1. Exemplar

Health care providers such as nurses come across patients that come from different socio-economic, cultural, and educational background. Among the many healthcare providers, nurses spend tremendous amount of time with their patients have earned the greatest amount of trust. This amount of time and close contact with patients is a great opportunity to inform, educate and empower clients.

Patients come to hospitals seeking health care for different kinds of health-related problems. Providers then help resolve the health-related issues that clients might have with different level of services. These services provided primarily fall under primary, secondary, and tertiary health care categories. According to world health organization (2011), “while primary health care mainly focusses on health equity producing social policy beyond the traditional health care system, secondary healthcare is provided by medical specialists. The third category, tertiary health care is concerned with advanced medical investigation and treatment”.

The area that needs improvement in this hierarchy is, primary health care that focusses on health equity and social policy beyond the traditional health care system. This arm of health care service could be utilized more in empowering nurses, patients, and family members.  Using the great deal of patient contact and trust nurses have, this opportunity could be used to influence healthcare related policies, laws, and ethical issues for the advancement of community health. When patients are equipped with socio-economic, cultural, and political knowledge, they can make the right decision when it comes to social concerns such as health care coverage law votes that affect their health.

At University and Metro Hospitals, patients come to my assigned floor with late stage cancer, heart disease, and other chronic and acute illnesses. These diseases processes took place over time and intervention at the source of the disease process before it had happened would have saved these patients lives. These patients could benefit from community empowerment programs that addresses the root cause of their illnesses. These root causes of health issues include lack of affordable fitness centers, lack of affordable health insurance, lack of access to fresh fruits and vegetables in their neighborhoods, and lack of strong advocacy group that could exert influence on health care policy makers among many others as well as patient education outside hospital setting. For these interventions to work, we need affordable health care insurance, strong policies that promote communities’ health, strong organized patient advocacy group, and other supportive infrastructures. And these changes are dependent up on well informed community with voting power and nurse advocacy group that exerts influence on our policy makers.

I chose this situation because I realized that we are focused too much on treating symptoms and not the underlying problem that caused the disease or illness. We need strong organized Nurse group that works to educate patients as well as exercise authority on elected officials to bring a positive change geared towards health care system in the USA. Such community empowerment and Nurse organization could address the root cause of chronic and acute illnesses in a community. I chose this situation is because the root cause of health problems associated with policies, laws, and legislations that affect our patient’s health. Bringing social awareness and having influential community organization would be the expected outcome of this proposed nurse and community organization

I would like to see systemic changes that benefit the greater good of society in building strong healthy society. I would like to see a strong nurse advocacy group that stands for a community and fend off any faulty social policy in our health care system that put people’s lives at risk. I would like us to address chronic and acute illnesses at the grass root level before they get worse or even before they start to develop.

The outcome of such social change could be a well-informed society that is literate enough to be able to vote on the right health care reforms that brings positive outcome to the community. This outcome will be achieved with the help of a strong nurse advocacy group that lobby and exerts influence on policy makers to have the public’s best interest and not those of corporations or profit. This way, we expect to see less patients with late stage diseases and complications on our hospital floors.

2. Criteria

The criteria used in this paper to evaluate the theories used broad questions under the umbrella of significance, internal consistency, empirical adequacy, and pragmatic adequacy. Within each category, specific pertinent questions are also used to evaluate the theories. The source for the set of criteria used to evaluate the theories is Fawcett’s criteria for evaluation of nursing theories and pertinent questions. Faucett’s (2005) criteria are the following:

The first criteria used to evaluate the empowerment and emancipatory nursing praxis theories were the significance of the theories in utility in practice. The pertinent questions asked to evaluate these theories include whether the metaparadigm concepts, the philosophical claims, the conceptual model, and propositions are explicit. After looking at the significance of the theories, the internal consistency of the theories was evaluated for utility practice by asking questions such, as are the context and the content of the theory congruent? Do the concepts reflect semantic clarity and semantic consistency? Do the propositions reflect structural consistency? The next pertinent questions asked to evaluate the two theories with regards to the parsimony were; is the theory content stated clearly and concisely? Next, Testability of the middle-range theory was evaluated using pertinent question such as, does the research methodology reflect the middle-range theory? Are the middle-range theories concepts observable through instruments that are appropriate empirical indicators of those concepts? Do the data analysis techniques permit measurement of the middle-range theory propositions?  Finally, the two theories were evaluated based on empirical and pragmatic adequacy by asking questions like, are theoretical assertions congruent with empirical evidence? Are education and special skill training required before application of the theory in nursing practice?

