VOL: 97, ISSUE: 32, PAGE NO: 39
Elaine Ryder, MSc, BA, RGN, DN, CPT, CertEd, RNT, DNT, senior lecturer in primary and community health at Oxford Brookes University
Sula Wiltshire, BA, PGDip(ed), RGN, RM, senior lecturer in primary and community health at Oxford Brookes University
Empowerment is a word we hear a lot in today’s health service and one that has become a central tenet of health policy (Department of Health, 1997).
According to Malin and Teasdale (1991), empowerment means the freedom to choose where and when one has treatment and also implies that patients should retain autonomy and responsibility for decision-making during their treatment.
Empowerment is described by Gibson (1991) as a composite of three factors: attributes that relate to the client; attributes that relate to the nurse; and those that relate to the client and nurse.
While the government’s emphasis on patient involvement is commendable, its actual policies (such as targets to reduce diseases) still encourage compliance and central control. To empower patients, there needs to be less rigid central control.
An example is the ‘expert patient’ initiative suggested in Saving Lives: Our Healthier Nation (DoH, 1999). The report says that as people are living longer, an increasing number will suffer from chronic illness. The expert patient programme is designed for people with chronic diseases who can actively participate in managing their own care. However, to enable the expert patient to become a reality, practitioners, patients and politicians will need to reach a consensus on the concept of empowerment.
Initiatives which encourage active participation in self-management are also seen as having the potential to reduce demand on NHS resources. However, health professionals have expressed concerns that it could actually lead to more ‘demanding’ patients and an increase in the use of resources (Wilson, 2001).
At an individual level, even when patients do participate in their health care, they are often met with barriers from professionals, what Wilson (2001) calls ‘punitive gatekeeping’.
The question that initiatives such as this raise is whether the reality is about saving resources or facilitating a real shift in power. Although the expert patient initiative does focus on the rights and responsibilities of those with chronic illness, should there not be a corresponding strategy that challenges professionals’ assumptions and actions towards those with chronic illness?
Arguably, access to the most appropriate services, such as NHS Direct, NHS Direct online and digital TV, are significant features in enabling people to take more control of their own care and a more active part in shaping service provision. Yet where does this leave clients who do not have access to such information and are not in a position to ‘argue their corner’? While empowerment suggests a move to reduce such inequality, the disadvantage of poverty and the reluctance of the current government to tackle it continues to be a barrier (Hoskins, 2001).
The philosophy of empowerment is laudable, but without recognising the underlying complexities that need to be addressed, encouraging patient self-reliance can turn into a mere cost-cutting exercise (Chavasse, 1992)
Empowerment also has implications for the relationship between nurse and patient. Nurses wishing to empower clients must understand the complexity of this approach because failure to do so could result in the nurse not recognising the need for an individual approach which takes into account patients’ differing circumstances. This could result in patients being overloaded with information, creating unnecessary anxiety, rather than the nurse using his/her skills to assess and address individual needs.