Lived Experiences of Nursing Autonomy

199 Pages·2016·1.32 MB·English

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
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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
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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.
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© Copyright by Rebekah Dubrosky, 2015
All Rights Reserved

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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!
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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
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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
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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
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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
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