Wk. 5.

Powerlessness, client Empowerment

Powerlessness
Powerlessness is defined by Johnson(1967) as the
“perceived lack of personal or internal control of
certain events or in
certain situations”(Kramer-Kile. Pg. 258).
Chronic illness threaten the well-being of the
individual and produces changes to the dynamic
between the individual and family members.
Powerlessness
Powerlessness is the inability to affect an outcome:
the inability to have agency in one’s own life.
At some point individuals with chronic illness
experience powerlessness. Powerlessness could be
• Real or perceived
• Short-lived or persistent
Power and powerlessness could exist
simultaneously.
The chronically ill live in a dual world of
Wellness/sickness, control/powerlessness,
hope/despair.
There is a continual shifting of perspectives. Illness-
wellness perspective is dynamic and changing.
Powerlessness and Chronic disease
The progressive nature of Ch. illness limits
possibilities and opportunities to exert control over
the daily life events and plans for the future.
Factors that exacerbate Powerlessness
1.Uncertainty of chronic illness- exacerbation of
symptoms, physical deterioration.
2.Depletion of social supports.
3.Decrease in the client’s psychological stamina.
4.Fatigue and inability to participate to social
activities contribute to social withdrawal and loss
of relationships

- Worse, the uncertainty and chronic illness,

further affects them
- The more the factors exacerbate the client the
more powerlessness becomes
Problems Associated with Powerlessness
1.Chronic illness management- The complexity of
Ch. illness has the potential to strip away the
client’s sense of self-wroth and confidence
resulting in clients unable to accurately assess
and manage their needs.
2.Lack of knowledge-leads to uncertainty
3.Marginalization/vulnerability-.
4.Stigma
- Stigma is a response to any physical or
social attribute or characteristic that devalues a
person’s social identity and disqualifies her\him
from full social acceptance(Geoffman1963
found Kramer-Kile p. 267) .
- Ex- client with hepatitis.

5.Culture and decision making.

Powerlessness-Aujoulet etal
 Powerlessness is defined as
- ‘occurring when an individual assumes the role
of an object acted on by the environment rather
than a subject acting in and, on the
environment’ (Aujoulat et al. p773)

 Powerlessness occurs in conditions where one is

devoid of strength or resources to affect their
agency.

 Chronic illness threaten the well-being of the

individual and produces changes to the dynamic
between the individual and family members.

 Ch illness negatively impacts the client’s

relationships with others, the client engaging in
social activities and results in social isolation.
The clients’ experience of Powerlessness-
Aujolet
Patient empowerment is
‘considered to be adoption of self-determined , not
necessarily health behaviours…. To make choices’
( Aujoulet. Pg 772).
Results from the study
1.Loss of one’s sense of internalized security.
2.Loss of one’s social and personal Identities.
The clients’ experience of Powerlessness-
Aujolet
These author describe and explain the following
themes from the data.
Sources of Powerlessness from the clients’
perspectives(Aujoulat etal. 2007) include the
following;-
1.Loss of one’s sense of internalized security:
feeling out of control; client is vulnerable
1.Loss of control over one’s body.
- not knowing the symptoms of the disease; how
to manage the condition
2.Loss of control over one’s emotions
- Client experience fear, anxiety; feeling insecure
3.Loss of control in the context of
Transgenerational.
- Try to make sense of the condition; find
meaning.
4. Loss of control over time.
5. Loss of control over one’s environment.
Feels like a fish out of water. Pg. 779
Powerlessness and the clients’
Perspectives(cont.)
2. Loss of control over one’s social and personal
identity-
Disrupted identity.
Social dimension of identity- changes in role in
the family
Personal dimension of identity-self-image; Loss
of self
Power
 Power is defined as the “ability to act or produce an
effect: and “possession of control” (Kramer-Kile. pg.
260)

 Associated with independence and self-determination.

 Power is a relational attribute.

