare, especially in critical care, it is still a valuable concept. The three defining features of empowerment are important to the patient, their next of kin and healthcare providers. Given that empowerment is both an intra and interpersonal process affecting everyone that is involved, its benefits will affect all the parties involved. The primary benefit of empowerment in healthcare is decreased level of stress as well as strain.

References

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Walker, L. O., & Avant, K. C .(2019).Strategies for theory construction in nursing. (6th ed.). New York, NY:Pearson/Prentice Hall.