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“Hispanic female undergraduates perception of nursing as a career choice: A phenomenological study”

Introduction

The present supply of registered nurses in the workforce is not adequate and has resulted in increased nurse to patient-ratios and an increase in injurious outcomes (Censullo, 2008). Each additional patient assigned to a nurse has been associated with increased job dissatisfaction and nurse burnout (Lange, Hodge, Olsen, Romano, & Kavitz, 2004). Studies have shown a reduction in nursing school graduation rates as fewer young people are entering nursing resulting in an aging workforce (Drury, Francis, & Chapman, 2009). Nurses have expressed dissatisfaction regarding the stress and physical demands placed upon them, heavy workloads, inadequate staff, use of overtime, and with their wages (Robinson, Jagim, & Ray, 2004). The current and emerging gap between the demand for and the supply of nurses will adversely affect a healthcare service organization and its ability to meet the healthcare needs of an ever-growing and aging population.

The Bureau of Labor Statistics reported that by 2016 the United States will need an additional 1 million registered nurses (RN; U.S. Bureau of Labor Statistics, 2007). It is also projected that by 2016 general medical and surgical hospitals will need to employ an additional 305,381 nurses, which is 21.8% over 2007 (U.S. Bureau of Labor Statistics, 2007). Forecasters predict that by 2030, as the Baby Boomers age, the over 65 population would have tripled adding new demands on the healthcare system and approximately 37 million Baby Boomers will be diagnosed with more than one chronic medical condition (Trustee, 2008). As a result, the Center for Medicare and Medicaid Service reported that 90% of long-term care facilities will be understaffed (Center for California Health Workforce Studies, 2006).

The Department of Health and Human Services National Sample Survey of Registered Nurses is the largest survey of professional nurses in the United States. To guarantee there is an ample supply of nurses available to provide general healthcare services the data is used by policymakers and stakeholders to assess the U.S. nursing workforce (Health Resources and Service Administration [HRSA], 2010). According to the 2008 National Sample Survey of Registered Nurses, only 16.8% of the RN population is represented by racial and ethnic minority groups with 3.65% of all RNs being of Hispanic origin (HRSA, 2010).

The Hispanic population is the fastest and largest growing minority population resulting in significant demands on the current U.S. healthcare system (Office of Minority Health, 2009). Based on the 2000 U.S. Census 7.9% of the population residing in Northwest Arkansas spoke Spanish at home. The University of Arkansas’ Center for Business and Economic Research (CBER, 2007) reported that in 2005 the proportion of Hispanics in Northwest Arkansas’ metropolitan area accounted for 9.5% of the population. The report projected that by 2025 the population percentage will increase to 16% (CBER, 2007). In 2006, hospital administrators in the Northwest Arkansas metropolitan area reported that only 3.5% of their workforce had bilingual capabilities (CBER, 2007). When a bilingual nurse is not available, 49% of personal communication is accomplished through an adult relative of the patient and 29% by a bilingual minor relative. Of non-English speaking patients 52.2% reported that the ability to receive prompt answers to medical questions was beneficial.

The CBER comparison study examined the perceptions of hospital administrators and nurses and the effect of non-English speaking patients’ interactions with nonbilingual 3 nurses. Respondents believed that several patient care quality indicators can be negatively affected when non-English speaking patients interact with nonbilingual nurses for instance record confidentiality, standard of care, patient assessment and facility efficiency. Based on the data, a shortage of bilingual qualified nurses has an impact on healthcare services and organizations resulting in increased cost of care (CBER, 2007).

According to the Office of Minority Health (OMH; 2009), the health of the Hispanic population can be affected by several barriers: for example, language, lack of access to preventive care, and lack of health insurance. When interacting with a Hispanic population, it is imperative that our healthcare system has nurses who are bilingual and understand the Hispanic culture. Cultural competence is a set of behaviors and attitudes that occur among professionals. Cultural competencies are important in a cross-cultural situation as they can close the disparities gap in health care and make effective work possible. Healthcare services that respect health beliefs, practices, and cultural needs of a diverse population can bring about positive health outcomes (OMH, 2005). Hispanics are the fastest growing minority population in the United States. The number of Hispanics is expected to triple by 2050 and represent a quarter of the total U.S. population (Marguand, 2007). The lack of culturally competent Hispanic registered nurses in the Northwest Arkansas metropolitan area can result in suboptimal patient care among a growing Hispanic population.

