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Jordan University of Science and Technology
Faculty of Nursing
Concept analysis paper: Empowerment
Prepared by:
Ashraf Ali AlSmadi
Advised by:
Dr.Nemeh AlKour RN, PhD
Empowerment concept 2
Introduction:
The concept has been used to give different meanings. (Melies, 1991) said that a
concept is vital to build the scientific theory, research and theory development, and it is the
description of a phenomenon. On the other hand, King (1988) explained it as an idea or
mental image of reality.
Empowerment concept is explained and defined by various disciplines; including:
social work, psychology, education, community psychology, and nursing. In addition,
Empowerment concept is lately used in different phenomenon, such as: student
empowerment, empowerment of teachers, empowerment of patient and empowerment of
nurses. From reviewing the related literature of the concept in the nursing field, there is no
specific definition of empowerment because it is used depending on the writer and the
framework of his/ her paper.
According to (Norries, 1982) one of the major problems with the nursing science is
that its concepts are words that lack the elements of the system that are necessary for a
scientific discipline (e.g. categories, taxonomies and rules). For that, the writer will present a
concept analysis of empowerment which will identify and examine its attributes,
characteristics, antecedents, consequences and uses of the concept in the nursing field.
According to the assumptions for this concept analysis paper, the writer believes that each
nurse manager must empower his/her followers' autonomy, accountability, decision making
abilities, problem solving, and managerial skills.
Usually an analysis of the concept is held to clarify its meaning and to show the
relations of its elements in various fields. In this paper the concept of empowerment will be
studied in the field of nursing to clarify its meaning to develop nursing knowledge base and
to show its importance in this profession. As the writer believes that when the nurses are
empowered, the productivity and effectiveness of the nursing health care services will
Empowerment concept 3
increase. The empowerment is a complex concept, for example, it is easy to be understood,
however; it is hard to be defined.
Literature Review:
From the literature of empowerment, it is difficult to be found as an independent
concept since it's linked with other concepts, such as: coping skills, personal efficacy, support
self esteem, and self sufficiency (Kieffer, 1984). Empowerment concept emphasized by
World Health Organization through the definition of health promotion as a "process of
enabling people to increase control over and to improve their own health" (Maglacas, 1988).
Furthermore, the concept of empowerment is not only captured by personal
responsibility in performing health, it more requires the effect of the social environment on
1986) suggestions for an educated nurse that fits the definition of an empowered nurse " the
graduate well exhibit qualities of mine and character that are necessary to live a free and
fulfilling live, act in the public interest locally and globally, and contribute to health care
improvements and the nursing profession". During the process of empowerment the
individuals must have a strong commitment to achieve the goals of empowerment in effective
ways (Rogers, 1983; Green, 1986; Report, 1989; Ellsworth, 1989).
The concept empowerment derived from the Latin word 'potere'meaning "to be able"
(McLeod, 1987). Empowerment has been examined by different sciences and multiple
definitions were put forward. Linguistically, empowerment was defined in Webster's New
World Dictionary of the American Language (Guralnik, 1970) as follows: the verb Empower
is "To give power or authority to, authorize; to give the ability to, enable, and permit"'. The
suffix 'ment' is defined as a "result or product". As a result, empowerment is the result of
empowering. "A synonym for empower include to give or confer power, invest, endue,
Empowerment concept 4
endow, strengthen, arm and delegate" (Chapman, 1977). More over, The Shorter Oxford
authorize, to license; to impart power; to enable, to permit". Merriam Webster's Third New
International Dictionary (1993) defined empowerment as: "to give official authority to,
delegate legal power to, and to give faculties or abilities to".
Sociologically, empowerment is the action of increase the influence of a social group
(kuokkanen, Leinokilpi and Katajisto, 2003). Rappaport (1981) defined empowerment as: a
worldview that have a method to the solution of social problems and social policy a
stemming from powerlessness". Berger and Neuhaus (1977) defined empowerment as: an
approach of supporting the good services by social organizations. Solomon (1976, 1985)
proposed empowerment as: an approach of social activities.
