1. APPLICATION OF COMMUNITY
EMPOWERMENT TO PRACTICE
NR.110.500 Philosophical, Theoretical, and Ethical Basis for
Nursing
Sara Cawrse, Jamie Hatcher, Sandeep Lehil, & Jessica Vargas

2. INTRODUCTION
Apply the Community
Empowerment theory
to socio-economically
disadvantaged, urban
African Americans with
uncontrolled type 2
diabetes

3. PROBLEM & SIGNIFICANCE
 According to ADA, African Americans (AA) are at
high risk for diabetes due to:
 Genetics
 High rates of obesity
 Low levels of physical activity
 In 2005, more than 18 million adults
had diabetes in the United States
 AA accounted for a disproportionate amount (Green, McClellan,
Gardner, & Larson, 2006).
 AA are 1.6 times more likely to develop diabetes
than non-Latino Whites

4. PROBLEM & SIGNIFICANCE
 AA have higher rates of diabetes than their white
counterparts, and tend to have poorer outcomes.
 Social, economic, and environmental factors
contribute to health disparities (Green, McClellan, Gardner, & Larson,
2006).
 Differences in glucose control persist between AA
and Whites even after adjusting for socioeconomic
status, access to health care, and severity of
disease (Marshall, 2005).

5. PROBLEM & SIGNIFICANCE
 AA increased rates of
diabetic sequelae
including
 retinopathy,
 microalbuminuria,
 end stage renal
disease,
 lower extremity
amputation
 mortality
(Green, McClellan, Gardner, & Larson, 2006;
Marshall, 2005).

6. PROBLEM & SIGNIFICANCE
 AA less likely to attain glucose control
 Possible reasons:
 Poor compliance with self-monitoring
 Poor adherence to treatment
 Cost of test strips and drugs
 Literacy rates
 Lack of diabetic education
 Sociocultural components
 Physician related factors

7. PROBLEM & SIGNIFICANCE
 Patients who are able to control their diabetes, (Green,
McClellan, Gardner, & Larson, 2006; Austin & Claiborne, 2011):
 Often have friends or family with diabetes
 Seek out information about the disease
 Evidence-based self-management strategies
 Accurate perceptions of their own diabetes control
 Experience “turning point” events

8. PROBLEM & SIGNIFICANCE
 Further focus needed on:
 Preventing and controlling diabetes in this population
 Alternative interventions to traditional primary care
 Peer support and education
 Community Empowerment Theory

9. N U R S I N G T H E O RY: C O M M U N I T Y
EMPOWERMENT
 Developed by Eugenie Hildebrandt and Cynthia
Armstrong Persily (Persily & Hildebrandt, 2008)
 Middle range nursing theory
 Built off both empowerment and the community
development theories
 Creates a community involvement approach
 Members of the community take responsibility for
increasing their knowledge and decision-making
abilities.

10. N U R S I N G T H E O RY: C O M M U N I T Y
EMPOWERMENT
 Three main concepts:
Involvement
Lay Workers
Reciprocal Health
 Involvement:
 People in the community create support groups or
coalitions to identify their mutual needs, resources, and
barriers to ultimately respond to a problem the
community is facing.
 Done through planning, implementing, and intervening
as a group (Persily & Hildebrandt, 2008)

11. N U R S I N G T H E O RY: C O M M U N I T Y
EMPOWERMENT
 Lay Workers (Persily & Hildebrandt, 2008):
 Trained persons indigenous to the community to which
they live in and work in.
 Reach out to families in the community
 Know community cultural values firsthand
 Encourage preventative services, healthy behaviors,
and assist with access to social services

12. N U R S I N G T H E O RY: C O M M U N I T Y
EMPOWERMENT
 Reciprocal Health (Persily &
Hildebrandt, 2008):
 Actualization of inherent
and acquired human
potential.
 Occurs when professionals
and community residents
work together, respecting,
and sharing what each
other has to offer.
 Desired outcome of
community empowerment
as community members
participate proactively in
ways to attain their highest
potential.

13. N U R S I N G T H E O RY: C O M M U N I T Y
EMPOWERMENT
(Smith & Lierhr, 2008)

14. E VA L U AT I O N : S I G N I F I C A N C E
 Clearly addresses the metaparadigm concepts of the
person, the environment, health, and nursing
goals/processes.
 Person: members of the community (these are the
individuals who will receive the care/intervention)
 Environment: community itself as well as the
community's social constructs, the neighborhood, and
the economy of the community
 Health: issues identified by the community as important
to address
 Nursing goals/processes: empowerment of members
of the community (lay persons and other community
members) in order to promote changes that will address
the needs and issues identified by the community

15. E VA L U AT I O N : S I G N I F I C A N C E
 The metaparadigm propositions addressed include:
 life processes
 patterns of human-environment interaction
 processes that affect health
 interaction between health and environment
 Philosophical basis: the foundation of this theory is
that through empowerment change is possible.

