One of the many issues concerning the profession of nursing is the concept of empowerment. This concept can be looked at from two different levels. One is from the level of nurses empowering the clients and two the nurses being empowered by their environm
Chinny Ejiogu
Feb 06 Group 2
In the essay, I will first name the concept and mention the major issues that I have identified from the research as a group. I will critically look at the link to practice using example from my clinical areas. Finally I reflect on the whole process using the Gibbs (1994) Reflective Cycle which encourages a description of the situation, analysis of feelings, evaluation of experiences and analysis to make sense of the experience and to examine what you would do if the situation rose again.
The presentation was on the concept of empowerment. Through the presentation, I was able to identify that empowerment is a multi-dimensional social process that helps people gain control over their own lives. It is also the process that fosters power in communities and society by acting on issues they define as important. Nevertheless, one can ask is empowerment a universal concept? According to Lukes (1994) empowerment is like obscenity, you have trouble defining it but you know it when you see it. Another issue identified was that of the history/origin of empowerment. According to Oxford English dictionary the English term empowerment originated in the second half of the 17th century. But it gained widespread currency in the 1960 linked to North American Black radicalism. It's modern use originated in the civil rights movement, which sought political empowerment for its followers. (The American Heritage)
We looked at the advantages and disadvantages of empowerment. One of the benefits is that the individual changes in confidence and consciousness therefore leading to increase in skills, abilities e.g. earning an income, access to market and network. Another benefit is the increase in informed choice within a framework of human right and equality (Jack 1995). It was also identified that empowerment enhanced perception of a person own individuality, interest and value by allowing one to express their likes, dislikes and morals. It also increased role in decision making by allowing one to have more power over the decision making and choices as well as participate in activities and planning (Kendel 2004). One of the disadvantages was that it may lead to decrease in individual empowerment particularly if strategies to increase participation fail to take account of one's wishes to be involved and their specific aptitudes, self belief and skills (Jack 1995). Another draw back is that an individual can be disempowered if there is a mismatch between their wish for empowerment and the expectation of others. Some people may not desire the goals set for them the extent of change often depends on resources and the decisions of people in positions of power (Kreisberg 1992).
In view of the benefits and problems, one may ask who has the right to empower. Do people want to be empowered and what are the right ways to empower. According to Luke (1994), a zero-sum conception of power means that power remains in the hand of the powerful unless they give it up. Although this is certainly one way that power is experienced, it neglects the way power is experienced in most interactions.
Other issues identified were the importance and means of empowerment. Self help groups, patient are initiative, communication strategies and health promotion was mentioned in this section. In the conclusion of the presentation the empowerment of the patient and nurse were not clearly identified and lacked reference.
LINK TO PRACTICE
One of the many issues concerning the profession of nursing is the concept of empowerment. This concept can be looked at from two different levels. One is from the level of nurses empowering the clients and two the nurses being empowered by their environment (Lewis and Urmston ...
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Other issues identified were the importance and means of empowerment. Self help groups, patient are initiative, communication strategies and health promotion was mentioned in this section. In the conclusion of the presentation the empowerment of the patient and nurse were not clearly identified and lacked reference.
LINK TO PRACTICE
One of the many issues concerning the profession of nursing is the concept of empowerment. This concept can be looked at from two different levels. One is from the level of nurses empowering the clients and two the nurses being empowered by their environment (Lewis and Urmston 2000). Nurses in the field of client care come across empowerment in the context of nurse and client relationships many times over their career. It is then the job of the nurse to help the client become empowered. As with becoming healthy, clients must empower themselves, as they has the maximum impact on their life and health (Kuokkanen and Leino-Kipi 2003). Nurses can only help by creating a sense of client self-worth and supporting the process by providing knowledge and skill.
A nurse's goal in a client empowering situation is the well-being of the client and the client playing the part of an equal partner and active participatant in regaining health. For example in one of my clinical placement, patients are invited to a weekly discussion on the progress of their health. They bring in their opinions and suggestions of the way they think is best to look after them. The active participation of the client in regaining health and creating a client-nurse setting is an advancement of client empowerment from the traditional passive patient, nurse patient setting, where the client would be on the receiving end of the relationship and depend entirely on the care-giver to help him or her gain health (Nyatanga and Dann 2002). In nurse-client relationship however, power is sometimes shared, there is mutual respect, trust equality and understanding of client healthcare needs (Nyatanya and Dann 2002).