To remedy the situation the healthcare profession must seek out solutions to solve the endemic problem. One solution to aid in reducing the nursing shortage is to identify how nursing is perceived by young Hispanic college women, factors that may have influenced their decision to disallow nursing as a career choice, and effective ways that may encourage other Hispanic students to consider nursing as a possible career option. Vygotsky’s sociocultural theory (John-Steiner & Mahn, 1996) and Ajzen’s (2006) theory of planned behavior were the theoretical frameworks used to guide the study. Vygotsky’s psychological theory considers human beings as the subjects of their culture. Vygotsky believed there was a social and cultural explanation for human activity. Vygotsky’s sociocultural approach viewed the relationship and the dynamic interdependence between individual processes and social processes in the construction of knowledge. The role played by culture in human development is an essential component of Vygotsky’s framework. Ajzen’s theory helps explain human action and the process of behavioral change. He stated that three factors can influence willingness to perform a specific behavior (behavioral intentions): one’s personal view toward a behavior (behavioral beliefs), outside influences that may have an effect on one’s behavior (normative beliefs), and the amount of control an individual has over his or her behavior (control beliefs; Ajzen, 2006).

The study used a qualitative phenomenological approach to identify factors influencing a Hispanic female undergraduate’s perception of nursing as a career choice. The purpose of the study was to explore the phenomenon of female Hispanic’s, enrolled in an undergraduate program and explore their decision to disallow nursing as a career option, further contributing to the shortage of Hispanic nurse in the Northwest Arkansas metropolitan area. The target population for the study was college women of Hispanic descent, enrolled in nonnursing majors, at three universities/colleges in Northwest Arkansas.

Chapter 1 includes an overview into the nursing shortage and issues associated with the underrepresentation of Hispanic nurses. The continued nursing shortage has the potential to increase the number of patient deaths, and jeopardize the economic base of a healthcare service organization (Texas Center for Nursing Workforce, 2006). The proportion of the RN workforce that is of Hispanic origin approximately has doubled since 1983 but continues to be underrepresented relative to their presence in the population and the national workforce (Buerhaus et al., 2008). The shortage of culturally competent registered Hispanic registered nurses has the potential to result in lower levels of compliance with patient care instructions and suboptimal patient care (Steefel, 2004).

Issues of concern are recognized within the background, problem statement, purpose, and significance of the study. The methodology is described in the nature of the study. Research questions, theoretical framework, definitions, assumptions, limitations, and delimitation are discussed. A summary of the chapter includes a review of key perspectives and introduces chapter 2.

Background of the Problem

Nurses are an important resource in any healthcare system. An insufficient supply of RNs can result in organizational stressors. The current nursing shortage began in 1998 as the result of an increased demand for nurses, little change in salary, changes in workplace demographics and workplace environmental stressors (Buerhaus et al., 2007). According to the HRSA (2010), the 2008 National Sample Survey of Registered Nurses population shows as of March 2008, there were approximately 10 million licensed registered nurses in the United States. Over the last 2 decades the age of the RN population has seen an increase. Of the RN population, the average age of nurses less than 40 years old accounted for 29.5% of all RNs. Since 1988 the RN population has been represented by an older age group (Health Resources and Services Administration [HRSA], 2010). By 2008, 16.2% of RNs were 50 to 54 years, the highest average age reported since 1980. The aging nursing population raises concerns regarding retirement and the reduction of the nursing workforce during a time the U.S. population is on the rise and the proportion of elderly is ever increasing, resulting in a growing demand for health care and nursing services (HRSA, 2010). Research has established a relationship between the nursing shortage and adverse patient outcomes. Adverse patient outcomes include hospital acquired infections, pressure ulcers, falls, urinary tract infections, satisfactory pain management and patient education and readmission rates (Chitpakdee, Kunaviktikul, Srisupham, & Akkadechanunt, 2008). A prolonged nursing shortage could reduce the quality of patient care provided, increase labor and operating costs, and decrease the efficiency and effectiveness of care (Buerhaus et al., 2007).

The Johnson and Johnson Campaign for Nursing’s Future predict that the nursing shortage could deepen and reach a shortage of 500,000 by 2025 and if allowed to continue could affect access to care, patient safety, quality of care, and cause care to be rationed (Healthcare Traveler, 2008). The number of RNs will increase up to 3% annually over the next 20 years but the increase will be over shadowed by the larger number of RNs retiring. According to Buerhaus (2008), “For patients the large and prolonged shortage has the potential to delay receiving care and an increased risk of experiencing adverse outcomes” (para. 9).

