Quotes
“Power as a nurse is inferior to the power of a physician. The focus is curative over caring. The shift to focus on the technical versus needs of the patient” Participant C (age 24)
“Our past experiences, the environment we grew up in, how we view ourselves.” Participant K (age 51)
“Our ethics, morals, culture, education, and open-mindedness.” Participant I (age 55) “Interactions with staff, doctors, morals and values, recognition an compliments.” Participant E (age 42)
“Specific patient situations, basic human rights, our upbringing.” Participant A (age 27) “Our identity, past experience, and hospital culture.” Participant G (age 24)
Summary: Sentiments shared by the participants on why nurses might feel inferior to physicians include the idea that physicians get more attention and credit for the patient’s recovery. Also, the participants discussed the notion that curing patients (the primary focus
of physicians) is generally considered more important that caring for them (the primary focus of nurses). With the focus on patient satisfaction and comfort, one participant related that she felt that nurses are not really appreciated by patients in today’s hospital setting. Question 5. Can you explain how dialogue and self-awareness can help nurses with the dual roles of leadership and oppression?
Quotes
“Not allowing horizontal violence, remembering what it is like to be new.” Participant G (age 24)
“Empowers that nurses to have a voice and an awareness that their opinions and feelings matter.” Participant A (age 27)
“Know the signs of oppression and be aware of lateral violence.” Participant E (age 42) “Communication is important in all we do we have to listen.” Participant I (age 55) “As we become more aware of our experiences and feelings, we can be empowered to speak out.” Participant K (age 51)
“I like how this article said if we are self-aware and put our opinions aside. We must have self-awareness and real dialogue to really work together and collaborate.” Participant C (age 24
Learning stage: strategy building, planning, resource-acquisition. In the learning stage of strategy building, planning, resource-acquisition (Freire, 2016), the participants evaluated their environment and work in terms of (a) individuals; (b) organizations; (c) institutions; and (d) government. The purpose of this learning stage is to help the groups evaluate and plan action projects that would yield achievable results. Those items listed in the “for” column refer to what or who can be helpful to their cause, and those in the “against” column refer to what or who can be unhelpful to the cause. Table 6 provides the result of Group 1’s exercise.
Table 6
Strategy Building, Planning, Resource-Acquisition, Implementation Group 1.
FOR AGAINST
Individuals More RNs than MDs
Good leadership Experience/mentorship
Rounding on patients is helpful
gossip
Bad leadership Lateral violence Burnout/turnover
Patient expectations unrealistic Organizations American Nurses Association
Magnet Certification Shared Leadership Council Professional Organizations
Joint Commission on
Accreditation of Health care Organizations (JCAHO) has too much power over hospitals and reimbursement
Institutions Rounding
Celebrating Daisy Nurses Education and tuition reimbursement
JCAHO took away power from individuals.
No support for moral or emotional distress in nurses. Less staff leads to nurse burnout. Patients do not really understand the workload of a nurse or how a hospital works.
Government Do Not Resuscitate order is
legal and binding in court Medicare too much involvement Patient satisfaction scores weigh too much on reimbursement when it is not about outcomes
Below, I report the results of the group discussion regarding Group 1’s Strategy Building exercise. In the individual focus, looking at experience and mentorship, one nurse pointed out, “It is important to mentor each individual to have respect and self-awareness and voice,” and another participant added, “The problem is that instead of the individual voice, we have a revolving door mentality.” Looking through the focus of organizations, and the control that is taken away from them a participant added, “a lot of the times the
organization focuses on finance and patient satisfaction, while staff satisfaction takes a back seat to those things.” When discussing the institutional focus, examples given by the nurses were that rounding on patients was something that could help if, as one nurse said, “The institution gave bedside manner classes for physicians and some nurses.” Evaluating the effect of the governmental focus, one participant stated, “The health care industry kind of
lets certain insurances companies dictate payments, so we have great financial constraints,” and another participant added, “I think we need a better health care system, a national health care.”
Learning stage: action projects. The development of an action project was the final learning stage for the intervention (Freire, 2016). These critical action projects were
developed after the evaluation of the individual, organizational, institutional, and
governmental impacts were weighed. The purpose of the action projects was to address the moral distress in nursing that requires input from individuals, institutions, and sometimes the public and governmental agencies. In Table 7, I display Group 1’s Action Project using the template tool.
Table 7
Group 1 Action Project
WHAT Unit-Based Debriefing Workshops using different techniques such as journaling, mindful meditation, healing touch, yoga, and therapeutic group discussion.
WHY To decrease emotional distress; to accommodate varied coping strategies; to target specific emotionally or morally distressing situations; to be proactive instead of reactive.
WHEN Monthly
WHERE A casual, safe space on or off the unit
HOW Unit groups leaders to organize with nursing, chaplaincy, social work, and others who can provide said experiences.
_________________________________________________________________________
In the discussion of Group 1’s Action Project exercise, one nurse from Group 1 stated, “our project is more like therapy for nurses. It’s unit-based exercises with nurses supporting one another.” This nurse added, “There could be a writing workshop, a faith- based workshop, a yoga class, a hiking class, because, not everyone copes in the same way.”
A participant outside of Group 1 noted, “This kind of thing shows that you are not alone, like there are people that you can do these things with.” Another member outside of Group 1 interjected, “One resource that we have, which I love, is that our chaplain is there for the staff.” She added, “I utilized him when I was new to critical care and saw lots of things I hadn’t been exposed to, and I kind of questioned whether or not this was the right choice for me.” Going on, she finished, “all I want to say is that “It's [interacting with the chaplain] been tremendously helpful for me.”
To review, during Session Three: Critical Action, the large group was led by a guide in the discussion and review of the journal article published by Fletcher (2006). This article introduced the concept of self-awareness and that it can be achieved through reflection as a strategy to break the cycle of oppression and initiate changes in the structures that oppress nurses. Next, each small group was guided through the learning stage of “strategy building, planning, resource-acquisition,” followed by the final exercise—an action project.
A schematic depicts the outcomes of each group’s movement of the Freirean process across three sessions (see Figure 7).
Figure 7. Schematic of movement through Freirean process Aim 3: Post-Intervention Interviews
A third data source for Aim 3 was the post-intervention interviews. The purpose of these questions was to evaluate the impact of the intervention on the nurses’ sense of
personal and group empowerment. Below are summarized responses from 13 interviews. As presented in Table 8 selected quotes from the post intervention interviews question
exemplifying the feelings and viewpoints of the participants and a summary from each question are presented
Table 8
Post intervention interview, Empowerment Questions-1-14 questions, Quotes, and Summaries
Question
1.What was your overall impression of this intervention? Quotes
“I loved it, I felt like it was very healing, almost like a form of therapy.” Participant B “So now, I look back and think about our discussions and when I’m at work and think how I can change things.” Participant A
“So, it really helped a lot because sometimes you do feel like you’re alone, like you’re Nurse’s understandings of
needed care made subordinate to physician
orders due to scope of practice
Lacking power to act on patients’ wishes Session One
Power Dynamics and MD story Recognize PowerlessnessSession Two Session ThreeAction Project Group 1
Group 2