APPLICATION OF COMMUNITY EMPOWERMENT TO PRACTICE NR.110.500 Philosophical, Theoretical, and Ethical Basis for Nursing Sara Cawrse, Jamie Hatcher, Sandeep Lehil, & Jessica Vargas
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1. APPLICATION OF COMMUNITYEMPOWERMENT TO PRACTICENR.110.500
Philosophical, Theoretical, and Ethical Basis forNursingSara
Cawrse, Jamie Hatcher, Sandeep Lehil, & Jessica Vargas
2. INTRODUCTIONApply the CommunityEmpowerment theoryto
socio-economicallydisadvantaged, urbanAfrican Americans
withuncontrolled type 2diabetes
3. PROBLEM & SIGNIFICANCE According to ADA, African
Americans (AA) are athigh risk for diabetes In 2005, more than 18
million adults had diabetes in the United States AA are 1.6 times
more likely to develop diabetesthan non-Latino Whites(Green,
McClellan, Gardner, & Larson, 2006)
4. PROBLEM & SIGNIFICANCE AA tend to have poorer outcomes.
Social, economic, and environmental factorscontribute to health
disparities (Green, McClellan, Gardner, &Larson, 2006).
Differences in glucose control persist between AAand Whites even
after adjusting for socioeconomicstatus, access to health care, and
severity ofdisease (Marshall, 2005).
5. PROBLEM & SIGNIFICANCE AA increased rates ofdiabetic
sequelaeincluding retinopathy, microalbuminuria, end stage renal
disease, lower extremity amputation mortality(Green, McClellan,
Gardner, & Larson, 2006;Marshall, 2005).
6. PROBLEM & SIGNIFICANCE AA less likely to attain glucose
control Possible reasons: Poor compliance with self-monitoring Poor
adherence to treatment Cost of test strips and drugs Literacy rates
Lack of diabetic education Sociocultural components Physician
related factors
7. PROBLEM & SIGNIFICANCE Patients who are able to control
theirdiabetes, (Green, McClellan, Gardner, & Larson, 2006;
Austin & Claiborne, 2011): Often have friends or family with
diabetes Seek out information about the disease Evidence-based
self-management strategies Accurate perceptions of their own
diabetes control Experience turning point events
8. PROBLEM & SIGNIFICANCE Further focus needed on:
Preventing and controlling diabetes in this population Alternative
interventions to traditional primary care
9. N U R S I N G T H E O RY: C O M M U N I T YEMPOWERMENT
Developed by Eugenie Hildebrandt and CynthiaArmstrong Persily
(Persily & Hildebrandt, 2008) Middle range nursing theory Built
off both empowerment and the communitydevelopment theories Creates
a community involvement approach Members of the community take
responsibility forincreasing their knowledge and
decision-makingabilities.
10. N U R S I N G T H E O RY: C O M M U N I T Y EMPOWERMENT
Three main concepts:InvolvementLay WorkersReciprocal Health
Involvement: Done through planning, implementing, and interveningas
a group (Persily & Hildebrandt, 2008)
11. N U R S I N G T H E O RY: C O M M U N I T YEMPOWERMENT Lay
Workers (Persily & Hildebrandt, 2008): Trained persons
indigenous to the community to which they live in and work in.
Reach out to families in the community Know community cultural
values firsthand Encourage preventative services, healthy
behaviors, and assist with access to social services
12. N U R S I N G T H E O RY: C O M M U N I T YEMPOWERMENT
Reciprocal Health (Persily &Hildebrandt, 2008): Actualization
of inherent and acquired human potential. Occurs when professionals
and community residents work together, respecting, an d sharing
what each other has to offer.
