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Empowerment - Expectations Vs Delivery

Empowerment - Expectations Vs Delivery. Michael Concannon. Initiation. MSc Dissertation CPD - Diabetes NSF - Standards 2001. NSF Standards Conclusion. “Diabetic services will be:

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Empowerment - Expectations Vs Delivery

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  1. Empowerment - Expectations Vs Delivery Michael Concannon

  2. Initiation • MSc Dissertation • CPD - Diabetes • NSF - Standards 2001

  3. NSF Standards Conclusion • “Diabetic services will be: • Person centred: - empowering the individual to adopt a healthy lifestyle and to manage their own diabetes through education and support which recognises the importance of lifestyle, culture and religion, and which where necessary tackles the adverse impact of material disadvantage and social exclusion.”

  4. Literature review • Heavy criticisms of the medical model of Empowerment. • “the medical model is no more than Capitalistic marketing” Grace 91 & Skelton 94 • Little evidence of success supporting the use of /need for, empowerment • Clear evidence needing the power to shift from the “so called expert” to the “actual expert” of the disease

  5. Empowerment should be interactive, cultivating control in others through the sharing of knowledge, expertise and resources. This philosophy breaks the tradition of patients receiving a service but encourages active partnerships between practitioner and patient. • It is suggested several times in the literature that the medical model will not allow this!

  6. Aim and objectives • Aim: • To explore the concept of empowerment from a delivery perspective for people with diabetes (within podiatry) • Objectives: • Level of knowledge • Attitudes towards empowerment • Establish the level of training

  7. Underlying question? • To achieve true empowerment of service users • Who should be empowered? • Who is teaching and who is learning?

  8. Method • Survey in the form of Questionnaire • 4 sections (5 point Likert Scales used) • Demographics • DAS (prevalidated and used with permission) • NSF offering validity in raising questions from official documentation from DOH • Training standards and competencies

  9. A 7 point Likert Scale

  10. The 5 point Likert scale used (semantic differential scale)

  11. Sampling Non randomised and convenient sample of 130 clinically active SRCh/podiatrists were targeted • Data collection Anonymity and informed consent assured • Data analysis Using SPSS a mixture of descriptive and parametric tests were used • Pilot studyThis was carried out on colleagues in an attempt to refine and ensure reliability of the chosen method • Final studyThe final study was carried out in line with ethical approval

  12. Results20 Pages in the dissertation illustrating 25 graphs and 8 tables • Mean, median and SD’s for DAS/NSF/TN • Box and Whisker plots • Graphs, Histograms and Pie Charts • Inferential Stats = Parametric Tests • Regression analysis using Pearson’s correlation (sunflower chart showing strength of relationships) • Unpaired (independent t tests) *consideration to = sections of Q’re, Gender, Grade, number of years post qualified

  13. Results • From 99 returned questionnaires: • The results indicated that podiatrists perceived themselves to have an awareness of diabetes and issues related to empowerment • DAS (18-90 possible) 70 • NSF (12-60 possible) 34 • Training Needs - only 17 people believed training was sufficient at undergraduate level

  14. Interpretation of results • No significant difference between gender • No significant difference between years qualified • There was a significant relationship between the 3 main sections of the questionnaire therefore offering validity to the results! (consistency!!??)

  15. Discussion • Crosstabulations • Pt with DM is the most important member of the MDT! 82/99 agreed 50/82 strongly – 3/99 disagreed 0/99 strongly Participants are forward thinking in attitude! 2 statements earlier however? • Individuals with DM should have the final say in setting blood glucose levels! 35/99 agreed 5/99 strongly – 32/99 disagreed 7/99 strongly • An opinion consistent with the medical model of care and its critical influence on empowerment, as highlighted in the literature review (Glaser 1990, Grace 1991, Skelton 1994, Johnston-Roberts 1999, Coulter 1999, Feder & Griffith 2000, Taylor 2000, Patterson 2001 and Traynor 2003).

