Patient Empowerment: Difference between revisions

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===== Suffering =====
===== Suffering =====
The patient / client in need, presenting to the clinic, may be experiencing a sense of suffering. The Suffering is an existential frustration associated with an unavoidable experience that threatens existence and loss of personal autonomy. A loss of personal autonomy is thought to be synonymous with a sense of powerlessness. Additionally, Suffering is commonly associated with pain. People in pain frequently report suffering when they feel chronic, dire, out of control, overwhelming, or unknown.<ref name=":0">Cassell, E. J. (1998). The nature of suffering and the goals of medicine. Loss, Grief & Care, 8(1-2), 129-142.</ref> However, pain by itself does not cause one to suffer. The perception of the pain and how it demands more of the person than they can manage better defines the nature of suffering.<ref name=":0" /><ref>Trachsel, L. A., Munakomi, S., & Cascella, M. (2021). Pain theory. In StatPearls [Internet]. StatPearls Publishing.</ref>
The patient / client in need, presenting to the clinic, may be experiencing a sense of suffering. Suffering is an existential frustration associated with an unavoidable experience that threatens existence and loss of personal autonomy. A loss of personal autonomy is thought to be synonymous with a sense of powerlessness. Suffering can be defined as the state of severe distress associated with events that threaten the integrity of the person, which induce the perception of an impending destruction.<ref>Cassell, E. J. (1998). The nature of suffering and the goals of medicine. ''Loss, Grief & Care'', ''8''(1-2), 129-142. </ref> Additionally, suffering is commonly associated with pain. People in pain frequently report suffering when they feel it as chronic, dire, out of control, overwhelming, or unknown.<ref name=":0">Cassell, E. J. (1998). The nature of suffering and the goals of medicine. Loss, Grief & Care, 8(1-2), 129-142.</ref> However, pain by itself does not cause one to suffer. The perception of the pain and how it demands more of the person than they can manage better defines the nature of suffering.<ref name=":0" /><ref>Trachsel, L. A., Munakomi, S., & Cascella, M. (2021). Pain theory. In StatPearls [Internet]. StatPearls Publishing.</ref>The implication is that the sense of suffering can become a driving and motivational force that enables empowerment.


===== Locus of Control =====
===== Locus of Control =====
Suffering is associated with powerlessness. Powerlessness is thought to come from a loss of internal and or external locus of control. Internal locus of control is the perception of one’s control over personal competence and motivation.<ref>Ajzen, I. (2002, January 1). Perceived Behavioral Control, Self-Efficacy, Locus of Control, and the Theory of Planned Behavior. JOURNAL OF APPLIED SOCIAL PSYCHOLOGY, 32(4), 665–683.</ref> Outside the parameters of the perception of personal competence and motivation is the external locus of control. High internal locus of control is the foundation for creating intrinsic motivation that leads to self-efficacy. Intrinsic motivation and self-efficacy are both mediated by competence, autonomy, and locus of control.<ref>Deci, E. L., and Ryan, R. M. (2000). The ‘‘what’’ and ‘‘why’’ of goal pursuits: human needs and the self-determination of behavior. Psychol. Inquiry 11, 227–268. doi: 10.1207/S15327965PLI1104_01</ref>  
Powerlessness is thought to come from a loss of internal and or external locus of control. Internal locus of control is the perception of one’s control over personal competence and motivation.<ref>Ajzen, I. (2002, January 1). Perceived Behavioral Control, Self-Efficacy, Locus of Control, and the Theory of Planned Behavior. JOURNAL OF APPLIED SOCIAL PSYCHOLOGY, 32(4), 665–683.</ref> Outside the parameters of the perception of personal competence and motivation is the external locus of control. High internal locus of control is the foundation for creating intrinsic motivation that leads to self-efficacy. Intrinsic motivation and self-efficacy are both mediated by competence, autonomy, and locus of control.<ref>Deci, E. L., and Ryan, R. M. (2000). The ‘‘what’’ and ‘‘why’’ of goal pursuits: human needs and the self-determination of behavior. Psychol. Inquiry 11, 227–268. doi: 10.1207/S15327965PLI1104_01</ref>  


===== Intrinsic Motivation =====
===== Intrinsic Motivation =====
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===== Self-efficacy =====
===== Self-efficacy =====
Self-efficacy is the actualization of one’s own competency with their skillset to achieve an established outcomes with a reliance of interaction with their environment.<ref>Howland, T. and McGuire, C. (2020). The development of intelligent behavior III: Robert W. White. Psychology in the Schools, 5, 230–239.</ref> Self-efficacy takes active competency over that which is perceived as controllable and resourceful to the person.  
Self-efficacy is the actualization of one’s own competency with their skillset to achieve an established outcomes with a reliance of interaction with their environment.<ref>Howland, T. and McGuire, C. (2020). The development of intelligent behavior III: Robert W. White. Psychology in the Schools, 5, 230–239.</ref> An understanding of personal competence of control and locus of control are also constructs that serve self-efficacy. Self-efficacy takes active competency over that which is perceived as controllable and resourceful to the person.  A locus of control establishes the outcome expectancy while self-efficacy mobilized specific skills to accomplish the established outcome.


