University of Wisconsin Milwaukee UWM Digital Commons Teses and Dissertations May 2015 Lived Experiences of Nursing Autonomy: a Phenomenological Exploration Rebekah Kalen Dubrosky University of Wisconsin-Milwaukee Follow this and additional works at: htps://dc.uwm.edu/etd Part of the Gender and Sexuality Commons, and the Nursing Commons Recommended Citation Dubrosky, Rebekah Kalen, "Lived Experiences of Nursing Autonomy: a Phenomenological Exploration" (2015).Teses and Dissertations. 869. htps://dc.uwm.edu/etd/869 Tis Dissertation is brought to you for free and open access by UWM Digital Commons. It has been accepted for inclusion in Teses and Dissertations by an authorized administrator of UWM Digital Commons. For more information, please contact LIVED EXPERIENCES OF NURSING AUTONOMY: A PHENOMENOLOGICAL EXPLORATION by Rebekah K. Dubrosky A Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy In Nursing at University of Wisconsin - Milwaukee May 2015 ABSTRACT LIVED EXPERIENCES OF NURSING AUTONOMY: A PHENOMENOLOGICAL EXPLORATION by Rebekah Dubrosky The University of Wisconsin - Milwaukee, 2015 Under the Supervision of Professor Mary Jo Baisch The purpose of this phenomenological study was to explore the meaning that acute care, bedside nurses’ assign to their autonomous actions. A feminist critique of the nursing work environment was applied using standpoint theory. This was balanced and supplemented by a post-modern critique using Foucault’s method of assessing power and knowledge in relation to the discipline of a profession. This study was designed to explore how issues of gender, knowledge, and power affected participants’ interpretations of their autonomous actions. This study used a qualitative, phenomenological approach with an emergent design. Purposive sampling was used to find registered nurses currently working in acute care settings and whose only form of practice was the provision of direct patient care. 10 Participants were recruited by email and snowball sampling and were from a wide variety of specialty areas. Data were collected using three semi-structured interviews. Each participant was interviewed three times, which allowed for an in-depth exploration of the issues of autonomy, gender, and power. The interviews were audio-recorded and then transcribed verbatim. The transcribed interviews were analyzed using DEDOOSE™, a ii web-based qualitative data management software program designed to facilitate analysis of qualitative data. Participants revealed that the context in which they acted was crucial to their autonomy. Poor nurse-physician relationships and fear created a negative context in which autonomy was inhibited while trust and respect created an environment in which autonomy could flourish. For these participants autonomy meant that they were able to do the right thing for their patients and it led to positive patient outcomes. Participants felt that gender issues negatively impacted their relationships with physicians which in turn negatively impacted their autonomy. While most participants discussed the positive benefits of nurse empowerment they had largely negative reactions to power in general. The purpose of this study was to understand the impact of gender and power on the autonomous decisions and practice of bedside nurses. It is clear that gender issues impact nurses’ work environments. Developing policies to improve nursing autonomy will require that we understand the social and political context in which these actions occur. iii © Copyright by Rebekah Dubrosky, 2015 All Rights Reserved
 iv Dedication To my daughter Jasmin Thank you for your support and encouragement as we moved through our school journeys together. Your always sage advice of “Don’t Panic!” helped me more than you know! v Table of Contents Abstract ....................................................................................................................ii Dedication ................................................................................................................v Acknowledgements ..................................................................................................x List of Figures .........................................................................................................xi List of Tables .........................................................................................................xii Chapter 1: Introduction of the Study .......................................................................1 Understanding Oppression and Autonomy ........................................................3 Standpoint theory and oppression. ...............................................................3 Intersectionality. ...........................................................................................5 Foucault and knowledge/power. ..................................................................5 Standpoint of the Researcher. ......................................................................6 Nursing Practice. ..........................................................................................7 Nursing autonomy. .......................................................................................9 Statement of the Problem ................................................................................10 Statement of Purpose .......................................................................................11 Assumptions .....................................................................................................13 Definition of Terms ..........................................................................................13 Significance to Nursing Science ......................................................................14 Chapter 2: Literature Review .................................................................................15 Context of the Phenomenon .............................................................................15 The origins of the problem. ........................................................................16 Birth of the disease model and medical dominance. ............................16 Nurse leaders play a part. .....................................................................17 Autonomy in the 21st century. ...................................................................20 Defining Autonomy .........................................................................................22 Measuring autonomy. .................................................................................24 The nursing work index – revised. .............................................................25 Essentials of Magnetism. ...........................................................................28 Healthy Workplace Index. ..........................................................................30 Feminist perspectives. ................................................................................31 Relational autonomy. ...........................................................................33 Standpoint theory. ................................................................................36 vi Intersectionality. .........................................................................................38 Foucault’s power/knowledge and autonomy. .............................................40 Into the Future ..................................................................................................43 Phenomenology and the lived experience ........................................................44 Phenomenology - Laying the Foundation. .................................................44 Husserl’s phenomenology. .........................................................................46 Heidegger’s phenomenology. .....................................................................48 Phenomenology and nursing autonomy. ....................................................51 Looking Forward .............................................................................................51 Chapter 3: Methodology ........................................................................................53 