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Power and
Power and empowerment in nursing: Three theoretical approaches
Definitions and uses of the concept of empowerment are wide-ranging: the term has been used to describe the human existence and development, but also aspects of organization effectiveness and quality. The empowerment ideology is rooted in social action where empowerment was associated with comminity interests and with attempts to increase the power and influence of oppressed groups (such as workers, women and ethnic minorities). Later, there was also growing recognition of the importance of the individual's characteristics and actions. Based on a review of the literature, this paper explores the uses of the empowerment concept as a framework for nurses' professional growth and development. Given the complexity of the concept, it is vital to understand the underlying philosophy before moving on to define its substance. The articles reviewed were classified into three groups on the basis of theirtheoretical orientation: critical social theory, organization theory and socialpsychological theory. Empowerment seems likely to provide for an umbrella concept of professional development in nursing.
Introduction
The concept of empowerment has been widely used but never adequately defined. Since the 1970s the ideology has been adopted to promote the rights of ethnic and sexual minorities, for training and educationmprogrammes as well as organizational devolepment programes, and by the feminist movement.recently ncept has alsonappeared more frequently in the nursing literature. there have been some concept analyses( gibson 1991, skelton 1994, rodwell 1996 ) and studies exploring the problem associated with empowerment and the concept of power itself ( gilbert 1995, fulton 1997 ) however, these analyses have failed to provide a coherent view on the content of the concept.
this paper will analyses and define empowerment in order to establish its compatibility as atheoretical framework for research into nurses' professional growth and development. the analysis is besed on literature searches from two databases, vis. CINAHL and MEDLINE. the former yieled 395 relevent papers from the period between 1980 and 1998, the latter 518 paper from the some period. there is, however, some overlap between the two indeces. the earlest papers, from the 1980s, consist of no more than 25 artiles, which deal empowerment primarily from the point of view of the development of the nursing profession. the number of articles on empowerment has aharply increased during the 1990s. over half of the leters discuss empowerment in the context of the patien-nurse relationship( e.g. in the treatment of psychiatric and HIV patient.preventive nursing and health educationt. the concent in this papers, however, is with the articles dealing with organizational developmant. these represent about one-third of the papers produced by the literature search. A total of 46 articles were concerned specifecaly with quostions of professional growth and devalopment in nursing.
the articles were divided into there categories on the .basis of their theoretical orientationand field of applicationt. the first category leans heavily on critical social theory and emancipatory theory, e. g. feminism. of the 46 articles in our review, 14 are included in this category. here empowerment is associated with imporving the living conditiont of oppresed groups sush as racial minorities, women and healt care patient. the secont catagory of empowerment ( 18 articles) consist of organization theories, where empowerment is associated wiith delegation of power and the subject's opportunity to take action. the third catagory is concerned with social psychological theory, bassed on the individual's devalopment. this theory suggest that empowerment origanetes within the individual and is conserned with the individual;s reflection within the environment. there are 14 articlesin the third category. those based on critical social theory stand clearly apart as an independent category. the phylosophy of the articles based on leadership and social phishicological theories is partly the same. one possible reason why articles in the secont category outnumber those in the first lies in the current popularity of empowerment as a management tool in the business world.
4 Social Psychologi
social psychological theories
The social psychological theory of development describes empowerment from the point of view of the individual, The earliest studies from the 1980s focus on the content of the concept(hess 1984, Rappapor 1984). More recently, Conger & Kanungo(1984) and Thomas & Vethouse(1990) worked on developing the theoretical background of empowerment. Empowerment is seen as a process of personal growth and development in which key factors are the individual' characteristics such as beliefs, views, values, perceptions, and relactionships with the empowerment. Empowerment variables at the individual level include race, sex, leisure interests, roles and standing. People do not usually pay very much attention to, or take the trouble to gather, information that is not directly relevant to them. Reflection is nevertheless a precondition for increased knowledge and personal development (Bandura 1977, 1978)
Kieffer (1984) and Rappaport (1984) were among the first to describe empowerment as a development process. Kieffer identified three dimensions which enhance the empowerment experience: a positive self-identity, extensive apprehension and reflection of one's environment, and the capability of social intercourse. An empowerment person does not pretend to have acquired more power but feels empowered. Power is both surrendered and conquered. The process is dynamic and synergetic and contains both positive and negative elements. It may also prove very painful (Hess 1984 pp. 2270-237). In Rappaport's (1984) view empowerment is a process, a 'mechanism by which people, organizations, and communities gain mastery over their own lives'. Conger & Kanungo (1988) developed the concept of empowerment further from the perspective of motivation theory. Leadership theories, they argue, interpret empowerment too narrowly as being concerned solely with the distribution and delegation of power. There definitions have a limited scope, they are ambiguous and partly even misunderstood. The idea of instrumental exercise of power, the sharing of power leading automatically to empowerment, has given rise to certain criticism (thomas & Velthouse 1990). Similar criticisms have voiced against the philosophy of emancipatory empowerment( Page 1992, Skelton 1994). Power is not a tool of control or subjection but is generated through the individual's behaviour, actions and the relationship to another person. At the individual level the elements of power consist of the individual's standing, expertise and possibilities to act and to acquire information (foucault 1978, McNay 1994). An empowered person feels capable of doing things well, even perfectly.
power and the exercise of power merge within empowerment. this, however, does not imply that empowerment is merely an autocome of power and its exercise. employes cannot be empowered simply by means of delegetiont. they all have their them to seek knowledge and to act in an oppropriate, meaningful way (McNay 1994). it is important to note the reciprocal character of the power relationship.