  16. Only 41 people disagreed with thisYet! Only 17 people felt that the training was sufficient • Only 10 people disagreed with this!

  17. Conclusion • Health Professionals, whilst good intentional are reluctant to relinquish control to patients therefore tokenistic and paternalistic with practice of empowerment • The framework is not conducive to a true empowerment model Gibson 91, Henwood et al 2003, Christie & Cross 2003. • Health promotion based on issues perceived important by the HCP are unlikely to succeed and should address the beliefs and priorities of people with DM Boulton et al 2000

  18. Conclusions Did you know? The QAAHE 2001, NSF 2001, HPC 2004(in partnership with SOCP) have benchmarks stating: “The graduate should be able to educate motivate and alter behaviour. They should also be able to recognise opportunities to influence social policy!” • Only 17 people believed their undergraduate training in empowerment was sufficient

  19. Conclusions (cont) • Yet the majority of the results indicated a perceived understanding of the surrounding issues of empowerment • The author proposed several flaws in the fundamental basis of the method: i.e. if a person has insufficient knowledge of empowerment then they are not in a position to offer self criticism of the same issue!

  20. Critique of study Larger than the results section! • Sampling methods • Training needs invalidating the training section • Closed ended questions • Suitabilility of staff experience

  21. Outcome of research • This presentation • More research • Qualitative • Discursive forum of data collection/analysis i.e.Focus groups • Need for training and policy change

  22. References Boulton AJM., Connor H., Cavanagh PR."The foot in Diabetes" 3rd Edition 2000 John Wiley & Sons Ltd Christie, A & Cross, V (2003) "Clinical specialisms: patient empowerment or professional control?" British Journal of Therapy and Rehabilitation Vol.: 10, No: 3 pp100-108 Coulter A (1999) "Paternalism or partnership“ BMJ vol 319 18th Sept 1999 Department of Health NSF "A practical aid to implementation in primary care“ August 2002 http://www.doh.gov.uk/nsf/diabetes.htm Feder G., Griffiths C, Eldridge S., Gantley M., "Patient empowerment and coronary heart disease" Lancet Volume 356 Issue 9237 Page 1278, 7th Oct 2000 Gibson, C"A concept analysis of empowerment“ Journal of Advanced Nursing Vol.: 16 pp 354-361 1991 Glaser NY., "The home as a workshop: women as amateur nurses and medical care providers" Gender and society (1990) 4 479-499 Grace VM., "The marketing of empowerment and the construction of the health consumer: a critique of health promotion" International journal of health services (1991) 21: 2 329-343 Health Professions Council 2004 "Standards of education and training and the approvals process - Education and training paper" www.hpc-uk.org site accessed 11/03/04 Henwood F, Wyatt S, Hart A, Smith J (2003) 'Ignorance is bliss sometimes': constraints on the emergence of the 'informed patient' in the changing landscapes of health information, Sociology of Health and Illness Sep 2003,Volume 25, Issue 6, Page 589-607 Johnston-Roberts K., "Patient empowerment in the United States: a critical commentary" Health expectations Vol. 2, Issue 2, May 1999, pages 82-92 Paterson B 2001 "Myth of empowerment in chronic illness“ Journal of advanced Nursing 34 (5) 574-581 The Quality Assurance Agency for higher education 2001 "Podiatry (chiropody) subject benchmark statements for health care programmes“ Frontier print and design Ltd Skelton R"Nursing and empowerment: concepts and strategies" Journal of advanced nursing, (1994) 19:415-423 Taylor.P., "Patients, Power and Politics. Health and empowerment: Research and Practice" Health and Social Care in the Community. Sept 2000.vol 8 issue 5 pp350 Traynor M (2003) "A brief history of empowerment: response to discussion with Julianne Cheek". Primary Health Care Research and Development. 4 129-136

  23. Any Questions? • Thanks for listening!

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