Control In An Age Of Empowerment Pdf Viewer

1. Control In An Age Of Empowerment Pdf Viewer Software

Background: Renal transplantation is a vital treatment for end-stage renal disease. To help improve quality of life after renal transplant surgery, interventions are needed to strengthen the coping skills and self-care behaviors of patients. However, most research studies on self-care after renal transplantation have addressed related factors.

Few studies have examined the effects of interventions on renal transplant recipients.Purpose: This study investigated the effects of an empowerment support group on the empowerment levels and self-care behaviors of renal transplant recipients.Methods: This study was a randomized controlled trial. Eligible participants were individuals who had undergone a renal transplant within the past 20 years, were 18 years old or older, were able to read and write in Chinese, and were willing to participate. We recruited 122 renal transplant recipients from two medical centers in southern Taiwan.

The renal transplant outpatients were randomly assigned into empowerment support ( n = 56) and comparison ( n = 66) groups. The developed measures as well as the content, protocols, and the two groups were assessed for reliability and validity. The intervention involved one 2-hour meeting every 2 weeks for a total of six meetings.

The topics included goal setting, problem solving, coping with daily stress, seeking social support, and staying motivated. The sessions consisted of introductions that highlighted the topic, group discussions, identifying areas of difficulty with self-care behaviors after renal transplant, and developing a set of goals and strategies to overcome these problems.Results: The empowerment group reported significant increases both in terms of level of empowerment ( F = 5.29, p =.023) based on age and time interaction ( F = 9.86, p. IntroductionThe number of patients with renal failure is increasing in Taiwan, with nephritis and nephritic syndrome now the 10th leading cause of death ( ). In 2008, the incidence of end-stage renal disease (ESRD) in Taiwan had reached 421 per million populations, and the prevalence was 2348 per million populations ( ). Taiwan currently has the highest rate of ESRD-related renal dialysis in the world, with an estimated 60,000 patients with ESRD (0.25% of the population) currently in need of renal dialysis or renal transplantation ( ).

For many patients with ESRD, a living donor renal transplant offers the optimum treatment and avoids the need for dialysis. At the end of 2009 in the United States, 398,861 patients with ESRD were being treated with some form of dialysis, and 172,553 patients with ESRD had a working transplanted kidney ( ). In contrast to the United States, only 2750 patients had undergone renal transplant between 1997 and 2009 in Taiwan ( ). Renal transplantation has been shown to be more effective than dialysis therapy in terms of improving the physical and mental health of patients and to be more cost-effective ( ). Because of the limited availability of renal donor resources, there are long wait lists for renal transplantation at most medical centers in Taiwan.

Many patients with ESRD travel to China to obtain a transplant and then return to Taiwan for posttransplant care. Post-renal-transplant care requires the administration of immunosuppressive drugs to prevent rejection, which makes patients more susceptible to infections. Moreover, patients may gain weight and experience side effects from the immunosuppressive drugs, organ rejection, and psychological and social stresses (; ). Many renal transplant recipients worry about rejection, infection, drug side effects, and changes in body image. These issues may interfere with posttransplant quality of life ( ). Although typically effective in extending the life of recipients, transplantation often causes physiological distress, reduced quality of life, and decreased levels of hope for resuming a normal life style (; ).Previous studies indicate the need for interventions that empower transplant patients with coping skills and self-care to help improve their posttransplant quality of life.

With empowerment, these patients may recognize and be better prepared to deal with their health problems. Utilization of strategies and resources to solve problems may enhance self-control over activities of daily living ( ). The perceived level of empowerment of renal transplant recipients experienced after renal transplantation in Taiwan has yet to be measured. Most research studies on self-care after renal transplantation address relationship factors, with few exploring the effects of empowerment groups on renal transplant recipients. Therefore, the purpose of this study was to investigate whether the use of empowerment support groups increases self-care behaviors and empowerment in renal transplant recipients. The results of this study are expected to highlight how empowerment support groups impact the self-care behaviors of renal transplant recipients in newly industrialized countries, using Taiwan as an example.Orem’s self-care theory focuses on the ability of a patient to perform self-care, which is defined as the practice of activities that individuals initiate and perform on their own behalf in maintaining life, health, and well-being ( ). Self-care refers to the behavior undertaken by individuals to promote or restore their health.

Self-care encompasses more than just adherence to medications and also includes how patients follow dietary recommendations, monitor symptoms, maintain physical function, execute medical regimens, and make decisions about seeking care ( ). Self-care has been shown to improve health function, decrease readmission rates, and promote quality of life (; ). Synthesized many studies and organized the concept and definition of self-care into a set of meaningful and thoughtful behaviors in which both inner and outer resources are used in the process of self-determination, with the goal of strengthening overall health and well-being both in the present and in the future. The concept of self-care has been gradually applied in nursing research.

