Empowerment Support With Adult Female Survivors of ChildhoodIncest: Part II-Application of Orem’s Methods of Helping Joan C. Urbancic
This report addresses the integration and application of empowerment support with Orem’s methods of helping, which include (1) providing a developmental environment, (2) psychological support, (3) guiding another, and (4) teaching another. Empowerment support is viewed as basic helping methods (supportive psychotherapy) for the psychiatric nurse to use with adult female survivors of childhood incest.
Copyright
0 1992 by W.B. Saunders
of this report described empowerment support and incest trauma in relation to Orem’s (1991) self-care deficit theory. Empowerment support is viewed as a type of nursing system within Orem’s methods of helping and incest trauma as a basic conditioning factor. Both concepts are explicated by clinical and research literature. This report focuses on the integration and application of Orem’s (199 1) methods of helping and empowerment support in the nursing care of the adult female survivors of childhood incest. These nursing interventions are concerned with basic helping methods that are appropriate for psychiatric and other nurses to use with survivors. The methods can generally be described as supportive psychotherapy. It is frequently the case that posttrauma symptoms in the survivor are initially so severe that they limit the use of insight therapy until more ego strengths are developed. Although insight may de-
P
ART I
Company
velop as a result of supportive interventions, the primary concern is providing the initial assistance that the survivor needs to disclose, ventilate, focus on the here-and-now, and gain relief from symptoms related to the trauma and anxiety of confronting and resolving her abuse. Despite the frequent attention in media to sexual abuse, many women continue to experience disbelief, minimization, or blame when they attempt to disclose or seek support from family, friends, and therapists. Many aspects of empowerment support discussed here have commonalities with solutionfocused therapy (de Shazer, 1985; Dolan, 1991). From this perspective, the survivor’s strengths and resources are used to relieve painful symptoms; the client and nurse collaboratively determine and implement solutions so that the survivor learns that she is the expert on her problems, and their solutions. The term “survivor” is used to emphasize that the woman is one who possesses the courage and strength to progress beyond victimization. OREM’S METHODS OF HELPING AND
From the University of Detroit Mercy, School of Nursing, Detroit MI. Address reprint requests to Joan C. Urbancic, R.N., Ph.D., C.S., Assistant Professor of Nursing, University of Detroit Mercy, School of Nursing, 8200 W. Outer Dr., Detroit MI 48219. Copyright 0 1992 by W.B. Saunders Company 0883-9417/92/0605-0005$3.00/0
282
EMPOWERMENT SUPPORT
Orem identified five methods of helping within her concept of nursing system: (1) acting for or doing for another, (2) guiding another, (3) supporting another (physically or psychologically), (4) providing a developmental environment, and (5)
Archives of Psychiatric Nursing, Vol. VI, No. 5 (October), 1992:
pp. 282-286
EMPOWERMENT
SUPPORT & OREM’S METHODS OF HELPING
teaching another. The following discussion will involve clinical interventions based on empowerment support and organized according to Orem’s methods of helping. Some interventions may be viewed as belonging to more than one method of helping. Physical helping will not be addressed, since empowerment support is primarily psychological. Providing
a Developmental
Environment
According to Orem (199 l), the nurse functions as a supplier and regulator of environmental conditions that are necessary for promoting personal growth and development in people who require nursing care. With the incest survivor, the nurse functions as a significant other who establishes a safe environment in order to encourage the survivor to allow herself to experience the feelings of sadness, guilt, shame, fear, and anger that she may have repressed. This safe environment encourages the survivor to learn and test new behaviors that will contribute to the resolution of incest trauma. A basic step in establishing a developmental environment for empowering incest survivors involves restructuring traditional power relations. Rather than the traditional patriarchical relationship of the all-knowing professional and the unknowing client, the relationship becomes a partnership in which both nurse and client collaborate in establishing and achieving objectives that serve to resolve the incest trauma. Thus, the nurse provides an environment in which the survivor becomes the “expert” on what she needs and realizes that she has the ability to make appropriate decisions for her health and well-being. Both strengths and weaknesses of the survivor are realistically discussed and analyzed, and the survivor is given recognition for having the courage to address these areas. Many current troublesome behaviors and habits that the survivor identifies are explained by the nurse as having been childhood self-care behaviors that were necessary and adaptive to cope with the incest, but as an adult these behaviors may no longer be helpful to the survivor. Nevertheless, it is reinforced that these behaviors were creative self-care behaviors. Psychological