===== Therapeutic Alliance =====
===== Therapeutic Alliance =====

Revision as of 18:34, 8 April 2023

Welcome to  Arkansas Colleges of Health Education School of Physical Therapy Musculoskeletal 1 Project.  This space was created by and for the students at Arkansas Colleges of Health Education School in the United States. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!

Patient Empowerment  [edit | edit source]

The intention of practicing physical therapist is to facilitate patients successfully gain long-term independence and sustainable function. The facilitated long-term independence is empowerment. The recognition of a patient’s powerlessness or sense of powerlessness is where empowerment begins. The patient asking for help is challenged by a lack of self-efficacy to manage their recovery. The suffering of those in need of healthcare and rehabilitation exemplifies this relationship between patient / client and physical therapists, which is where the facilitation of empowerment begins. Empowerment as a process requires self-mastery and the ability to transcend through suffering by challenging adversity.[1][2][3]

Empowerment Defined

Empowerment is thought to have four (4) dimensions: Meaning, competence, choice, and impact.[4] Choice may have the greatest impact on empowerment Choice comes from realizing there is a way through an obstacle, which allows the individual to forge through a specific challenge. Competence to follow through is pivotal after recognizing the choice. Often a wavering competence and compromised internal locus of control are key obstacles for an impactful outcome. Self-efficacy and internal locus of control represent personal influence over the outcome, which reflects choice and competence. This indicates that self-efficacy is a prerequisite for empowerment.

Empowerment is the expansion of freedom of choice and action. It means increasing one’s authority and control over the resources and decisions that affect one’s life: when we exercise real choice, we gain increased control over our lives and are able to change ourselves.[5]

Empowerment may be defined as a complex experience of personal change.[6]

The process of empowerment is the discovery and development of one’s inherent capacity to be responsible for one’s own life.[7]

Patient empowerment is defined as helping patients discover and develop the inherent capacity to be responsible for one's own life.[8]

Suffering[edit | edit source]

The patient / client in need, presenting to the clinic, may be experiencing a sense of suffering. Suffering is an existential frustration associated with an unavoidable experience that threatens existence and loss of personal autonomy. A loss of personal autonomy is thought to be synonymous with a sense of powerlessness. Suffering can be defined as the state of severe distress associated with events that threaten the integrity of the person, which induce the perception of an impending destruction.[9] Additionally, suffering is commonly associated with pain. People in pain frequently report suffering when they feel it as chronic, dire, out of control, overwhelming, or unknown.[10] However, pain by itself does not cause one to suffer. The perception of the pain and how it demands more of the person than they can manage better defines the nature of suffering.[10][11]The implication is that the sense of suffering can become a driving and motivational force that enables empowerment.

Locus of Control[edit | edit source]

Powerlessness is thought to come from a loss of internal and or external locus of control. Internal locus of control is the perception of one’s control over personal competence and motivation.[12] Outside the parameters of the perception of personal competence and motivation is the external locus of control. High internal locus of control is the foundation for creating intrinsic motivation that leads to self-efficacy. Intrinsic motivation and self-efficacy are both mediated by competence, autonomy, and locus of control.[13]

Intrinsic Motivation[edit | edit source]

Intrinsic motivation is shaped by the perception of self-competency. Self-competency begins with recognition that a new skill is needed to achieve a positive outcome.[14] Successful attempts and acquisition of new skills and completion of tasks provide reinforcement of competency. The reinforcement and continued momentum fuel motivation, which remains a conscious decision to continue creating a cycle that proves to be autonomous.[15]

Self-efficacy[edit | edit source]

Self-efficacy is the actualization of one’s own competency with their skillset to achieve an established outcomes with a reliance of interaction with their environment.[16] An understanding of personal competence of control and locus of control are also constructs that serve self-efficacy. Self-efficacy takes active competency over that which is perceived as controllable and resourceful to the person.  A locus of control establishes the outcome expectancy while self-efficacy mobilized specific skills to accomplish the established outcome.

Therapeutic Alliance[edit | edit source]

The therapeutic alliance (TA) refers to a sense of collaboration, warmth, and support between a client and their practitioner. TA is associated with a combination of emotional flexibility, interpersonal communication, and trust.[17] Building trust through communication creates patient/practitioner collaboration and builds a relationship that inspires personal motivation toward the goals of therapy. Goal flexibility is centered around the needs of the patient and allows for appropriate modifications that support those needs. TA enables the physical therapist to transfer knowledge and power to the patient / client and enables the patient to receive the transferred knowledge and power.[18] Patient education emphasized with empathy that is directed toward personal choices and ideas help patient empowerment.  

Conclusion[edit | edit source]

Goal directed physical therapy is insufficient for sustainable and comprehensive recovery.[17] Patient empowerment begins with patient education and ends with the active participation of the patient in their physical therapy. Empowerment takes place with the transcendence and sustainable management of the patient’s impairment or dysfunction by the patient giving the autonomy and authority over their own rehabilitation and life.

