Using Freirean Empowerment for Health Education With Adolescents in Primary, Secondary, and Tertiary Psychiatric Settings

Journal of Child and Adolescent Psychiatric Nursing, Apr-Jun 2004 by Rindner, Ellen C

TOPIC. Engaging adolescents in health education through the application of Paulo Freire's three-stage empowerment model in primary, secondary, and tertiary psychiatric settings.

PURPOSE. To demonstrate how nurses can support adolescent autonomy and facilitate adolescent self and collective learning through group process, peer teaching, and development of critical thinking skills.

SOURCES. A synthesis of nursing, medical, and health education literature resulted in identification of Freire's empowerment model and its application with adolescents in primary prevention settings.

CONCLUSIONS. Adolescents in primary, secondary, and tertiary psychiatric settings can identify their health needs, make health choices, and take action to achieve them by using Freire's model.

Search terms: Adolescents, health education, nurse as advocate, oppression, patient empowerment, problem-solving skills, teacher and student as co-learners

Nurses who care for adolescents in primary, secondary, and tertiary psychiatric settings face the daunting challenge of engaging adolescents in the health education process. Teaching adolescents in psychiatric settings is difficult at best because of the myriad of developmental and environmental forces impinging on the adolescent. Trying to teach adolescents whose parents may have committed them to treatment settings against their will or who feel oppressed requires skill and perseverance on the nurse educator's part.

Parents often voluntarily sign their adolescent minors into inpatient and outpatient settings. Since adolescents constitute a vulnerable population whose legal and ethical rights are in need of protection (Association of Child and Adolescent Psychiatric Nursing, 2000; Pieranunzi & Freitas, 1992; Scharer, 1996), nurses working with adolescents in psychiatric settings need to serve as patient advocates. Whether or not commitment to treatment was against their will, I maintain that in either case adolescents will be acutely aware of any threats to their personal freedom and may sometimes feel oppressed while in treatment. Adolescents who feel oppressed will not only be angry with their parents, they will also be more resistive to working with nurses and other authority figures in the treatment setting. The nurse educator will want to help the adolescent shift his or her perception from being an "oppressed student" to that of being an "empowered student."

Stevens (1989) and Kendall (1992) advocate a critical social view of the nurse-client environment. Kendall's model of emancipatory nursing directly applies empowerment principles put forth by Freire (1993) by the "use of freeing educational experiences, by encouraging and creating empowering situations, and by keeping the dialogic process permanently alive" (p. 12). Nurses caring for adolescents can alter oppressive environmental circumstances and practice emancipatory nursing by applying the empowerment health education model I propose in this paper rather than engage the adolescent in traditional health teaching in which the nurse is the subject-matter expert. The purpose of this article is to demonstrate how the nurse can use the empowerment model to facilitate adolescent self and collective learning through group process, peer teaching, and development of adolescent critical thinking skills.

Freire, a Brazilian educator and philosopher, developed his education theory while teaching Brazilian peasants to read. He shared his critical social learning theory of education in Pedagogy of the Oppressed (1993). Freire recommends that the teacher (in this case, the nurse) becomes a co-learner or equal partner with the student (the adolescent in a primary, secondary, or tertiary psychiatric setting) in the learning process. In this way, the nurse can avoid a power struggle with the adolescent and facilitate active involvement in health education.

Freire's Empowerment Education Model

Freire (1993) offered the world a democratic and liberatory vision of education. He believed the principles of social justice (liberation, equal access, empowerment) were necessary to help individuals and communities address the larger socioeconomic causes of oppression and poor health. His goal was to liberate oppressed people though education.

Freire saw liberation as occurring when the oppressed could see the potential for change and transform their environment. He emphasized the oppressed group's active participation in their education and the need for them to take full control of their lives. Freire's view of students as fully empowered participants in the education process shifted the locus of control in traditional health education programs from teachers to students (Rudd & Comings, 1994).

Freire believed personal freedom and development of the individual should occur through supported interaction with others. He valued group learning over individual learning. His teaching occurred in small groups or "culture circles" (Freire, 1994, p. 44) through the process of engaging in dialogue and in problem-posing education. Each culture circle consisted of a teacher and several students interacting in a small group. The culture circles were structured so they were participant, not teacher centered (Rudd & Comings, 1994). Freire (1993) maintained that collective knowledge resulted from group dynamics, small group discussion of past experiences, and critical reflection occurring within the culture circles.