Support
According to Orem (1991), psychological support involves being a listener and an understanding presence. This is the most critical intervention to
283
be used with a survivor, since she most likely has been disbelieved and discouraged from disclosing and/or blamed for the behavior if she did disclose. It is expected that many survivors will be reluctant to disclose because of past negative experiences in this regard. Therefore, validation of the abuse and its personal meaning to the survivor is the single most critical intervention that can be provided in early stages of recovery. The nurse gives permission to the survivor to disclose the details of her incest experiences by inviting her to discuss them when and however she chooses. The nurse must be open, sensitive to cues, willing to listen, and must validate the survivor’s perception and details of the event. This approach is empowering for the survivor, because she is able to exert control over the disclosure process. The nurse can also assist the survivor to recognize that self-disclosure is a strength, and one which requires great courage. Too often the nurse is uncomfortable with the topic of incest. This discomfort can be communicated nonverbally to the client and interpreted as a sign that she is not to discuss her incest experiences. If the nurse shows horror, shock, or dismay, it may add to the survivor’s existing feelings of being alienated, different, shameful, and unworthy. Although eventual disclosure of the details of the abuse is essential for recovery, it is crucial that the survivor not be overwhelmed with excessive disclosure. Repeated disclosures of the abuse without therapeutic interventions can result in revictimization of the survivor. When disclosing, the survivor is encouraged to control the discussion, but sometimes she may need assistance in protecting herself. Dolan (1991) advocates combining a visual symbol of the present with a verbal descriptive task as a method for keeping in touch with the present and limiting the trauma of discussing the abuse. This symbol can be some personal possession, some article in the room, or just holding the nurse’s hand. Psychological support may also be needed in dealing with flashbacks and trances, expressing feelings of anger without fear of losing control, expressing needs without feeling frightened or guilty, coming to terms with the failure of mother or other family members to protect her, trying new experiences and relationships, and learning to set time aside for herself.
284
Guiding Another
According to Orem (1991), guiding another involves providing factual or technologic information relevant to the regulation of self-agency or meeting self-care requisites. The nurse gives helpful suggestions and factual information to the survivor when she is trying to make decisions about some course of action. This information must be solicited from the survivor and differentiated from unsolicited advice if the support is to be empowering. A critical area for guidance when working with incest survivors is the need to link current symptoms with the childhood abuse. This can be done by simply asking the woman if there is anything stressful or painful going on in her life that reminds her of the past abuse. Most frequently flashbacks, nightmares, and feelings of panic and anxiety can be linked to a current event that has triggered feelings related to the sexual abuse. An overreaction to negative relationships with a boss, teacher, friend, or family member may be related to feelings of victimization from the past. The loss of job or boyfriend may stimulate powerful feelings of abandonment that the survivor may have felt when she was not protected by her mother. Because she does not connect the triggering of the current event to the abuse, she may fear she is literally “going crazy. ’ ’ Many times the survivor has no cognitive memory of the abuse, but sensory memories have been stored and are connected to highly traumatic feelings in the survivor. In the author’s study, one survivor who had total repression for her abuse, reported experiencing an overwhelming flashback while simultaneously reading an advertisement for the study in a newspaper and hearing a song on the radio that her offender played while abusing her in childhood. Thus, the pairing of visual and auditory stimuli overcame the protection of her repression. If the survivor can learn to connect current flashbacks, anxieties, and terrors to the past abuse, these intrusive experiences will gradually lose their power. In addition, making connections with the abuse may provide cues about events that trigger the trauma. These triggers can be avoided or strategies can be developed to minimize the stressful effects of the traumatic memories. The survivor is assisted to recognize what is helpful and soothing
JOAN C. URBANCIC
