Empowerment concept 1

Jordan University of Science and Technology

Faculty of Nursing

Concept analysis paper: Empowerment

Prepared by:

Ashraf Ali Al­Smadi

Advised by:

Dr.Nemeh Al­Kour RN, PhD

Empowerment concept 2

Introduction:

The concept has been used to give different meanings. (Melies, 1991) said that a

concept is vital to build the scientific theory, research and theory development, and it is the

description of a phenomenon. On the other hand, King (1988) explained it as an idea or

mental image of reality.

Empowerment concept is explained and defined by various disciplines; including:

social work, psychology, education, community psychology, and nursing. In addition,

Empowerment concept is lately used in different phenomenon, such as: student

empowerment, empowerment of teachers, empowerment of patient and empowerment of

nurses. From reviewing the related literature of the concept in the nursing field, there is no

specific definition of empowerment because it is used depending on the writer and the

framework of his/ her paper.

According to (Norries, 1982) one of the major problems with the nursing science is

that its concepts are words that lack the elements of the system that are necessary for a

scientific discipline (e.g. categories, taxonomies and rules). For that, the writer will present a

concept analysis of empowerment which will identify and examine its attributes,

characteristics, antecedents, consequences and uses of the concept in the nursing field.

According to the assumptions for this concept analysis paper, the writer believes that each

nurse manager must empower his/her followers' autonomy, accountability, decision making

abilities, problem solving, and managerial skills.

Usually an analysis of the concept is held to clarify its meaning and to show the

relations of its elements in various fields. In this paper the concept of empowerment will be

studied in the field of nursing to clarify its meaning to develop nursing knowledge base and

to show its importance in this profession. As the writer believes that when the nurses are

empowered, the productivity and effectiveness of the nursing health care services will

Empowerment concept 3

increase. The empowerment is a complex concept, for example, it is easy to be understood,

however; it is hard to be defined.

Literature Review:

From the literature of empowerment, it is difficult to be found as an independent

concept since it's linked with other concepts, such as: coping skills, personal efficacy, support

system, community organization, mutual support, neighborhood participation, competence,

self esteem, and self sufficiency (Kieffer, 1984). Empowerment concept emphasized by

World Health Organization through the definition of health promotion as a "process of

enabling people to increase control over and to improve their own health" (Maglacas, 1988).

Furthermore, the concept of empowerment is not only captured by personal

responsibility in performing health, it more requires the effect of the social environment on

personal health (Maglacas, 1988). The American Association of Colleges of Nursing (AACN,

1986) suggestions for an educated nurse that fits the definition of an empowered nurse " the

graduate well exhibit qualities of mine and character that are necessary to live a free and

fulfilling live, act in the public interest locally and globally, and contribute to health care

improvements and the nursing profession". During the process of empowerment the

individuals must have a strong commitment to achieve the goals of empowerment in effective

ways (Rogers, 1983; Green, 1986; Report, 1989; Ellsworth, 1989).

The concept empowerment derived from the Latin word 'potere'­meaning "to be able"

(McLeod, 1987). Empowerment has been examined by different sciences and multiple

definitions were put forward. Linguistically, empowerment was defined in Webster's New

World Dictionary of the American Language (Guralnik, 1970) as follows: the verb Empower

is "To give power or authority to, authorize; to give the ability to, enable, and permit"'. The

suffix '­ment' is defined as a "result or product". As a result, empowerment is the result of

empowering. "A synonym for empower include to give or confer power, invest, endue,

Empowerment concept 4

endow, strengthen, arm and delegate" (Chapman, 1977). More over, The Shorter Oxford

English Dictionary (1989) defined the verb to empower as "to invest legally with power, to

authorize, to license; to impart power; to enable, to permit". Merriam Webster's Third New

International Dictionary (1993) defined empowerment as: "to give official authority to,

delegate legal power to, and to give faculties or abilities to".

Sociologically, empowerment is the action of increase the influence of a social group

(kuokkanen, Leino­kilpi and Katajisto, 2003). Rappaport (1981) defined empowerment as: a

world­view that have a method to the solution of social problems and social policy a

stemming from powerlessness". Berger and Neuhaus (1977) defined empowerment as: an

approach of supporting the good services by social organizations. Solomon (1976, 1985)

proposed empowerment as: an approach of social activities.

