Duquesne University Duquesne Scholarship Collection Electronic Theses and Dissertations Summer 2009 Culture Care Beliefs, Meanings and Practices Related to Health and Well-Being of South Sudanese "Lost Boy and Lost Girl" Refugees Margaret Bowles Follow this and additional works at: https://dsc.duq.edu/etd Recommended Citation Bowles, M. (2009). Culture Care Beliefs, Meanings and Practices Related to Health and Well-Being of South Sudanese "Lost Boy and Lost Girl" Refugees (Doctoral dissertation, Duquesne University). Retrieved from https://dsc.duq.edu/etd/345 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]. CULTURE CARE BELIEFS, MEANINGS AND PRACTICES RELATED TO HEALTH AND WELL-BEING OF SOUTH SUDANESE “LOST BOY AND LOST GIRL” REFUGEES A Dissertation Submitted to the School of Nursing Duquesne University In partial fulfillment of the requirements for the degree of Doctor of Philosophy By Margaret Elizabeth Bowles August 2009 Copyright by Margaret Elizabeth Bowles 2009 PhD PROGRAM APPROVAL OF FINAL DEFENSE OF DISSERTATION STUDENT: Margaret Bowles DATE OF ADMISSION: Fall 2003 DISSERTATION TITLE: Culture Care Beliefs, Meanings and Practices Related to Health and Well-Being of South Sudanese "Lost Boy and Lost Girl" Refugees __________________________________________________________________________ DISSERTATION COMMITTEE: Type name below Signature Date Dissertation Chair: Rick Zoucha, PhD, APRN-BC, CTN Internal Member: Shirley Smith, PhD, RN, CRNP External Member: Jok Madut Jok, PhD Ad hoc, if applicable: Approved by Dissertation Chair and Committee _______________________________________________________ ____________________ Joan Such Lockhart, PhD, RN, CORLN, AOCN®, CNE, FAAN Date Professor & Associate Dean for Academic Affairs iii ABSTRACT CULTURE CARE BELIEFS, MEANINGS AND PRACTICES RELATED TO HEALTH AND WELL-BEING OF SOUTH SUDANESE “LOST BOY AND LOST GIRL” REFUGEES By Margaret Elizabeth Bowles August, 2009 Dissertation Supervised by Professor Rick Zoucha, PhD, APRN-BC, CTN The purpose of this ethnonursing study was to describe, analyze and interpret the culture care beliefs, meanings and practices related to health and well-being of South Sudanese “Lost Boy and Lost Girls” following resettlement in the United States. Leininger’s theory of culture care diversity and universality and the ethnonursing method provided the organizing framework for studying the domain of inquiry. Interviews were conducted with nineteen general informants and ten key informants, all who lived in the Midwest United States. Extensive analysis of digitally recorded interviews together with the researcher’s participant observations and field notes revealed nine data categories and five patterns from which three main themes emerged. The themes were (a) spiritual care, grounded in a belief in the strength and wisdom of one God, is health promoting and illness preventing; (b) contributing to and meeting the expectations of the community are necessary for health and well-being; and (c) the conflicting expectations of two cultures iv are affecting health and well-being. The findings of this study provide a framework from which to develop culturally congruent care for the “Lost Boys and Girls.” Implications and recommendations for nursing theory, practice, education, and research are offered. v DEDICATION This dissertation is dedicated to my husband Robin, and our children, Colin and Anne, who have supported me in so many ways over the past six years of doctoral studies. I couldn’t have done it without your love, support and encouragement. I also dedicate this dissertation to my mother Jessie Herreshoff, who led the way by being the first person in our family to go to college, and the first to earn a PhD. She consistently told me I could do it. It is also dedicated to the memory of my father, Archie Edwards, who believed I could do no wrong. vi ACKNOWLEDGMENT My sincere gratitude goes to Dr. Rick Zoucha, my committee chair, for helping me in countless ways through the sharing of his wisdom, knowledge, humor, and continuous support. I would also like to thank my dissertation committee members Dr. Shirley Powe Smith and Dr. Jok Madut Jok for supporting me through this process with their insightful comments and thoughtful advice. Special thanks to the Kappa Epsilon Chapter of Sigma Theta Tau for awarding me the 2008 Research Award that assisted with the costs of this study, and to the Transcultural Nursing Society for awarding me the 2003 Graduate Research Award which assisted with the costs of the Mini-Study which provided the foundation for this study. vii TABLE OF CONTENTS Page Abstract .............................................................................................................................. iv Dedication .......................................................................................................................... vi Acknowledgement ............................................................................................................ vii 1 Introduction 1.1 The “Lost Boys and Lost Girls of Sudan”…………………………………….......1 1.2 Background..............................................................................................................4 1.3 Domain of Inquiry and Rationale ............................................................................5 1.4 Purpose and Goals ....................................................................................................5 1.5 Research Questions ..................................................................................................6 1.6 Significance to Nursing............................................................................................7 1.7 Orientational Definitions .......................................................................................12 1.8 Assumptions ...........................................................................................................16 1.9 Summary ................................................................................................................17 2 Review of the Literature 2.1 Sudan .....................................................................................................................18 2.2 Historical Overview ...............................................................................................21 2.3 Ethnohistory ...........................................................................................................24 2.4 The People and Languages ....................................................................................26 2.5 Worldview .............................................................................................................27 2.6 Religion ..................................................................................................................28 2.7 Education ...............................................................................................................30 viii 2.8 Political and Legal Systems ...................................................................................32 2.9 Economics ..............................................................................................................33 2.10 Kinship Structure .................................................................................................34 2.11 Cultural Values and Lifeways ..............................................................................36 2.12 Refugee Camps ....................................................................................................38 2.13 Health and Well-being of Lost Boys and Lost Girls in Refugee Camps .............40 2.14 Health and Well-being of Lost Boys and Lost Girls in Resettlement .................44 2.15 Synthesis of the Literature ...................................................................................48 2.16 Theoretical Framework Orientation Using Leininger’s Theory of Culture Care Diversity and Universality ...........................................................................................49 2.17 Summary ..............................................................................................................52 3 Methodology 3.1 Ethnonursing Method .............................................................................................54 3.2 Mini Study ..............................................................................................................55 3.3 Context of the Study ...............................................................................................57 3.4 Entry into the Community ......................................................................................57 3.5 Informants ...............................................................................................................59 3.6 Data Collection .......................................................................................................60 3.7 Human Subjects and Ethical Considerations ..........................................................63 3.8 Data Analysis ..........................................................................................................64 3.9 Summary .................................................................................................................65