Individual empowerment helps in making healthpromotional changes as it enhances
the motivations by using some counseling techniques (McWhirter, 1991; Fahlberg LL, 1991
process including thoughts or thinking and behaving. Gibson (1991) defined empowerment
as: the individual's recognition, promotion and improvement of his abilities to achieve his
own requirements, solve their own problems and mobilize resources to control their own lives
by helping them to build a critical awareness of the situation and ease the proposition of a
plan of action. Zimmerman and Rappaport (1988) defined empowerment as: a build that
connects personal capabilities and power, positive behaviors and natural healing systems to
issues of social change and social policy.
In social psychology, empowerment is the personal growth and developments were
the qualities, efforts and values are inherent in the person himself. (Kuokkanen, Kilpi &
Katajisto, 2003). Browne (1995) stated that empowerment is the method that is used to
change the workers' ability to function. Furthermore, Simmons and Persons (1983) added that
Empowerment concept 5
empowerment is a method that makes the individual able to control his environment and
achieve selfdetermination. This may happen by adopting an individual change, interpersonal
change, interactional change or changing the social structure to that have an impact on the
levels: individual, organizational, and community level.
In addition, nursing literature held many definitions of empowerment. In nursing and
for the purpose of this paper, empowerment is the process of enabling the nurses to work
efficiently through some activities that are named empowering. Those activities were
classified into analytic nursing, change activities, funding and collegiality (Gorman &
Clark's, 1986). Client empowerment was defined as a process initiating from nurses staff,
"enabling individuals to feel effective so that they can successfully execute their jobs".
Chandler (1992) proposed two definitions of "enabling" existed in relation to the
empowerment in nursing; either positive or negative denotation. The positive denotation of
enabling explains a professional in the mental health who helps patients in their acceptance
back into society. The negative denotation of the enabling is to let an individual maintenance
of substance abuse or other negative health habits (Campbell, 1996).
In summary, from my perspective as a nursing management student, empowerment in
nursing management is a process performed through delegating power or authority to staff
nurses to assist them to control or lead, to increase ability to problem solving, and to increase
quality of nursing care services. For this paper, empowerment is defined as an interactive
help or assist in changing behaviors.
Empowerment concept 6
Defining Characteristics of the empowerment concept:
The empowerment concept is a communicational concept because the process of
individual needs, it is nurtured by the outcome of mutual efforts (Kieffer, 1984). Wallerstein
and Bernstein (1988) said that the empowerment includes more than growing one's self
confidence and efficiency or supporting optimistic health behaviors in persons; it includes
environmental modification too. The reason of difficulty to find a specific definition of
empowerment is that empowerment concept is changeable. It varies depending on the
researcher and the situation. Therefore, empowerment meaning depends on the context.
Wallerstein; Bernstein, (1988), and Kiffer, (1984), empowerment is not able to be defined in
a single method: it requires to be cleared by the individual concerns (Rappaport, 1984). Katz,
(1984) explained empowerment in that it has intrinsic and extrinsic connection between
paradigm where persons are interdependent, there is a mutual exchange of resources, and
partnership is enhanced.
Obviously, a systems approach is essential to learn empowerment (Hess, 1984) as the
concept has different views and also it's concern on solutions more than problems (Kiffer,
1984). It titled person's strengths, abilities, and human rights more than requirements and
shortage. Consequently, the process of empowerment encompasses prospective activities that
done prior to work. Empowerment is a positive, changeable or dynamic concept (Hess 1984).
Empowerment concept reveal a female perspective of power, in which power is
conceptualized as a circumstance of being able to perform some purpose in collaboration
with individuals, on the contrary with a male perspective of power somewhere there is an
inadequate provide that must be effort for and protected against others (Hurty, 1984, Watt's,
1990, Wheeler and Chin, 1989). Also we can say the empowerment is a democratic concept
Empowerment concept 7
because the process of empowerment proposes a rearrangement of power and improvement
of social justice. (Hegar & Hunzeker, 1988).