Individual empowerment helps in making health­promotional changes as it enhances

the motivations by using some counseling techniques (McWhirter, 1991; Fahlberg LL, 1991

& Parsons RJ, 1991). Clifford (1992) and Johnson (1992) defined empowerment as: a dyadic

process including thoughts or thinking and behaving. Gibson (1991) defined empowerment

as: the individual's recognition, promotion and improvement of his abilities to achieve his

own requirements, solve their own problems and mobilize resources to control their own lives

by helping them to build a critical awareness of the situation and ease the proposition of a

plan of action. Zimmerman and Rappaport (1988) defined empowerment as: a build that

connects personal capabilities and power, positive behaviors and natural healing systems to

issues of social change and social policy.

In social psychology, empowerment is the personal growth and developments were

the qualities, efforts and values are inherent in the person himself. (Kuokkanen, Kilpi &

Katajisto, 2003). Browne (1995) stated that empowerment is the method that is used to

change the workers' ability to function. Furthermore, Simmons and Persons (1983) added that

Empowerment concept 5

empowerment is a method that makes the individual able to control his environment and

achieve self­determination. This may happen by adopting an individual change, interpersonal

change, interactional change or changing the social structure to that have an impact on the

person. Zimman (1990) explained empowerment as a multi level build that happen at three

levels: individual, organizational, and community level.

In addition, nursing literature held many definitions of empowerment. In nursing and

for the purpose of this paper, empowerment is the process of enabling the nurses to work

efficiently through some activities that are named empowering. Those activities were

classified into analytic nursing, change activities, funding and collegiality (Gorman &

Clark's, 1986). Client empowerment was defined as a process initiating from nurses staff,

"enabling individuals to feel effective so that they can successfully execute their jobs".

Chandler (1992) proposed two definitions of "enabling" existed in relation to the

empowerment in nursing; either positive or negative denotation. The positive denotation of

enabling explains a professional in the mental health who helps patients in their acceptance

back into society. The negative denotation of the enabling is to let an individual maintenance

of substance abuse or other negative health habits (Campbell, 1996).

In summary, from my perspective as a nursing management student, empowerment in

nursing management is a process performed through delegating power or authority to staff

nurses to assist them to control or lead, to increase ability to problem solving, and to increase

quality of nursing care services. For this paper, empowerment is defined as an interactive

process through a nurse­patient or nurse­multidisciplinary team relationship considered to

help or assist in changing behaviors.

Empowerment concept 6

Defining Characteristics of the empowerment concept:

The empowerment concept is a communicational concept because the process of

empowerment includes a connection with individuals. Although empowerment entail an

individual needs, it is nurtured by the outcome of mutual efforts (Kieffer, 1984). Wallerstein

and Bernstein (1988) said that the empowerment includes more than growing one's self

confidence and efficiency or supporting optimistic health behaviors in persons; it includes

environmental modification too. The reason of difficulty to find a specific definition of

empowerment is that empowerment concept is changeable. It varies depending on the

researcher and the situation. Therefore, empowerment meaning depends on the context.

Wallerstein; Bernstein, (1988), and Kiffer, (1984), empowerment is not able to be defined in

a single method: it requires to be cleared by the individual concerns (Rappaport, 1984). Katz,

(1984) explained empowerment in that it has intrinsic and extrinsic connection between

persons and society empowerment. He presented empowerment within a wholeness

paradigm­ where persons are interdependent, there is a mutual exchange of resources, and

partnership is enhanced.

Obviously, a systems approach is essential to learn empowerment (Hess, 1984) as the

concept has different views and also it's concern on solutions more than problems (Kiffer,

1984). It titled person's strengths, abilities, and human rights more than requirements and

shortage. Consequently, the process of empowerment encompasses prospective activities that

done prior to work. Empowerment is a positive, changeable or dynamic concept (Hess 1984).

