Wrightaa dissertation

THE LIVED EXPERIENCE OF REGISTERED NURSES CARING FOR PATIENT LIVING WITH HIV/AIDS IN BROWARD COUNTY, FLORIDA: A PHENOMENOLOGICAL INQUIRY DISSERTATION Presented in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy in Nursing Barry University Archimore Alexander Wright 2016 THE LIVED EXPERIENCE OF REGISTERED NURSES CARING FOR PATIENTS LIVING WITH HIV/AIDS IN BROWARD COUNTY, FLORIDA DISSERTATION by Archimore Alexander Wright 2016 APPROVED BY: ____________________________________ Claudette R. Chin, PhD, ARNP Chairperson, Dissertation Committee ____________________________________ Ferrona A. Beason, PhD, ARNP Member, Dissertation Committee ____________________________________ Jessie M. Colin, PhD, RN, FRE, FAAN Member Dissertation Committee Program Director, College of Nursing and Health Sciences __________________________________ John McFadden, PhD, CRNA Dean, College of Nursing and Health Sciences Copyright by Archimore Alexander Wright, 2016 All Rights Reserved Abstract Background: Vulnerability, opportunistic infections, and infection-related illnesses, caused by the human immunodeficiency virus (HIV), progressively overwhelms the human immune system resulting in acquired immunodeficiency syndrome (AIDS).

The HIV/AIDS epidemic continues to slowly and non-discriminately spread continentally with dramatic consequences on the life expectancy of anyone who develops this pervasive illness/disease. The virus, HIV is well documented and is commonly transmitted through risky behaviors of human contact, and if left unattended and untreated, leaves a path of destruction and devastation of monumental proportions. HIV/AIDS dramatically leads to long struggles and concerns for human rights and end-of-life (EOL) care. Purpose: The purpose of this research study was to gain an in-depth epistemology of registered nurses lived experiences in caring for people living with HIV/AIDS in Broward County, Florida.

Philosophical Underpinnings: The philosophical underpinnings that directed this study were buried in the interpretivistic paradigm to investigate the meaning of a particular sample of registered nurses using a qualitative research approach. Method: This study employed a descriptive/interpretive paradigm navigated by Max van Manen’s phenomenological method. Purposive and snow-ball sampling were utilized by the researcher to recruit registered nurses (RNs) for the study. Data collection was acquired using digital voice recorders to conduct semi-structured face-to-face interviews with a maximum of 12 elected participants.

Results: Four major related themes were conclusive from the findings of the study, as iv unknowing, incapacitating, dejecting, and nurturing, and five sub-themes of swimming in deep waters, exasperating, dreading occupational exposures, feeling of emptiness, and emotional and physical support through this phenomenological descriptive/interpretive exploration. These themes and sub-themes showcased registered nurses experience in providing care to patients living with HIV/AIDS in Broward County, Florida. Margaret Newman’s (1978) grand theory of Health as Expanding Consciousness was the theoretical framework applied to the themes/sub-themes for further understanding. Conclusion: This phenomenological research inquiry coupled with Max van Manen descriptive/interpretive methodology exhibited the complexity registered nurses endure when providing care to patients living with HIV/AIDS in Broward County, Florida.

The results of the study emphasized the quintessence of nurse’s experiences by illuminating the fear of the unknown dealing with the disease HIV/AIDS, in which they displayed courage, resilience, empathy, and nurturing while caring for this fragile population. The experiences described in this study by the participants caring for patients living with HIV/AIDS in Broward, County Florida, highlighted the numerous effects of the disease on healthcare and nurses alike. There is a necessity for a comprehensive approach to make it possible to provide appropriate nursing care that can also address the new threat of HIV infection in Broward County, which has developed rapidly than expected. Participant’s enthusiasm in sharing their life world experience on caring for patients living with HIV/ADS culminate the general purpose of this phenomenological study.

v ACKNOWLEDGMENTS After an intensive period of three years three months and 24 days, today is the day that the Lord has made, I shall rejoice and be exceedingly glad in it. This note is written anxiously to place the finishing touch on my dissertation. It has been a period of intense learning for me, not only in the scientific arena, but also on a personal level. The Lord has given me the ability to write this dissertation, which has left an everlasting effect on my intellectual well-being.

In the ring of fascinating things, the obligation takes precedent to reflect on the people who have supported and helped me through this cumbersome period of my life. No one ever said attaining a PhD was an easy task, this certainly was not, and my life was dedicated to this torturous pathway. Overtaken by the spirit of humility with a penitent and contrite heart the time has arrived to thank a few people who have made life so much easier on this journey. First and foremost I must first give thanks to the Almighty God and ruler of my life for spearing and preserving me with the courage to undertake this brave journey in my delicate life.

I also would like to express my sincere thanks and gratitude to all the participants who dedicated their time and patience in letting me in their lives to comprehend their experience caring for patients living with HIV/AIDS in Broward County, Florida. The very elite and courageous doctoral committee deserves to be recognized at this time for their kind, unselfish, diligent, and supportive expertise offered to me through this marathon was indispensable and matchless. They were there in living colors as a torch that light my pathway in guiding my foot steps on this journey and culminating this vi degree. Chin, my committee chair.

To whom I am deeply indebted for her unselfish love and unwavering devotion, always there at the drop of a hat in my darkest hours of need. It is really a pleasure to have you as my chair, which I consider myself very blessed and fortunate to have you in my life, your faith, confidence, and trust that you placed in me, and the support and guidance delineated to me when I needed it the most word cannot express. From the delicate fiber of my being, I simply want to say a joyful thank you from the bottom of my heart. Colin and Dr.

