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A quality improvement project on empowerment in chronic kidney care: an interactive research approach
Jönköping University, School of Health and Welfare, HHJ, Dep. of Nursing Science. Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

One way of improving health care has been conceptualized as personcentred care. In person-centred care the concept of empowerment is crucial. This thesis aims was to explore the meaning of empowerment from the perspective of persons with chronic kidney disease (CKD) and their family members and to evaluate the outcomes of an improvement intervention (QI) for the persons with CKD. Furthermore, to explore the implementation of an QI for empowerment in the context of chronic kidney care from a professional perspective. The research was based on an interactive approach in which the findings relating to the experiences of empowerment by persons with CKD and their family members in chronic kidney care were used in developing the QI. The methods of data collection were both qualitative and quantitative. In all, 20 persons with CKD (Study I) and 12 family members (Study II) participated in the interviews. In the quasi-experimental evaluation of the QI, 25 individuals took part in the intervention group and 21 persons in the comparison group (Study III). Twelve healthcare professionals participated in the case study of the QI (Study IV). Empowerment in chronic kidney care for the persons with CKD was described in terms of creation of trust and learning through encounters. The family members of the persons with CKD described empowerment as having the strength to assume responsibility. The outcomes of the QI after 2 years showed significantly higher scores for individualized care in the intervention group than in the comparison group. The facilitators in the QI were the healthcare professionals' moving spirit and encouragement from involved persons. As a barrier, the healthcare professionals referred to the limitation of the organization. In conclusion, the individual’s perspective of empowerment is important, both for quality of care and as a facilitator for QI in chronic kidney care.

Place, publisher, year, edition, pages
Jönköping: School of Health Sciences , 2013. , 93 p.
Series
Hälsohögskolans avhandlingsserie, ISSN 1654-3602 ; 44
National Category
Nursing
Identifiers
URN: urn:nbn:se:hj:diva-21063ISBN: 978-91-85835-43-0 (print)OAI: oai:DiVA.org:hj-21063DiVA: diva2:618837
Public defence
2013-05-31, Forum Humanum Hälsohögskolan, Jönköping, 13:00
Opponent
Supervisors
Available from: 2013-04-30 Created: 2013-04-30 Last updated: 2016-01-04Bibliographically approved
List of papers
1. The experience of empowerment in the patient-staff encounter: the patient's perspective
Open this publication in new window or tab >>The experience of empowerment in the patient-staff encounter: the patient's perspective
2012 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 21, no 5/6, 897-904 p.Article in journal (Refereed) Published
Abstract [en]

Aim and objective.  The aim was to explore empowerment within the patient–staff encounter as experienced by out-patients with chronic kidney disease.

Background.  Empowerment has an important role to play in the patient–staff relationship in the case of patients with a chronic disease. When it comes to patients with chronic kidney disease, there has been little research on empowerment, for which reason interviewing such patients about their experiences of empowerment will provide useful knowledge within the context of out-patient care.

Design.  A qualitative interview study was chosen to gain an understanding of empowerment from the patient perspective.

Method.  The study was carried out at an out-patient clinic in Sweden and involved 20 patients with chronic kidney disease. The interviews were subjected to latent content analysis.

Results.  Five of the seven sub-themes emerging from the analysis represented empowerment: Accessibility according to need, Confirming encounter, Trust in the competence of the healthcare staff, Participation in decision-making, Learning enables better self-management. The other two represented non-empowerment: Meeting with nonchalance, Lack of dialogue and influence. From the seven sub-themes, one comprehensive theme was generated: Creation of trust and learning through encounter.

Conclusion.  The main finding regarding the central role of the creation of trust and learning through the patient–staff encounter underlines the importance of understanding empowerment from the patient’s perspective.

Relevance to clinical practice.  Nursing and other healthcare staff need knowledge and understanding of the meaning of empowerment from the patients’ perspective to meet their needs in out-patient care.

Keyword
chronic kidney disease, empowerment, nurses, nursing, out-patient care, patient perspective
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-17012 (URN)10.1111/j.1365-2702.2011.03901.x (DOI)
Projects
Briding the Gap I
Available from: 2012-01-05 Created: 2012-01-05 Last updated: 2017-12-08Bibliographically approved
2. Empowerment in outpatient care for patients with chronic kidney disease - from the family member's perspective.
Open this publication in new window or tab >>Empowerment in outpatient care for patients with chronic kidney disease - from the family member's perspective.
2011 (English)In: BMC Nursing, ISSN 1472-6955, E-ISSN 1472-6955, Vol. 10, no 21, 2-8 p.Article in journal (Refereed) Published
Abstract [en]

Background: Family members of persons with pre-dialysis chronic kidney disease may experience feelings of vulnerability and insecurity as the disease follows its course. Against this background, the aim of the present study was to explore empowerment in outpatient care as experienced by these family members.

Methods: An inductive approach for qualitative data analysis was chosen. The study sample comprised 12 family members of pre-dialysis patients at an outpatient kidney clinic. Two interviews with each family member were subjected to content analysis to gain an understanding of empowerment from the family members' perspective.

Results: Having strength to assume the responsibility was the main theme that emerged from the following five sub-themes: Being an involved participant, Having confirming encounters, Trusting in health-care staff, Comprehending through knowledge, and Feeling left out. Four of these five sub-themes were positive. The fifth subtheme illuminated negative experience, indicating the absence of empowerment.

Conclusions: Family members' experience of empowerment is dependent on their ability to assume the responsibility for a relative with chronic kidney disease when needed. The findings emphasise the need for a family perspective and the significance of a supportive environment for family members of persons in outpatient care.

National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-17013 (URN)10.1186/1472-6955-10-21 (DOI)
Projects
Briding the Gap I
Available from: 2012-01-05 Created: 2012-01-05 Last updated: 2017-12-08Bibliographically approved
3. Empowerment Intervention in Outpatient Care of Persons with Chronic Kidney Disease Pre-Dialysis
Open this publication in new window or tab >>Empowerment Intervention in Outpatient Care of Persons with Chronic Kidney Disease Pre-Dialysis
2012 (English)In: Nephrology Nursing Journal : Journal of The American Nephrology Nurses Association, ISSN 1526-744X, E-ISSN 2163-5390, Vol. 39, no 4, 285-294 p.Article in journal (Refereed) Published
Abstract [en]

Empowering interventions can improve person-centered care. A pre- and post-evaluation using interactive research involving two years of empowering interventions was designed to improve quality of care in outpatients with chronic kidney disease who were pre-dialysis. The results showed significantly increased empowerment in the intervention group. Interactive research facilitated the implementation of the empowerment intervention, which may increase sustainability over time.

National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-21058 (URN)23061113 (PubMedID)
Available from: 2013-04-30 Created: 2013-04-30 Last updated: 2017-12-06Bibliographically approved
4. Facilitators and barriers in the implementation process of an improvement intervention in chronic kidney care: a case study
Open this publication in new window or tab >>Facilitators and barriers in the implementation process of an improvement intervention in chronic kidney care: a case study
(English)Manuscript (preprint) (Other academic)
National Category
Nursing
Identifiers
urn:nbn:se:hj:diva-21062 (URN)
Available from: 2013-04-30 Created: 2013-04-30 Last updated: 2016-01-04Bibliographically approved

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