Empowerment concept reveal a female perspective of power, in which power is

conceptualized as a circumstance of being able to perform some purpose in collaboration

with individuals, on the contrary with a male perspective of power somewhere there is an

inadequate provide that must be effort for and protected against others (Hurty, 1984, Watt's,

1990, Wheeler and Chin, 1989). Also we can say the empowerment is a democratic concept

Empowerment concept 7

because the process of empowerment proposes a rearrangement of power and improvement

of social justice. (Hegar & Hunzeker, 1988).

Empowerment can be regarded as an argumentative concept, because during the

process of empowerment, it is able to change locations in the process and results. (Kataz,

1984 & Rappaport, 1984). In addition, empowerment is an improvement concept where

persons, groups, families and communities increase and potential are improved.

Rappaport, (1984). In the process of empowerment, inconsistency, tension, and expansion are

complex intertwined, therefore; complex solutions of problems are important in a way that

they make old problems never appear again.

Attributes of Empowerment:

The attributes of empowerment concept that were defined in the literature are

(Rodwell, 1996 and Hawks, 1992):

1. Collaborative process between two or more individuals characterized by open

communication, and common goal setting.

2. The availability of alternatives of decisions and the acceptance of accountability.

3. Reciprocal decision making in mobilizing the resources, the opportunities that are

available, and rightly using the power.

4. Helping process.

5. Interdependent participation between the patients and the nurses, dynamic listening

that will help each party to have experience and learn from others, and personal

knowledge or cognitive acquisitions gained from each other (Zimmerman et al, 1991).

6. Adds educating, leading, mentoring, providing, structuring, and actualizing (Vogt &

Murrell, 1990).

Empowerment concept 8

7. Offers up­to­date improvement, promotion, support and focus on the development of

individual's relationships (Craddock and Skinner, 2000).

8. Finally, in an attempt to empower individuals, the person requires some attributes

such as loyalty, instinctive thoughts, elasticity or flexibility, respect of diversity,

supportive, courage, readiness to negotiation and understanding (Katz, 1984;

Pinderhughes, 1983 & Watts, 1990).

Related concepts:

Related concepts are concepts which give the same meaning of empowerment

concept, (Rodgers, 1989). The related concepts of empowerment are:

1. Accountability.

2. Liability.

3. Alternative.

4. Power.

5. Encouragement.

6. Enthusiasm.

7. Authority.

8. Responsibility.

Antecedent

Antecedent situations are essential circumstances that must occur prior to the

empowerment process begins. Respect is a vital antecedent to the empowerment process

because a person must always have respect and attentiveness for individuals' believes and

values (Tones, 1986, Manthey, 1992). In addition, education is a very significant transporter

for empowerment persons (Mason, et al, 1991; D'onofrio, 1992). In the same way; trust is a

Empowerment concept 9

cornerstone to empowerment that develops from directness, integrity, authenticity, open

communication, and mutual relation between the individuals. The empowerer must trust

personal abilities to accept accountability, responsibility, and make decision. (Hawks, 1992;

Manthey, 1992).

The shared commitment is very important antecedent, because the empowerment will

not be successful if both individuals are not committed to the process. Also inspiration and

contribution are very significant antecedents to perform the process of empowerment in a

success way (Labonte, 1989 & O'neill, 1992). Persons also must have the ability to think

about how human behaviors need to be changed, by thinking about the advantage and

disadvantage of behavior change, and problem solving with persons to achieve the goal of

behavior change (McWhirter, 1991; Connelly & Keele, 1993; Worrell & McGinn , 1987).

The empowerer must acquire and use specialized skills, knowledge, good manners,

and recognition of some behaviors that promote empowerment, For example, an antecedent

of empowerment in the health care sector related to patient empowerment is a nursing staff

empowerment. As an empowered nursing staffs, the RN's will recognize from their previous

knowledge and experiences about the communication and distribution of power.

Consequently, the empowered RN's will have a structure of references and will recognize the

impact of their personal power base. For these nurses, the nurse­patient relationship will be

improved by patient empowerment. Conversely, for the nurses who are not knowledgeable

about the empowerment, the roles of nurses and empowered patients will give unclear

impression with no clear line of responsibility. Then, most likely, the nurses will feel in

jeopardy, and at risk with patient empowerment. (Gurley, 1995).

