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Community empowerment presentation
1. APPLICATION OF COMMUNITY
EMPOWERMENT TO PRACTICE
NR.110.500 Philosophical, Theoretical, and Ethical Basis for
Nursing
Sara Cawrse, Jamie Hatcher, Sandeep Lehil, & Jessica Vargas
3. PROBLEM & SIGNIFICANCE
According to ADA, African Americans (AA) are at
high risk for diabetes due to:
Genetics
High rates of obesity
Low levels of physical activity
In 2005, more than 18 million adults
had diabetes in the United States
AA accounted for a disproportionate amount (Green, McClellan,
Gardner, & Larson, 2006).
AA are 1.6 times more likely to develop diabetes
than non-Latino Whites
4. PROBLEM & SIGNIFICANCE
AA have higher rates of diabetes than their white
counterparts, and tend to have poorer outcomes.
Social, economic, and environmental factors
contribute to health disparities (Green, McClellan, Gardner, & Larson,
2006).
Differences in glucose control persist between AA
and Whites even after adjusting for socioeconomic
status, access to health care, and severity of
disease (Marshall, 2005).
5. PROBLEM & SIGNIFICANCE
AA increased rates of
diabetic sequelae
including
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 their diabetes, (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
Peer support and education
Community Empowerment Theory
9. N U R S I N G T H E O RY: C O M M U N I T Y
EMPOWERMENT
Developed by Eugenie Hildebrandt and Cynthia
Armstrong Persily (Persily & Hildebrandt, 2008)
Middle range nursing theory
Built off both empowerment and the community
development theories
Creates a community involvement approach
Members of the community take responsibility for
increasing their knowledge and decision-making
abilities.
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:
Involvement
Lay Workers
Reciprocal Health
Involvement:
People in the community create support groups or
coalitions to identify their mutual needs, resources, and
barriers to ultimately respond to a problem the
community is facing.
Done through planning, implementing, and intervening
as 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 Y
EMPOWERMENT
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 Y
EMPOWERMENT
Reciprocal Health (Persily &
Hildebrandt, 2008):
Actualization of inherent
and acquired human
potential.
Occurs when professionals
and community residents
work together, respecting,
and sharing what each
other has to offer.
Desired outcome of
community empowerment
as community members
participate proactively in
ways to attain their highest
potential.
13. N U R S I N G T H E O RY: C O M M U N I T Y
EMPOWERMENT
(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 of the
person, the environment, health, and nursing
goals/processes.
Person: members of the community (these are the
individuals who will receive the care/intervention)
Environment: community itself as well as the
community's social constructs, the neighborhood, and
the economy of the community
Health: issues identified by the community as important
to address
Nursing goals/processes: empowerment of members
of the community (lay persons and other community
members) in order to promote changes that will address
the needs and issues identified by the community
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 is
that 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
Derived from a merging of the empowerment theory and the community
development theory.
Posits that individuals and groups "grow through community participant
interaction and achievement of identified goals."
Guided by models that advocate for supporting individuals and
communities to develop while working together on commonly identified
problems.
Empowerment involves developing problem-solving capacity and
competence that allows individuals and communities to gain mastery
over their lives.
Critical in primary health care
Part of the nurse-individual dyad
Vital for linking health care providers and communities.
When community development and empowerment are considered
together, they demonstrate the "potential for empowerment of community
people through the involvement of lay workers in promoting reciprocal
health” (Persily & Hildebrant, 2008).
It does not appear that the theory acknowledges use of adjunct or
antecedent theories.
17. E VA L U AT I O N :
CONSISTENCY & CLARITY
Congruency between context and content
Context: includes both change through empowerment
and that change must come from within (oneself or the
community).
Content: includes identification of problems by the
community and education of lay persons (members of
the community) who will then educate others in the
community, thus empowering them to change.
The content is semantically clear and consistent.
18. E VA L U AT I O N : A D E Q U A C Y
The theory assertions appear to be fairly well
supported by empirical evidence.
The theory itself was developed based on the
experiences and observations of the two theorists
and has been applied by them in their research.
19. E VA L U AT I O N : F E A S I B I L I T Y
Pragmatic adequacy:
Special training and skills may be required
Implementing the theory primarily be limited by the motivation of
the community
Cost may or may not be a factor
Legally, the nurse will likely be practicing within her scope of
practice when providing health education to the lay persons and
measuring its effectiveness within the community.
Education and empowerment and key components of nursing practice,
The theory is organized in such a way that, should one want to,
Comparisons could be made between a community in which this
theory was applied and a community in which the theory was not
used
Outcomes to be measured would depend upon the problems
identified by the community
Measurement of such outcomes should accurately indicate the
effectiveness of the theory.
20. RATIONALE FOR THEORY SELECTION
Significant disparities exist between AA and whites with
regards to diabetes management and the rates of
associated morbidity and mortality,
AA face several barriers: including poor access to care,
limited resources for physical activity due to residential
barriers, and interference of care due to other life 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 patient’s lifestyle and culture.
For diabetes management to be effective, it must be
approached with an understanding of the population’s
social, cultural, and familial influence (Chesla, et al., 2004; Samuel-
Hodge, et al., 2000; Two Feathers, et al., 2005)
21. POSSIBLE SOLUTION
Community health worker (CHW) programs have
shown promise in improving health behaviors and
health outcomes
Particularly for racial and ethnic minority
communities and for those who have disparate
access to health care (Spencer, Rosland, Kieffer, Sinco, Valero, Palmisano, &
Anderson, 2011).