Sample ..............................................................................................................53 Protection of the participants. ..............................................................55 Methodology ....................................................................................................55 Procedures. .................................................................................................59 Method of analysis. ..............................................................................61 Ensuring Quality ..............................................................................................63 Validity: the primary concerns. ..................................................................63 Meeting the primary concerns. ..................................................................63 Credibility. ...........................................................................................64 Authenticity. .........................................................................................65 Criticality. .............................................................................................65 Integrity. ...............................................................................................66 Validity: the secondary concerns. ..............................................................67 Explicitness. .........................................................................................67 Vividness. ............................................................................................68 Creativity. .............................................................................................68 Thoroughness. ......................................................................................69 Congruence. .........................................................................................70 Sensitivity. ............................................................................................70 Summary ..........................................................................................................71 Chapter 4: Results ..................................................................................................72 vii Profile of the Participants .................................................................................72 Themes and Sub-Themes .................................................................................74 Context of Autonomy .......................................................................................76 Failed autonomy. ........................................................................................76 Tasking. ................................................................................................77 Poor nurse-physician relationships. ...........................................................78 Fear of negative repercussions. ............................................................81 Assumed autonomy. ...................................................................................83 Shift dependent. ...................................................................................83 Autonomy and the nursing environment. .............................................84 Earned autonomy. ......................................................................................86 Experience. ...........................................................................................86 Trust. ....................................................................................................87 Respect. ................................................................................................90 Meaning of Autonomy .....................................................................................93 Part of the team. .........................................................................................93 Freedom of practice. ..................................................................................95 Benefit the patient. .....................................................................................98 Nursing concerns. ................................................................................98 Doing what’s right. ...............................................................................99 Gender’s Influence .........................................................................................102 Personal versus global influence. .............................................................103 Male nurses. .............................................................................................106 The doctor-nurse game. ...........................................................................109 Professional relationships. .................................................................109 Knowing the right approach. ..............................................................111 Power .............................................................................................................115 Physicians and power. ..............................................................................115 Power as negative. ....................................................................................117 Power as positive. ....................................................................................120 viii Reactions to Participation ..............................................................................122 Summary ........................................................................................................124 Chapter Five: Discussion and Analysis ................................................................127 Experiencing Autonomy, Experiencing Oppression ......................................128 Making Sense of Meaning .............................................................................134 Gender and Autonomy ...................................................................................136 Male nurses and privilege. .......................................................................137 Playing the game. .....................................................................................140 Power and Autonomy .....................................................................................143 Views of power. .......................................................................................143 Power as domination. .........................................................................143 Empowerment. ...................................................................................145 Power as a positive force. ..................................................................146 Interrupting Domination ................................................................................147 Limitations of the Study .................................................................................148 Implications ...................................................................................................150 Implications for nursing education. .........................................................151 Implications for nursing research. ............................................................151 Implications for nursing practice. ............................................................153 Implications for nursing policy. ...............................................................156 Conclusion .....................................................................................................157 References ............................................................................................................160 Appendix A: Consent Form .................................................................................175 Appendix B: Demographic Sheet ........................................................................177 Appendix D: Concept Maps .................................................................................181 Curriculm Vitae ....................................................................................................183 ix