13. N U R S I N G T H E O RY: C O M M U N I T
YEMPOWERMENT(Smith & Lierhr, 2008)
14. E VA L U AT I O N : S I G N I F I C A N C E Clearly
addresses the metaparadigm concepts ofthe person, the environment,
health, andnursing goals/processes. Person Environment Health
Nursing goals/processes
15. E VA L U AT I O N : S I G N I F I C A N C E The
metaparadigm propositions addressed include: life processes
patterns of human-environment interaction processes that affect
health interaction between health and environment Philosophical
basis: the foundation of this theory isthat through empowerment
change is possible.
16. E VA L U AT I O N : S I G N I F I C A N C E Merging of the
empowerment theory and thecommunity development theory.
Development: individuals and groups "grow throughcommunity
participant interaction and achievementof identified goals."
Empowerment: developing problem-solvingcapacity and competence that
allows individualsand communities to gain mastery over their
lives.(Persily & Hildebrant, 2008)
17. E VA L U AT I O N :CONSISTENCY & CLARITY Congruency
between context and content Context Content
18. E VA L U AT I O N :ADEQUACY & FEASIBILITYBased on
Fawcetts (2005) criteria for adequacy of a theory, the
CommunityEmpowerment Theory is pragmatically adequate and feasible.
Feasible to implement practice derived from this theory, The
practitioner has the legal ability to implement and measure
theeffectiveness of theory-based nursing actions, Compatible with
expectations for nursing practice, Theory-based nursing actions
lead to favorable outcomes, Comparisons can be made between
outcomes of use of the theory andoutcomes in the same situation
when the theory was not used Outcomes are measured in terms of the
problem-solving effectiveness ofthe theory.The Community
Empowerment Theory has not shown to be empiricallyadequate as a
systematic review has not been done.
19. RATIONALE FOR THEORY SELECTION Significant disparities
exist between AA and whites withregards to diabetes management and
the rates ofassociated morbidity and mortality, AA face several
barriers: including poor access tocare, limited resources for
physical activity due toresidential barriers, and interference of
care due to otherlife events or stressors (Samuel-Hodge, et al.,
2000). Can address barriers by: Bringing the care to the patient
through lay-educators, Altering the care so that it is appropriate
and reasonable for the patients lifestyle and culture. For diabetes
management to be effective, it must beapproached with an
understanding of the populationssocial, cultural, and familial
influence (Chesla, et al., 2004; Samuel-Hodge, et al., 2000; Two
Feathers, et al., 2005)
20. POSSIBLE SOLUTION Community health worker (CHW) programs
haveshown promise in improving health behaviors andhealth outcomes
Particularly for racial and ethnic minoritycommunities and for
those who have disparateaccess to health care (Spencer, Rosland,
Kieffer, Sinco, Valero, Palmisano, &Anderson, 2011).
21. POSSIBLE SOLUTION CHWs use their ethnic, cultural, or
geographicbackgrounds to promote health within their
owncommunities.
22. EXAMPLE OF THEORY IN USE In Heisler, Spencer, Forman, et
al.(2009), participants felt CHWs gave them clearand specific
strategies on managing diabetescare, nonjudgmental assistance to
increaseconfidence in maintaining diabetic care, and socialand peer
support. CHW programs may be effective in promoting moreeffective
diabetes care and patientdoctorrelationships among African-American
adults withdiabetes than without CHW support(Heisler, Spencer,
Forman, et al., 2009).
23. POTENTIAL PROBLEMS WITHIMPLEMENTING Most studies on
community health workers havenot used a randomized controlled trial
design. Studies have small samples in a localizedneighborhood and
therefore have threats toexternal validity. Potential problems may
arise with training andretaining community health workers
whenimplementing programs (Hill-Briggs, Batts-Turner, Gary,
Brancati, Hill, Levine, Bone, 2007).
24. REFERENCESAustin, S. A., Claiborne, N. (2011). Faith
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(2004).Family and disease management in African-American patients
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(2005). Criteria for evaluation of theory. Nursing Science
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Levine, D. M., McGuire, M. Saudek, C., and Brancati, F. L.(2003).
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25. REFERENCESMadden, M. H., Tomsik, P., Tercheck, J.,
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