The nurse does not simply take over and assume what is right for the client, but participates in a collaboration of ideas, views and opinions. The final decision, after being appropriately informed about the positive and negative of the situation is left to the client (Gibson 1991). Example of this is where I witnessed a doctor explaining the reason why a patient have to sign a consent form after explaining the benefit and problems he will face after his surgery. Patient was given opportunity to ask questions and decide whether he wants to go ahead or not. In order for mutual understanding to take place there must be self awareness on the part of the nurse. The nurse must not only be aware of patient personal values, but also their views and opinions.
Although empowering the patient may be a useful slogan there's a danger that it acts as an ill defined or even misleading banner to travel under. As we know empowerment literally means the giving of power, but might more accurately be interpreted as creating opportunities which enable and encourage power to be taken. Patient self empowerment may therefore be a more accurate description than empowering patients (Jack 1995). While we cannot empower patients, practices and structures can be changed so that people are no longer disempowered in being unable to exercise existing powers of control or choice.
The other important concept in the profession of nursing is the empowerment of nurses themselves. Empowerment of nurses, like that of clients holds the importance of autonomy and independence. A nurse's empowerment is mainly defined by the use of Kanters (1993) theory of organizational empowerment, where in order to feel empowered the nurse must be able to have access to information, support, resources and opportunities to grow and develop with the nursing environment (Lashinger and Wong 1999). These empowering structures have a personal effect on the nurse, causing the nurse to have more feelings of independence and self-efficiency, allowing the nurse to carry out his/her job effectively without any doubts or misunderstanding. Example of this is during my clinical placement, nurses go on study days to help in their professional development.
Empowerment of nurses also brings accountability which is ability to give explanation for one's actions. Accountability is becoming more and more detrimental to the health field and is playing a bigger role in the outcome of empowerment. Education and training is important in the process of empowering the nurse. Education causes knowledge and skill, which allow the nurse to first provide healthcare and second know the reason behind what he or she is doing, which empowers the nurse as knowledge is a precursor to feeling in control (Dooher and Byrt 2003).
One of the hurdles in the empowerment of nurses is the tendency to rely on the management. One of the hindrances of empowerment is caused by hierarchy within the situation, whether it is between the client and nurse or the client and management. A further challenge resides not so much in the obstacles to achieving nurse empowerment but in the likely consequences of it. That is there are risks involved for those who are sufficiently empowered to speak up and challenge vested political and economic interests as part of a broader health promotion role (Kendel 2004).
A final point worthy of consideration concerns not so much the challenge of empowering nurses, but the issue of empowering patients in a care setting, facilitating the ability for them to exert greater control over their care and decision making may not always be appropriate and desirable. In spite of the arguments, there is the underlying assumption that by acting in an empowering way, health professionals will become more effective and people will become healthier (Kendel 2004).
In conclusion, nurses' power may arise from three components: a workplace that has the requisite structures that promote empowerment; a psychological belief in one's ability to be empowered; and acknowledgement that there is power in the relationships and caring that nurses provide. (Jack 1995)
REFLECTION on EBL
Reflection has been defined by Taylor (2000) as: "The throwing back of thoughts and memories, in cognitive acts such as thinking, contemplation, meditation and any other form of attentive consideration, in order to make sense of them, and so make contextually appropriate changes if they are required". In order to reflect on the process of the presentation, I will adapt the Gibbs's reflective cycle.
Description
As a group the concept of empowerment was given to us. A chair, a scribe and time keeper was appointed. We also divided the group into three sub group because it was a large group. On the first session, list of things was achieved which includes ground rules, different definition of empowerment, means, importance of and the pro and cons of empowerment. Each sub group was then allocated a topic to research and report back with. On the second session every sub group delivered their findings to the whole group but we still lacked the major points. These lead to delayed progression of the work. Decision was reached to use PowerPoint presentation and for each sub group to type their work and send it to the scribe. On the last session, we still lacked some major information but managed to put the whole work together. On the whole there was a lot of ideas and information but we lacked organisation. We had no time for practice run. The presentation was done but on reflection, our weakness and strengths was well acknowledged.
