A few years ago, while critiquing a text for a publication, I mentioned that the focus was to empower older adults to take charge and control of their care. The journal technical writer called me on the phone to make certain I had not misspelled a word, since she had difficulty finding empower in the dictionary.
That is no longer the case; the word is often seen. John Nesbitt and Patricia Aburdene in Megatrends 2000 discuss computers, cellular phones, and fax machines as empowering individuals.1 How can the information technology readily available to us as health-care practitioners enable us to empower our older clients, patients, residents, and family members? My initial thought on empowering the older adult is to define what we mean and then decide if the decision is worth the challenging effort involved. I use the word "challenging" because one has to be willing to accept a challenge to make the outcome a reality. Ultimately, the gerontology professional has to make a commitment to this effort.
Empowerment, now defined by Webster, means to enable. For our purposes, empowerment is defined as "fostering independence of the older adult." The 1990 census reports startling numbers of older adults; however, none that have not been previously anticipated. We now have the created challenge to act on these statistics and empower older adults in all settings: care, institutional, residential, home, and community settings.
Specifically, for nursing, empowerment of the elderly is embedded in a frustration "that we can never do enough." The nurse in an acute care setting attempts to teach her patients and instruct caregivers prior to discharge. The challenge created is for the institution to have a specific "patient educator" and use fact sheets developed by the institution for specific interventions, discharge criteria, and drug interactions. The nurse must, in reality, begin that discharge plan immediately and outline selfcare practices for the client and family to initiate. All too often, teaching occurs 1 5 to 30 minutes prior to leaving. Ideally, the education discharge materials should be developed in a simple format on yellow paper and large, black print. A refrigerator magnet should be provided to the patient or significant others. It could have a phrase on it specific to the instruction, eg, "medication alert."
Frustrated home care nurses who need only a few more visits to feel comfortable about a family's and patient's ability to "handle things" are bound by paper dictating their visits. Their efforts at empowerment must be dictated by the community they serve. Volunteer- based groups can be trained from churches and high school service organizations, fifteen years ago, student nurses provided basic and assistive care to prevent institutionalization. The students were part of a grant written with the agency and were paid a minimal salary. A volunteer organization entitled "Rsh" was created through a coalition of churches in the area. Volunteers signed up a month in advance for the days and times they were available to transport patients to clinics, doctor appointments, or diagnostic tests. The list was circulated among all the agencies and provided an invaluable service. The churches rotated the coordination of the program. Innovative community approaches as well as grant/foundation support must be attempted to keep our elders functioning in their homes and communities as long as possible.
Conceptually, motivation is the key that must exist within the client for a change to healthy behavior to occur. Sharon Williams Utz suggests that nurses view motivation holistically. Orem's self-care deficit theory describes motivation as one of the power components of self-care to which the nurse can attend to help clients harness their energies. Within this framework, the nurse respects personal autonomy in decision making, capitalizes on the client's strengths, and empowers the person to promote health and healing. "But if the nurse is to enable the person to want to take care of himself or herself, great skill must be exercised in presenting information to enhance healthful decisions and actions."2
Cost containment now dictates our practice, and as nurses we know that it is difficult to price quality. Empowering the elderly may be an outcome measure to place into our quality assurance criteria. Doctors must also develop outcome measures for reimbursement and ally themselves more with the community to define these measures. Challenge surrounds us to not only make it work, but also to provide for prevention of chronicities and further loss.
The word CARE is developed to specifically designate professional nursing empowerment in varied disciplines.
C - Clinicians must develop selfcare components to their care plans and involve significant others in discharge planning. Continuity of care plans are needed to go home with the patient or to another facility if he or she is transferred.
A - Administrators should investigate the reality of a discharge holding unit or specific beds on a unit where patients plan for home.
R - Researchers must develop implications for home care in clinical design studies. More research is needed applicable to home care and middle age to prevent/empower adults as they age.
E - Educators should expand their ambulatory care undergraduate curriculum to have a prevention focus and teach responsibility for self-care and contracting with patients for that care.
The demographic realities dictate an ambulatory health-care agenda, and that can only be fruitful if control is given to the recipient of health care. Motivating the older adult to accept physical change and prevent further chronicity must be an ongoing goal: we will be empowerment facilitators and offer our older cliente choices. These may require our involvement in legislative dictates, nursing home reform, and developing an advocacy attitude toward the older adult. Empowering the powerless must dictate our practice.
Although I have offered only a few ideas, it will be up to each of us to develop individual practices for our clients and assist their family members with the responsibilities of caregiving. You are invited to submit specific ideas on empowering the older adult; what has worked for you may help others. Empowerment must be the gerontological nursing imperative for the future. Come with me as I recommit to the awesome challenge ahead.
- 1. Nesbitt J, Aburdene P. Megatrends 2000. New York: Megatrends, Ltd; 1990.
- 2. Utz SW. Motivating self-care: A nursing approach. Holistic Nursing Practice. 1990; 4(2): 13-21.