Although not labeled empowerment, there are descriptions in the
nursing literature of interventions that are congruent with the ideology
of empowerment. Indeed, empowerment appears to epitomize
what Faux and Knafl (1996) have called the new paradigm of familyhealth
professional relationships. In the old paradigm, families were
expected to behave and care for their affected family member as dictated
by the health care experts. In the new paradigm, the family is the
center of care and interactions with health professionals are
collaborative.
In a review of nursing interventions related to families and chronic
illness, Robinson (1994) described a continuum of approaches, which
can be broadly categorized as traditional, transitional, and nontraditional.
In the traditional approach, the underlying belief is that there
is a correct response to illness and that the nurse can cause this response.
In contrast, in the nontraditional approach the so-called correct
response to illness depends on the situation and is affected by
many factors, not just the nurse’s intervention. Nursing interventions
cannot be predetermined because every situation is different.
The tenets of empowerment are evident in many of the descriptions
Robinson (1994) used to describe the nontraditional approach.
In this approach, the family is the architect of change; nurses request
rather than demand the family to change; the family make choices in
how to influence the illness and how the illness influences them; the
family is expert in the illness experience and its effects on the family
system; family behaviors always make sense in context; it is important
to determine as many perceptions of the problem and solutions
as possible; and the family is enabled to discover its own solutions.
Using a somewhat different approach, Leahey and Harper-Jaques
(1996) described five assumptions, theoretically grounded, on which
a collaborative family-nurse relationship is built: reciprocity, nonhierarchical
relationships, nurses and families both possess specialized
expertise for maintaining health and managing health problems, both
parties bring strengths and resources into the relationship, and feedback
processes can simultaneously occur at several different relationship
and systems levels. Again, empowerment ideology is congruent
with these assumptions. Leahey and Harper-Jaques (1996) also discussed
how nurses themselves can change and grow with this approach, personally demonstrating the critical consciousness that true
empowerment entails.
As a final note to this section, it must be mentioned that an important
aspect of the empowerment process for individuals and families
is to be heard by health professionals (Gibson, 1995; Wuest & Stern,
1991). To incorporate this experiential knowledge in an empowerment
intervention would seem of paramount importance, even when
the term empowerment is not mentioned in the study. Therefore, the
experiential knowledge described in the following two studies was
included in the intervention activities suggested in Table 1. In a
grounded theory study of five families who were having problems
managing a member’s chronic health condition, Robinson (1996)
found that being a curious listener, compassionate stranger, nonjudgmental
collaborator, and mirror of family strengths invited participation
and involvement in the change process and ultimately healing.
Knafl, Breitmayer, Gallo, and Zoeller (1992) also used grounded theory
to analyze the data from 51 families of children with a chronic
health condition. Advice to health professionals these parents gave
was provide accurate and complete information on the child’s condition
and its management, be empathetic and show genuine concern,
acknowledge and enhance the parents’ competence in caring for the
child, and establish a direct relationship with the child.
Although not labeled empowerment, there are descriptions in thenursing literature of interventions that are congruent with the ideologyof empowerment. Indeed, empowerment appears to epitomizewhat Faux and Knafl (1996) have called the new paradigm of familyhealthprofessional relationships. In the old paradigm, families wereexpected to behave and care for their affected family member as dictatedby the health care experts. In the new paradigm, the family is thecenter of care and interactions with health professionals arecollaborative.In a review of nursing interventions related to families and chronicillness, Robinson (1994) described a continuum of approaches, whichcan be broadly categorized as traditional, transitional, and nontraditional.In the traditional approach, the underlying belief is that thereis a correct response to illness and that the nurse can cause this response.In contrast, in the nontraditional approach the so-called correctresponse to illness depends on the situation and is affected bymany factors, not just the nurse’s intervention. Nursing interventionscannot be predetermined because every situation is different.The tenets of empowerment are evident in many of the descriptionsRobinson (1994) used to describe the nontraditional approach.In this approach, the family is the architect of change; nurses requestrather than demand the family to change; the family make choices inhow to influence the illness and how the illness influences them; thefamily is expert in the illness experience and its effects on the familysystem; family behaviors always make sense in context; it is importantto determine as many perceptions of the problem and solutionsas possible; and the family is enabled to discover its own solutions.Using a somewhat different approach, Leahey and Harper-Jaques(1996) described five assumptions, theoretically grounded, on whicha collaborative family-nurse relationship is built: reciprocity, nonhierarchicalrelationships, nurses and families both possess specializedexpertise for maintaining health and managing health problems, bothparties bring strengths and resources into the relationship, and feedbackprocesses can simultaneously occur at several different relationshipand systems levels. Again, empowerment ideology is congruentwith these assumptions. Leahey and Harper-Jaques (1996) also discussedhow nurses themselves can change and grow with this approach, personally demonstrating the critical consciousness that trueempowerment entails.As a final note to this section, it must be mentioned that an importantaspect of the empowerment process for individuals and familiesis to be heard by health professionals (Gibson, 1995; Wuest & Stern,1991). To incorporate this experiential knowledge in an empowermentintervention would seem of paramount importance, even whenthe term empowerment is not mentioned in the study. Therefore, theexperiential knowledge described in the following two studies wasincluded in the intervention activities suggested in Table 1. In agrounded theory study of five families who were having problemsmanaging a member’s chronic health condition, Robinson (1996)found that being a curious listener, compassionate stranger, nonjudgmentalcollaborator, and mirror of family strengths invited participationand involvement in the change process and ultimately healing.Knafl, Breitmayer, Gallo, and Zoeller (1992) also used grounded theoryto analyze the data from 51 families of children with a chronichealth condition. Advice to health professionals these parents gavewas provide accurate and complete information on the child’s conditionand its management, be empathetic and show genuine concern,acknowledge and enhance the parents’ competence in caring for thechild, and establish a direct relationship with the child.
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