Anyinam_Charles_K_2018_PhD - Work Experiences of Nurses with Self-Identified Disabilities CHARLES KENNEDY ANYINAM A DISSERTATION SUBMITTED TO THE

Anyinam_Charles_K_2018_PhD - Work Experiences of Nurses...

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Unformatted text preview: Work Experiences of Nurses with Self-Identified Disabilities CHARLES KENNEDY ANYINAM A DISSERTATION SUBMITTED TO THE FACULTY OF GRADUATE STUDIES IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY Graduate Program in CRITICAL DISABILITY STUDIES York University Toronto, Ontario January 2018 © CHARLES KENNEDY ANYINAM, 2018 Abstract Globally and in Canada, meaningful participation of disabled people in the labour market is a relatively new occurrence. While the literature about disabled people’s experiences and perceptions related to employment is established, very little is known about disabled nurses’ work experiences. The aim of this study was to produce a rich descriptive account of the practise experiences of disabled registered nurses (RNs) from their perspectives. The research aim was addressed through a qualitative descriptive study that explored the perspectives and experiences of study participants. In-depth, semistructured interviews were conducted with 12 female RNs residing and working in the province of Ontario. Data was analyzed using conventional content analysis and presented as textual summaries organized under categories. The study found that participants’ experiences of practising with a disability were a mix of positive and negative aspects strongly influenced by factors relating to workplace milieu such as interactions with others in the work environment. Participants identified a greater number of facilitators to practising with a disability than barriers; however, the barriers identified corresponded with actual or desired facilitators. The findings of this study contribute meaningfully to knowledge on the topic of disabled nurses’ work experiences by confirming the findings of previous studies and addressing the scarcity of detailed accounts on the topic. Additionally, the study lends support to a more universal understanding of nurses’ work experiences that is not UScentric. The findings signal that the organizations and institutions that employ disabled nurses need to be more responsive to their situations and address barriers impeding ii their success. In the context of education, the findings encourage self-reflection and actions that will support the success of disabled students and inculcate positive attitudes and behaviours towards disabled nurses. Lastly, the findings highlight several areas where further research could be undertaken to inform policy, educational curricula, and attitudes and behaviours related to disabled nurses. iii Acknowledgements Undertaking this PhD has truly been a life-changing experience for me that would not have been possible were it not for the support and guidance of many people. First and foremost, I would like to extend my deepest appreciation to my dissertation committee members, Dr. Geoffrey Reaume, dr. nancy viva davis halifax, and Dr. Neita Israelite, for their unwavering support throughout this process. As my supervisor, Geoffrey has taught me more than I could ever give him credit for here. Geoffrey has always kept his door open for me and I am thankful for his patience and understanding towards my research. He has shown me, by his example, what a good scholar-educator (and person) should be. nancy has been a source of inspiration and guidance. Her immense knowledge of qualitative methodology, her enthusiasm for my research, and her cheerful encouragement made all the difference. Neita has continuously shown faith in my work, and generously gave of her time, promptly responding to my writing and inquiries. I benefited greatly from her guidance and support. I am extensively grateful to the nurse participants who shared their histories, experiences, and thoughts with me. Without their openness and willingness to participate in this research this study would not have been possible. I am hopeful that the analysis did justice to the trust and confidence they showed in me to tell their stories and help others to understand the complexities of practising nursing with disabilities. Finally, I could not have completed this project without my family and friends. I would like to thank my parents, whose love and guidance are with me in whatever I pursue. I am indebted to my dearest friend, Dr. Sue Coffey, who has been the ultimate role model for my career and my life. And I wish to thank my loving partner, Dale, who iv provided unending support. His encouragement, patience, and faith in gave me what I needed to get this work done. v Table of Contents Abstract .......................................................................................................... ii Acknowledgements ........................................................................................ iv Table of Contents ........................................................................................... vi List of Tables .................................................................................................. xi Chapter 1: Introduction................................................................................... 1 Introduction ..................................................................................................................... 1 Disability and Work in Canada ....................................................................................... 2 Disability Policy in Canada ......................................................................................... 4 Disability Legislation in Ontario................................................................................. 5 Disability and Nursing in Canada ....................................................................................7 Nursing Practice in Canada .........................................................................................7 Registered Nurses Practice Trends and Issues ........................................................... 9 Disability and Nursing Regulation ............................................................................ 11 Disabled Nurses in Canada ........................................................................................ 13 Disability Research and Disabled Nurses .................................................................. 13 Purpose and Aims .......................................................................................................... 14 Research Question ......................................................................................................... 15 Significance of the Research .......................................................................................... 15 Terminology and Definitions ......................................................................................... 16 Definition of Disability............................................................................................... 19 Summary ....................................................................................................................... 20 Chapter 2: Literature Review ........................................................................ 21 Introduction ................................................................................................................... 21 Constructions of Disablement ...................................................................................... 22 Individual vs. Social Approaches to Disability ......................................................... 24 The Social Model of Disability .............................................................................. 26 Embodiment and Impairment .................................................................................. 27 Identity and Identity Politics .................................................................................... 29 Disability in the Context of Nursing .............................................................................. 31 Portrayals of Disability in Nursing Practice and Scholarship .................................. 32 Portrayals of Disability in Nursing Education .......................................................... 33 Nurses’ Attitudes Towards Disability and Disabled People ..................................... 35 Work Experiences of Disabled Nurses...........................................................................37 vi Studies of Others’ Experiences with Disabled Nurses .............................................. 39 Studies of the Practice and Work-Life Experiences of Disabled Nurses .................. 40 Gaps and Limitations of the Literature ........................................................................ 49 Summary ........................................................................................................................ 51 Chapter 3: Methodology ................................................................................ 52 Introduction .................................................................................................................. 52 Approach to the Research ............................................................................................. 52 Philosophical Assumptions....................................................................................... 53 Approach to Inquiry.................................................................................................. 54 Positionality and Research Topic ..............................................................................55 Research Methodology and Methods ........................................................................... 56 Research Methodology ..............................................................................................57 Table 3.1 Basic Beliefs of Constructivist Inquiry Approach (cont’d) ........................ 