Control in chronic condition self-care management: How it occurs in the health worker-client relationship and implications for client empowerment

TY - JOUR

T1 - Control in chronic condition self-care management

T2 - How it occurs in the health worker-client relationship and implications for client empowerment

AU - Lawn, Sharon

AU - Delany, Toni

AU - Sweet, Linda

AU - Battersby, Malcolm

AU - C. Skinner, Timothy

PY - 2014/2/1

Y1 - 2014/2/1

N2 - Aim: To examine health worker-client interactions during care planning to understand processes that foster client empowerment and disempowerment. Background: It is unclear how health worker-client exchanges and information sharing through chronic condition care planning currently operate in primary health care. Moreover, it is unclear how control in these exchanges either enhances collaborative decision-making, partnership and client empowerment, or works to create client disempowerment and dependency on workers and health services. Design: Critical discourse analysis of qualitative data from ethnographic observations and audio-taped worker-client consultations. Method: Multidisciplinary teams in two Australian community-based primary healthcare sites participated. This included nurses, general practitioners and allied health workers and their clients who had a chronic condition care plan. Nineteen worker-client consultations were observed/recorded in 2011. Results: Control was expressed through multiple processes inherent in the worker role and in their interactions with clients. When workers exercised disproportionate control and clients relinquished their own control, client disempowerment and dependency were evident. Clients' attempts to gain control and workers' attempts to relinquish control alleviated clients' disempowerment and dependency. However, structural features of information sharing systems and workers' care planning behaviours diminished such efforts. Conclusion: Worker awareness of their communication style and the power of their role must improve for client chronic condition self-care management to be achieved. Training on the impacts of control in worker communication and systems where they work must be provided if unbeneficial forms of client dependency are to be overcome and true self-care management is to be realized.

AB - Aim: To examine health worker-client interactions during care planning to understand processes that foster client empowerment and disempowerment. Background: It is unclear how health worker-client exchanges and information sharing through chronic condition care planning currently operate in primary health care. Moreover, it is unclear how control in these exchanges either enhances collaborative decision-making, partnership and client empowerment, or works to create client disempowerment and dependency on workers and health services. Design: Critical discourse analysis of qualitative data from ethnographic observations and audio-taped worker-client consultations. Method: Multidisciplinary teams in two Australian community-based primary healthcare sites participated. This included nurses, general practitioners and allied health workers and their clients who had a chronic condition care plan. Nineteen worker-client consultations were observed/recorded in 2011. Results: Control was expressed through multiple processes inherent in the worker role and in their interactions with clients. When workers exercised disproportionate control and clients relinquished their own control, client disempowerment and dependency were evident. Clients' attempts to gain control and workers' attempts to relinquish control alleviated clients' disempowerment and dependency. However, structural features of information sharing systems and workers' care planning behaviours diminished such efforts. Conclusion: Worker awareness of their communication style and the power of their role must improve for client chronic condition self-care management to be achieved. Training on the impacts of control in worker communication and systems where they work must be provided if unbeneficial forms of client dependency are to be overcome and true self-care management is to be realized.

KW - Control

KW - Critical discourse analysis

KW - Dependency

KW - Empowerment

KW - Nursing interactions

KW - Nursing practice

KW - Power

KW - Primary health care

KW - Self-care management

KW - Self-management

UR - http://www.scopus.com/inward/record.url?scp=84891913428&partnerID=8YFLogxK

U2 - 10.1111/jan.12203

DO - 10.1111/jan.12203

M3 - Journal article

C2 - 23834649

AN - SCOPUS:84891913428

SN - 0309-2402

VL - 70

SP - 383

EP - 394

JO - Journal of Advanced Nursing

JF - Journal of Advanced Nursing

IS - 2

ER -