A measure of patient empowerment in hospital environments catering for older people

Aim: The principal aim of this research was to develop a valid and reliable measure of patient empowerment and disempowerment in hospital environments catering for older people. Rationale: It is argued that empowerment is linked to Learned Mastery (Peterson, Maier & Seligman 1993) and increasing patient independence, whilst disempowerment is linked to Learned Helplessness (Seligman 1975) and increasing patient dependence. Consequently, the development of a measure of these concepts would represent a valuable quality assurance tool. Method: Measures were developed using the 'act frequency approach' of Buss and Craik (1983) whereby registered nurses (n=38) were asked to nominate empowering and disempowering acts relevant to interactions between staff and older patients. The resulting lists of 98 acts for each disposition were hypothetically judged by older hospitalized people (n=20) as to the extent they would be either 'control giving' (empowering acts) or 'control taking' (disempowering acts) if personally experienced. The twenty highest scoring acts in each category were incorporated into the Patient Empowerment Scale. Results: Using this scale, older hospitalized people (n=102) resident on five different hospital wards were asked to judge how often they had encountered each act over a predetermined period of time. Wards varied in speciality including acute medicine, surgery and elderly care rehabilitation. The ward scoring lowest on the PES (i.e. the least empowering) was the elderly care rehabilitation ward. Moreover, this ward showed an inverse correlation between participant age and exposure to empowering care. Alpha scores ranged from 0·74 to 0·87 for empowerment and 0·65 to 0·87 for disempowerment. Conclusion: The PES is offered as a valid and reliable measure of empowerment and disempowerment in hospital settings catering for older people. It enables the identification of environments which place patients at risk of becoming dependent, or alternatively facilitate increasing independence.