60 Methods .................................................................................................................... 60 Sampling and Sample Size ..................................................................................... 61 Data Generation .................................................................................................... 62 Positionality and Data Generation ....................................................................... 64 Data Analysis ........................................................................................................ 65 Ethical Considerations .............................................................................................. 67 Trustworthiness ............................................................................................................. 71 Trustworthiness Criteria ........................................................................................... 72 Credibility ............................................................................................................. 72 Transferability....................................................................................................... 74 Dependability ........................................................................................................ 74 Confirmability ....................................................................................................... 76 Reflexive Approach to Research ................................................................................ 77 Reflexivity as Introspection .................................................................................. 79 Reflexivity as Intersubjective Reflection ...............................................................81 Reflexivity as Critique of Social Position and Power ............................................ 84 Gender and Power ............................................................................................ 86 Thoughts on Doing Reflexivity ............................................................................. 89 Summary ........................................................................................................................ 91 Chapter 4: Participant Interviews ................................................................. 93 Introduction .................................................................................................................. 93 Study Participants ......................................................................................................... 93 Participant Demographics ........................................................................................ 93 Participant Vignettes ................................................................................................ 96 Participant 1: “Dorothy”........................................................................................ 96 Participant 2: “Sophia” ......................................................................................... 98 Participant 3: “Rose” ........................................................................................... 100 vii Participant 4: “Blanche” ...................................................................................... 101 Participant 5: “Helen” ..........................................................................................102 Participant 6: “Louise” ........................................................................................ 104 Participant 7: “Jenny” ..........................................................................................105 Participant 8: “Mary” ........................................................................................... 107 Participant 9: “Sondra” ....................................................................................... 108 Participant 10: “Florence”.................................................................................... 110 Participant 11: “Heather” ..................................................................................... 112 Participant 12: “Natalie” ...................................................................................... 113 Summary ...................................................................................................................... 115 Chapter 5: Findings Participant Experiences and Perceptions .................116 Introduction ................................................................................................................. 116 Practising Nursing with a Disability ............................................................................ 116 Experiences .............................................................................................................. 117 Practising nursing with a disability ......................................................................... 117 Content Areas........................................................................................................... 117 Practising with a disability....................................................................................... 117 Perceptions of others ............................................................................................... 117 Facilitators of practice ............................................................................................. 117 Barriers to Practice .................................................................................................. 117 Categories................................................................................................................. 117 Experiences Interactions Exposures........................................................................ 117 Uncertainty Perceptions of abilities Perception of person ...................................... 117 Facilitating factors Factors that would facilitate ..................................................... 117 Nature of disability Nature of nursing Work Work environment factors ............... 117 Changes .................................................................................................................... 117 Changes in the Amount of Time Spent Practising ............................................... 117 Changes in Ability to Practice ..............................................................................120 Poor Practice Conditions ..................................................................................... 124 Reactions.............................................................................................................. 126 Embodied Responses ...........................................................................................130 Negative Emotional Responses ....................................................................... 131 Cognitive Responses ........................................................................................ 134 Physical Responses ..........................................................................................138 Interactions .............................................................................................................. 139 Negative Interactions .......................................................................................... 140 Positive Interactions ............................................................................................ 142 Negative Perceptions ........................................................................................... 143 Positive Perceptions ............................................................................................. 145 Negative Outcomes ..............................................................................................146 Positive Outcomes................................................................................................150 Exposures ................................................................................................................. 151 Being Visible ........................................................................................................ 152 Degree of Visibility ........................................................................................... 152 viii Consequences of Being Seen ............................................................................ 154 Disclosing ............................................................................................................. 155 Decision to disclose.......................................................................................... 155 Consequences of Disclosing ............................................................................. 159 Perceptions of Others................................................................................................... 161 Uncertainty about Perceptions ................................................................................ 161 Perceptions about Competence ............................................................................... 162 Perception Towards Person .....................................................................................166 Attributed Characteristics ....................................................................................166 Feelings and Attitudes .........................................................................................168 Behaviour Towards ..............................................................................................169 Summary ...................................................................................................................... 171 Chapter 6: Findings – Barriers and Facilitators of Practice ....................... 173 Introduction ................................................................................................................. 173 Barriers to Practice ...................................................................................................... 173 Nature of Disability .......................................................
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