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Discovering the Healthcare Beliefs and Practices of Rural Mestizo Ecuadorians: an Ethnonursing Study Julie A

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Discovering the Healthcare Beliefs and Practices of Rural Mestizo Ecuadorians: an Ethnonursing Study Julie A View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Duquesne University: Digital Commons Duquesne University Duquesne Scholarship Collection Electronic Theses and Dissertations Summer 2010 Discovering the Healthcare Beliefs and Practices of Rural Mestizo Ecuadorians: An Ethnonursing Study Julie A. Moss Follow this and additional works at: https://dsc.duq.edu/etd Recommended Citation Moss, J. (2010). Discovering the Healthcare Beliefs and Practices of Rural Mestizo Ecuadorians: An Ethnonursing Study (Doctoral dissertation, Duquesne University). Retrieved from https://dsc.duq.edu/etd/954 This Immediate Access is brought to you for free and open access by Duquesne Scholarship Collection. It has been accepted for inclusion in Electronic Theses and Dissertations by an authorized administrator of Duquesne Scholarship Collection. For more information, please contact [email protected]. DISCOVERING THE HEALTHCARE BELIEFS AND PRACTICES OF RURAL MESTIZO ECUADORIANS: AN ETHNONURSING STUDY A Dissertation Submitted to the School of Nursing Duquesne University In partial fulfillment of the requirements for the degree of Doctor of Philosophy By Julie Ann Moss August 2010 Copyright by Julie Ann Moss 2010 DISCOVERING THE HEALTHCARE BELIEFS AND PRACTICES OF RURAL MESTIZO ECUADORIANS: AN ETHNONURSING STUDY By Julie Ann Moss Approved April 20, 2010 ________________________________ ________________________________ Rick Zoucha, PhD, APRN, CTN Shirley Powe Smith Associate Professor of Nursing Assistant Professor of Nursing (Committee Chair) (Committee Member) ________________________________ ________________________________ Gretchen Schumacher, PhD, GNP,FNP, NP-C Assistant Professor of Nursing (Committee Member) ________________________________ ________________________________ Eileen Zungalo, Linda Goodfellow, Phd Dean, School of Nursing Chair, Department of Nursing Professor of Nursing Professor of Nursing iii ABSTRACT DISCOVERING THE HEALTHCARE BELIEFS AND PRACTICES OF RURAL MESTIZO ECUADORIANS: AN ETHNONURSING STUDY By Julie Ann Moss August 2010 Dissertation supervised by: Dr. Richard Zoucha Purpose The purpose of this ethnonursing study was to observe and collect data related to the role of the nurse, healthcare beliefs and practices of rural mestizo Ecuadorians. Background The current literature regarding Ecuadorian health practices has been limited to the study of indigenous Americo-Indian groups. No studies have been conducted in the mestizo rural setting. Discovering these beliefs and practices will enable nurses and other healthcare workers to provide care that is acceptable, congruent in culture, and health promoting. iv Research Design An ethnonursing method was used to uncover and discover phenomena of interest to nursing. The research questions related to healthcare beliefs, practices, and what constitutes culturally acceptable care within the context of their culture? Participants The researcher interviewed 28 general informants. Informants The researcher had contact over the past seven years in Tosagua, Ecuador. The familiarity with the residents, local leadership, and fluency in the Spanish language has promoted her acceptance. After obtaining IRB approval from Duquesne University the initial informants were recruited by the gatekeeper then the snowball method was used to recruit additional informants. Participation was voluntary and they were free to withdraw at any time. Data Collection and Analysis The Four Phases of Ethnonursing Qualitative Data Analysis and NVIVO8 software was used to manage data. Results Eighteen categories were extracted from the raw data of interviews, observation, and field notes. These categories were the meaning of health (la salud), meaning of illness (la enfermedad), folk and common illnesses (enfermedades común y folklóricos), folkhealers (curanderos) medicinal plants (plantas naturales), professional healthcare (cuidado professional, spirituality (la espiritualidad), environment (el medioambiente), meaning of family (la familia), nutrition (nutricion), exercise (ejercicio), education v (educación), health education (educación sobre la salud), role of the nurse (papel de la enfermera), politics, and hope for the future (eperanza por el futuro. Phase three of data analysis is the discovery of patterns of data inherent in the categories related to the DOI. The interviews were conducted until data saturation of patterned meaning in context. Six patterns of data inherent in the categories emerged from this phase are a pattern of belief in God and the power of prayer, valuing self-care and preservation practices, pattern of external factors negatively effecting health, pattern of identified barriers to healthcare, pattern of hope being essential to well-being and health, and pattern of valuing family caring. From the patterns four themes were teased out and were discussed. The themes are spirituality and prayer are necessary for health and well-being, living in a community with like-minded people positively affects health and well-being, incorporation of traditional medicine with modern medicine is essential to health, and environmental context beyond the people’s control greatly affects health and well-being. Conclusions and Implications Four substantive themes which were teased out are complex and inter-related. Spirituality and prayer are necessary to maintain health, healing and well-being. Rural mestizo Ecuadorians living in a community with like-minded people positively affects health and well-being. The incorporation of traditional medicine with modern medicine is essential to health. Many external factors beyond the control of the people greatly affect health and well-being. The intertwining thread between all of the themes is hope. The rural mestizo Ecuadorians are buoyed by hope in something better for the future. Their vi hope lies in the power of God to change their circumstances and the core value of living in community. vii DEDICATION My heartfelt love, appreciation, and gratitude goes to my husband, Kevin Moss, who has endured hours of listening to me talk about coursework, culture and nursing without as much as a yawn. Thank you for being my steadfast rock when the tempests and I were swaying and raging. Thank you for undeserved grace. I love you. Thank you to my wonderful children who have supported me with love and encouragement through an educational journey that stretches back to Ecuador. You have been my inspiration and endless source of hugs. I would like to thank my parents, Harold and Lucrecia Minnich who have supported my decisions to be a nurse since buying me endless “medical” kits as a child. Thank you to my brothers, Dan and Stan Minnich and especially to my sister-in-law Cindy who modeled nursing excellence and encouraged me to apply to nursing school. Thank you! Thank you to my dissertation chair, Dr. Rick Zoucha who has been an integral part of my Duquesne education from my PhD interview through the countless hours and phone calls urging me to “dig deeper”. You have my sincere thanks and gratitude for your sage wisdom and patience. Thank you for sharing your passion for transcultural nursing and research. I look forward to collaborating with you on future research in Latin America. Thanks also to my dissertation committee, Dr. Shirley Smith and Dr. Gretchen Schumacher who have made this process an actual pleasure and have been so gracious with their time and talents. viii ACKNOWLEDGEMENT Thank you to the Transcultural Nursing Society for their monetary research award used toward this study. ix TABLE OF CONTENTS Page Abstract.............................................................................................................................. iv Dedication........................................................................................................................ viii Acknowledgement ............................................................................................................. ix Chapter 1............................................................................................................................. 1 1.1 Introduction............................................................................................................... 1 1.2 Domain of Inquiry..................................................................................................... 1 1.3 Purpose and Goal ...................................................................................................... 1 1.4 Rationale ...................................................................................................................2 1.5 Research Questions................................................................................................... 3 1.6 Significance for Nursing........................................................................................... 3 1.7 Orientational Definitions .......................................................................................... 6 1.8 Assumptions.............................................................................................................. 8 1.9 Summary................................................................................................................... 9 Chapter 2........................................................................................................................... 10 Review of the Literature ................................................................................................... 10 2.1 Ethnohistory:
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