Empowerment can be regarded as an argumentative concept, because during the
process of empowerment, it is able to change locations in the process and results. (Kataz,
1984 & Rappaport, 1984). In addition, empowerment is an improvement concept where
persons, groups, families and communities increase and potential are improved.
Rappaport, (1984). In the process of empowerment, inconsistency, tension, and expansion are
complex intertwined, therefore; complex solutions of problems are important in a way that
they make old problems never appear again.
Attributes of Empowerment:
The attributes of empowerment concept that were defined in the literature are
(Rodwell, 1996 and Hawks, 1992):
1. Collaborative process between two or more individuals characterized by open
communication, and common goal setting.
2. The availability of alternatives of decisions and the acceptance of accountability.
3. Reciprocal decision making in mobilizing the resources, the opportunities that are
available, and rightly using the power.
4. Helping process.
5. Interdependent participation between the patients and the nurses, dynamic listening
that will help each party to have experience and learn from others, and personal
6. Adds educating, leading, mentoring, providing, structuring, and actualizing (Vogt &
Murrell, 1990).
Empowerment concept 8
7. Offers uptodate improvement, promotion, support and focus on the development of
individual's relationships (Craddock and Skinner, 2000).
8. Finally, in an attempt to empower individuals, the person requires some attributes
such as loyalty, instinctive thoughts, elasticity or flexibility, respect of diversity,
Pinderhughes, 1983 & Watts, 1990).
Related concepts:
Related concepts are concepts which give the same meaning of empowerment
concept, (Rodgers, 1989). The related concepts of empowerment are:
1. Accountability.
2. Liability.
3. Alternative.
4. Power.
5. Encouragement.
6. Enthusiasm.
7. Authority.
8. Responsibility.
Antecedent
Antecedent situations are essential circumstances that must occur prior to the
empowerment process begins. Respect is a vital antecedent to the empowerment process
because a person must always have respect and attentiveness for individuals' believes and
values (Tones, 1986, Manthey, 1992). In addition, education is a very significant transporter
for empowerment persons (Mason, et al, 1991; D'onofrio, 1992). In the same way; trust is a
Empowerment concept 9
cornerstone to empowerment that develops from directness, integrity, authenticity, open
communication, and mutual relation between the individuals. The empowerer must trust
Manthey, 1992).
The shared commitment is very important antecedent, because the empowerment will
contribution are very significant antecedents to perform the process of empowerment in a
success way (Labonte, 1989 & O'neill, 1992). Persons also must have the ability to think
about how human behaviors need to be changed, by thinking about the advantage and
disadvantage of behavior change, and problem solving with persons to achieve the goal of
The empowerer must acquire and use specialized skills, knowledge, good manners,
and recognition of some behaviors that promote empowerment, For example, an antecedent
empowerment. As an empowered nursing staffs, the RN's will recognize from their previous
knowledge and experiences about the communication and distribution of power.
Consequently, the empowered RN's will have a structure of references and will recognize the
improved by patient empowerment. Conversely, for the nurses who are not knowledgeable
about the empowerment, the roles of nurses and empowered patients will give unclear
impression with no clear line of responsibility. Then, most likely, the nurses will feel in
jeopardy, and at risk with patient empowerment. (Gurley, 1995).
Empowerment concept 10
Consequences
Consequences refer to product, result or outcomes of the empowerment process. The
outcome of empowerment process encloses improved selfconfidence (Tones, 1986; Mason,
et al, 1991). A sense of manage over life and the alteration of processes (French, 1990,
Mason et al. 1991, Zerwek, 1992). The capability to put and achieve goals (French,
1990).The empowerment process is a verification of thoughts, ambitions, abilities, and one's
principles, believes, and values (Mason, et al, 1991).
