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The circle of strength and power: Experiences of empowerment in intensive care
Linköping University, Department of Medicine and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Patients and next of kin in intensive care often experience powerlessness, anxiety and distress and intensive care staff are repeatedly exposed to traumatic situations and demanding events. Empowerment has been described as a process of overcoming a sense of powerlessness and a model through which people may develop a sense of inner strength through connections with others. The aim of this thesis was to describe empowerment as experienced by patients, next of kin and staff in intensive care and to compare patient's experiences with staff and next of kin beliefs. Empowerment is reflected in this thesis as experiences of inner strength and power and of participation/self-determination.

The study was based on open-ended interviews with 11 patients, 12 next of kin and 12 staff members from two intensive care units in southern Sweden. A phenomenological perspective was applied in three studies, while a qualitative content analysis was used in the forth study.

Findings showed that nourishing relationships were of crucial importance, and contributed to every participant's experiences of empowerment regardless of whether he/she was an intensive care patient, a next of kin or a staff member. Patients were found to be strengthened and empowered by a positive environment where their own inherent joy of life and will to fight was stimulated, where they felt safe and a sense of value and motivation were encouraged and where they were taken seriously and listened to. Next of kin were extremely important to patients' experiences of safety, value, human warmth and motivation, and patients were strengthened when their next of kin were acknowledge and welcomed by staff.

Next of kin in intensive care were strengthened and empowered by a caring atmosphere in which they received continuous, straightforward and honest information that left room for some hope and in which closeness to the patient was facilitated and medical care was experienced as the best possible. Some informants were also empowered by family support and/or participation in caring for the patient. Intensive care staff were empowered by both internal processes such as feelings of doing good, increased self-esteem/self-confidence and increased knowledge and skills, and by external processes such as nourishing meetings, excitement and challenge, well functioning teamwork and good atmosphere.

When comparing patient experiences with staff and next of kin beliefs, there was agreement regarding joy of life and will to fight being essential to patients' experiences of inner strength and power, but staff and next of kin seemed to see this as a more constant individual viewpoint or characteristic than the patient did. Next of kin, and especially staff, seemed to regard the patient as more unconscious and unable to participate in the communication and interaction process than the patient him/herself experienced. A mutual and friendly relationship was experienced by the patients as highly empowering, while a more professional relationship was emphasized by the staff. These findings could serve as a basis for reflection about patient, next of kin and staff experiences of strength and power and if empowerment is seen as a dimension in quality of care, the findings from this thesis ought to be taken into consideration to increase the quality of care in intensive care.

Abstract [sv]

Patienter och närstående inom intensivvård upplever ofta maktlöshet, oro och inre stress. Upplevelser från intensivvårdstiden har visat sig kunna påverka patienters och närståendes psykologiska välbefinnande under lång tid, även efter det fysiska tillfrisknadet. Intensivvårdspersonal utsätts mer eller mindre frekvent för svåra och traumatiska händelser, vilket kan orsaka stress och utbrändhetssymtom.

Empowerment har beskrivits som en process för att övervinna upplevelser av maktlöshet eller en modell genom vilken människor kan utveckla en känsla av inre styrka. Syftet med denna avhandling var att beskriva patienters, närståendes och personals upplevelser av empowerment inom intensivvård. Syftet var också att jämföra patienters upplevelser med vad närstående och personal tror att de upplever. Med empowerment avses här upplevelser av inre kraft och styrka samt av delaktighet/självbestämmande.

Avhandlingen är baserad på öppna intervjuer med 11 patienter, 12 närstående och 12 personal vid två intensivvårdsavdelningar i södra Sverige. Alla intensivvårdspatienter upplevde att den egna livsgnistan och kämparvilja var avgörande för deras upplevelser av inre kraft och styrka och inverkade på deras möjlighet att tillfriskna. Livsgnistan och kämparviljan påverkades i sin tur av vad som hände runt omkring patienterna. En positiv atmosfär där de kände sig trygga, betydelsefulla och blev lyssnade på, stärkte deras livsgnista och kämparvilja, liksom extra omsorg, uppmuntran och stärkt motivation. Närstående spelade en viktig roll i att förstärka patienternas upplevelser av trygghet, värde och motivation och öka deras upplevelse av inre kraft och styrka.

Atmosfären hade stor betydelse för närståendes upplevelser av kraft och styrka och de påverkades mer av hur något utfördes än av vad som utfördes. Det var viktigt för närstående att känna att det fanns både en kapacitet och en vilja att hjälpa och lindra och de upplevde det stärkande att känna att personalen brydde sig såväl om patienten som om dem. En kontinuerlig, rak och ärlig information som lämnade rum för hopp, tillsammans med möjlighet att få vara nära den svårt sjuke familjemedlemmen samt en upplevelse av att patienten fick bästa möjliga medicinska vård, upplevdes av närstående som stärkande. Några stärktes även av stöd från andra familjemedlemmar och av att få vara delaktiga i vården.

