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

Lawn, Sharon, Delany, Toni, Sweet, Linda, Battersby, Malcolm and Skinner, Timothy C. (2014). Control in chronic condition self-care management: How it occurs in the health worker-client relationship and implications for client empowerment. Journal of Advanced Nursing,70(2):383-394.

Document type: Journal Article
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IRMA ID 82794376xPUB112
Title Control in chronic condition self-care management: How it occurs in the health worker-client relationship and implications for client empowerment
Author Lawn, Sharon
Delany, Toni
Sweet, Linda
Battersby, Malcolm
Skinner, Timothy C.
Journal Name Journal of Advanced Nursing
Publication Date 2014
Volume Number 70
Issue Number 2
ISSN 0309-2402   (check CDU catalogue open catalogue search in new window)
Scopus ID 2-s2.0-84879648428
Start Page 383
End Page 394
Total Pages 12
Place of Publication United Kingdom
Publisher Wiley-Blackwell Publishing Ltd.
HERDC Category C1 - Journal Article (DIISR)
Abstract 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.
Keywords control
critical discourse analysis
dependency
empowerment
nursing interactions
nursing practice
power
primary health care
self-management
self-care management
DOI http://dx.doi.org/10.1111/jan.12203   (check subscription with CDU E-Gateway service for CDU Staff and Students  check subscription with CDU E-Gateway in new window)
 
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