Realizing empowerment in difficult diabetes care: a guided self-determination intervention.

Although health professionals advocate empowerment in patient care, they often fail to realize it in practice. Through grounded theories we previously explained why barriers to empowerment were seldom overcome in diabetes care. Zoffmann used these theories as a basis for developing a decision-making and problem-solving method called guided self-determination (GSD). To realize empowerment, health professionals need detailed knowledge of the barriers, their own roles in these barriers, ways to overcome them, and recognizable evidence of having succeeded. Through theory-driven, qualitative evaluation, the previously developed grounded theories helped us recognize changes consistent with empowerment in dyads of nurses and patients with poorly controlled type 1 diabetes. By completing GSD reflection, patients remarkably improved their ability to identify, express, and share unique and unexpected difficulties related to living with diabetes. As signs of empowerment, patients and health professionals accomplished shared decision making, resolved life-disease conflicts, and established meaningful and effective relationships.