Empowerment concept 10

Consequences

Consequences refer to product, result or outcomes of the empowerment process. The

outcome of empowerment process encloses improved self­confidence (Tones, 1986; Mason,

et al, 1991). A sense of manage over life and the alteration of processes (French, 1990,

Mason et al. 1991, Zerwek, 1992). The capability to put and achieve goals (French,

1990).The empowerment process is a verification of thoughts, ambitions, abilities, and one's

principles, believes, and values (Mason, et al, 1991).

Accordingly, the empowerment process includes alteration of awareness, in which the

borders of personality develop into more transparent and expand with the intention that a

sense of attachment will produce (Wallerstein and Bernstein, 1988). The result of the ability

to empower persons, families, and communities, as revealed in the literature, involved: self­

improvement, a feeling of trust, self­efficiency, a sense of attachment, personal satisfaction, a

sense to manage or control, enhance ability to problem solving, communication, leadership

and management skills, get better quality of life, and social fairness (American nurse's

foundation, 1989, Dunst et, al.1988, Kieffer, 1984, labonte, 1989, Wallenstein and Bernstien,

1988).

The consequences of patient empowerment process in the health care sector arrive

further than patient outcomes. Furthermore, the consequences of patient empowerment

consist of doctor impact, healthcare payer impact, nursing staff impact, regulation and policy

impact, and organizational impact. (Craddock and Skinner, 2000). Empowerment moves

toward diminishing the sense of gratitude felt by the patient to the nurse. As a result, the

psychological costs of accepting help are diminished. (Dunst et, al. 1988).

Empowerment concept 11

Application to nursing

Ammar, a 62­year­old post mitral valve replacement surgery patient, arrived at the

hospital­based cardiac rehabilitation clinic in King Abdullah University Hospital with his

son. The cardiac rehabilitation nurse Ashraf took them into special room, where he spent

about one assessing physical, psychosocial, and cultural aspects (showing signs of strong

participation, acquiring knowledge, and good individual listening). Ashraf, after finishing

physical assessment, gave some instructions about benefits of home exercise, how to monitor

blood pressure and weight, and explained a plan for dietary changes related to sodium and fat

restrictions (Active listening by the patient and his son).

Ashraf described the benefits of this rehabilitation program, and took feedback from

the patient and his son to evaluate their knowledge about the instructions given (strong

listening by Ashraf). Also, he gave written instructions. The patient expressed some fears and

stress during rehabilitation exercises.

At the second day, the patient asked Ashraf about the range of exercises that must be

completed. (Exhibiting personalized information and good listening to help patient and his

son about health behavior changes).Ammar followed the instructions given to him by Ashraf

and kept in contact with Ashraf for any explanations needed later. The program was

successfully achieved, as proofed by decreased serum lipids and increased exercise tolerance.

Ammar demonstrated compliance in attending appointments at the cardiac clinic, and kept

the latest modifications of his life style on.

The given example illustrated good listening; acquired knowledge, and active

participation by Ashraf and Ammar in the process of empowerment. Ashraf participated by

assuming the role of facilitator and giver of knowledge for these specific groups of patients,

and afforded mutual listening to patient comments, and personalized information for Ammar

Empowerment concept 12

and his son to get the maximum benefit. Ammar adapted health behavior changes through

following rehabilitation program instruction

Contrary case

Ahmad a 51­year­old teacher who diagnosed as unstable angina by the residence

doctor at the Emergency room of King Abdullah university hospital. Ahmad has feel of

tiredness and fatigue while he was teaching a class in the school. Some of the students advise

the teacher to rest his self and after she noted that the teacher was sweaty, unsteady and the

discoloration of his skin has been started.

Suddenly the teacher was laying in the floor, emergency medical services brought

teacher Ahmad to emergency room of King Abdullah hospital, after the doctor has diagnosed

Ahmad unstable angina, Ashram who was a good nurse has assigned to work with Ahmad

case, started to teach Ahmad how to deal with his disease by the appropriate medical method

to prevent further complication or any advancement related to his disease process. Ahmad

was ignoring Ashraf dialogue and was asking Ashraf to complete his communication,

because he was want to smoke a cigarette (lack of participation, a defining attribute).