CHWs can provide comprehensive care regarding social
and some medical needs at a less expensive cost (Gary,
Bone, Hill, Levine, McGuire, Saudek, & Brancati, 2003).
22. POSSIBLE SOLUTION
CHWs use their ethnic,
cultural, or geographic
backgrounds to promote
health within their own
communities.
They are a bridge for those with disparities to accessible
healthcare
Become part of the patient’s support system
Can also provide resources, transportation, and
coordinate case management.
23. EXAMPLE OF THEORY IN USE
In Heisler, Spencer, Forman, et al. (2009), participants
felt CHWs gave them “clear and specific strategies on
managing diabetes care, nonjudgmental assistance to
increase confidence in maintaining diabetic care, and
social and peer support”.
CHW programs that provide both one-on-one support
and group self-management training sessions may be
effective in promoting more effective diabetes care and
patient–doctor relationships among African-American
adults with diabetes than without CHW support (Heisler,
Spencer, Forman, et al., 2009).
24. POTENTIAL PROBLEMS WITH
IMPLEMENTING
Most studies on community health workers have
not used a randomized controlled trial design.
Studies have small samples in a localized
neighborhood and therefore have threats to
external validity.
Potential problems may arise with training and
retaining community health workers when
implementing programs (Hill-Briggs, Batts-Turner, Gary, Brancati, Hill, Levine,
Bone, 2007).
25. REFERENCES
Austin, S. A., Claiborne, N. (2011). Faith wellness collaboration: A community-based approach to
address type II diabetes disparities in an African-American community. Social Work Health
Care, 50(5), 360-375.
Chesla, C. A., Fisher, L., Mullan, J. T., Skaff, M. M., Gardiner, P., Chun, K., & Kanter, R. (2004).
Family and disease management in African-American patients with type 2 diabetes. Diabetes
Care, 27: 2850-2855.
Fawcett, J. (2005). Criteria for evaluation of theory. Nursing Science Quarterly, 18(2), 131-135.
Gary, T. L., Bone, L. R., Hill, M. N., Levine, D. M., McGuire, M. Saudek, C., and Brancati, F. L.
(2003). Randomized controlled trial of the effects of nurse case manager and community health
worker interventions on risk factors for diabetes related complications in urban African
Americans., 37 (1), 23–32.
Greene, C., McClellan, L., Gardner, T., & Larson, C. O. (2006). Diabetes management among low-
income African Americans: A description of a pilot strategy for empowerment. Journal of
Ambulatory Care Management, 29(2), 162-166.
Heisler, M., Spencer, M., Forman, J., Robinson, C., Shultz, G., Graddy Dansby, G., Kieffer, E.
(2009). Participants' assessments of the effects of a community health worker Intervention on
their diabetes self-management and interactions with healthcare providers. American Journal of
Preventive Medicine, 37(6, 1), S270-S279.
Hill-Briggs, F. Batts-Turner, M., Gary, T. L., Brancati, F. L., Hill, M. N., Levine, D. M., Bone, L. R.
(2007). Training community health workers as diabetes educators for urban African Americans:
Value added using participatory methods. Progress in Community Health Partnerships:
Research, Education, and Action, 1(2), 185-194.
26. REFERENCES
Madden, M. H., Tomsik, P., Tercheck, J., Navracruz, L., Reichsman, A., Clarck, T. C., & Werner, J.
J. (2011). Keys to successful diabetes self-management for uninsured patients: Social support,
observational learning, and turning points. Journal of the National Medical Association, 103(3),
257-264.
Marshall, M. C. (2005). Diabetes in African Americans. Postgraduate Medical Journal, 81(962),
734-740.
Persily, C. A. & Hildebrant, E. (2008). Theory of community empowerment. In Smith, M. J. & Lierhr,
P. R. Middle Range Theories for Nursing (2nd Eds.). New York, NY: Springer Publishing
Company.
Samuel-Hodge, C. D., Headen, S. W., Skelly, A. H., Ingram, A. F., Keyserling, T. C., Jackson, E. J.,
& Elasy, T. A. (2000). Influences on day-to-day self-management of type 2 diabetes among
African American women. Diabetes Care, 23: 928-933.
Shacter, H. E., Shea, J. A., Achabue, E., Sablani, N., & Long, J. A. (2009). A qualitative evaluation
of racial disparities in glucose control. Ethnic Disparities, 19(2), 121-127.
Spencer, M. S., Rosland, A. Kieffer, E. C., Sinco, B. R., Valero, M., & Palmisano, G., Anderson, M.,
Guzman, R., & Heisler, M. (2011). Effectiveness of a community health worker intervention
among African American and Latino adults with type 2 diabetes: A randomized controlled trial.
American Journal of Public Health, e1-e8.
Two Feathers, J., Kieffer, E.C., Palmisano, G., Anderson, M., Sinco, B., Janz, N., & James, S. A.
(2005). Racial and ethnic approaches to community health (REACH) Detroit partnership:
Improving diabetes-related outcomes among African American and Latino adults. The American
Journal of Public Health, 95(9): 1552-1560.