5.teori krisis social
critical social theory and empowerment
critical social theory is often associated with improving the living conditions of the underprivileged (ward & mullender 1991). where the individual nurse's professional growht and develoment is concernad, the perspective must be broadened to encompass the development of the whole profession and its relative position. for instance, an emancipatory starting-point has been sugessted for the education of nurses ( harden 1996). some writers have drawn attetion to a transfer effect where an empowered nurse will also inspire increased empowerment among patients (chandler 1992).most articles deal with critical social theory and empowerment from a theoretical vantege-point (parker & mcfarlane 1991). on the empirical side mention should be made of a recent qualitative study by fulton (1997), who interviewed a small group of experienced and newly graduated nuurses in great britain fulton
crtical social theory can be traced back to the frankfurt school in germany
the feminist movement has tended to associate empowerment primarily with the exercise or power. the development of nursing care and nurses' professional competencies are seen as an exercise in promoting the position of women.this theory suggests that early head nurses were feminists. some writers point out that efforts to strengthen the professional status of nurses may have adverse effects on the patient's position.this view refers to the tradional relationship between the dominant expert and passive patient (roberts 1983,parker & mcfarlen 1991,porter 1997).however,critical theory insist that patients also need to be empowered.a therapeutic nurse-paas well as their tient relationship is implied,based upon mutual respect,turst and equality of worth. patients must be active and equal participants in their own empowerment.
in other words, rather than empower patients,nurses facilitate the empowerment of patients (rafael 1996,anderson 1996).
roberts (1996) describes nurses as an oppressed group because they have assimilated their values from nursing and because they have adapted their behaviour accordingly. the views of the nursing profession as an oppressed group are largely shaped and influenced by myths and beliefs(haerden 1996,clifford 1992).most typically,the main obstcles to nurses' independence in hospitals are represented by head nurses and doctors as well as their patrirchal and doctors as well as their patriachal and autoritarian leadership styles.
critical social theory has also been used in nursing studies to describe the power assumed by nurses,their self-development and educationt.in many cases it has also served as the frame of reference for studies into patients' empowerment (doering 1992,rafael 1996).hewison (1995) observed 175 nurse-patients interactions.the crucial issue in the research was how nurses exert power through language.it was suggested that the power dimensions inherent in the relationship constitutes a barrier to open and meaningful communicationt between nerses and pateints.
6. empowerment
empowerment : defining the concept
empowerment is not new word inthe english language. according to the oxford english dictionary(simpthom & bradley 1989 ) the word empowering and impowering were used as early as the 17 th century in administrative latters. the dictonary's definition of the verb empower is to invest legally or formally with power or authority : authorize, license, empowerment is defined as the action of empowering, the state of being empowered.
the etymological dictionary ( patridge 1966 ) leads us back to the root of power. the latin word potere means to be able and to have the ability to choose. synonym for empowerment listed in the original roget;s thesaurus ( kirkpatrick 1992 ) include make possible , commission,permit, invest with power, authorize, allow, facilitate, and power emporwd, powerful, authortative, according to these definitions, the concept may be understood both in term of qualities and asprocess assosiated with the individual and the environment.
empowerment is an abstract concep that is fundamentallly positive, referring to solutions rather than to problem. it is also a dynamic concept: power is taken over and given away, power is shared. in the empowering process individuals, organizations and communities pursue maximal impact on their own life and eventual choices ( kieffer 1984, gibson 1991 ). empowerment is associated with growth and development. the process of individual empowerment requires criticles introspection and changing patterns of activity accordingly. at the community level empowerment is understood in terms of people uniting to achieve common goals ( rappaport 1984,rodwell 1996). empowerment has also been described in term of a negation, i.e. through it absence. since human decision differ from person to person and are individual within organizations, it is difficult to give a brief and unambiguous definition ot the concept
7. conclusion
. it is clear from the growing number of papers dealing with empowerment that the concept has been more widely adopted in nursing reseach.empowerment is a useful umbrella concept to describe the elements of professional growth and development in the nursing profession.in some studies,however, defenitions of empowerment have been so broad and sweeping that it has become almost synonymous with the concept of nursing care.this bound to undermine the value and utility of the concept.it is crucially important that the concept is propely defined.the classification proposed above between critical social theory, organization theory and social psycohologycal theory may be helpful when the concept is used as frame of reference for reseach and development projects.
critical social theory starts out from the premise that certain groups are in a subordinated position.in the nursing context this means primarily nurses and patients.empowerment connotates influence rather than striving to enhance one's power by taking it from others.critical social theory is explicitly defineble,stimulating and inspiring.it may prove useful in studies with ethical implications,for instance in research concerned with the priorities of nursing care.
Empowerment is also useful conceptual innovation for organization theories. Here empowerment provides well being at both the individual and organization level, which ultimately reinforces staff self-images and cooperation networks. it may be assumed that management influenced by this idea of empowerment will serve to strengthen staff nurses' professional self-esteem , development. Staff cannot , however, be empowerment merely by delegation, by transferring tasks downwards in the organizational hierarchy.
at the authoritarian type of leadership assumes less arbitrary forms, the individual's personal qualities and ways of acting assume increasing importance. voluntary spontaneous activity as well as a willingness and ability for self-improvement are expected of individuals. nursing is unique as an occupation in being grounded almost entirely on human relations, and in this sense it differs completely from industrial production. it would be interesting to identify which variables inherent in the nurses themselves and in the nursing environment serve to enhance nurses' professional development and inner feelings of stength. given its emphasis on the individual and environmental factors, social psychological theory provides a suitable framework for such studies. the information obtained would be extremely useful for the development of both organizations, staff and nursing care. the factors involved in empowerment may also open up new perspectives for the development of quality nursing care.
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