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Mark Faulkner considers the effects on patients' independence of nursing care that empowers, and the consequences of disempowering care, with reference to two key psychological theories: learned mastery and learned helplessness
key words
Patients: empowerment
Elderly
Nursing
This article will explore the impact of empowering and disempowering care on older people. In particular, it will consider the relational links between empowering care and patient independence, and disempowering care and patient dependence. To unravel these links, reference will be made to the psychological theories of learned mastery (Peterson, Maier and Seligman 1993) and learned helplessness (Seligman 1975). These theories are crucial to our understanding of the therapeutic and non-therapeutic dynamics of interpersonal care. I will conclude by evaluating whether empowering strategies of care are suitable for all older patients.
empowerment and disempowerment
The concept of empowerment, as it relates to health care, implies that patient independence may be optimised through the provision of care that assists patients to assert control over their lives (ENB 1989, Malin and Teasdale 1991, Gibson 1991, Faulkner 2000).
This principle is amplified in a number of professional and governmental guidelines where it is seen as a vital ingredient in the provision of quality health services. For instance, from the perspective of professional guidelines, the code of professional conduct (UKCC 1992) emphasises that it is the nurses' responsibility to foster patient independence by recognising and respecting their involvement in the planning and delivery of care.
From the governmental perspective, the NHS Guide (DoH 2000) broadens this emphasis on empowerment by committing the NHS to providing 'client-centred' services that reflect the needs and preferences of individuals. The overarching theme in both of these examples is patient control, which is facilitated through the provision of information and the patient's right to be involved in the decisionmaking process.
Despite this emphasis on empowering care, numerous studies have indicated how hospitalised/institutionalised people are often exposed to circumstances that seem to be antithetical to this principle (Clark and Bowling 1990, Kitwood and Bredin 1992, Mountain and Bowie 1995, Grau et al 1995, Draper 1996, Alzheimer's Disease Society 1997).
This 'disempowering' care ranges from mildly negative interactions, such as invading patient's privacy or disturbing patients while they are resting, to more severe examples such as...