As the United States becomes more diverse healthcare providers are beginning to see an increase in the number of patients with a range of healthcare concerns that are influenced by their cultural background (Betancourt, Green, Carrillo, & Park, 2005). Another barrier to overcome is the underrepresentation of Hispanics in nursing. The proportion of the RN workforce that is of Hispanic origin approximately has doubled since 1983 but continues to be underrepresented relative to the Hispanic presence in the population and the national workforce (Buerhaus, 2008). Cultural competence in health care can eliminate ethic and racial disparities and improve the quality of care provided. A nationwide survey conducted by the American Association of Colleges of Nursing (2010) reported in 2009 that students of Hispanic or Latino ethnicity made up 6.5% of baccalaureate enrollment in a generic nursing program, only a 2.1% increase over the last 9 years. The slow increase in Hispanic students is a social concern as the percentage of increase is not enough to close the gap between the rapid growth of the Hispanic population and the number of cultural competent Hispanic nurses.

Putting a stop to the nursing shortage will require the nursing profession to seek out potential solutions. Research has identified many academic, social, and psychological reasons for the continued lack of Hispanics in nursing. A report to the National Advisory Council on Nurse Education and Practice stressed, to direct the nursing profession in the right direction ongoing studies are needed so more aggressive recruitment and retention strategies can be implemented as they apply to the Hispanic workforce (Peragallo, 2003). Therefore, identifying and eliminating possible barriers that may prevent Hispanics from becoming nurses may provide one opportunity to increase the long-run supply of RNs (Buerhaus, 2008). Eliminating barriers could also close the gap between a rapidly growing Hispanic population and the number of cultural competent Hispanic nurses.

Problem Statement

In 2006, the Bureau of Labor statistics reported, to meet the needs of the nation, the United States will need 1.2 million new RNs by 2014, 500,000 to replace RNs leaving nursing practice, RNs 55 years of age or older and who are expected to retire and an additional 700,000 to meet the growing demands for nursing services (HRSA, 2007). The 2006 the U.S. Census Bureau report has identified the Hispanic population as the nation’s largest and fastest growing minority group with one in six U.S. residents being of Hispanic or Latino descent (Grover, 2009). According to the 2008 National Sample Survey of Registered Nurses, only 16.8% of the RN population is represented by racial and ethnical minority groups (HRSA, 2010), although predominately Caucasian and female the RN population is progressively becoming more culturally diverse. Yet the cultural distribution of the RN population is significantly different from that of the U.S. population as a whole. In 2008, the ethnic and racial distribution of the RN population was 83.2% White, non-Hispanic with 16.8% identified as a member of a minority group. The general problem is even though RNs identified as Hispanic increased 1.3% between 2004 and 2008, compared to the U.S. population of Hispanics (15.4%) the Hispanic RN (3.6%) remains one of the most underrepresented racial/ethical groups in the United States (HRSA, 2010).

The increasing racial and ethnic population growth can present a challenge to the healthcare delivery system (OMH, 2005). To provide care that is culturally sensitive, and assist a growing diverse population with improving their health care, minority nurses are needed (Simmons, 2002). An individual’s culture could influence a patient’s wellness belief system, how health and illness is perceived, attitudes toward healthcare providers 9 and the delivery of services by healthcare providers (OMH, 2005). In 2004, Arkansas was reported to be below the national average for registered nurses with projections predicting a severe shortage of 34.2 % by 2020. In 2005, the proportion of Hispanics in Northwest Arkansas’ metropolitan area accounted to 9.5% of the population. The report projected that by 2025 the population percentage will increase to 16% (CBER, 2007). In the U.S. students of Hispanic or Latino ethnicity, enrolled in a generic nursing program, increased by only 2.1% over the last 9 years (American Association of Colleges of Nursing, 2010). Specifically the problem is the ongoing national low percentage of Hispanic students enrolled in generic nursing programs and the increasing Hispanic population in the Northwest Arkansas metropolitan area has resulted in a gap between the Hispanic population and the number of culturally competent Hispanic registered nurses in the area. Cultural competence incorporates ethical and cultural beliefs into all aspects of nursing care, patient education, health promotion, and disease prevention (Killian & Waite, 2009). The lack of cultural competent Hispanic nurses has the potential to result in lower levels of compliance with patient care instructions, poor patient outcomes and lengthening hospital stays.