Vårdpersonalen fick kraft och styrka både av interna och externa processer. Exempel på stärkande interna processer var upplevelsen av att göra gott, av att ha kunskaper och färdigheter för att klara de uppgifter och utmaningar man ställdes inför, samt av att känna sig trygg både i sig själv (självkänsla) och i det man gjorde (självförtroende). Närande möten med närstående och patienter, spänning och utmaningar, välfungerande teamarbete och en positiv atmosfär är exempel på externa processer som bidrog till personalens upplevelse av inre kraft och styrka.

När patienternas upplevelser jämfördes med vad närstående och personal trodde att de upplevde, fanns en samsyn i att patienternas egen livsgnista och kämparvilja hade stor betydelse för deras upplevelse av kraft och styrka. Närstående och personal betraktade emellertid patientens livsgnista och kämparvilja som ett tämligen statiskt karaktärsdrag, medan patienterna själva menade att livsgnistan och kämparviljan i hög utsträckning påverkades av atmosfären runt omkring dem och av hur de blev bemötta. Närstående och personal, tycktes betrakta patienterna som mer omedvetna och oförmögna att kommunicera och samverka med omgivningen än vad patienterna själva upplevde. Patienterna upplevde det som ytterst stärkande när de fick känna sig som medlemmar i vårdteamet och inte ”bara som en patient”.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press , 2009. , 63 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1120
Keyword [en]
Empowerment, Critical care, Experiences, Relationships, Work satisfaction, Patient, Family, Nurse, Physician, Comparison, Atmosphere, Quality of care, Interview
National Category
Anesthesiology and Intensive Care
Identifiers
URN: urn:nbn:se:liu:diva-17732ISBN: 978-91-7393-646-0 (print)OAI: oai:DiVA.org:liu-17732DiVA: diva2:211696
Public defence
2009-04-24, Berzeliussalen, Campus US, Linköpings Universitet, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2009-04-22 Created: 2009-04-17 Last updated: 2009-08-21Bibliographically approved
List of papers
1. Patient empowerment in intensive care: An interview study
Open this publication in new window or tab >>Patient empowerment in intensive care: An interview study
2006 (English)In: Intensive and Critical Care Nursing, ISSN 0964-3397, Vol. 22, no 6, 370-377 p.Article in journal (Refereed) Published
Abstract [en]

Intensive care patients often experience a lack of control, as well as inner chaos. Experiences from intensive care can continue to affect patients for a long time. Empowerment is a positive and dynamic process that focuses on people's strengths, rights and abilities. It takes on different expressions for different people in different environments and must be described by the people involved. The aim of this study was to describe patient empowerment in an intensive care situation. The study was based on open-ended interviews with 11 patients in two intensive care units. The interviews were analysed according to the empirical phenomenological psychological method. The results showed that patient empowerment in intensive care consists of strengthening and stimulating the patients’ own inherent joy of life and will to fight. A positive environment that encouraged feelings of value and motivation and in which the patient felt safe, received additional care and participated as he/she wished had a positive influence.

Place, publisher, year, edition, pages
Elsevier, 2006
Keyword
Critical care; Empowerment; Experiences
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-17841 (URN)10.1016/j.iccn.2006.05.003 (DOI)
Available from: 2009-04-22 Created: 2009-04-22 Last updated: 2009-09-04Bibliographically approved
2. Empowerment from the perspective of next of kin in intensive care
Open this publication in new window or tab >>Empowerment from the perspective of next of kin in intensive care
2009 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 18, no 18, 2580-2587 p.Article in journal (Refereed) Published
Abstract [en]

Aims and objectives. The aim of the study was to describe next of kin empowerment in an intensive care situation.

Background. Next of kin is important in reducing intensive care patients’ fear and anxiety. However, admission to an intensive care unit is often recognised as an extremely stressful event, causing next of kin to experience shock, fear, anxiety and vulnerability. More knowledge is needed about how next of kin in intensive care can be strengthen and empowered.

Design and methodology. The study was conducted using a phenomenological method and is based on ten interviews with intensive care patients’ next of kin.

Findings. Perceptions of both a genuine will and a capacity to help and relieve were found to be essential for next of kin’s experiences of empowerment in an intensive care situation. All informants were strengthened and empowered by a caring atmosphere in which they received continuous, straightforward and honest information that left room for hope, and in which closeness to the patient was facilitated and medical care was experienced as the best possible. Some of the informants were also strengthened by support from other family members and/or by being involved in caring for the patient.

