I like words, especially if everyone seems to get it except me! On these occasions, my colleagues seem to nod appropriately in unison, as if they all have a profound understanding of the concept. Unsure, I often scramble for the thesaurus or Google Scholar, or relentlessly ask my colleagues what a particular medical term "du jour" means. For example, a term like "patient-centered care" is confusing to me, because I thought that the patient had been the center of our focus all the while. To complicate matters, I recently learned that the term "empowerment" is an extension of the patient-centered care concept. Some of the terms in the genera related to patient empowerment represent a movement from a prescriptive-adherence-transactional patient encounter model to a more participatory action scenario between the patient and the provider.
Over the last decade or so, the term "empowering the patient" has insidiously crept into our taxonomy of discourse, especially when related to the management of chronic diseases, such as diabetes and wound care.
To support this reality Johnson1 stated, "Establishment of a unified theory of empowerment has fallen victim to this lack of a specific and agreed-upon definition of the construct.1,2 In a review of 55 articles related to empowerment, Aujoulat et al2 were unable to distill a unified, well-articulated theory of empowerment in health care."2,3
Why the new lexicon to refine patient care transactions? Some believe that the quest for patient compliance is too prescriptive and that the term empowerment allows for some negotiation and shared decision making between the patient and the provider.2 In my view, empowerment is a bidirectional transaction where the patient transfers some of the authority and responsibility of his/her care to the healthcare team and we, in turn, transfer knowledge, biomedical therapeutics, and hope to the patient. Therefore, empowerment can be seen as both a process and an outcome, albeit hard to measure.
Empowerment
The concept of empowerment is rooted in the social sciences or "social action" ideology of the 1960s and the "self-help" perspectives of the 1970s.1,2,4 Empowerment has diverse and complex meanings. From a health status perspective, the state or condition that gives rise to the potential for individual empowerment is simply the antithesis of power, and that is known as a feeling or a reality of powerlessness. The sense or state of having zero power over our health or future can seem as if our own actions will be ineffective in influencing the outcome of life events,5 such as with the diagnosis of inoperable cancer. This life-changing health situation sets up a theoretical or actualized framework for self-restructuring-a path or a tactical movement toward restoration of some semblance of control and power or partnering with the health system or the wound care team.
Patient Vignette
As an illustration of powerlessness, let's consider the patient who has diabetes, nonhealing wounds, poor vascular supply, and infected bone and who is beginning to give up hope that he and his wound care team will find a solution that can preempt an inevitable below-the-knee amputation. At this particular point in this all-too-familiar story and process, the patient suddenly, sequentially, or in a protracted period of time moves from having power over his health and life to a position of "powerlessness." To facilitate the regaining of power for the patient, the team must explore options for the patient through a power sharing and gaining experience. Yet, the transactional nature of gaining and losing power in the clinical environment is not a straightforward process. It is dependent on multiple factors, such as the social, educational, and insurance coverage for a given plan of action; moreover, it also depends on the patient's understanding of the options ahead.
As wound care practitioners, authors, and, on behalf of our patients, we need to question and analyze terms as they creep into the clinical environment. This requirement is especially important in meeting the Centers for Medicare & Medicaid Services (CMS) Conditions of Coverage. The CMS mandates a more "patient-centered, outcome-oriented approach to care."6
I submit that we need more research on the concept of empowering patients, especially in establishing best practices related the process and outcomes using the patient empowerment model in wound care.
Richard "Sal" Salcido, MD
References