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Exploring the Experiences of African American Nurses: an Emancipatory Inquiry Laurie Pierce

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Exploring the Experiences of African American Nurses: an Emancipatory Inquiry Laurie Pierce University of North Dakota UND Scholarly Commons Theses and Dissertations Theses, Dissertations, and Senior Projects January 2018 Exploring The Experiences Of African American Nurses: An Emancipatory Inquiry Laurie Pierce Follow this and additional works at: https://commons.und.edu/theses Recommended Citation Pierce, Laurie, "Exploring The Experiences Of African American Nurses: An Emancipatory Inquiry" (2018). Theses and Dissertations. 2310. https://commons.und.edu/theses/2310 This Dissertation is brought to you for free and open access by the Theses, Dissertations, and Senior Projects at UND Scholarly Commons. It has been accepted for inclusion in Theses and Dissertations by an authorized administrator of UND Scholarly Commons. For more information, please contact [email protected]. EXPLORING THE EXPERIENCES OF AFRICAN AMERICAN NURSES: AN EMANCIPATORY INQUIRY by Laurie Pierce Associate of Science, J. Sargeant Reynolds Community College, 1985 Bachelor of Science in Nursing, Virginia Commonwealth University. 2006 Master of Science in Nursing, Old Dominion University, 2008 A Dissertation Submitted to the Graduate Faculty of the University of North Dakota in partial fulfillment of the requirements for the degree of Doctor of Philosophy Grand Forks, North Dakota August 2018 Copyright 2018 Laurie Pierce ii PERMISSION Title Exploring the Experiences of African American Nurses: An Emancipatory Inquiry Department Nursing Degree Doctor of Philosophy In presenting this dissertation in partial fulfillment of the requirements for the graduate degree from the University of North Dakota, I agree that the library of this University shall make it freely available for inspection. I further agree that permission for extensive copying for scholarly inquiries may be grated by the professor who supervised my dissertation work or, in her absence, by the Chairperson of the department or the dean of the School of Graduate Studies. It is understood that any copying or publication or other use of this dissertation or part thereof for financial gain shall not be allowed without my written permission. It is also understood that due recognition shall be given to me and to the University of North Dakota in any scholarly use which may be made of any material in my dissertation. Laurie Pierce July 8, 2018 iv TABLE OF CONTENTS LIST OF TABLES ........................................................................................................ x ACKOWLEDGEMENTS ............................................................................................ xi ABSTRACT ................................................................................................................. xii CHAPTER I. INTRODUCTION ................................................................................... 1 Background Topic ........................................................................... 1 Ethnic Congruence of Healthcare Providers .......................... 2 Problem Statement .......................................................................... 4 Purpose Statement ........................................................................... 6 Research Questions ......................................................................... 6 Significance..................................................................................... 7 Expanding Nursing Knowledge ............................................. 7 Emancipatory Knowing ................................................ 8 Conceptual Definitions ................................................................... 9 Conclusion ..................................................................................... 11 II. REVIEW OF THE LITERATURE ........................................................ 12 White Privilege .............................................................................. 14 Healthcare and Discrimination ...................................................... 20 History, Laws, and Federal Policy Initiatives Related To Healthcare ........................................................................ 20 v Effects of Discriminatory Practices on Health Outcomes .... 21 Current Perceptions of the Healthcare System ..................... 24 History of African American Women in Nursing .......................... 28 Case Law ............................................................................... 33 Nurses as an Oppressed Group ...................................................... 35 Empowerment ................................................................................ 44 Structural Empowerment ...................................................... 45 Psychological Empowerment................................................ 47 Nurses’ Empowerment.......................................................... 49 Nurses’ Perceptions of Empowerment......................... 50 Organizational Structures and Empowerment within Nursing ............................................................. 54 Critical Social Theory Empowerment within Nursing ......................................................................... 63 Meeting the Emancipatory Interests of Nurses ..................... 64 Conclusion ..................................................................................... 68 III. METHODS ............................................................................................. 69 Theoretical Tenets of the Inquiry ................................................... 70 Habermas’ Critical Social Theory ........................................ 70 Freire’s Pedagogy of the Oppressed ..................................... 72 Webb and Feminist Theory ................................................... 73 Research Design............................................................................. 74 Research Assumptions .......................................................... 75 Reflexivity...................................................................................... 76 vi Reflexivity and Decentering ................................................. 76 Decentering ................................................................... 76 Personal Assumptions ................................................... 77 Population and Sampling ............................................................... 78 Recruitment of Participants................................................... 79 Data Collection .............................................................................. 80 Communicating the Experience ............................................ 80 Data Analysis ................................................................................. 81 Rigor ..................................................................................... 83 Transferability ....................................................................... 84 Dependability ........................................................................ 84 Confirmability ....................................................................... 84 Ethical Considerations ................................................................... 85 Conclusion ..................................................................................... 87 IV. RESULTS ............................................................................................... 88 Oppression is Multifaceted ............................................................ 90 Personal Experiences of Oppression ..................................... 90 African American Nurses Must Work Harder ............. 90 Unfair Work Assignments and Disciplinary Actions .. 93 Being Viewed as a Nurse Aid ...................................... 94 Patients who Demonstrate Racism ............................... 96 Response to Racism ..................................................... 97 Feeling of Isolation ...................................................... 98 vii Nurses Oppressing Other Nurses ......................................... 100 Age as an Oppressive Mechanism ....................................... 101 Being Female as an Oppressive Mechanism ....................... 102 Hierarchal Structures: “My voice is not heard.” .................. 103 Hierarchy within the Interdisciplinary Team .............. 103 Hierarchy of Administration ....................................... 105 Nurses Do Not Have a Voice within the Hierarchy .... 106 Valuing Humbleness ................................................... 109 Empowerment is Being a Voice for Self and Others .................... 110 Autonomy, Expert Knowledge, and Education ................... 110 Having a Voice .................................................................... 111 Empowering Others is Empowering to Self ........................ 112 Conclusion .................................................................................... 114 V. DISCUSSION ....................................................................................... 115 Envisioning the Ideal Work Environment .................................... 116 Administration in the Ideal Work Environment .................. 116 Working with Others............................................................ 119 Being Active Participants in the Professional Setting .................. 121 Experiencing Oppression .............................................................. 124 Experiences of Racism ......................................................... 124 Contrapuntal Voices...................................................
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