Taking charge of health: an educational intervention for patients and staff

Attitudes about attributing health effects to oneself (internal locus of control on health issues), as opposed to fate, chance, or powerful others, have resulted in improved health behavior and treatment outcome. Although this construct has been researched among patients and self-efficacy has been studied for patients and nurses, changes in internal health control beliefs among staff following specific empowering interactions have not been studied. Psychiatric nursing students at Middlesex Community College took part in one of three types of practicum experiences: a psychoeducation practicum with psychiatric patients utilizing "empowering" learning principles, a traditional psychiatric placement, or a medical-surgical placement. The Achterberg and Lawlis Health Attribution Test was administered to all groups, before and after the clinical placement. The psychoeducation group evidenced a significant rise in internality following the placement; other groups did not experience this change. Specifically, after being involved in an empowering educational experience, the nurses themselves attributed more power to the patient for maintaining good health rather than to doctors and other health staff, or to fate. These nurses saw the patient as more powerful and empowered. Scales that measured attribution of causality to "powerful others" (such as doctors, etc.) or to just "chance" (such as "it was my fate--these things happen"), were stable across administrations of the test. Implications for educational and medical communities were discussed.