A critical analysis of health promotion and ‘empowerment’ in the context of palliative family care‐giving

Abstract

Traditionally viewed as in opposition to palliative care, newer ideas about 'health-promoting palliative care' increasingly infuse the practices and philosophies of healthcare professionals, often invoking ideals of empowerment and participation in care and decision-making. The general tendency is to assume that empowerment, participation, and self-care are universally beneficial for and welcomed by all individuals. But does this assumption hold for everyone, and do we fully understand the implications of health-promoting palliative care for family caregivers in particular? In this study, we draw on existing literature to highlight potential challenges arising from the application of 'family empowerment' strategies in palliative home-care nursing practice. In particular, there is a risk that empowerment may be operationalized as transferring technical and medical-care tasks to family caregivers at home. Yet, for some family caregivers, a sense of security and support, as well as trust in professionals, may be equally if not more important than empowerment. Relational and role concerns may also at times take precedence over a desire for empowerment. The potential implications of 'family empowerment' are explored in this regard. 'Family empowerment' approaches need to be accompanied by a strong understanding of how to best support individual palliative family caregivers.

Client involvement in home care practice: a relational sociological perspective

“…2006). It is further shown how relatives are caught between being actively involved in care tasks and decision‐makings and being able to withdraw from such responsibilities (Hegli and Foss 2009; Stajduhar et al. 2010).…”

Applying the concept of structural empowerment to interactions between families and home‐care nurses

“…When family empowerment is interpreted narrowly-as maximum participation in home-based care throughout the illness trajectory (and being confident and capable in doing so)-this obscures the needs of carers who may benefit from controlling the level and type of their involvement, especially when clients are near the end of life (Stajduhar et al, 2010). When family empowerment is interpreted narrowly-as maximum participation in home-based care throughout the illness trajectory (and being confident and capable in doing so)-this obscures the needs of carers who may benefit from controlling the level and type of their involvement, especially when clients are near the end of life (Stajduhar et al, 2010).…”

“…Instead, it is often assumed that full and active family participation in care is always empowering for both clients and families; family members' choice in becoming carers tends to be viewed unproblematically (Funk, 2013;Funk et al, 2011;Stajduhar, Funk, Jakobsson, & Öhlén, 2010;Stajduhar et al, 2011). 1 Echoing this, academic health literature advances conceptualizations of carer empowerment focused primarily on enhancing skills, knowledge and psychological resilience (e.g.…”

Concept Analysis of Empowerment From Survivor and Nurse Perspectives Within the Context of Cancer Survivorship

“…Both nurses and survivors agree that a trusting, respectful relationship is crucial to empowerment (Liu, Mok, & Wong, 2006;Stajduhar, Funk, Jakobsson, & Ohlén, 2010) and survivors' concerns need to be voiced so that they can factor into the health care decision making process (Kaplan & Frosch, 2005). Because of the feelings of vulnerability and uncertainty that frequently occur in cancer survivors, it is important to develop a partnership that demonstrates mutual trust and respect for autonomy (McCorkle et al, 2011).…”