After with, Ahmed has returned to the hospital emergency room by emergency

medical services with three of students, they were worry about their teacher, the cardio

pulmonary resuscitation established at emergency room because of cardiac stopping. Students

inform the nurse that teacher was smoking post each class, and so on till they brought him to

the emergency room. Autopsy shows progressive of disease process proofed by myocardial

infarction.

Ahmad case shows lack of active participation and good listening with nurse, so no

empowerment process achieved, Ahmad non compliance to the healthy behavior that was in

order to changing his habit exemplified the opposite of empowerment .

Empowerment concept 13

References

American association of colleges of nursing (1986). Essential of college and university education for professional nursing. Washington, DC: AACN.

American nurse's foundation (1989). On specialization in nursing: toward a new empowerment. American nurses' foundation, Kansas City: Missouri.

Barbara Solomon 1976, 1985, Chapter two, paper one.

Browne, J. (1995). Empowerment in social worker practice with older women, Journal

of Social work, 40 (3): 358­364.

Campbell, R.J. (1996). Psychiatric Dictionary (7th ed.). New York: Oxford Univ Press.

Carnegegie Councel on Adolesent development. (1989).Turning points: preparing American

youth for the 21st century. The report of the task force on education of young

adolescent. Ccad: New York.

Chandler, G. (1992). The source and process of empowerment, journal of Nursing Admin , (

3):65­71.

Chapman, R. (1977). Roget's international thesaurus( 4th ed.). NewYork: Harper and row.

Gibson, C. (1991). A concept analysis of empowerment, Journal of Advanced Nursing, 16,

354­361.

Rodwell, M. (1996).An analysis of the concept of empowerment, Journal of advance nursing,

26, 305­313.

Clifford, P. (1992 ). The myth of empowerment, Journal of Nursing Administration,

16(3):1­5.

Connelly, L and Stoll, E Cynthia, C. (1993) . A place to be yourself: empowerment from the

client's perspective. Journal of advance in nursing science 21(2): 62­68.retervied Dec

4, 2007, from Ovid database.

Empowerment concept 14

Craddock S, and Skinner, T. (2000). Patient Empowerment and Ethical Decision Making,

dimensions of critical care nursing 21(3): 100­104.

D'onofrio, R.S. (1992).Theory and the empowerment of health education practitioners, Health

education quarterly 19(3), 385­703.

Dunts, C, Trivette, C, Davis, M and Cornwell, j. (1988). Enabling and empowering families of children with health impairments. Children's health care 17(2), 71­81.

Ellsworth E. (1989). why doesn't this feel empowering? Working through the repressive myths of critical pedagogy. Harvard educational review 59, 297­324.

Fahlberg L, Poulin A, Girdano D, Dusek D. (1991). Empowerment as an emerging approach in health education. J Health Educ 22, 185­193.

French, J. (1990). Boundaries and horizons: the role of health education within health promotion, Health education journal 49(1), 7­9.

Gorman, S. & Clark, N. (1986). Power and effective nursing practice. Nursing outlook 34, 129­134.

Green, M. (1986). In research of critical pedagogy. Harvard educational review 56, 427­441.

Guralnik, D.(1970). Webster's New world Dictionary of the American language( 2 nd ed.). New York.: the world.

Gurley, M. (1995). Determine ICU visiting hours, MEDSURG Nursing 4(1):40­43.

Hegar, R and Hunzeker, J (1988).Moving toward empowerment based practice in public child welfare, Social work 33(6): 499­502.

Hess, R. (1984).Thoughts on empowerment, prevention in human services 3, 227­230.

Hawks, J. (1992).Empowerment in nursing education: concept analysis and application to philosophy, learning and instruction, Journal of advance nursing 17(5): 609­618.

Hurty, K. (1984).Power in a new key: the hidden resources of empowerment, Philippine journal of nursing 54(2): 56­61.

Johnson, L. (1992).Interactive planning: a model for staff empowerment, Nursing Administration Quarterly 16(3): 47­57.

Katz, R. (1984).Empowerment and synergy: expending the community's healing resources, Prevention in human services 3: 201­226.

Keffer, C. (1984).Citizen empowerment: a developmental perspective, Prevention in human services 3: 9­36.

Empowerment concept 15

King, M. (1988).Concept: essential elements of theories, Nursing science quarterly: 1(1): 22­ 25.