during these traumatic periods, and to develop healing strategies based on these experiences. Simple interventions such as calling a friend, taking a warm bath, listening to favorite music, or rocking a baby can be helpful. Many survivors have a tendency to cope with stress by spontaneously dissociating. This coping technique has developed and been maintained because of its success during the actual childhood abuse episodes. Usually it is an unconscious mechanism that manifests itself as numbing or “spacing out.” However, the dissociation as a means of coping is no longer an effective self-care strategy, since the women are unable to protect themselves or their children from abuse if they dissociate. (Survivors frequently report that their own mothers seemed casual or spaced out when the incest was disclosed in childhood. This suggests dissociation by the mothers). The survivor may seek guidance and direction on a wide number of issues, including confrontation of the offender and/or nonoffending parent, disclosing to family members or friends, relationships with men, and family conflicts. However, these discussions are always based on clarification of what the survivor feels is comfortable and appropriate for her. Throughout their discussions, the nurse consistently points out each small positive step of change that indicates healing. de Shazer (1985) emphasizes the need to explore with the client feelings and behaviors associated with these positive changes so that the focus is one of healing and surviving, rather than of victimization. In addition, this approach encourages the survivor to discover and use her own strengths and resources and gradually feel empowered. Maintaining a journal is invaluable in facilitating this process. Teaching
Teaching involves facilitating the development of knowledge necessary for managing self-care and overcoming limitations in self-care. Since the survivor’s self-care limitations are usually mental health-related, the teaching is focused on mental health self-care. Many of the empowerment support strategies that the nurse uses with the survivor involve teaching. According to Freire (1974), teaching cannot
EMPOWERMENT
SUPPORT & OREM’S METHODS
285
OF HELPING
foster empowerment in the learner unless it involves a mutual process between teacher and learner. For the incest survivor and the nurse, this entails sharing experiences and knowledge and understanding the societal factors that contribute to the abuse of women and children. Survivors can be assisted to realize how family, friends, and society contribute to their feelings of shame and guilt by minimizing, denying, and blaming the victim. Many times the survivor doubts her own reality about the abuse because of the vehement denial and blame by others. Dolan (199 1) suggests that the survivor carry some reminder of the truth of the abuse with her all the time. This reminder can be a note or something from her past that represents her innocence and the trauma of the abuse. New behaviors and corrections of myths and distortions about incest are taught. Because the myths and distortions have shaped and conditioned the survivor from childhood, corrective learning is a lengthy and ongoing process for the survivor. The nurse will be repeatedly called upon to reinforce that the adult is always the responsible party in childhood sexual abuse, but women who have derived pleasure and even sought the childhood sexual activity may become especially shamed and guilt-ridden. Thus, basic principles of normal physiology and child development are taught, and it is emphasized that children normally seek out that which is rewarding or feels good. Understanding the concept of traumatic sexualization (Finkelhor, 1986) can be helpful to the survivor who is having difficulty forgiving herself. New behaviors are explored and practiced and the survivor is able to choose strategies that she finds most appropriate for herself. Examples include assertive skills, anger control techniques, journal-writing, drawing, sculpturing, relaxation and imagery techniques, self-defense training, letter-writing. drawing, mask-making, sculpturing, and physical exercise. Many survivors find reading some of the excellent books written specifically for survivors especially helpful. In the author’s study (Urbancic, 1992), the book, Courage to Heal (Bass & Davis, 1988), was repeatedly cited by survivors as being helpful in the healing process. Nurses can encourage survivors to attend conferences, work shops, and wilderness retreats as part of their healing experiences. Since a multitude
of self-help groups and newsletters exist, the nurse needs to become knowledgeable about these sources so that she can provide information for those who request it. Since many survivors do not have the financial resources for private therapy it is crucial for them to have the option of attending self-help groups such as Survivors of Incest Anonymous @IA). The SIA groups are based on the Alcoholics Anonymous 12-Step Program and are available in many communities across the country. Information on self-help groups can be obtained by calling your local state Self-Help Clearing House. SUMMARY