Accordingly, the empowerment process includes alteration of awareness, in which the
borders of personality develop into more transparent and expand with the intention that a
sense of attachment will produce (Wallerstein and Bernstein, 1988). The result of the ability
to empower persons, families, and communities, as revealed in the literature, involved: self
improvement, a feeling of trust, selfefficiency, a sense of attachment, personal satisfaction, a
sense to manage or control, enhance ability to problem solving, communication, leadership
and management skills, get better quality of life, and social fairness (American nurse's
foundation, 1989, Dunst et, al.1988, Kieffer, 1984, labonte, 1989, Wallenstein and Bernstien,
1988).
The consequences of patient empowerment process in the health care sector arrive
further than patient outcomes. Furthermore, the consequences of patient empowerment
consist of doctor impact, healthcare payer impact, nursing staff impact, regulation and policy
impact, and organizational impact. (Craddock and Skinner, 2000). Empowerment moves
toward diminishing the sense of gratitude felt by the patient to the nurse. As a result, the
psychological costs of accepting help are diminished. (Dunst et, al. 1988).
Empowerment concept 11
Application to nursing
Ammar, a 62yearold post mitral valve replacement surgery patient, arrived at the
hospitalbased cardiac rehabilitation clinic in King Abdullah University Hospital with his
son. The cardiac rehabilitation nurse Ashraf took them into special room, where he spent
about one assessing physical, psychosocial, and cultural aspects (showing signs of strong
participation, acquiring knowledge, and good individual listening). Ashraf, after finishing
physical assessment, gave some instructions about benefits of home exercise, how to monitor
blood pressure and weight, and explained a plan for dietary changes related to sodium and fat
restrictions (Active listening by the patient and his son).
the patient and his son to evaluate their knowledge about the instructions given (strong
listening by Ashraf). Also, he gave written instructions. The patient expressed some fears and
stress during rehabilitation exercises.
At the second day, the patient asked Ashraf about the range of exercises that must be
completed. (Exhibiting personalized information and good listening to help patient and his
son about health behavior changes).Ammar followed the instructions given to him by Ashraf
and kept in contact with Ashraf for any explanations needed later. The program was
successfully achieved, as proofed by decreased serum lipids and increased exercise tolerance.
Ammar demonstrated compliance in attending appointments at the cardiac clinic, and kept
the latest modifications of his life style on.
The given example illustrated good listening; acquired knowledge, and active
assuming the role of facilitator and giver of knowledge for these specific groups of patients,
and afforded mutual listening to patient comments, and personalized information for Ammar
Empowerment concept 12
and his son to get the maximum benefit. Ammar adapted health behavior changes through
following rehabilitation program instruction
Contrary case
Ahmad a 51yearold teacher who diagnosed as unstable angina by the residence
doctor at the Emergency room of King Abdullah university hospital. Ahmad has feel of
tiredness and fatigue while he was teaching a class in the school. Some of the students advise
discoloration of his skin has been started.
Suddenly the teacher was laying in the floor, emergency medical services brought
teacher Ahmad to emergency room of King Abdullah hospital, after the doctor has diagnosed
Ahmad unstable angina, Ashram who was a good nurse has assigned to work with Ahmad
case, started to teach Ahmad how to deal with his disease by the appropriate medical method
to prevent further complication or any advancement related to his disease process. Ahmad
was ignoring Ashraf dialogue and was asking Ashraf to complete his communication,
because he was want to smoke a cigarette (lack of participation, a defining attribute).
After with, Ahmed has returned to the hospital emergency room by emergency
medical services with three of students, they were worry about their teacher, the cardio
pulmonary resuscitation established at emergency room because of cardiac stopping. Students
inform the nurse that teacher was smoking post each class, and so on till they brought him to
the emergency room. Autopsy shows progressive of disease process proofed by myocardial
infarction.
Ahmad case shows lack of active participation and good listening with nurse, so no
empowerment process achieved, Ahmad non compliance to the healthy behavior that was in
order to changing his habit exemplified the opposite of empowerment .
Empowerment concept 13
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