Conclusions. The findings emphasise the essential entirety of what is done and how these acts are performed. A warm and positive atmosphere in which next of kin always feel welcome, are met with empathy in an unaffected way, are confirmed and receive support or advice when needed, are crucial to next of kin’s experiences of empowerment.

Relevance to clinical practice. Knowledge of how to empower next of kin in an intensive care situation allows caring staff to support these persons in a more sensitive and appropriate way. Findings underline the importance of creating caring relations.

Keyword
critical care, empowerment, experiences, family, interview, nurses
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-17842 (URN)10.1111/j.1365-2702.2008.02744.x (DOI)
Note
This is the authors’ version of the following article: Ingrid Wåhlin, Anna-Christina Ek and Ewa Idvall, Empowerment from the perspective of next of kin in intensive care, 2009, Journal of Clinical Nursing, (18), 18, 2580-2587. which has been published in final form at: http://dx.doi.org/10.1111/j.1365-2702.2008.02744.x Copyright: Blackwell Publishing Ltd http://www.blackwellpublishing.com/ Available from: 2009-08-28 Created: 2009-04-22 Last updated: 2017-12-13Bibliographically approved
3. Staff empowerment in intensive care: nurses' and physicians' lived experiences
Open this publication in new window or tab >>Staff empowerment in intensive care: nurses' and physicians' lived experiences
2010 (English)In: Intensive and Critical Care Nursing, ISSN 0964-3397, Vol. 26, no 5, 262-269 p.Article in journal (Other academic) Published
Abstract [en]

Aim

The purpose of the study was to describe empowerment from the perspective of intensive care staff. What makes intensive care staff experience inner strength and power?

Background

Intensive care staff are repeatedly exposed to traumatic situations and demanding events, which could result in stress and burnout symptoms. A higher level of psychological empowerment at the workplace is associated with increased work satisfaction and mental health, fewer burnout symptoms and a decreased number of sick leave days.

Method

Open-ended interviews were conducted with 12 intensive care unit (ICU) staff (four registered nurses, four enrolled nurses and four physicians) in southern Sweden. Data were analysed using a phenomenological method.

Findings

Intensive care staff were found to be empowered both by internal processes such as feelings of doing good, increased self-esteem/self-confidence and increased knowledge and skills, and by external processes such as nourishing meetings, well functioning teamwork and a good atmosphere.

Conclusion

Findings show that not only personal knowledge and skills, but also a supporting atmosphere and a good teamwork, has to be focused and encouraged by supervisors in order to increase staff's experiences of empowerment. Staff also need a chance to feel that they do something good for patients, next of kin and other staff members.

Keyword
Critical care, workplace empowerment, empowering processes, work satisfaction, nurses, physicians, enrolled nurses, interview, experiences, phenomenology
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-17843 (URN)10.1016/j.iccn.2010.06.005 (DOI)20674363 (PubMedID)
Available from: 2009-04-22 Created: 2009-04-22 Last updated: 2010-11-12Bibliographically approved
4. Empowerment in Intensive Care: Patient experiences compared to next of kin and staff beliefs
Open this publication in new window or tab >>Empowerment in Intensive Care: Patient experiences compared to next of kin and staff beliefs
2009 (English)In: Intensive & Critical Care Nursing, ISSN 0964-3397, E-ISSN 1532-4036, Vol. 25, no 6, 332-340 p.Article in journal (Refereed) Published
Abstract [en]

Experiences of critically ill patients are an important aspect of the quality of care in intensive care units. If next of kin and staff try to empower the patient, this is probably performed in accordance with their beliefs about what patients experience as empowering. As intensive care patients often have difficulties communicating, staff and next of kin need to interpret their wishes, but there is limited knowledge about how proper a picture next of kin and staff have of the intensive care patient’s experiences. The aim of this study was to compare intensive care patients’ experiences of empowerment with next of kin and staff beliefs. Interviews with 11 intensive care patients, 12 next of kin and 12 staff were conducted and analysed using a content analysis method. The findings show that the main content is quite similar between patient experiences, next of kin beliefs and staff beliefs, but a number of important differences were identified. Some of these differences were regarding how joy of life and the will to fight were generated, the character of relationships, teamwork, humour, hope and spiritual experiences. Staff and next of kin seemed to regard the patient as more unconscious than the patient him/herself did. 2

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-17844 (URN)10.1016/j.iccn.2009.06.003 (DOI)
Available from: 2009-04-22 Created: 2009-04-22 Last updated: 2017-12-13Bibliographically approved

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