Adult female survivors of incest are a population in need of specialized nursing interventions, which will empower them to gain a sense of mastery, competency, control, and self-worth, and to act on these new beliefs and attitudes to resolve their incest trauma. The integration of empowerment support with Orem’s methods of helping can guide the nurse in designing nursing interventions for this population so that the survivor can achieve incest trauma resolution, mental health self-care, and well-being. If nurses are to provide empowerment support for survivors, it is crucial that a collaborative, rather than a traditional patriarchical dominant/submissive, relationship be established. However, empowerment support interventions must not only be designed and implemented, they must also be tested to determine which are effective in the healing of incest trauma. Propositions from Orem’s self-care deficit theory can provide the basis for testing the relationship between empowerment support, incest trauma resolution, mental health self-care, and well-being. These relationships are currently being examined as part of the author’s dissertation. The author has developed and is testing an instrument to measure empowerment support (Urbancic, 1992) in adult female survivors of incest. If the discipline of nursing is to practice from a scientific body of knowledge, then testing of nursing theories such as Orem’s is crucial. Although this report focuses on the influence of empowerment support on the adult female survivor of childhood incest experiences, the concept as a part of Orem’s methods of helping is relevant to many populations that require nursing. Research with
286
JOAN C. URBANCIC
other populations that experience stressful life events is needed to understand the relationship between empowerment support, and the regulation and production of self-care, health, and wellbeing. REFERENCES Bass, E., & Davis L. (1988). The courage to heal. New York: Harper and Row. de Shazer, S. (1985). Keys to solution in brief therapy. New York: W.W. Norton & Co. Dolan, Y.M. (1991). Resolving sexual abuse: Solution focused
therapy and Ericksonian hypnosis ,for adult survivor. New York: W.W. Norton & Co. Finkelhor. D. (1986). A sourcebook on child sexual abuse. Beverly Hill, CA: Sage. Freire,
P. (1974). Pedagogy of the oppressed. Seabury Press.
New York:
Orem, D.E. (1991). Nursing: Concepts of practice (4th ed.). St. Louis: Mosby Yearbook. Urbancic, J. (1992). The relationship between empowerment support, mental health self-care, well-being, and incest trauma resolution in adultfemale survivors of childhood incest. Unpublished doctoral dissertation, Wayne State University, Detroit.
This report addresses the integration and application of empowerment support with Orem’s methods of helping, which include (1) providing a developmental environment, (2) psychological support, (3) guiding another, and (4) teaching another. Empowerment support is viewed as basic helping methods (supportive psychotherapy) for the psychiatric nurse to use with adult female survivors of childhood incest.
Copyright
0 1992 by W.B. Saunders
of this report described empowerment support and incest trauma in relation to Orem’s (1991) self-care deficit theory. Empowerment support is viewed as a type of nursing system within Orem’s methods of helping and incest trauma as a basic conditioning factor. Both concepts are explicated by clinical and research literature. This report focuses on the integration and application of Orem’s (199 1) methods of helping and empowerment support in the nursing care of the adult female survivors of childhood incest. These nursing interventions are concerned with basic helping methods that are appropriate for psychiatric and other nurses to use with survivors. The methods can generally be described as supportive psychotherapy. It is frequently the case that posttrauma symptoms in the survivor are initially so severe that they limit the use of insight therapy until more ego strengths are developed. Although insight may de-
P
ART I
Company
velop as a result of supportive interventions, the primary concern is providing the initial assistance that the survivor needs to disclose, ventilate, focus on the here-and-now, and gain relief from symptoms related to the trauma and anxiety of confronting and resolving her abuse. Despite the frequent attention in media to sexual abuse, many women continue to experience disbelief, minimization, or blame when they attempt to disclose or seek support from family, friends, and therapists. Many aspects of empowerment support discussed here have commonalities with solutionfocused therapy (de Shazer, 1985; Dolan, 1991). From this perspective, the survivor’s strengths and resources are used to relieve painful symptoms; the client and nurse collaboratively determine and implement solutions so that the survivor learns that she is the expert on her problems, and their solutions. The term “survivor” is used to emphasize that the woman is one who possesses the courage and strength to progress beyond victimization. OREM’S METHODS OF HELPING AND
From the University of Detroit Mercy, School of Nursing, Detroit MI. Address reprint requests to Joan C. Urbancic, R.N., Ph.D., C.S., Assistant Professor of Nursing, University of Detroit Mercy, School of Nursing, 8200 W. Outer Dr., Detroit MI 48219. Copyright 0 1992 by W.B. Saunders Company 0883-9417/92/0605-0005$3.00/0
