An exploration of empowerment discourse within home-care nurses’ accounts of practice

Abstract

In this study, we explore how client and family caregiver 'empowerment' is interpreted by home-care nurses talking about their practice with palliative (and to a lesser extent, non-palliative) clients and families. We draw on secondary analysis of qualitative data collected through in-person interviews with 27 home-care nurses from a western Canadian health authority. First, we illustrate how the practice ideal of empowerment, in the sense of 'respecting autonomy and choices', can be understood as reflecting home-care nurses' needs to mitigate the emotional impact of feeling unable to effectively help palliative clients/families. Then, we illustrate how the practice ideal of empowerment, in the sense of 'promoting independence', can be understood to accomplish the need to shift responsibility for particular care tasks to clients and family members. Lastly, home-care nurses, talk about 'promoting choices' is also investigated. 'Choice' was framed narrowly with respect to allowing palliative clients and families to determine visit time and frequency. Findings are discussed in relation to the concept of 'responsibilization'.

Family caregiver learning—how family caregivers learn to provide care at the end of life: A qualitative secondary analysis of four datasets

“…While self-care is a highly valued ideal within healthcare culture, 59 in the context of at-home care, it is important to also acknowledge that some family caregivers, while highly confident and resourceful, may still have unmet needs that require intervention. 60 Healthcare providers should also recognize that not all family caregivers will be self-initiators and may require enhanced support from the healthcare system to allay fears and uncertainties associated with a lack of knowledge about how to best provide care. Even those family caregivers who are ambivalent-providing care because of a strong sense of responsibility for the patient-often feel better supported when they have accessible, comprehensible, and consistent information that supports the learning process and thereby enhances their sense of security and comfort.…”

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

“…This analysis draws on data from an ethnographic study of family empowerment in home-care nursing, where the research question was 1 To a more limited extent, it may encompass encouraging clients and carers to help choose visit time or frequency (Funk, Stajduhar, & Purkis, 2011). Programmes promoting self/family managed care have also been touted as empowering for clients and families (Larkin & Milne, 2014).…”

“…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.…”

Improving the process of care setting transitions for adult palliative patients: recommendations for nurse practitioner practice

“…Since informal caregivers often assume responsibility for the care of a patient as palliative status progresses, NPs need to empower both the palliative patients and their caregivers. This review of research findings indicates that, when patients feel empowered in the process of care setting transfers, their transitions felt less burdensome In general, palliative patients and their caregivers identified education, preparation, and reassurance as vital components of their sense of empowerment (Stajduhar et al, 2011 ).…”

“…The literature as a whole recognizes that patients benefit by receiving ongoing education from their health care providers. For example, Stajduhar et al (2011) found that empowered palliative patients and their caregivers experienced increased comfort, felt more positive about their care experience, were less reliant on health care services, and had the potential to remain at home longer. The goal of patient empowerment is to promote independence, improve well-being, and increase patient satisfaction (Funk,Stajduhar,Purkis,201 0).…”