1. 1. APPLICATION OF COMMUNITYEMPOWERMENT TO PRACTICENR.110.500 Philosophical, Theoretical, and Ethical Basis forNursingSara Cawrse, Jamie Hatcher, Sandeep Lehil, & Jessica Vargas
2. 2. INTRODUCTIONApply the CommunityEmpowerment theoryto socio-economicallydisadvantaged, urbanAfrican Americans withuncontrolled type 2diabetes
3. 3. PROBLEM & SIGNIFICANCE According to ADA, African Americans (AA) are athigh risk for diabetes In 2005, more than 18 million adults had diabetes in the United States AA are 1.6 times more likely to develop diabetesthan non-Latino Whites(Green, McClellan, Gardner, & Larson, 2006)
4. 4. PROBLEM & SIGNIFICANCE AA tend to have poorer outcomes. Social, economic, and environmental factorscontribute to health disparities (Green, McClellan, Gardner, &Larson, 2006). Differences in glucose control persist between AAand Whites even after adjusting for socioeconomicstatus, access to health care, and severity ofdisease (Marshall, 2005).
5. 5. PROBLEM & SIGNIFICANCE AA increased rates ofdiabetic sequelaeincluding retinopathy, microalbuminuria, end stage renal disease, lower extremity amputation mortality(Green, McClellan, Gardner, & Larson, 2006;Marshall, 2005).
6. 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. 7. PROBLEM & SIGNIFICANCE Patients who are able to control theirdiabetes, (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. 8. PROBLEM & SIGNIFICANCE Further focus needed on: Preventing and controlling diabetes in this population Alternative interventions to traditional primary care
9. 9. N U R S I N G T H E O RY: C O M M U N I T YEMPOWERMENT Developed by Eugenie Hildebrandt and CynthiaArmstrong Persily (Persily & Hildebrandt, 2008) Middle range nursing theory Built off both empowerment and the communitydevelopment theories Creates a community involvement approach Members of the community take responsibility forincreasing their knowledge and decision-makingabilities.
10. 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:InvolvementLay WorkersReciprocal Health Involvement: Done through planning, implementing, and interveningas a group (Persily & Hildebrandt, 2008)
11. 11. N U R S I N G T H E O RY: C O M M U N I T YEMPOWERMENT 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. 12. N U R S I N G T H E O RY: C O M M U N I T YEMPOWERMENT Reciprocal Health (Persily &Hildebrandt, 2008): Actualization of inherent and acquired human potential. Occurs when professionals and community residents work together, respecting, an d sharing what each other has to offer.
13. 13. N U R S I N G T H E O RY: C O M M U N I T YEMPOWERMENT(Smith & Lierhr, 2008)
14. 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 ofthe person, the environment, health, andnursing goals/processes. Person Environment Health Nursing goals/processes
15. 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 isthat through empowerment change is possible.
16. 16. E VA L U AT I O N : S I G N I F I C A N C E Merging of the empowerment theory and thecommunity development theory. Development: individuals and groups "grow throughcommunity participant interaction and achievementof identified goals." Empowerment: developing problem-solvingcapacity and competence that allows individualsand communities to gain mastery over their lives.(Persily & Hildebrant, 2008)
17. 17. E VA L U AT I O N :CONSISTENCY & CLARITY Congruency between context and content Context Content
18. 18. E VA L U AT I O N :ADEQUACY & FEASIBILITYBased on Fawcetts (2005) criteria for adequacy of a theory, the CommunityEmpowerment Theory is pragmatically adequate and feasible. Feasible to implement practice derived from this theory, The practitioner has the legal ability to implement and measure theeffectiveness of theory-based nursing actions, Compatible with expectations for nursing practice, Theory-based nursing actions lead to favorable outcomes, Comparisons can be made between outcomes of use of the theory andoutcomes in the same situation when the theory was not used Outcomes are measured in terms of the problem-solving effectiveness ofthe theory.The Community Empowerment Theory has not shown to be empiricallyadequate as a systematic review has not been done.
19. 19. RATIONALE FOR THEORY SELECTION Significant disparities exist between AA and whites withregards to diabetes management and the rates ofassociated morbidity and mortality, AA face several barriers: including poor access tocare, limited resources for physical activity due toresidential barriers, and interference of care due to otherlife 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 patients lifestyle and culture. For diabetes management to be effective, it must beapproached with an understanding of the populationssocial, cultural, and familial influence (Chesla, et al., 2004; Samuel-Hodge, et al., 2000; Two Feathers, et al., 2005)
20. 20. POSSIBLE SOLUTION Community health worker (CHW) programs haveshown promise in improving health behaviors andhealth outcomes Particularly for racial and ethnic minoritycommunities and for those who have disparateaccess to health care (Spencer, Rosland, Kieffer, Sinco, Valero, Palmisano, &Anderson, 2011).
21. 21. POSSIBLE SOLUTION CHWs use their ethnic, cultural, or geographicbackgrounds to promote health within their owncommunities.
22. 22. EXAMPLE OF THEORY IN USE In Heisler, Spencer, Forman, et al.(2009), participants felt CHWs gave them clearand specific strategies on managing diabetescare, nonjudgmental assistance to increaseconfidence in maintaining diabetic care, and socialand peer support. CHW programs may be effective in promoting moreeffective diabetes care and patientdoctorrelationships among African-American adults withdiabetes than without CHW support(Heisler, Spencer, Forman, et al., 2009).
23. 23. POTENTIAL PROBLEMS WITHIMPLEMENTING Most studies on community health workers havenot used a randomized controlled trial design. Studies have small samples in a localizedneighborhood and therefore have threats toexternal validity. Potential problems may arise with training andretaining community health workers whenimplementing programs (Hill-Briggs, Batts-Turner, Gary, Brancati, Hill, Levine, Bone, 2007).
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