282
EMPOWERMENT SUPPORT
Orem identified five methods of helping within her concept of nursing system: (1) acting for or doing for another, (2) guiding another, (3) supporting another (physically or psychologically), (4) providing a developmental environment, and (5)
Archives of Psychiatric Nursing, Vol. VI, No. 5 (October), 1992:
pp. 282-286
EMPOWERMENT
SUPPORT & OREM’S METHODS OF HELPING
teaching another. The following discussion will involve clinical interventions based on empowerment support and organized according to Orem’s methods of helping. Some interventions may be viewed as belonging to more than one method of helping. Physical helping will not be addressed, since empowerment support is primarily psychological. Providing
a Developmental
Environment
According to Orem (199 l), the nurse functions as a supplier and regulator of environmental conditions that are necessary for promoting personal growth and development in people who require nursing care. With the incest survivor, the nurse functions as a significant other who establishes a safe environment in order to encourage the survivor to allow herself to experience the feelings of sadness, guilt, shame, fear, and anger that she may have repressed. This safe environment encourages the survivor to learn and test new behaviors that will contribute to the resolution of incest trauma. A basic step in establishing a developmental environment for empowering incest survivors involves restructuring traditional power relations. Rather than the traditional patriarchical relationship of the all-knowing professional and the unknowing client, the relationship becomes a partnership in which both nurse and client collaborate in establishing and achieving objectives that serve to resolve the incest trauma. Thus, the nurse provides an environment in which the survivor becomes the “expert” on what she needs and realizes that she has the ability to make appropriate decisions for her health and well-being. Both strengths and weaknesses of the survivor are realistically discussed and analyzed, and the survivor is given recognition for having the courage to address these areas. Many current troublesome behaviors and habits that the survivor identifies are explained by the nurse as having been childhood self-care behaviors that were necessary and adaptive to cope with the incest, but as an adult these behaviors may no longer be helpful to the survivor. Nevertheless, it is reinforced that these behaviors were creative self-care behaviors. Psychological
Support
According to Orem (1991), psychological support involves being a listener and an understanding presence. This is the most critical intervention to
283
be used with a survivor, since she most likely has been disbelieved and discouraged from disclosing and/or blamed for the behavior if she did disclose. It is expected that many survivors will be reluctant to disclose because of past negative experiences in this regard. Therefore, validation of the abuse and its personal meaning to the survivor is the single most critical intervention that can be provided in early stages of recovery. The nurse gives permission to the survivor to disclose the details of her incest experiences by inviting her to discuss them when and however she chooses. The nurse must be open, sensitive to cues, willing to listen, and must validate the survivor’s perception and details of the event. This approach is empowering for the survivor, because she is able to exert control over the disclosure process. The nurse can also assist the survivor to recognize that self-disclosure is a strength, and one which requires great courage. Too often the nurse is uncomfortable with the topic of incest. This discomfort can be communicated nonverbally to the client and interpreted as a sign that she is not to discuss her incest experiences. If the nurse shows horror, shock, or dismay, it may add to the survivor’s existing feelings of being alienated, different, shameful, and unworthy. Although eventual disclosure of the details of the abuse is essential for recovery, it is crucial that the survivor not be overwhelmed with excessive disclosure. Repeated disclosures of the abuse without therapeutic interventions can result in revictimization of the survivor. When disclosing, the survivor is encouraged to control the discussion, but sometimes she may need assistance in protecting herself. Dolan (1991) advocates combining a visual symbol of the present with a verbal descriptive task as a method for keeping in touch with the present and limiting the trauma of discussing the abuse. This symbol can be some personal possession, some article in the room, or just holding the nurse’s hand. Psychological support may also be needed in dealing with flashbacks and trances, expressing feelings of anger without fear of losing control, expressing needs without feeling frightened or guilty, coming to terms with the failure of mother or other family members to protect her, trying new experiences and relationships, and learning to set time aside for herself.
