Empowerment

In the 21st century, health care has been going through a paradigm shift called digital health. Due to major advances and breakthroughs in information technologies, most recently artificial intelligence, the patriarchy of the doctor-patient relationship has started evolving toward an equal-level partnership with initial signs of patient autonomy. Being an underused resource for centuries, patients have started to contribute to their care with information, data, insights, preferences, and knowledge. It is important to recognize that at its core, digital health represents a cultural transformation, where patient empowerment has likely played the most significant role in driving these changes. This viewpoint paper traces the remarkable journey of patient empowerment from its nascent stages to its current prominence in shaping health care's future. Spanning over two and a half decades, we explore pivotal moments and technological advancements that have revolutionized the patient's role in health care. We dive into a few historical milestones, mainly in the United States, that have challenged and redefined societal norms around agency, drawing parallels between patient empowerment and broader social movements, such as the women's suffrage and civil rights movements. Through these lenses, we argue that patient empowerment is not solely a function of knowledge or technology but requires a fundamental shift in societal attitudes, policies, health care culture, and practices. As we look to the future, we posit that the continued empowerment of patients will play a pivotal role in the development of more equitable, effective, and personalized health care systems. This paper calls for an ongoing commitment to fostering environments that support patient agency, access to resources, and the realization of patient potential in navigating and contributing to their health outcomes with an emphasis on the emerging significance of patient design.

AimTo explore the mediating effect of psychological empowerment in the association between transformational leadership and organizational citizenship behaviors in nursing context.BackgroundHealthcare organizations worldwide are facing unprecedented challenges, necessitating effective leadership strategies to ensure quality patient care and organizational success. Transformational leadership has emerged as a tool to promote positive workplace behaviors, including organizational citizenship behaviors, among nursing staff. However, the mediating role of psychological empowerment in this relationship remains underexplored.MethodsA cross-sectional survey was conducted from March 2023 until August 2023 involving 305 registered nurses at King Khalid Hospital to investigate the relationship among transformational leadership, psychological empowerment, and organizational citizenship behaviors. Validated scales were used to assess these variables. A single mediation analysis was conducted through processing macro version 3.5 model 4.ResultsThis study found a strong positive association between transformational leadership and both psychological empowerment (r = 0.507, p r = 0.445, p B = 0.110, CI: 0.058-0.166).ConclusionsTransformational leadership positively impacted nurses' feelings of empowerment, which then led to higher exhibition of organizational citizenship behaviors. Implications for Nursing Management. Leadership development programs should prioritize the cultivation of transformational leadership qualities and support the psychological empowerment of nursing staff. This approach can enhance organizational effectiveness, foster positive workplace environments, and improve patient outcomes.

Background: To strengthen and motivate the nursing workforce, this study explored the relationship between nurses' self-efficacy, job embeddedness, and psychological empowerment, and how this relationship varied across three regions in the Guangdong-Hong Kong-Macao Greater Bay Area of China. Methods: A multicenter cross-sectional study surveyed 3806 nurses between March and July 2023 using the Sociodemographic Information Questionnaire, Self-Efficacy Scale, Job Embeddedness Scale, and Psychological Empowerment Scale. A directed acyclic graph was used to expose the minimum sufficient adjustment sets for the influence hypothesized model, which was used as a covariate in the model. Pearson correlation analysis, multiple linear regression, and mediation effect analysis were used to test the relationship between variables. The moderated mediation model was employed to test the moderating effect of regions. Results: The psychological empowerment score of 3806 participants was medium-high level (45.22 ± 6.89); self-efficacy (B = 0.642, p B = 0.189, p B = 0.300, 95% CI: [0.266, 0.355]), but there was no indirect association between self-efficacy and psychological empowerment among Hong Kong participants (B = 0.024, 95% CI: [-0.079, 0.150]). Specifically, regions of Guangdong-Hong Kong moderated the relationship between self-efficacy and job embeddedness (B = -1.447, p B = 0.147, p=0.539) among Hong Kong nurses. Conclusion: Managers should acknowledge the influence and significance of nurses in the current healthcare environment. By truly enhancing nurses' psychological empowerment, organizations can foster a genuine sense of empowerment, thereby promoting nurse leadership and improving nurse retention. Improving nurses' self-efficacy can increase job embeddedness and further increase psychological empowerment. This model needs further validation in regions with different cultural and societal backgrounds. Future interventions can be made by identifying work scenarios that affect nurses' self-efficacy, providing information on self-efficacy and increasing nurses' job embeddedness, which may help to improve their psychological empowerment.

The principle of (respect for) patient autonomy has traditionally emphasized independence in medical decision-making, reflecting a broader commitment to epistemic individualism. However, recent philosophical work has challenged this view, suggesting that autonomous decisions are inherently dependent on epistemic and social supports. Wilkinson and Levy's "scaffolded model" of autonomy demonstrates how our everyday decisions rely on distributed cognition and various forms of epistemic scaffolding-from consulting others to using technological aids like maps or calculators. This paper explores how Large Language Models (LLMs) could operationalize scaffolded autonomy in medical informed consent. We argue that rather than undermining patient autonomy, appropriately designed LLM systems could enhance it by providing flexible, personalized support for information processing and value clarification. Drawing on examples from clinical practice, we examine how LLMs might serve as cognitive scaffolds in three key areas: enhancing information accessibility and comprehension, supporting value clarification, and facilitating culturally appropriate decision-making processes. However, implementing LLMs in consent procedures raises important challenges regarding epistemic responsibility, authenticity of choice, and the maintenance of appropriate human oversight. We analyze these challenges through the lens of scaffolded autonomy, arguing that successful implementation requires moving beyond simple questions of information provision to consider how technological systems can support genuinely autonomous decision-making. The paper concludes by proposing practical guidelines for LLM implementation while highlighting broader philosophical questions about the nature of autonomous choice in technologically mediated environments.