Patient interview[edit | edit source]

This interview was conducted with Ellen who demonstrates empowerment by her resilience, self-efficacy and her positive mindset. Ellen had a level of self-efficacy prior to her being diagnosed with Parkinson's that has enabled Ellen to transcend her diagnosis. Ellen was able to push outside of her comfort zone and engage in a HIIT/CrossFit research program at the Arkansas College of Health Education. The variability and intensity of the program along with the group dynamic has lead Ellen to empowerment. We recently interviewed a research participant that is in a Parkinson’s study involving high intensity CrossFit workouts. This participant was handpicked by the researchers as someone who exemplifies empowerment.


References

  1. ↑ Tedeschi, R. G., & Calhoun, L. G. (2004). " Posttraumatic growth: conceptual foundations and empirical evidence". Psychological Inquiry, 15(1), 1-18.
  2. ↑ Walsh, F. (2007). Traumatic loss and major disasters: Strengthening family and community resilience. Family Process, 46(2), 207-227.
  3. ↑ VanderWeele, T. J. (2019). Suffering and response: Directions in empirical research. Social Science & Medicine, 224, 58-66.
  4. ↑ Spreitzer, G. M. (1995). Psychological empowerment in the workplace: Dimensions, measurement, and validation. Academy of Management Journal, 38(5), 1442-1465.
  5. ↑ Riva, G., Gaggioli, A., Gorini, A., Carelli, L., Repetto, C., Algeri, D., & Vigna, C. (2009). Virtual reality as an empowering environment for personal change: the contribution of the applied technology for neuro-psychology laboratory. Anuario de psicología, 40(2), 171-192.
  6. ↑ Aujoulat, I., d’Hoore, W., & Deccache, A. (2007). Patient empowerment in theory and practice: polysemy or cacophony?. Patient Education and Counseling, 66(1), 13-20.
  7. ↑ Funnell, M. M., & Anderson, R. M. (2004). Empowerment and self-management of diabetes. Clinical diabetes, 22(3), 123-128.
  8. ↑ Funnell, MM,Anderson, RM, Arnold MS, Barr PA, Donnelly MB, Johnson PD, Taylor-Moon D,White NH: Empowerment: an idea whose time has come in diabetes education. Diabetes Educ 17:37-41, 1991.
  9. ↑ Cassell, E. J. (1998). The nature of suffering and the goals of medicine. Loss, Grief & Care, 8(1-2), 129-142.
  10. ↑ 10.0 10.1 Cassell, E. J. (1998). The nature of suffering and the goals of medicine. Loss, Grief & Care, 8(1-2), 129-142.
  11. ↑ Trachsel, L. A., Munakomi, S., & Cascella, M. (2021). Pain theory. In StatPearls [Internet]. StatPearls Publishing.
  12. ↑ Ajzen, I. (2002, January 1). Perceived Behavioral Control, Self-Efficacy, Locus of Control, and the Theory of Planned Behavior. JOURNAL OF APPLIED SOCIAL PSYCHOLOGY, 32(4), 665–683.
  13. ↑ Deci, E. L., and Ryan, R. M. (2000). The ‘‘what’’ and ‘‘why’’ of goal pursuits: human needs and the self-determination of behavior. Psychol. Inquiry 11, 227–268. doi: 10.1207/S15327965PLI1104_01
  14. ↑ Deci, E. L., & Ryan, R. M. (1980). Self-determination Theory: When Mind Mediates Behavior. The Journal of Mind and Behavior, 1(1), 33–43.
  15. ↑ Di Domenico, S. I., & Ryan, R. M. (2017). The Emerging Neuroscience of Intrinsic Motivation: A New Frontier in Self-Determination Research. Frontiers in Human Neuroscience. https://doi.org/10.3389/fnhum.2017.00145
  16. ↑ Howland, T. and McGuire, C. (2020). The development of intelligent behavior III: Robert W. White. Psychology in the Schools, 5, 230–239.
  17. ↑ 17.0 17.1 Crom, A., Paap, D., Wijma, A., Dijkstra, P. U., & Pool, G. (2020). Between the Lines: A Qualitative Phenomenological Analysis of the Therapeutic Alliance in Pediatric Physical Therapy. Physical & Occupational Therapy in Pediatrics, 40(1), 1–14. https://doi.org/10.1080/01942638.2019.1610138
  18. ↑ Unsgaard-Tondel M, Soderstrom S. Therapeutic Alliance: Patients’ Expectations Before and Experiences After Physical Therapy for Low Back Pain--A Qualitative Study With 6-Month Follow-Up. PTJ: Physical Therapy & Rehabilitation Journal [Internet]. 2021 Nov 1 [cited 2023 Apr 1];101(11):1f. Available from: https://search.ebscohost.com/login.aspx?direct=true&AuthType=ip,shib&db=edsgao&AN=edsgcl.697168676&site=eds-live
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