284
Guiding Another
According to Orem (1991), guiding another involves providing factual or technologic information relevant to the regulation of self-agency or meeting self-care requisites. The nurse gives helpful suggestions and factual information to the survivor when she is trying to make decisions about some course of action. This information must be solicited from the survivor and differentiated from unsolicited advice if the support is to be empowering. A critical area for guidance when working with incest survivors is the need to link current symptoms with the childhood abuse. This can be done by simply asking the woman if there is anything stressful or painful going on in her life that reminds her of the past abuse. Most frequently flashbacks, nightmares, and feelings of panic and anxiety can be linked to a current event that has triggered feelings related to the sexual abuse. An overreaction to negative relationships with a boss, teacher, friend, or family member may be related to feelings of victimization from the past. The loss of job or boyfriend may stimulate powerful feelings of abandonment that the survivor may have felt when she was not protected by her mother. Because she does not connect the triggering of the current event to the abuse, she may fear she is literally “going crazy. ’ ’ Many times the survivor has no cognitive memory of the abuse, but sensory memories have been stored and are connected to highly traumatic feelings in the survivor. In the author’s study, one survivor who had total repression for her abuse, reported experiencing an overwhelming flashback while simultaneously reading an advertisement for the study in a newspaper and hearing a song on the radio that her offender played while abusing her in childhood. Thus, the pairing of visual and auditory stimuli overcame the protection of her repression. If the survivor can learn to connect current flashbacks, anxieties, and terrors to the past abuse, these intrusive experiences will gradually lose their power. In addition, making connections with the abuse may provide cues about events that trigger the trauma. These triggers can be avoided or strategies can be developed to minimize the stressful effects of the traumatic memories. The survivor is assisted to recognize what is helpful and soothing
JOAN C. URBANCIC
during these traumatic periods, and to develop healing strategies based on these experiences. Simple interventions such as calling a friend, taking a warm bath, listening to favorite music, or rocking a baby can be helpful. Many survivors have a tendency to cope with stress by spontaneously dissociating. This coping technique has developed and been maintained because of its success during the actual childhood abuse episodes. Usually it is an unconscious mechanism that manifests itself as numbing or “spacing out.” However, the dissociation as a means of coping is no longer an effective self-care strategy, since the women are unable to protect themselves or their children from abuse if they dissociate. (Survivors frequently report that their own mothers seemed casual or spaced out when the incest was disclosed in childhood. This suggests dissociation by the mothers). The survivor may seek guidance and direction on a wide number of issues, including confrontation of the offender and/or nonoffending parent, disclosing to family members or friends, relationships with men, and family conflicts. However, these discussions are always based on clarification of what the survivor feels is comfortable and appropriate for her. Throughout their discussions, the nurse consistently points out each small positive step of change that indicates healing. de Shazer (1985) emphasizes the need to explore with the client feelings and behaviors associated with these positive changes so that the focus is one of healing and surviving, rather than of victimization. In addition, this approach encourages the survivor to discover and use her own strengths and resources and gradually feel empowered. Maintaining a journal is invaluable in facilitating this process. Teaching
Teaching involves facilitating the development of knowledge necessary for managing self-care and overcoming limitations in self-care. Since the survivor’s self-care limitations are usually mental health-related, the teaching is focused on mental health self-care. Many of the empowerment support strategies that the nurse uses with the survivor involve teaching. According to Freire (1974), teaching cannot
EMPOWERMENT
SUPPORT & OREM’S METHODS
285
OF HELPING
