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Empowerment Approach to Diabetes Education: Promises and Challenges. 25 March 2006 (12-13:00) Society of Nursing Education Kan, Eva Shiu, Ann TY and Wong, Rebecca. Empowerment: Meaning. A common terminology New public health and health promotion: Specific meaning

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empowerment approach to diabetes education promises and challenges

Empowerment Approach to Diabetes Education: Promises and Challenges

25 March 2006 (12-13:00)

Society of Nursing Education

Kan, Eva

Shiu, Ann TY

and

Wong, Rebecca

empowerment meaning
Empowerment: Meaning
  • A common terminology
  • New public health and health promotion: Specific meaning
  • The WHO definition (1998)
    • Empowerment is a process through which people gain greater control over decisions and actions affecting their health.
relevance to nursing practice
Relevance to nursing practice

Tones (1998)

  • Self-empowerment model of health education (patient education) is suitable for nursing practice in the context of individual or small group education encounters.
  • This is the area where nursing practice can operationalise the concept of ‘health promotion at the micro level’.
the literature shows a paradigm shift
The literature shows a paradigm shift
  • Diabetes
    • A chronic illness
    • Over 95% of decision-making
    • Self-managed illness
    • Active engagement of patients
    • Education as the corner-stone
slide5
Diabetes research priority
    • A cursory MEDLINE search: over 450 citations of compliance in the title (all inclusive = 8000)
    • 21st century as an era of researching effective models of diabetes care delivery
    • In particular what model of care can better elicit patients’ cooperation
slide6
Diabetes education research
    • A gradual shift since 1990s: from a traditional/didactic/preventive model to an empowerment approach
    • The limitation of the preventive approach: knowledge does not always lead to change in behaviour, e.g., a systematic review 2004
    • As exemplar pioneering the shift in the patient education arena
slide7
A general agreement at the end of 1990s
    • Patients as active and informed participants
    • A preventive (compliance/adherence) model is an acute illness model
    • Empowering patients to take control of both physiological and psychological outcomes

– to be the major underpinning philosophy of care provision

slide8
In the new public health era, a preventive model to patient educationis regarded as
    • Without paying attention to psychosocial and economic factors
    • Imposing values
    • Victim blaming
victim blaming consists of
Victim blaming Consists of
  • “Ignoring the broader social, material, economic and cultural factors determining individual behaviour and
  • placing the entire burden of responsibility for action on individuals (victims) themselves while,
  • at the same time, not recognising the limits to the individual’s power to act and,
  • on occasions, denying the individual the opportunity to take responsibility when he or she actually has some scope for making choices”(Tones and Tilford, 2001).
prevention of diabetes complications
Prevention of diabetes complications
  • Extremely important: A goal of diabetes education
  • But may become victim blaming
    • when the environmental factors are ignored or
    • when patients’ opportunity to take responsibility and make choices are denied
facilitating active engagement of patients
Facilitating active engagement of patients
  • The approach to diabetes care should change from compliance to empowerment
    • does not abandon educating for knowledge
    • but goes beyond it
  • The shift is likely to
    • enhance knowledge and cooperation
    • foster appropriate self-management abilities
    • enable patients to overcome some of the personal, social and environmental barriers
an empowerment paradigm
An empowerment paradigm
  • Education strategies derived from the empowerment model may be more effective in achieving prevention of diabetes complications
  • For example, A randomised control trial study shows that patient empowerment can improve patient outcomes such as HbA1c and QoL (Anderson et al., 1995)
empowerment as the philosophy
Empowerment as the philosophy
  • The Anderson team at Michigan started advocating patient empowerment in the 1990s
  • ‘This philosophy is based on the assumption that to be healthy, people need to have the psychosocial skills to bring about changes in
    • their personal behaviour,
    • their social situations, and
    • the institutions that influence their lives.

These skills probably play an important role in the development and implementation of a successful diabetes self-care plan, i.e., a plan that enhances the patient’s health and quality of life’(Anderson et al., 1995).

empowerment as the education process
Empowerment as the education process
  • Aims at facilitating patients’ sense of control (confidence) in
    • Achieving goals
    • Overcoming barriers
    • Determining suitable methods
    • Obtaining support
    • Coping
empowerment as the outcome
Empowerment as the outcome
  • Include self-efficacy beliefs, sense of coherence, self esteem
  • To assess the outcome of programmes guided by patient empowerment, a measure of meaning to the philosophy should be used
  • Anderson et al. (1995) developed and psychometrically tested the Diabetes Empowerment Scale – measures diabetes psychosocial self-efficacy
how to implement empowerment in education encounters
How to implement empowerment in education encounters
  • Clarify and internalise the philosophy
    • Beliefs about diabetes self-management
    • Values and associated beliefs about diabetes education
    • A deep reflection on the roles and responsibilities
  • Develop awareness of the basic assumptions of the use of this and other theoretical models
  • Use education strategies of meaning to the self-empowerment model
    • Two-way communication
    • Mutual respect: two experts
    • Experiential learning activities
scenarios and discussions
Scenarios and Discussions
  • Some scenarios from our clinical experience

Aim to stimulate discussion on

  • (1) promises and
  • (2) challenges of implementing empowerment in diabetes education, which may include the constraints arising from
    • the patient,
    • the nurse, and
    • the context
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