When the larger objective matters more: support workers’ epistemic and deontic authority over adult service‐users

We report on how support workers sometimes over‐ride the wishes of people living with cognitive impairments. This can happen when they are both involved in some project (such as an institutionally‐managed game, a physical journey, an educational activity and so on). The support worker might use their deontic authority (to propose, decide or announce future actions) to do things that advance the over‐arching project, in spite of proposals for what are cast as diversions from the person with impairments. They might also use their epistemic authority (their greater knowledge or cognitive capacity) to trump their clients’ choices and preferences in subordinate projects. Not orienting to suggested courses of actions is generally interactionally dispreferred and troublesome, but, although the providers do sometimes orient to their actions as balking their clients’ wishes, they usually do not, and encounter little resistance. We discuss how people with disabilities may resist or palliate such loss of control, and the dilemmas that support staff face in carrying out their duties.     

Myth of empowerment in chronic illness

AIMS: This article presents several findings of a study, conducted between 1996 and 1998, to investigate self-care decision making in diabetes. RATIONALE: The underlying assumption of many practitioners is that an invitation to people with chronic illness to participate as equal partners is sufficient to guarantee their empowerment. DESIGN: Using grounded theory, the research examined self-care decision making using a convenience sample of 22 Canadian adults with longstanding type 1 diabetes nominated as expert self-care managers. Participants audiotaped their decision making as it occurred for 3 weeks over the course of one calendar year. These audio-recordings were followed by an interview to clarify participants' decision making and factors that affected their decisions. FINDINGS: Participants identified several covert and subtle ways that practitioners contradict their stated goal of empowerment in their interactions with diabetics. Participants revealed that despite their intention to foster participatory decision making, practitioners frequently discount the experiential knowledge of diabetes over time and do not provide the resources necessary to make informed decisions. CONCLUSION: The article concludes with a discussion of the implications of the findings for practice.     

Involving patients in undergraduate health professions education: What’s in it for them?

ObjectivesPatients have become more involved in research, policy, and health professions education. They are involved in teaching students competencies required for person-centred care, but patient benefits have not received proper attention. This exploratory study identifies how patient involvement in health professions education help patients to practice self-management and shared decision-making.MethodsIndividual interviews were conducted with patients (hereafter ‘experts by experience’) (N = 11) who participated in the Patient As a Person Module, organised for students of health professions in The Netherlands. Additionally, one of their healthcare professionals (N = 10) and family members (N = 9) were interviewed. Directed content analysis was used.ResultsParticipants reported that sharing lived experiences helped experts by experience to reflect on their preferences regarding health and healthcare, accept their changed selves, and obtain a renewed sense of purpose. They reported gaining insight into the perspectives of healthcare professionals, which yielded more equal healthcare professional-patient relationships.ConclusionsSharing their lived experiences with health and health care with students could help patients in practising effective self-management and participate in shared decision-making.Practice implicationsApproaching patient involvement in health professions education from both the perspectives of students and experts by experience, as opposed to students alone, optimises its societal impact.     

Application of Empowerment Scale to patients with schizophrenia: Japanese experience

Rogers et al. invented the Empowerment Scale, and conducted a factor analysis, which found five factors: self-esteem, power, activism, righteous anger and optimism. Hata et al. translated this scale into Japanese and named it Empowerment Scale-J. They found that the score of the righteous anger factor does not have a significant correlation with the overall score of the Empowerment Score-J. With the aim of clarifying the characteristics of the Empowerment Scale-J, the purpose of the present study was to assess the levels of empowerment in 72 Japanese patients with chronic schizophrenia using the scale, and examine the relationship between the results of the scale and the results of the following two batteries: Social Adjustment Scale II (SAS II), and Expanded Attributional Style Questionnaire (EASQ; a questionnaire to assess some aspects of attitude toward negative circumstances). Four results were obtained as follows. No significant correlation was found between the score of righteous anger factor and overall score. No significant correlation was found between the Empowerment Scale-J score and the degree of social adjustment. Significant correlations were found between some subscales of Empowerment Scale-J and the degree of social adjustments: self-esteem and optimism, but inverse correlations were obtained between the power factor and the righteous anger factor and the degree of social adjustment. Results for the EASQ showed that subjects with a higher righteous anger score have a tendency opposite to that of subjects with higher social adjustment. On the basis of these results it is suggested that behavior related to the righteous anger among Japanese persons with schizophrenia may have some negative influence on their social adaptation and that in applying Empowerment scale-J attention should be paid to the significance of the righteous anger factor.     

Employee empowerment, innovative behavior and job productivity of public health nurses: a cross-sectional questionnaire survey

Background

Employee empowerment is an important organizational issue. Empowered employees with new ideas and innovative attributes may increase their ability to respond more effectively to face extensive changes in current public health care work environments.

Objectives

The objective of this study was to investigate the relationships between employee empowerment, innovative behaviors and job productivity of public health nurses (PHNs).

Design

This study conducted a cross-sectional research design.

Settings and participants

Purposive sampling was conducted from six health bureaus in northern Taiwan. 670 PHNs were approached and 576 valid questionnaires were collected, with a response rate of 85.9%.

Methods

Structured questionnaires were used to collect data by post.

Results

Meaning and competence subscales of psychological empowerment, information and opportunity subscales of organizational empowerment, and innovative behaviors were the predictors of job productivity, only accounting for 16.4% of the variance. The competence subscale of psychological empowerment made the most contribution to job productivity (β = 0.31). Meaning subscale of psychological empowerment has a negative impact on job productivity.

Conclusions

Employee empowerment and innovative behavior of PHNs have little influence on job productivity. Employees with greater competence for delivering public health showed higher self-evaluated job productivity. The negative influences on job productivity possibly caused by conflict meaning on public health among PHNs in current public health policy. It should be an issue in further researches. Public health department should strengthen continuing educations to foster competence of psychological sense of empowerment and innovative behavior to increase job productivity.     

Using popular education for community empowerment: perspectives of Community Health Workers in the Poder es Salud/Power for Health program

Empowerment has been advanced as a strategy for eliminating remaining health disparities. Popular education promotes community empowerment by increasing individuals’ and communities’ awareness of their capacity and providing a framework and strategies through which participants can identify and resolve problems. Poder es Salud/Power for Health, a community-based participatory research project, sought to improve health and decrease disparities in African American and Latino communities in Multnomah County, Oregon, through the intervention of Community Health Workers (CHWs) who used popular education. In-depth interviews were conducted with five CHWs involved in the project to explore their perceptions of the effects of the use of popular education on the CHWs and their communities. Results suggested that CHWs possessed a shared understanding of popular education. Effects on the CHWs included increases in community participation and identification, desire to advocate for the community, and sense of personal potential. Similarly, among communities, CHWs observed increases in level of participation in community events, quality and quantity of leadership, and sense of community solidarity. These results suggest that popular education, when used consistently throughout a health promotion program, can promote empowerment and thus contribute to eliminating health disparities.