foster empowerment in the learner unless it involves a mutual process between teacher and learner. For the incest survivor and the nurse, this entails sharing experiences and knowledge and understanding the societal factors that contribute to the abuse of women and children. Survivors can be assisted to realize how family, friends, and society contribute to their feelings of shame and guilt by minimizing, denying, and blaming the victim. Many times the survivor doubts her own reality about the abuse because of the vehement denial and blame by others. Dolan (199 1) suggests that the survivor carry some reminder of the truth of the abuse with her all the time. This reminder can be a note or something from her past that represents her innocence and the trauma of the abuse. New behaviors and corrections of myths and distortions about incest are taught. Because the myths and distortions have shaped and conditioned the survivor from childhood, corrective learning is a lengthy and ongoing process for the survivor. The nurse will be repeatedly called upon to reinforce that the adult is always the responsible party in childhood sexual abuse, but women who have derived pleasure and even sought the childhood sexual activity may become especially shamed and guilt-ridden. Thus, basic principles of normal physiology and child development are taught, and it is emphasized that children normally seek out that which is rewarding or feels good. Understanding the concept of traumatic sexualization (Finkelhor, 1986) can be helpful to the survivor who is having difficulty forgiving herself. New behaviors are explored and practiced and the survivor is able to choose strategies that she finds most appropriate for herself. Examples include assertive skills, anger control techniques, journal-writing, drawing, sculpturing, relaxation and imagery techniques, self-defense training, letter-writing. drawing, mask-making, sculpturing, and physical exercise. Many survivors find reading some of the excellent books written specifically for survivors especially helpful. In the author’s study (Urbancic, 1992), the book, Courage to Heal (Bass & Davis, 1988), was repeatedly cited by survivors as being helpful in the healing process. Nurses can encourage survivors to attend conferences, work shops, and wilderness retreats as part of their healing experiences. Since a multitude
of self-help groups and newsletters exist, the nurse needs to become knowledgeable about these sources so that she can provide information for those who request it. Since many survivors do not have the financial resources for private therapy it is crucial for them to have the option of attending self-help groups such as Survivors of Incest Anonymous @IA). The SIA groups are based on the Alcoholics Anonymous 12-Step Program and are available in many communities across the country. Information on self-help groups can be obtained by calling your local state Self-Help Clearing House. SUMMARY
Adult female survivors of incest are a population in need of specialized nursing interventions, which will empower them to gain a sense of mastery, competency, control, and self-worth, and to act on these new beliefs and attitudes to resolve their incest trauma. The integration of empowerment support with Orem’s methods of helping can guide the nurse in designing nursing interventions for this population so that the survivor can achieve incest trauma resolution, mental health self-care, and well-being. If nurses are to provide empowerment support for survivors, it is crucial that a collaborative, rather than a traditional patriarchical dominant/submissive, relationship be established. However, empowerment support interventions must not only be designed and implemented, they must also be tested to determine which are effective in the healing of incest trauma. Propositions from Orem’s self-care deficit theory can provide the basis for testing the relationship between empowerment support, incest trauma resolution, mental health self-care, and well-being. These relationships are currently being examined as part of the author’s dissertation. The author has developed and is testing an instrument to measure empowerment support (Urbancic, 1992) in adult female survivors of incest. If the discipline of nursing is to practice from a scientific body of knowledge, then testing of nursing theories such as Orem’s is crucial. Although this report focuses on the influence of empowerment support on the adult female survivor of childhood incest experiences, the concept as a part of Orem’s methods of helping is relevant to many populations that require nursing. Research with
286
JOAN C. URBANCIC
other populations that experience stressful life events is needed to understand the relationship between empowerment support, and the regulation and production of self-care, health, and wellbeing. REFERENCES Bass, E., & Davis L. (1988). The courage to heal. New York: Harper and Row. de Shazer, S. (1985). Keys to solution in brief therapy. New York: W.W. Norton & Co. Dolan, Y.M. (1991). Resolving sexual abuse: Solution focused
therapy and Ericksonian hypnosis ,for adult survivor. New York: W.W. Norton & Co. Finkelhor. D. (1986). A sourcebook on child sexual abuse. Beverly Hill, CA: Sage. Freire,
P. (1974). Pedagogy of the oppressed. Seabury Press.
New York:
Orem, D.E. (1991). Nursing: Concepts of practice (4th ed.). St. Louis: Mosby Yearbook. Urbancic, J. (1992). The relationship between empowerment support, mental health self-care, well-being, and incest trauma resolution in adultfemale survivors of childhood incest. Unpublished doctoral dissertation, Wayne State University, Detroit.
