Client-centred empowering partnering in nursing.
OBJECTIVE
This paper explores nurses' experiences 1 year after an organization's commitment to providing a client-centred and client-empowering partnering approach to care.


BACKGROUND
Historically, nurses' approach to providing care in all nursing contexts has been one of doing for clients, and previous studies have focused more on in-hospital care than on home care. However, the isolation inherent in in-home nursing and nurses' limited professional autonomy and power associated with physician control over patients in home care have been reported, as has their difficulty in finding the meaning and satisfaction of human connectedness and mutuality in nurse-client relationships. Overall, research to date does not inform us about how nurses might make a change toward a more client-centred and client-empowering approach to nursing.


METHODS
An interpretive phenomenological design was used to elicit in-depth understanding about Registered Nurses' experiences of providing care using this innovative empowerment model. A purposefully selected sample of eight Registered Nurses participated in in-depth interviews. Data were generated during 2002. Hermeneutic analysis was used to elicit themes and patterns emerging from the data.


RESULTS
Caring, client-centredness and the context of in-home care were important in implementing the new partnering approach. Barriers encountered at system, organizational and personal levels distracted nurses from fully comprehending and enacting the approach. After a year, they had begun to contemplate potential strategies for partnering with clients, but had not yet explored the power of their professional autonomy.


CONCLUSIONS
Nurses are inclined to practise within the expert model of service delivery. They need to work through issues of professional autonomy and rise to the challenge of exercising their autonomy within the current healthcare context if they are to attend more consistently to client-centred empowering partnering. The home care setting offers an excellent environment for achieving these aims.
Brown
Darlene
D
Client-Centred Care Project Manager, Community Living, South Huron, Ontario, Canada. darlenembrown@hotmail.com
McWilliam
Carol
C
Ward-Griffin
Catherine
C
D000328:Adult; D001291:Attitude of Health Personnel; D005260:Female; D006699:Home Care Services / Q000458:organization & administration; D006801:Humans; D008297:Male; D008875:Middle Aged; D016294:Models, Nursing; D009723:Nurse-Patient Relations; D015403:Nursing Evaluation Research; D009864:Ontario; D010358:Patient Participation / Q000523:psychology*; D018802:Patient-Centered Care / Q000458:organization & administration*; D017009:Professional Autonomy