Feelings
I often felt anxious and uncertain about what the group are expected to do. I felt that everyone wanted their piece of work to be used. I thought that the time allocated to the presentation was limited. I strongly believe that the group put a lot of time and effort into the process but did not show this at sometimes. I felt unable to assert my views, so I avoided open conflict in favour of an outwardly harmonious team. Looking back I wish I had the courage to challenge some views being expressed. According to Johns and Freshwater (2005) that the process of learning is experiential and it not on a conceptual level.
Evaluation
The aims of the presentation were clearly stated. We had a clear indication of the purpose in the introduction. Although we had appropriate delivery of presentation, but it could have been developed using variation in the PowerPoint presentation. We should have assessed and looked at how the information was verbally presented. It was a good group work and we worked well to develop the contents, however material represented was often not referenced and on occasions unclear. We also had limited links to practice. Nevertheless, we provided quite a background to empowerment and overall, this proved to be a positive experience that made me learn to adapt to the circumstances around me.
Analysis
Working in an EBL group helped me to develop and practice the skills of communication like listening, eye contact, tone of voice and team working that are essential for caring for patients in my practice area. Johns and Freshwater (2005) emphasis that communication group learning and guidance takes place through dialogue and the first art is listening. It helped me to make joined and collective decision making. I was able to learn how to share tasks and responsibilities. I acquired the knowledge of negotiation and reflection as a group. Through it, I learnt concept of empowerment as a whole. In relation to my clinical experience, I will be able to share information, knowledge and skills which will help me to participate in patient self empowerment and decision making. My own process of learning has improved dramatically through this process.
Conclusion
We could have focused more in analysing and looking at the concept of empowerment. We should have ensured that the aims identified were properly addressed and explored other variation of PowerPoint presentation. The link to practice could have also been clearly demonstrated. According to Johns and Freshwater (2005) reflecting on experience after event draws insights that may inform your future practice in a positive way.
Action plan
If in the same situation, I will suggest to the group that we be less descriptive and provide more analysis of the concept of empowerment. To use a more coherent approach when presenting and allow time for practice run and communicate more. In regards to me as the chair, I will be more assertive in a different way.
REFERENCES
. Dooher, J and Byrt, R. (2003) Empowerment and the Health service User. Vol 2 Quay Books London.
2. Gibbs, G. (1994) Learning by doing: A guide to teaching and learning methods. Further education Unit. Oxford University.
3. Gibson, H.C. (1991) A concept analysis of Empowerment. Journal of Advanced Nursing, 16, 354-361. 06/04/07.
4. Jack, R. (1995) Empowerment in Community Care. Chapman and Hall. London.
5. Johns, C and Freshwater, D. (2005) Transforming Nursing through Reflective Practice. Blackwell Publishing. Oxford.
6. Kanter, H. (1993) The Theory of Organisational Empowerment. Galerie Hellingman. London.
7. Kendel, S. (2004) Health promotion Practice: Power and Empowerment. Sage Publications. London.
8. Kreisberg, S. (1992) Transforming Power: Domination, Empowerment and Education. New York Press. New York.
9. Kuokkanen, L. and Leino-kipi, H. (2002) Empowerment in Nursing: the role of the philosophical and psychological factors. Nursing Philosophy, 3, 234-239. 11/05/07.
0. Lashinger, S.K.H and Wong, C. (1999) Staff Empowerment and collective accountability: effect on perceived productivity and self-rated work effectiveness. Nursing Economics, 17, 308-318. 30/06/07.
1. Lewis, M and Urmston, J. (2000) Flogging the dead hose: the myth of nursing empowerment? Journal of Nursing Management, 8, 209-218. 26/07/07.
2. Lukes, S. (1994) Power: a radical View. Macmillan Press Limited. London.
3. Nyatanga, L and Dann, L.K. (2002) Empowerment in nursing: the role of the Philosopher. Nursing Philosophy, 5, 222-239. 16/06/07.
4. Oxford University press (2006) Concise Oxford English Dictionary. Oxford.
5. Taylor, B. (2000) Reflective Practice. Open University. Buckingham.