16. E VA L U AT I O N : S I G N I F I C A N C E
 Derived from a merging of the empowerment theory and the community
development theory.
 Posits that individuals and groups "grow through community participant
interaction and achievement of identified goals."
 Guided by models that advocate for supporting individuals and
communities to develop while working together on commonly identified
problems.
 Empowerment involves developing problem-solving capacity and
competence that allows individuals and communities to gain mastery
over their lives.
 Critical in primary health care
 Part of the nurse-individual dyad
 Vital for linking health care providers and communities.
 When community development and empowerment are considered
together, they demonstrate the "potential for empowerment of community
people through the involvement of lay workers in promoting reciprocal
health” (Persily & Hildebrant, 2008).
 It does not appear that the theory acknowledges use of adjunct or
antecedent theories.

17. E VA L U AT I O N :
CONSISTENCY & CLARITY
 Congruency between context and content
 Context: includes both change through empowerment
and that change must come from within (oneself or the
community).
 Content: includes identification of problems by the
community and education of lay persons (members of
the community) who will then educate others in the
community, thus empowering them to change.
 The content is semantically clear and consistent.

18. E VA L U AT I O N : A D E Q U A C Y
 The theory assertions appear to be fairly well
supported by empirical evidence.
 The theory itself was developed based on the
experiences and observations of the two theorists
and has been applied by them in their research.

19. E VA L U AT I O N : F E A S I B I L I T Y
 Pragmatic adequacy:
 Special training and skills may be required
 Implementing the theory primarily be limited by the motivation of
the community
 Cost may or may not be a factor
 Legally, the nurse will likely be practicing within her scope of
practice when providing health education to the lay persons and
measuring its effectiveness within the community.
 Education and empowerment and key components of nursing practice,
The theory is organized in such a way that, should one want to,
 Comparisons could be made between a community in which this
theory was applied and a community in which the theory was not
used
 Outcomes to be measured would depend upon the problems
identified by the community
 Measurement of such outcomes should accurately indicate the
effectiveness of the theory.

20. RATIONALE FOR THEORY SELECTION
 Significant disparities exist between AA and whites with
regards to diabetes management and the rates of
associated morbidity and mortality,
 AA face several barriers: including poor access to care,
limited resources for physical activity due to residential
barriers, and interference of care due to other life events
or stressors (Samuel-Hodge, et al., 2000).
 Can address barriers by:
 Bringing the care to the patient through lay-educators,
 Altering the care so that it is appropriate and reasonable for
the patient’s lifestyle and culture.
 For diabetes management to be effective, it must be
approached with an understanding of the population’s
social, cultural, and familial influence (Chesla, et al., 2004; Samuel-
Hodge, et al., 2000; Two Feathers, et al., 2005)

21. POSSIBLE SOLUTION
 Community health worker (CHW) programs have
shown promise in improving health behaviors and
health outcomes
 Particularly for racial and ethnic minority
communities and for those who have disparate
access to health care (Spencer, Rosland, Kieffer, Sinco, Valero, Palmisano, &
Anderson, 2011).
 CHWs can provide comprehensive care regarding social
and some medical needs at a less expensive cost (Gary,
Bone, Hill, Levine, McGuire, Saudek, & Brancati, 2003).

22. POSSIBLE SOLUTION
 CHWs use their ethnic,
cultural, or geographic
backgrounds to promote
health within their own
communities.
 They are a bridge for those with disparities to accessible
healthcare
 Become part of the patient’s support system
 Can also provide resources, transportation, and
coordinate case management.

23. EXAMPLE OF THEORY IN USE
 In Heisler, Spencer, Forman, et al. (2009), participants
felt CHWs gave them “clear and specific strategies on
managing diabetes care, nonjudgmental assistance to
increase confidence in maintaining diabetic care, and
social and peer support”.
 CHW programs that provide both one-on-one support
and group self-management training sessions may be
effective in promoting more effective diabetes care and
patient–doctor relationships among African-American
adults with diabetes than without CHW support (Heisler,
Spencer, Forman, et al., 2009).

24. POTENTIAL PROBLEMS WITH
IMPLEMENTING
 Most studies on community health workers have
not used a randomized controlled trial design.
 Studies have small samples in a localized
neighborhood and therefore have threats to
external validity.
 Potential problems may arise with training and
retaining community health workers when
implementing programs (Hill-Briggs, Batts-Turner, Gary, Brancati, Hill, Levine,
Bone, 2007).

25. REFERENCES
Austin, S. A., Claiborne, N. (2011). Faith wellness collaboration: A community-based approach to
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Chesla, C. A., Fisher, L., Mullan, J. T., Skaff, M. M., Gardiner, P., Chun, K., & Kanter, R. (2004).
Family and disease management in African-American patients with type 2 diabetes. Diabetes
Care, 27: 2850-2855.
Fawcett, J. (2005). Criteria for evaluation of theory. Nursing Science Quarterly, 18(2), 131-135.
Gary, T. L., Bone, L. R., Hill, M. N., Levine, D. M., McGuire, M. Saudek, C., and Brancati, F. L.
(2003). Randomized controlled trial of the effects of nurse case manager and community health
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(2009). Participants' assessments of the effects of a community health worker Intervention on
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26. REFERENCES
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