Labonte, R. (1989).Community and professional empowerment.Infirmiere canadienne 85(3): 23­28.

Kuokkanen, L & Dr kilpi, L & Ms Katajisto. (2003).Nurse empowerment, job related satisfaction, and organizational commitment, journal nurse care quality 18(3): 184­ 192.

Maglacas, A. (1988).Health for all: nursing's role, Nursing outlook 36(2): 66­71.

Manthey, M. (1992). Issue in practice: Empowerment for teachers and students, Nurse educator 17(4): 6­7.

Mason J, Backer, A & Georges, C. (1991). Towards a feminist model for the political empowerment of nurses. IMAGE journal of nursing scholarships 23(2): 72­77.

Mcleod, W. (1987). The New Collins Dictionary and Thesaurus in one volume(2 nd ed.) . London: Collins.

McWhirter, EH. (1991). Empowerment in counseling, J Counsel Devel 69:222­228.

Meleis, A. (1991). Theoretical nursing development and progress (2 nd edn.). Philadelohia: Lippincott.

Grove, PB. (1993). Merriam Webster's Third New International Dictionary(n.d ed.). Springfield: MA: Merriam­Webster.

Norries, C. (1982). Concept Clarification in Nursing.London: Aspen.

O'Neill, M. (1992). Community participation in quebec's health system: a strategy to curtail community empowerment? International journal of health services 22(2): 287­301.

Parsons, RJ. (1989). Oxford English dictionary (2 nd ed.) Oxford: Clarendon press,

Berger, P. and Neuhaus, R. (1977), Chapter two paper one.

Pinderhughes, E. (1983). Empowerment for our clients and ourselves, The journal of contemporary social work 64(6): 331­338.

Prestby, J. Wandersman, A. Florin, P. Rich, R. Chavis, D. (1990). Benefits, costs, incentive management and participation in voluntary organizations: a means to understanding and promoting empowerment. Am J Community Psychol 18:117­149.

Rafael, A. (1995). Advocacy and empowerment: dichotomous or synchronous concepts? Adv Nurs Sci.18:25­32.

Empowerment concept 16

Rappaport, J. (1984).Studies in Empowerment: introduction to the issue. Prevention in human services 3, 1­7.

Rappaport, J. (1981). Chapter two, paper one.

Rodgers, K. (1989). Concepts analysis and the development of nursing knowledge: the evolutionary cycle, Journal of advance nursing 14(4): 330­335.

Simmons, C. & Parsons R. (1983). Empowerment for role alternatives in adolescence. Adolescence 18 (69), 193­200.

Tones, K. (1986). Health education and the ideology of health promotion: a review of alternative approaches. Health education research 1(1): 3­12.

Vogt J, Murrell K. (1990). Empowerment in Organizations: How to Spark Exceptional Performance. San Diego: Pfeiffer.

Wallerstein N. & Bernstein E. (1988) Empowerment education: freire's ideas adapted to health education, Health education quarterly 15(4): 379­394.

Watts, R. (1990).Democratization of health care: challenge for nursing, Advances in nursing science 12(2): 37­46.

Wheeler c. & chin p. (1989).Peace and power: a handbook of feminist process (2 nd ed.) New York: National leage for nursing.

Wolff, T. (1987). Community psychology and empowerment: an activist's insights, Am J Community Psychol 15:151­166.

Worrell JD, McGinn A, Black E, Holloway N, Nay P. The RN­BSN student: developing a model of empowerment. J Nurs Educ. 1996; 35:127­130.

Zimmerman, M. (1990). Taking aim on empowerment research: on the distinction between individual and psychological conceptions. Am J Community Psychol 18:169­177.

Zimmerman, M. (1990). Toward a theory of learned hopefulness: a structural model of analysis of participation and empowerment, Journal of Research in Personality 24(1): 71­86.

Zimmerman, M. Israel, A. Schulz, A. Checkoway, B (1992). Further explorations in empowerment theory: an empirical analysis of psychological empowerment. Am J Community Psychol 20:707­727.

Zimmerman, M. and Rappaport, J. (1988). Citizen Participation, perceived control and psychological empowerment, American Journal of Community Psychology,16(5):725­50.