Nursing: empowerment and the problem of power

The concept of empowerment is one which is often invoked in discussions over the nature of nursing practice in a range of health and welfare services A short excursion through the Cumulative Index to Nursing and Allied Health Literature reveals that over the last 10 years 378 papers are identified which list empowerment as one of the topics discussed In 1993, the number is 55 These papers cover a diverse range of health related issues health promotion and HFV, breast feeding, mental health, management and leadership, change, training and education, feminism and women's issues, sexual abuse and violence, advocacy and working with immigrants, professionalism, and nursing theory However, few of these papers discuss the relationship between empowerment and the notion of power itself This gives rise to particular problems for nursing practice, for without a clear conceptualization of what is meant by power it is difficult to convincingly argue that one form of practice is more or less empowering than another Alternatively, this dilemma may be stated in the following question how do we work to empower others when we have no clear notion of what power is? This paper demonstrates that the concept of power demands a very specific consideration In order to illustrate this it briefly identifies problems within two models of power which are drawn upon in nursing It also demonstrates the way in which the work of Michel Foucault can be drawn upon to inform nursing in the analysis of the relationship between power and health     

Interpersonal learning in groups: an investigation

The dissatisfaction of patients with communication in health care has largely been addressed by providing more communication skills training Research into why skills training might be ineffective has identified various factors, which include organizational resistance, personal defences against anxiety and a need for personal reflection and support In one college of nurse education small group discussion and reflection had become established practice for students in their first and second clinical experience The groups met once weekly and were facilitated by a nurse teacher Discussion was unstructured and focused on the nurse's interpersonal relationship with his or her patients This project examined one such group and sought to examine the use of small group reflective discussion by nurses about ther patients as a means of improving interpersonal communication The research was conducted over a period of 6 months with nine student nurses meeting once weekly during their first two episodes of clinical experience Kelly's personal construct theory was used and two repertory grids were constructed by the group One grid examined processes and change in intrapersonal construing, and the other grid examined processes and change in construing about certain patients These grids were completed by the students at the beginning and at the termination of the groups Notes were taken after each group meeting, which recorded impressions and processes, these were discussed once weekly with supervision The notes were analysed using a grounded theory methodology The results show some changes in patterns of constructing in relation to self which indicate an increase in anxiety and reluctance to self-reflect The need for defensive structures in order to facilitate self-reflection is discussed in the light of the qualitative analysis Finally the value of this type of work is supported by evidence of the group working as a social microcosm The limitations and indications for further research are noted, but this project supports the contention that in order to be truly effective those who come in contact with the emotional needs of patients     

Patient centred leadership in practice

Aim To explore patient centred leadership at every level in an organisation and provide practical examples of how this was demonstrated in an acute tertiary NHS Trust. Background There is a direct relationship between leadership and quality of care. With increasing expansion of their role nurses are in a key position to influence and lead colleagues to improve patient care. Evaluation The Leadership Qualities Framework (NHS Institute of Innovation and Improvement 2006) is used to illustrate the various qualities used by clinical leaders in examples of leadership in practice. Key issue Leadership development with the emphasis on the patient drives improvements in service delivery and patient safety. Conclusion Patient centred leadership is demonstrated when there is support at the top of the organisation. Politically aware nurses make effective patient centred leaders. Leadership development programmes provide staff with opportunities to acquire essential skills and qualities in order to contribute to the vision of the organisation. Implications for nursing management Managers should support staff and take risks in order to empower nurses to implement initiatives which improve patient care. A process of communication using a variety of tools can have a impact on a range of staff. Patient centred leaders are role models for tomorrow’s leaders, their impact has lasting effect and wider implications within an organisation and beyond.     

A standard for professional development: the use of self and peer review; learning contracts and reflection in clinical practice

An initiative to develop a standard for professional development is outlined. The standard takes a structure, process, outcome format. Its development resulted in several initiatives being introduced to the unit including: the introduction of a self and peer review system, the introduction of learning contracts and the introduction of the concept of reflection. It was considered that these initiatives would promote individual professional accountability, increased self-awareness and reflective practice. The initiatives may be viewed in the context of PREP, United Kingdom Central Council for Nursing, Midwifery and Health Visiting (1990) and the Higher Award, English National Board for Nursing, Midwifery and Health Visiting (1991). The audit of the standard may be a tool to measure 'value for money' used in professional development.     

The Patient-Centredness Multi-Choice Questionnaire: developing an instrument for the measurement of patient-centredness in student nurses

An earlier paper by the writer reported on the construction and administration of an instrument for the measurement of therapeutic attitudes in student nurses This paper continues that work by producing a short, appropriate and easily administered test, known as the Patient-Centredness Multi-Choice Questionnaire The instrument was tested for validity and reliability, and was piloted on a large group of new Project 2000 students from several colleges and institutes of nursing, to produce a database for use in further studies     

A framework for recognition of prior learning within a Postgraduate Diploma of Nursing Management in South Africa

jooste k. & jasper m. (2010) Journal of Nursing Management  18, 704–714
A framework for recognition of prior learning within a Postgraduate Diploma of Nursing Management in South Africa Aims The present study focuses on the development of an initial framework to guide educators in nursing management in designing a portfolio for the recognition of prior learning for accreditation of competencies within a postgraduate diploma in South Africa. Background In South Africa, there is a unique educational need, arising from the legacy of apartheid and previous political regimes, to facilitate educational development in groups previously unable to access higher education. Awareness of the need for continuous professional development in nursing management practice and recognition of prior learning in the educational environment has presented the possibility of using one means to accomplish both aims. Evaluation Although the content of the present study is pertinent to staff development of nurse managers, it is primarily written for nurse educators in the field of nursing management. Key issues The findings identify focus areas to be addressed in a recognition of prior learning portfolio to comply with the programme specific outcomes of Nursing Service Management. Further work to refine these focus areas to criteria that specify the level of performance required to demonstrate achievement is needed. Conclusion and implications for nurse managers Managers need to facilitate continuous professional development through portfolio compilation which acknowledges the learning opportunities within the workplace and can be used as recognition of prior learning.     

A focus group inquiry into the perceptions of primary health care teams and the provision of health care for adults with a learning disability living in the community

This study addresses the primary health needs of adults with learning disabilities living in the community Policies specific to this client group and incorporating the ideology of normalization are noted and evidence of their implementation is sought Previous research suggests that the adoption of a social rehabilitative model of care may have resulted in the neglect of health care needs The recent closure of a local, subnormality hospital provided a critical situation and context for the study The research question is, how do primary health care teams perceive the needs of adults with learning disabilities living in the community, and are they meeting their needs' Three primary health care teams formed the sample and data were obtained through semi-structured, focus group interviews A conceptual framework developed early in the study influenced both the interview guide and the data analysis The study suggests that practitioners working within primary health care teams have a limited awareness of the health care needs of adults with learning disabilities Contributing factors were identified and include negative attitudes towards the concept of normalization, inadequate education, a shortfall in financial and human resources, and poor collaboration with the specialist team