Empowerment

Issues of Concern

Empowerment has found its use in a wide variety of causes and groups, such as the women’s movement, gay rights, the black power movement, AIDS patients, students, teachers, and employees. Empowerment has become well-studied in various disciplines such as education, philosophy, social work, business, and nursing.[4][5][6]

Empowerment is viewed as a process or an outcome. Looking broadly, it is a process by which people, organizations, and communities gain power. As a result, empowerment reflects a quality or property a nurse possesses, allowing for influence over their environment. The focus of empowerment as an outcome is more on solutions than problems.

Empowerment at the community level is people uniting to accomplish common goals. Two underlying assumptions exist in the literature regarding empowerment and the community. First, every person has the potential to become empowered. Second, it is an assumption that empowered communities develop from empowered individuals working together to achieve a mutual goal for that community. Fostering relationships within the community is an integral part of successful empowerment.

If empowerment in the community emerges from the individual, how does the person gain the skills to be empowered? In cognitive psychology literature, empowerment means to enable one to act. Psychological empowerment at the individual level is a link between a sense of personal control and efficacy and a willingness to change and take action. Empowerment is a process enabling individuals to understand the relationship between their actions and outcomes, allowing people the power to achieve the results they desire.

Empowerment is an intrinsic motivation made up of four cognitions: meaning, competence, self-determination, and impact. These reflect a person’s orientation to their work. Building on this premise, the four cognitions can be defined as follows:[7] 

• Meaning is the fit between the requirements of a work role and a person’s beliefs, values, and behaviors;
• Competence is the self-efficacy related to work, the belief in one’s capability to perform work activities with skill;
• Self-determination is a sense of choice in initiating and regulating actions;
• The impact is the degree to which a person can influence strategic, administrative, or operating outcomes at work.
• Empowerment comes from within the individual and manifests in decision-making.

Motivation regarding empowerment is present throughout the literature, but what seems to be lacking is explaining what factors motivate people to change their behaviors successfully and determine the time required for behavioral change. Wach, Darbach, Ruffind, Bruken, and Spinath (2016) suggest empowerment is the belief or motivational state found within the individual. Knowledge and skill are necessary components but are not sufficient to bring out change. Viewed through the lens of the Self-efficacy Theory developed by Bandura, human behavior is a continuous interaction between behavior, cognitive, and environmental influences. When individuals with low self-efficacy encounter stressful situations, they tend to doubt their abilities, decrease their efforts, or give up altogether. On the contrary, people with high self-efficacy will exert greater effort to bring about the desired changes. Empowering an individual will increase their self-efficacy.

Empowerment can be examined from an organizational level as well. As a psychological construct, empowerment often is seen as different from work autonomy. Merriam-Webster defines autonomy as self-directing freedom. Autonomy can be attributable to the design of the job, allowing the person to be in charge of how they go about their work and how they use personal initiative to complete their jobs. Others cite that job autonomy is a determinant of empowerment. Highly autonomous tasks encourage empowerment, allowing the individual a choice in job-related activities, although autonomy alone is not reflective of empowerment.

In business, Rosabeth Kanter viewed empowerment as access to information, support, resources, and opportunities within the work setting. Empowerment is developed or supported from within the organization; it is external to the person. She describes six components of empowerment: (a) opportunity, (b) information, (c) support, (d) resources, (e) formal power, and (f) informal power. Kanter’s theory maintains that people are empowered to reach organizational goals if their work environments provide access to information, support, and resources necessary to perform their jobs, as well as access to learning opportunities. Personal behavior in organizations is determined by the work environment and conditions related to the organization's operation, not by individual personality traits.[8][9]

Clinical Significance

The history of nursing provides the roots of a lack of empowerment within the nursing profession. An emphasis on self-sacrifice, charitable work, and obedience when following physicians' orders contributes to the lack of empowerment. In general, nurses have been viewed by society as being in a powerless position, with poor performance and high levels of attrition and dissatisfaction within the profession. Studies trace this back to the early 1960s when discrepancies between professional and bureaucratic roles within nursing were present. In the 1970s, nurses were identified in the literature as lower on the hierarchical structure compared to other healthcare providers, identifying a phenomenon that continues to this day, with many nurses experiencing shock as they enter the nursing profession.

Empowerment within nursing is defined as community advocacy, patient care, and empowerment of nurses. Nursing literature offers many definitions of empowerment similar to those in other disciplines, focusing on the outcomes of nurses and empowering the patient. Several concept analyses of empowerment examine its attributes, characteristics, and uses. Many studies have linked an empowering work environment to job satisfaction, engagement in one’s job, and intent to remain in the current position (Cziraki & Laschinger, 2015; Han, Trinkoff & Gurses, 2015; Wirtz, Rigotti, Otto & Loeb, 2016). Healthy work environments encourage empowerment in employees. Within nursing, shared governance is one example of a healthy work environment (Brull, 2015), allowing employees to have a say in their work.

Nursing, Allied Health, and Interprofessional Team Interventions

Empowering nursing staff to be more active participants in patient care will result in improved patient outcomes, as nurses become more clinically competent and relevant and are empowered to interact and provide input regarding patient care instead of merely being agents who blindly follow orders from clinicians. This will also reduce medication and other medical errors, resulting in improved patient outcomes. [Level 5]