Academic journal article Research and Theory for Nursing Practice

Concept Analysis of Empowerment from Survivor and Nurse Perspectives within the Context of Cancer Survivorship

Academic journal article Research and Theory for Nursing Practice

Concept Analysis of Empowerment from Survivor and Nurse Perspectives within the Context of Cancer Survivorship

Article excerpt

The liberal usage of the concept of empowerment has led to the development of a broad and ambiguous term. In health care, empowerment is a core principle of patient-centered care that promotes patient engagement in health management. This is an analysis of the concept of empowerment within the context of cancer survivorship using both Rodgers' evolutionary concept analysis and Caron and Bower's dimensional analysis. The dimensional analysis followed the evolutionary concept analysis as the perspectives of patients and nurse providers emerged in the analysis. Data sources included a sample of 249 papers from multiple disciplines covering the period 2000-2013. Empowerment is defined as power-with that is actualized through a beneficial relationship of mutual trust and respect for autonomy that develops within a dynamic and patient-centered process. The attributes, along with the antecedents and consequences, provide a foundation for future theory development of empower- ment in the context of cancer survivorship. This analysis demonstrated that although nurses and survivors may have a similar definition of the concept of empowerment, the uses and assumptions of that definition may differ. Future studies should be conducted measuring the effectiveness of an intervention that uses the components of the process of empowerment from survivors' perspectives.

Keywords: concept analysis; empowerment; chronic illness; cancer; patient participation; patient-centered care

The liberal usage of the term empowerment to describe any event in which individuals or groups take control of some aspect of their lives (Malterud, 2010) has led to a broad and ambiguous understanding of the term (McCarthy & Freeman, 2008). New initiatives within health care reform encourage patient engagement in health management through the process of empowerment as the burden of chronic illness grows; now accounting for 60% of deaths worldwide (Improving Chronic Illness Care, 2012; National Institutes of Health, 2011). Advances in technology and treatment have resulted in the reconceptualization of cancer as a terminal to a chronic illness, a shift of focus from cancer patients as victims to survivors (National Coalition for Cancer Survivorship [NCCS] ,2010), and a consumer movement advocating for improved care strategies for survivors (Hewitt, Greenfield, & Stovall, 2005). Development and specification of the concept of empowerment within the context of survivorship is needed to provide a foundation for interven- tions to improve the cancer survivor's experience.

BACKGROUND

According to the NCCS (2011), patients are cancer survivors from the time of diagnosis until death. Empowerment is a practical way to address the feelings of uncertainty and vulnerability associated with the complexity of treatment that cancer survivors experience (Ganz, 2009; Peck, 2008) because it facilitates patient engagement in care planning and self-management of health (McCorkle et ak, 2011) during and after cancer treatment. Although patients are ultimately the ones responsible for engaging in self-management behaviors, it is well-recognized that nurses can strengthen patients' self-management abilities by providing support and guidance (Kawi, 2012; McCorkle et ak, 2011).

The World Health Organization (2009) recently rallied for empowerment as a way to advance health promotion efforts and improve health outcomes. The NCCS (2006) urges cancer survivors to become knowledgeable and informed consumers so that they have an understanding of possible late-onset treatment effects, self-management expectations, and surveillance plans (Morgan, 2009). Although survivors are expected to become self-advocates in their care so that they can navigate the complex health care system safely and efficiently (Hagan & Donovan, 2013), much of the survivorship literature focuses on the content of cancer survivorship care rather than methods providers can use to actively engage survivors in their care (Marbach & Griffie, 2011). …

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