Date of Award
Doctor of Philosophy (PhD)
Weiss, Marianne E.
PATIENT PERCEPTIONS OF PATIENT-EMPOWERING NURSE BEHAVIORS, PATIENT ACTIVATION, AND FUNCTIONAL HEALTH STATUS
Teresa A. Jerofke, BSN, MSN, APNP-BC
Marquette University, 2013
Patient empowerment has been advocated as a way to engage patients in self-management of chronic illnesses in emerging patient-centered models for healthcare improvement. The majority of research on patient empowerment has studied empowerment as an outcome in outpatient settings, with little attention to provider processes used to empower patients during a hospitalization. Post-operative patients with life-threatening chronic illnesses face multiple illness-related transitions associated with the recovery from their surgery and taking on the role of managing their life-threatening chronic illnesses upon hospital discharge.
A correlational, longitudinal design framed by Meleis' Transitions Theory and the Individual and Family Self-Management Theory (IFSMT) was used to determine the relationship between patient perceptions of patient-empowering nurse behaviors in an acute care setting and patient activation and functional health status six-weeks post-discharge in patients who recently underwent a surgical procedure for cancer or cardiac disease. In addition, tests of validity and reliability were conducted on a newly constructed instrument, the Patient Perceptions of Patient-Empowering Nurse Behaviors Scale (PPPNBS).
One hundred thirteen post-surgical cancer and cardiac patients participated. Patient perceptions of patient-empowering nurse behaviors and baseline patient activation were measured prior to discharge with the PPPNBS and 13-item Patient Activation Measure (PAM 13). Patient activation and functional health status were measured six-weeks following discharge with the PAM 13 and SF-36. Multiple linear regression using a simultaneous equation approach was used to identify significant relationships. Patient perceptions of patient-empowering nurse behaviors were significantly positively associated with post-discharge patient activation, which was significantly positively associated with mental functional health status. Length of stay was the only significant predictor of physical functional health status. The PPPNBS demonstrated acceptable validity and reliability in post-surgical patients with a life-threatening chronic illness.
Implications for nursing practice, nursing research, and nursing education are identified. Patient-empowering nurse behaviors can be used to facilitate engagement in self-management behavior, improve functional health status, and should be examined as a way to improve the cost of chronic illness care through improved patient activation levels. Transitions Theory and the IFSMT provided a useful framework to examine the contribution of nursing care, represented by patient-empowering nurse behaviors, to patient self-management outcomes.