Interviewed 92 patients who were recovering from renal transplant surgery and found positive correlations between self-care, infection management, and medication management and overall quality of life. The seven dimensions of self-care behavior were ranked by participants in order of importance as follows: outpatient clinic follow-up, adherence to medication regimens, graft-rejection management, dietary control, self-monitoring of health, regular exercise, and prevention of infection.Empowerment facilitates and enhances the process of movement as well as of special cultural changes and related processes. Empowerment is a stage in the growth and development of individuals ( ). Revealed that, in the process of empowerment, clients have the power and freedom to make choices and to take responsibility for their choices and actions. Empowerment is promoted by viewing all individuals as personally responsible and capable of growth and self-determination (; ). Empowerment involves recognizing, promoting, and enhancing the abilities of patients to meet their own needs so that they feel in control of their own lives and their own care ( ).

Empowerment allows an individual to obtain the resources needed to fulfill his or her needs, and, with the power of authority, to take actions to improve health with confidence, hope, and a feeling of self-worth (; ). Freire emphasized that the goal of empowerment is to integrate the processes of listening, reflecting, and taking action ( ).An empowerment support group is a group of patients who have the same disease or similar health conditions. The main purpose of this group is to share experiences; fulfill needs; relieve stress; strengthen self-confidence; and overcome disease-related fears, insecurity, and loneliness through mutual interactions and support ( ). In addition, empowerment groups help members to manage and resolve target problems and to increase self-confidence ( ).

Applied the concept of empowerment in hemodialysis patient care. The objective results of that study showed improvements in terms of “improvements in self-care knowledge and ability,” “stress relieved, happier mood,” “elevated confidence,” “establishment of new life,” “improvements in responsibility of own health and in higher compliance with the medical team,” and “higher compliance with hemodialysis and increased willingness to face society.” and applied an empowerment program, respectively, to two groups of patients with diabetes. Their research results showed that empowerment programs significantly improve the control that patients with diabetes have over their disease as well as their self-care abilities and self-efficacy. Furthermore, results showed that the programs significantly improved the glucose control status of participants. A similar study by found increases in the self-control, self-awareness, and self-esteem of patient participants with diabetes and that level of participation and patient appreciation of the value of life and level were positively associated with patient trust and agreement with the decisions of the organization. Conducted a systematic review of prior research and reported a general and significant improvement in HbA1c levels among participants with diabetes mellitus who had participated in empowerment interventions. Furthermore, Wong and colleagues ( ) reported that enrollment in a patient empowerment program in Hong Kong was associated with lower all-cause mortality and a lower number of first cardiovascular disease events among primary care patients with Type 2 diabetes mellitus.

These participants exhibited significantly improved control of blood sugar levels and significantly reduced complications of diabetes mellitus.The function of empowerment groups is affirmative. Most empowerment groups are led by professionals. To minimize the risk that the needs of these professional group leaders will take precedence over the needs of the participants, using a patient-led empowerment group model allows participants to establish new friendships through experience sharing and increase their desire to get better through their support network. Nursing staffs help groups develop empowerment skills and facilitate the process of empowerment.

Control In An Age Of Empowerment Pdf Viewer Software

The professional group leaders view patients as participating partners and assist these patients to identify their needs and provide resources as needed to solve patient problems. There have been few articles published on the effects of empowerment groups on renal transplant recipients in Taiwan. Therefore, the purpose of this study was to evaluate the impact of participation in empowerment groups on the empowerment and self-care of post-renal-transplant recipients. Definitions of VariablesThis study adopted the definition of empowerment used by Chen: “a process of participation that facilitates cooperation among participants and care providers to clarify needs, information, and resources in order to resolve specific problems.” Multiple opportunities facilitate the self-reflection abilities of participants. Identifying needs and then making decisions to improve communication skills facilitate problem solving ( ).

The definition of self-care behaviors used by Lin was adopted in this study. This definition includes the concept of patients following the directions of their physicians and/or nurses to maintain or enhance health. These directions include taking medications on time, exercising regularly, controlling diet, preventing infections, monitoring and managing the signs and symptoms of infection and organ rejection, making regular clinical follow-up visits, and self-monitoring health ( ).

Methods Study Design and ParticipantsThis study used an experimental research design. Participants were randomly assigned either to the empowerment group or to the comparison group.

Power analysis conducted using G.Power 3.1 software determined a minimum sample size of 102, with an alpha level of.05 and an effect size value of.25. After adding 20% to account for the expected withdrawal rate, a total sample size of 122 was set as the target for recruitment. The follow-up with participants is described in. After approval from the institutional review board of the target medical center, participants were recruited, and written informed consent was obtained. Eligibility for participation included having received a renal transplant within the past 20 years, being 18 years old or older, being able to read and write Chinese, and having willingness to participate. Renal transplant recipients with psychiatric or cognitive disorders were excluded.

