PPN201 - Week 9 Powerlessness, Power and Empowerment

Article 1 - Aujoulat et al. 2007 - powerlessness

Occuring when an individual assumes the role of an object acted on by the envrioment rather than subject acting in envrioment
- Inability to have Agency in life
- Situational attribute, real/percieved

powerlessness and control

Chronically ill live in a dual world of wellness/sickness, control/powerlessness
- dynamic shift between illness and wellness

factors that exacerbate powerlessness

Uncertianity of CI; exacerbation of symptoms/physical deterioration
lack of knowledge/health literacy
depletion of social supports
decrease in stamina, fatigue/inability to paricipate = social withdrawals

7 perspectives of the experience of powerlessness

1. loss of ones sense of internalized security
2. loss of control over body
3. loss of control over ones emotion
4. LOC in context of transgenerational transmissons
5. LOC over time
6. LOC over ones enviroment
7 . LOC over ones social and personal identity

1. loss of ones sense of internalized security

unpredictable, feeling insecure out of control

2. LOC over ones body

not being able to distniguish between normal/abnormal symptoms

3. LOC over ones emotion

pt exp. fear, anxiety, insecurity

4. LOC in context of transgenerational transmissons

trying to make sense of condition, meaning

5. LOC over time

Time remaining after disease onset, Long term plans

6. LOC over ones envrioment

feeling like a fish out of water, any enviroment other than home feels threatning

7. LOC over ones social/personal idenity

Social identity - Role change in family/work needing to be taken care of by someone
Personal identity - Self image, loss of self, self reputation

Ajoulant et Al findings

Insecurity/disrupted identity = 2 major factors of powerlessness
- Successful empowerment = pt comes to terms w their threatened sense of security
- Primary aim of empowering relationships = provide reassurance/self exploration

Article 2 - Oudshoorn, 2005 - CST and powerlessness

Recognition of social domination, explotation, opression
- domination/opression engrained in social structures
- from false-conciousness
- social changes begin at home

power and powerlessness

coexsists w powerlessness in a social context
- the ability to act or do/ produce an effect
- associated w independence and self-determination

what is power over?

ability to persuade/influence a stiuation or others
- exercising knowledge to control/influence e.g. medical language that a nurse uses to explain a condition

what is power to

Empowerment
- gaining ability to act/create change in a way one desires

what are the 2 sources of power

Macro and Micro

Macro power

Systems, organizational/societal levels
coditions that marginalize/opress individuals, perpetuate dominant class

Micro power

Interpersonal and relational levels, interelational

What is power?

relational, dynamic process that is gained/maintained and diminished in relationships and personal interactions
- dialogical (thru language)

outcome/process of empowerment

Outcome = producing positive self concept, personal satisfaction, self efficacy/esteem, mastery control, sense of connectedness
Process = collaboration w pt that strengthens and helps pt gain control

Values in empowerment practice

Relational
power is shared > power over
mutual respect and trust
knowledge comes from the client

How can empowerment occur?

individuals and groups must empower themselves
- come to understand the power that individuals already possess
- critical consciousness - reflection on own situation
- happens on all levels; micro and macro

Intrapersonal interventions for empowerment

Crictical consciousness - Self-Awareness

Interpersonal interventions for empowerment

Moving away from bio-medical, expert model to a sociological model of care, focus on client and client family
- being empathetic
- act as educators

Contextual interventions for empowerment

Advocacy; systemic practice change

Article 3 - Galuska, 2016 - empowerment strategies

1. Advoacy
2. Providing cultural competent care (Cultrual competence, awareness, sensitivity)

1.Advocacy

A process or strategy consisting of a series of actions to preserve/represent patients' rights, best interests, and values.
- Safeguarding the client's autonomy
- Acting on behalf of pt and social justice
- building trust, reassuring words, nurse engagement, effective comms

2. providing culturally competent care

Creative, sensitive and meaningful understanding of health care knowledge to coordinate the needs of individual/groups for acquiring meaningful health/well-being or coping with illness

Cultural competence

dynamic process of acquiring the ability to provide safe, effective, and quality care to pts thru different cultural aspects

Cultural awareness

Individual understanding of their own biases and prejudices and forms the basis for valuing others values and beliefs.
- pt may impose their values from their own culture to others

Cultural sensitivity

Value and respect cultural diversity.
Nurses undertstand how pt attitudes and viewpoints affect their behaviours

Empowerment strategies outcomes

Measured from 3 perspectives
- The self
- Relationships with others
- partnership with healthcare professionals

what is person centered care (PCC)?

Formation of a therapeutic narrative between the pt and professional that is built on mutual trust/understanding

Attributes of PCC

Holisitc, Individualized, empowering, respectful

Antecedents of PCC

Therapeutic relationship vision and commitment to PCC, demonstrated thru attitudes and behaviors

Consequences of PCC

Improved quality of care, improved pt health outcomes and pt satisfaction