Powerlessness is a serious problem that is often neglected by most health care providers (Kubsch & Wichowski, 1997). According to Wilkinson (2005), powerlessness is a feeling of loss of control on a certain event or situation. Powerlessness can be exhibited subjectively through feelings and may be observed in another person. As a nurse, observations must always be validated with the client through constant communication and ongoing assessment. The level of control and decision-making that the patient has must be continuously assessed as well as the effects that loss of control has brought about. In particular, older people are more vulnerable to experience powerlessness due to physiologic and psychological changes brought about by aging. If powerlessness remains undiagnosed and untreated, it can have severe effects that could even lead to death.
- What do you think has caused the change in Mrs. Rose’s behavior?
In the case study, Mrs. Rose is an 80 year old female who had lived with her son up until her son died several months before due to an MI. This significant event has had a major effect on Mrs. Rose as she now has to deal with the loss of her son and find the means to function independently. Mrs. Rose has been described as a very independent person, a characteristic that is often true for most of the older population. As Mrs. Rose suddenly fell victim to an accident which caused her a broken hip, her life was further thrown into disequilibrium. She now had to be hospitalized and has to be dependent on other people to take care of her. Furthermore, she had heard allegations from the staff of how clients such as herself never get the chance to go home and eventually die within the facility. The health care environment has also caused this change in Mrs. Rose’s behavior as she had gotten the wrong information from the staff regarding her stay there
As Mrs. Rose had been described as someone who is determined to stay in her home until her death, this news could only serve to bring her down more.
- How could you assess and validate your conclusions?
Powerlessness is largely a subjective domain, thus necessitating that nurses validate all data that has been collected. In the case scenario, Mrs. Rose exhibited several characteristics that pointed to the diagnosis of hopelessness such as:
- Refusal to attend therapy and statement from Mrs. Rose that therapy is useless
- Rose’s verbalization of her belief that she would not be able to return to her home
- Expression of lack of control over her current situation
- Decreased social interaction with the other people
- Decreased participation in activities that promote independence
- Rose’s belief that staff are lying to her.
These can be validate through the use of feedback from the patient as well as constant and clear communication with the patient
Indeed, health care workers need to be able to determine the patient’s strengths and inherent abilities and to make full use of this. Through this intervention, a patient may feel more control over his life and powerlessness may be eliminated. The elderly, in particular, need to have a positive concept in order to make the right decisions and feel that these decisions are the best for them. Autonomy must always be respected even in the simple things such as choosing clothes to wear for the day or a choice of meals.
Kapp, M. (1989) Medical empowerment of the elderly. Hastings Center Report 19(4):5-7.
Kubsch, S. & Wichowski, C. H. (1997). Restoring power through nursing intervention. Nursing Diagnosis, 8(1), 7-15.
Wilkinson, J. M. (2005) Prentice Hall nursing diagnosis handbook with NIC interventions and
NOC outcomes. (8th ed.) Upper Saddle River, NJ: Pearson Education.