One hundred fifty eligible participants were recruited from outpatient clinics and from the ESRD Patient Association. Twenty eligible patients chose not to participate because of travel distance or limited time.

Each of the 130 eligible participants was randomly assigned using the flip of a coin to either the empowerment group or the comparison group. Six participants withdrew from the empowerment group because of moving away from the area (2), refusal to take the posttest (2), family commitments (1), and hospitalization (1). Two participants withdrew from the comparison group because of taking a new job (1) and refusal to take the posttest (1).

Therefore, 56 and 66 participants in the empowerment group and comparison group, respectively, completed the pretest, empowerment intervention ( empowerment group only), and posttest (see, flow diagram). Empowerment ScaleThe Empowerment Scale was used to measure perceived level of empowerment. Its original version consists of 28 items in three subscales and assesses the management of the psychosocial aspects of the disease, assessment of dissatisfaction and readiness to change, and the setting and the achievement. The questionnaire, developed at the University of Michigan Diabetes Research and Training Center ( ), has a reported Cronbach’s alpha coefficient of.81–.93 among patients with diabetes ( ). The scale used in this study was approved by Anderson et al.

And was translated into Chinese by bilingual experts. After reliability and validity testing, the Chinese version of the Empowerment Scale was revised, and 11 items were deleted because of cultural differences and the results of factor analysis. The scoring method for this scale used the Likert scale, with 0 indicating strongly disagree and 4 indicating strongly agree. Total possible scores for the scale ranged from 0 to 44, with higher scores indicating higher level of perceived empowerment.

The content validity of the Chinese version with a 17-item scale was 0.92, with a Cronbach’s alpha coefficient of.90 and an intraclass correlation coefficient of.84 ( ). Self-Care Behavior ScaleThe Self-Care Behavior Scale with 14 items was modified based on the original Self-Care Scale developed by, who reported a Cronbach’s alpha coefficient of.84. The attributes of the Self-Care Behavior Scale included taking medications on time, regular exercise, diet control, infection prevention, monitoring and management of signs and symptoms of infection and rejection, regular clinical follow-up, and health self-monitoring.

This scale used a Likert scale method of scoring, with 0 = never to 4 = almost every time. Total possible scores for this scale ranged from 0 to 56, with higher scores indicating the more frequently that self-care behavior was practiced. Five experts were enlisted to measure the content validity of the Self-Care Behavior Scale, with a resultant content validity index of 0.93. The internal consistency reliability (Cronbach’s alpha) was.78, and the test–retest intraclass correlation coefficient was.86 in a previous study ( ). Procedures and Empowerment Support ProgramPretest scores of the indicators served as the control and were compared with the posttest findings. The participants in the empowerment group participated in the empowerment support group, which met every 2 weeks for 2 hours for a total of six meetings.

Changes in perceived empowerment and self-care behaviors were measured 4 weeks after the intervention.Literature and clinical experience, including repeated guidance by a clinical psychologist and nephrologist and clinical trials on six patients, were integrated to establish an empowerment support group protocol. The empowerment support group for renal transplant recipients was developed based on the guidelines for facilitating a patient empowerment program ( ). The researchers encouraged the participants to lead the empowerment group during the fifth and sixth sessions. Therefore, the empowerment group in this study was led by the professionals for the first-to-fourth group sessions and led by peer leaders for the fifth and sixth group sessions.

Before the sessions, the professionals designed and discussed the goals and process with the peer leaders to make sure the group functioned as intended. The research assistants helped to prepare the materials and environment for the sessions based on peer-leader designs.The program consisted of six small-group sessions, each lasting 120 minutes. Topics included setting goals, solving problems, coping with renal transplant, coping with daily stresses, seeking social support, and staying motivated. Sessions consisted of introductions that highlighted the topic, group discussions, and patient identification of problem areas for self-care behaviors after renal transplant.

Furthermore, the emotions associated with these problems were explored, and a set of goals and strategies to overcome these problems was developed. Active learning (sharing experiences with others and choosing personal solutions) was encouraged. ResultsThe comparisons of demographic characteristics between the two groups of renal transplant recipients are presented in. Fifty-six participants were in the empowerment group.

Most participants in the empowerment group were men (55.4%). The mean age was 48.57 years; 78.6% were married, 46.4% were employed, and their mean number of months since transplant was 64.86.

Sixty-six participants were in the comparison group. Most comparison group participants were men (54.5%). The mean age was 45.91 years; 84.8% were married, 54.5% were employed, and their mean number of months since transplant was 69.53 (see ). There were no significant differences between the two groups in terms of age, gender, educational level, months since transplant, serum creatinine levels, pretest scores for empowerment (46.76 ± 9.67 in the empowerment group vs.