Table 1: Faucett’s criteria for selection

(Fawcett, 2005)

3. Theories considered

Theory of community empowerment was developed by Eugenie Hildebrandt and Cynthia Armstrong Persily. Caerse et al. (2011) stated that, “this theory was developed to give direction to improving health in communities.” The first conceptualization of the theory came out of participatory action research using an exploratory design. The mid-range theory is a merging of empowerment and community development theory for promoting health by building relationships both at individual and community levels. Persily and Hildebrandt (2008) states that “The theory is mid-range theory built on empowerment and creates a community involvement approach. With this theory, members of the community take responsibility for increasing their knowledge and decision making abilities.”

According to Persely & Hildebrandt, 2008, “The three main concepts in this theory include involvement, lay workers and reciprocal health.” Vargas et al. (2011) explained that involvement means when people in the community create support groups 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.

Liehr and Smith (2008) stated that “the purpose of the theory is to provide a framework for research and practice through development of effective interventions at individual and community levels” (p.111). Caerse et al. (2011) found that empowerment theory  developing problem-solving capacity and competence that allows individuals and communities to gain mastery over their lives. 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.

Liehr and Smith (2008) also stated that “the lay worker concept involves trained persons indigenous to the community to which they live in and work in. These trained persons such as nurses reach out to families in the community. They know the community’s cultural values and they encourage preventative services, healthy behaviors, and assist with access to social services (p.113).

Here is where we can expand on the theory and add a new concept of empowering and informing the community. For example, informing a community about health care bill which is outside of the immediate health care needs of the community but directly affects the community. According to Caerse et al. (2011), the reciprocal aspect of the theory is concerned with the “actualization of inherent and acquired human potential. This occurs when professionals and community residents work together, respecting, and sharing what each other should offer”.

The reciprocal health is a concept where the community and professionals engage to promote proactive healthy behavior.

According to Fitzpatrick and Wallace (2006), “The theory was designed to structure a community involvement approach that enables community people to increase their knowledge and health care decision making capabilities. The desired outcome of community empowerment as community members participate proactively in ways to attach their highest potential” (p.343).

According to Caerse et al. (2011), “The community empowerment theory clearly addresses the metaparadigm of person, the environment, health, and nursing goals / processes and the theory explicitly states the members of the community who will receive the care/ intervention.”

The philosophical claims of this theory are also explicitly stated. Caerse et al. (2011), states that “the environment is mentioned as community’s social construct, as well as the neighborhoods, and the economy of the community. The theory also raises health issues identified by the community as important to address. The theory also mentions empowerment of members of the community to promote changes that will address the needs and issues identified by the community.”

In this theory, Caerse et al. (2011) states, “the metaparadigm propositions addressed include: life processes, patterns of human environment interaction, process that affect health, and interactions between health and environment.”

In this regard, empowering a community with information and involving strong nurse advocacy group could bring a profound change in society and bring about drastic health improvement among the community member.

My second theory choice is the emancipatory nursing praxis (ENP): a theory of social justice in nursing. According to National Institute of Health, “emancipatory nursing praxis (ENP): a theory of social justice in nursing is a middle-range nursing theory of social justice developed from an international, grounded theory study of the critical factors influencing nurses’ perceptions of their role in social justice.” (National Institute of Health, 2016).

According to Walter (2016), “the ENP theory implements processes such as becoming, awakening, engaging, and transforming. And the two conditional contexts the theory presents relational and reflexive, provide an in-depth understanding of the transformative learning process that determines nurse engagement in social justice.”

The relational context consisted of the numerous relational states for engaging in social justice.

These compartments of engagement include individual, group, organization/institutional, community, national, and international context. The emancipatory reflection promoted praxis and the ability to envision and act toward the possibility of individual and collective self-determination. The interpretive findings of this theory include the voice of privilege primarily informed ENP theory, the lack of nursing educational and organizational support in social justice role development, and the advocate role should expand to include the role of an ally. Health and disparities and inequality are socioeconomically constructed. The theory encourages nurses to engage in social justice to identify and redress the social conditions that negatively impact individual and public health (Walter 2016).

Professional awareness and involvement may increase if a theoretical framework is developed and this theory could be used in addressing the root cause of public and individual health concerns. For example, using this theory, the health problems that we are witnessing in our community today such as diabetes associated with sugary beverages could be addressed by implementing the ENP theory.

Table: 2 Theories considered