 Individual power resources include

o Physical strength and physical reserve;
o Psychological stamina-positive self-concept,
knowledge, motivation and hope.

 Power resources (individual)facilitate coping with Ch.

illness.
Theoretical perspective to examine Power and
Powerlessness- Oudshoorn
 Critical social perspective to examine
powerlessness

 Important features that underpin Critical social

theory are as follows:- (Oudshoorn; Falk)

- “ A future free of domination, exploitation and

oppression; Structures of domination are
reproduced through a false-consciousness:
Social change begins at home; Individuals are
responsible not to perpetuate domination
themselves’ (Oudshoorn p.58)
Theoretical perspective to examine Power and
Powerlessness- Oudshoorn (cont.)
Power and powerlessness coexists simultaneously
within a social context.
Many definitions of Power.
Power is associated with independence and self-
determination.
Power is dialogical , mediated through language in
the nurse-client partnership. (Oudshorn, Falk).
Power is shared in the nurse-nurse-client
partnership. (Oudshorn, Falk). Characterized by a
collaborative approach where client goals are
mutually determined
Theoretical perspective to examine Power and
Powerlessness(cont..)
Move to creating a possibility of change for nurses
to consider. Move from “ Power over ” vs “Power to”
“Power over”–the ability to persuade and influence
situation or others.
- Exercising knowledge to exercise control or
influence-Ex medical language that a nurse
uses to explain the condition.
“Power to” or empowerment-
- gaining the ability to act or create change in a
way that one desires.
The nurse demonstrates being open to the
client’s views\opinions; Building trust and effective
communication
Power as relational-
Theoretical perspective to examine Power and
Powerlessness- Oudshoorn
Power is a relational attribute.
- It is a dynamic, interactive process that is
gained, maintained and diminished in
relationships and personal
interactions(Oudshorn)

Sources of Power-
Macro-Refers to system, organizational or societal
levels.
 Conditions that marginalizes individuals

Micro-Refers to interpersonal or relational levels

Individual power resources include
 Physical strength and physical reserve;
 Psychological stamina-positive self-concept,
knowledge, motivation and hope.
Power resources (individual)facilitate coping with
Ch. illness.
Theoretical Perspectives of Powerlessness
1. Shifting Perspectives model.
We move away from the bio-medical model to a
sociological model of care, client and family
empowerment are essential.
Empowerment Interventions
Empowerment interventions
Interpersonal-Self-awareness

Intrapersonal-
1.Advocacy and decision making
2.Providing factual, evidence-informed information
in the language that the client understands.
3.Cultural and Linguistic competence and cultural
humility.
4.Person-centered approach.
- Self-determination-client has the autonomy to
make decisions based on her\his choice to
reach personal goals.
5.Nursing interventions move away from the bio-
medical model to a sociological model of care.
Focus on the client and client’s family.

Contextual-
Patient Empowerment-Weisbeck etal
 Chronic pain is the leading cause of disability
worldwide.
 Pts with chronic pain and HCP report feelings of
frustration and powerlessness with the treatment
process.
 Pt empowerment is a
- ‘ process that facilitates self-care and behaviour
change that requires a mutual and trustful
relationship between patients and HCP” (pg 2)
Patient Empowerment-Weisbeck etal
Patient empowerment consists of the following
Attributes
Self-determination
Partnership and supportive relationship
Antecedents
Motivation
Patient competency
Consequences
An integrated self.
Increased quality of life.

Attributes - client characteristics

Antecedents - previous patient history

Empowerment Interventions
Empowerment interventions
1.Interventions that a nurse could use-
i. Guiding clients in establishing a sense of
mastery.
ii. Cultural competence
iii. Advocacy and guide the client in her\his
decision making
iv. Discharge planning-client focused
v. Navigating the health care system
vi. Health coaching
vii. Collaboration

2.Client needs to enable

1.Self-management-increases adherence to
treatment plan.
2.Self-determination-client has the autonomy
to make decisions based on her\his choice
to reach personal goals.