Ferrona Beason; both of my committee members. Sincere thanks and kudos to both of you for being there for me every step of the way with your special words of encouragement. It is incumbent on me to also compliment you both on the tireless effort of reading and reading this dissertation over and over again; God knows I really do not know how you all do it. There is a special place in Heaven for this committee.

To my family and friends; let it be known “you are simply the best.” Special arrangements were made for me to study without disturbances, how considerate, my wife make sure I am fed, clean, and ready to go at all times, insanely matchless a priceless act. This acknowledgement would not be resolute without offering gratitude and recognition to a few of my very dear friends Vedete Llewellyn-Borde, David Anthony Harris, Marie Nestant-Brown, Garfield Young, Georgia Peart-Jackson, and my very supportive cousin Michelle Smith-Blair who have all been there for me every step of the way cheering me on. Always relentless in wanting to know my academic status and vii requesting an updated and even a grade card as if they were my professors or guardians. Kudos to you guys friends for life.

Memories to cherish for a lifetime. Special tribute goes out to my cohort, a dream team of three, namely, Betty Bogart and Jamela Morton sergeants who does not take “no” for an answer. We have been through thick and thin together, sweet and bitter moments, but held on tightly to get this degree completed together. A dream team with memories for life.

How must I forgotten my adopted sister Dezma Blair who is a tower of strength, and an excellent resource person who is invaluable, generous, a real dedicated public relations officer any one would be obliged to have on their team. viii DEDICATIONS To God be the glory, honor and strength who kept me in shape and reminded me every hour of the day that the race is not given to the swift nor the strong, but to he that endures to the end (Ecclesiastes 9:11and Matthew 24:13). In humility I would like to share this moment with my wonderful family; wife Arlene, son; Anthony, and daughters; Elisia, Deirdre, Shanice, and Jodi-Ann. Grandchildren; Kayhlia, Shania, Alyssa, O’dain, Amy, and Jordan who all adore me, and shower me with love unconditionally on this road, even when I have forgotten precious family get together.

I love you all from the deepest part of my heart. This dedication is centered securely on my dear grandmother Eva Dora (Doris) Coke, (1910 to 1995) gone but still not forgotten, always in my heart as I traverse this universe. She has nurtured and cherished me from the tender age of three months old through to young adulthood, placed the mantle at my feet always telling me education is the poor man ticket out of poverty. Insisted that I do well in school and was able to pull an accountant out of me as the fruit of her labor.

I want to close by saying she was my inspiration I can fly higher than an eagle because she was the wind beneath my wings, the rock of Gibraltar who inspired me that I could be everything I wanted to be. This leaves me to quote the scripture “I can do all things through Christ who strengthened me.” ix TABLE OF CONTENTS TITLE PAGE. ii COPYRIGHT PAGE. ix TABLE OF CONTENTS.

x LIST OF TABLES. xvi LIST OF FIGURES. xvii CHAPTER ONE. 1 Problem and Domain of the Inquiry.

3 Background of the Study. 3 HIV/AIDS on the Continental Landscape. 15 Purpose of the Study. 26 Hermeneutic (Interpretive) Phenomenological Approach.

32 Relationship of Phenomenology to This Study. 39 Significance of the Study. 40 Significance to Nursing. 40 Implications for Nursing Education.

41 Implications for Nursing Practice. 42 Implications for Nursing Research. 43 Implications for Health/Public Policy. 43 Scope and Limitation of the Study.

45 CHAPTER TWO: Review of the Literature. 49 Knowledge, Attitude, and Education in HIV/AIDS Care. 50 Related Stigma in the Care of People With HIV/AIDS. 62 Fear of Occupational Exposure to Infection and Transmission in.

HIV/AIDS Care. 70 Nursing in the Context of HIV/AIDS Care. 93 CHAPTER THREE: Methods. 95 Rationale for Qualitative Inquiry.

96 Rationale for Phenomenological Inquiry. 97 Sample and Setting. 101 Access and Recruitment of the Sample. 104 Ethical Consideration/Protection of Human Subjects.

104 Data Collection Procedures. 109 Data Analysis Process. 114 CHAPTER FOUR: Findings of the Inquiry. 123 Physiognomies of the Participants.

124 xii Nurse Fire. 129 Nurse Eula-Lee. 134 Emerging Themes and Sub-Themes. 138 Swimming in Deep Waters.

148 Dreading Occupational Exposure. 162 Feeling of Emptiness. 166 Lacking Emotional and Physical Support. 178 xiii Theory of Health as Expanding Consciousness.

190 Discussion and Conclusion of the Inquiry. 190 Exploration of the Meaning of the Study. 192 Interpretive Analysis of the Findings. 234 Theory of Health Expanding Consciousness.

241 The Assumptions of Theory. 242 Description of the Theory. 243 The Nursing Metaparadigm of the Theory. 244 Concepts of the Theory.

245 A Process of Becoming More of Oneself and Consciousness. 248 Finding a Greater Meaning in Life. 256 Synthesis of Theory Application. 258 Significance of the Study.

260 Significance to Nursing. 260 Implications for Nursing Education. 261 xiv Implications for Nursing Practice. 262 Implications for Nursing Research.

262 Implications for Health/Public Policy. 263 Strengths and Limitations of the Study. 264 Recommendations for Future Studies. 269 Appendix A: IRB CONSENT.

287 Appendix B: INFORMED CONSENT FORM. 289 Appendix C: RECRUITMENT FLYER. 291 Appendix D: DEMOGRAPHIC QUESTIONNAIRE. 292 Appendix E: INTERVIEW QUESTIONS AND PROMPTS.

294 Appendix F: PERMISSION LETTER. 295 Appendix G: CONFIDENTIALITY AGREEMENT .