45.08 ± 9.77 in the comparison group; t =.86, p =.39), or pretest scores for self-care behavior (44.73 ± 6.71 in the empowerment group vs. 42.39 ± 8.34 in the comparison group; t = 1.76, p =.08), as analyzed using chi-square tests and independent t tests. However, empowerment group participants had a higher percentage of posttransplant infections than their comparison group peers (46.43% vs. 24.24%) before participation. In addition, participant age correlated negatively with his or her pretest empowerment scores ( r = −.34, p =.009) in the empowerment group, with older participants perceiving significantly lower levels of empowerment in the pretest. Therefore, the age and the level of infection of participants were treated as covariates when analyzing the empowerment scores and self-care behaviors, and a linear mixed model was used.

The posttest scores for empowerment were 50.51 ± 8.19 for the empowerment group and 46.88 + 8.37 for the comparison group. The posttest frequencies for self-care behaviors were 45.51 ± 6.78 for the empowerment group and 41.62 ± 8.13 for the comparison group. The improved scores for empowerment (posttest scores minus pretest scores) for the participants in the empowerment support group correlated positively with participant age ( r =.3, p =.024), with older participants having significantly lower pretest scores for empowerment than their younger peers and significantly larger increases in level of empowerment than their younger peers after participation in the empowerment intervention.The empowerment group reported significantly increased levels of empowerment ( F = 5.29, p =.023) with age and time interaction ( F = 9.86, p. DiscussionThis study showed that, controlling for infection and age (time) variables, the empowerment scores of participants increased significantly more in the empowerment group than in the comparison group. Controlling for infection, age, and time variables, the participants in the empowerment support group had postintervention self-care behavior scores that had improved significantly more than those of the comparison group. These findings were consistent with the findings of. The improvement may be primarily because of the effect of individual empowerment, including overcoming barriers, determining suitable coping methods, achieving goals, obtaining support, and coping sessions.

The empowerment support group in this study provided participants with opportunities to reflect on their life after a renal transplant. The participants were empowered, had the capacity to bring about change, were willing and able to set appropriate goals, and were willing to make decisions to care for themselves. The improvements in empowerment scores were larger than those for self-care behaviors.

This may be because perceived increases in empowerment did not translate directly into enhanced self-care behaviors in daily life because of barriers such as limited time and lack of financial support.Participants in the empowerment support group gained strength from each other when they realized that they shared a common experience. In the empowering process of sharing their feelings and experiences regarding their illness, group members were able to access and use a range of coping skills. The participants were reassured that others had coped successfully with situations that were similar to theirs. The results from this study suggest that empowerment techniques may have an important role for renal transplant recipients in promoting self-care behaviors, showing that participants were empowered, had the capacity to bring about change, and were willing and able to set appropriate goals and make care decisions on their own. These findings are consistent with those reported in other studies of patients with ESRD ( ).The improvement of self-care behaviors in the empowerment group was significantly greater than that in the comparison group. In the empowerment group, the participants had opportunities to share their feeling and increase their ability to care for themselves by learning from other participants. During group activities, the participants would ask questions and receive feedback with practical suggestions from other participants.

Their self-care behaviors increased after participating in the empowerment intervention, which is consistent with the findings of. Participants in the empowerment group reported feeling accepted, which reinforced their motivation and ability to learn. Through the activities of supporting each other, the participants learned problem management skills and improved their self-care behaviors.

This was especially true for the older participants in the empowerment group, who had generally lower pretest scores for empowerment. The greater improvement in empowerment scores by older participants may be because of their better ability to learn, share, accept, and reinforce their motivation through group discussion as compared with younger participants. Because of their limited formal education, the older participants may find it difficult to learn from digital media, but they can learn through sharing experiences with other renal transplant patients. Therefore, participant age and infection experience may be taken into consideration when designing patient education and empowerment programs for renal transplant patients in the future to improve the efficacy of these programs. From a different perspective, reported that 38% of pre-renal-transplantation and post-renal-transplantation participants in their study were frequent Internet users in an urban city.

Those participants may benefit from Internet-based education and empowerment programs. Thus, future studies may explore the efficacy and cost-effectiveness of developing and conducting Internet-based empowerment interventions. ConclusionsEmpowerment and self-care behavior efficacy increased significantly more for participants in the empowerment group than for their peers in the comparison group.

This increase was particularly remarkable for older participants in the empowerment group who had scored particularly low on the pretest round. Empowerment support may be critical to improve the confidence and self-care behaviors of renal transplant patients. The results from this study identified a practice model for an empowerment support group that effectively enhances empowerment in renal transplant recipients.