The qualitative phenomenological study was used to explore the perceptions of female Hispanic college students currently enrolled in a nonnursing major in the Northwest Arkansas metropolitan area. The goal was to ascertain the central phenomenon behind female college students of Hispanic descent and their decision to choose against entering a nursing program by exploring the perceptions of the participants. Information gained may result in an improved knowledge of the fundamental problem of the current study, the underrepresentation of Hispanic nurses. The knowledge obtained from the study may help the nursing profession design an effective strategy to ease or alleviate the existing problem associated with the shortage of Hispanic nurses in the Northwest Arkansas metropolitan area as well as the continued underrepresentation of Hispanics in the nursing workforce.

Purpose of the Study

    The purpose of the qualitative phenomenological study was to understand the phenomenon; Hispanic female student’s experiences and perceptions of nursing, leading up to their decision to disallow nursing as a career choice. The U.S. demographics are changing and a major concern in health care is the lack of cultural diversity in nursing because of the underrepresentation of minorities (Gardner, 2005). RNs identified as Hispanic increased 1.3% between 2004 and 2008 but compared to the U.S. population of Hispanics, the Hispanic RN remains one of the most underrepresented racial/ethical groups in the nation (HRSA, 2010). The Northwest Arkansas metropolitan statistical area consists of Benton, Madison, and Washington counties, Arkansas and McDonald County, Missouri. In 2005 the proportion of Hispanics in Northwest Arkansas metropolitan area accounted to 9.5% of the population. It has been projected that by 2025 the percentage will increase to 16% of the population (CBER, 2007). To better serve the growing Hispanic population in Northwest Arkansas the number of registered nurses should reflect the population.

Perceptions and attitudes are influenced by personal experience, the media and sociodemographic factors. An increased understanding of factors affecting a female minority college student’s perception of nursing as a career choice could help healthcare educators as well as healthcare professionals more effectively meet the needs of the Hispanic student (Gardner, 2005). Understanding identified factors can have important implications as they relate to the recruitment of minorities to the nursing profession. The study includes the use of a qualitative phenomenological research design to explore the central phenomenon. Phenomenological research designs are effective when describing individual experiences and perceptions based on the participants perspective (Creswell, 2005). Phenomenological research is ambiguous but offers researchers the ability to further examine the relationship between individuals and society (Dahlberg, 2006). The participant’s words and actions represented the data of inquiry. Tapedrecorded interviews were used for data analysis and interpretation. Data analysis searched for patterns, themes and holistic features. The focus was on meanings, perspectives, and understanding the meaning behind the behavior. The goal was to discover the participants’ perspectives on nursing as a career and how they made their own career choice. The specific population group for the study was college women, of Hispanic descent, enrolled in nonnursing majors. The intent was to gain insight regarding their perception of nursing as a career choice and to identify related factors affecting a Hispanic women’s decision to disallow nursing as a career option at three universities and colleges in Northwest Arkansas. The data gathered from the exploration of experiences and perceptions of the female Hispanic students participating in the study has the potential to enrich and improve the knowledge of nursing leaders addressing the issue of the nursing shortage, particularly the continued shortage of Hispanic nurses and aid in the recruitment of new Hispanic nursing students.

Significance of the Study

The nursing shortage poses a threat to the healthcare professional as well as the healthcare consumer. The continued nursing shortage has the potential to increase the number of patient deaths, and jeopardize the economic base of a healthcare service organization (Censullo, 2008). The increasing racial and ethnic population growth can present a challenge to the healthcare delivery system (OMH, 2005). Our society is no longer homogenous as the United States has become more culturally diverse. According to Grover (2009), “Diversity is a part of the fabric of our country, and it continues to weave its way into important considerations for optimum public health” (para. 44). Nurses have been stereotyped to be White and female. Minority nurses are needed to provide care that is culturally sensitive, and assist a growing diverse population with improving their health care (Simmons, 2002).

Hispanics are the largest and fastest growing minority group with one in six U.S. residents being of Hispanic or Latino descent (Grover, 2009). Between July 2003 and July 2004 the Hispanic population grew by 2.9 million. In 2006, the U.S. Census Bureau reported the Hispanic population to be 44.3 million, 14.8% of the U.S. population (U.S. Census Bureau, 2006). In 2008, the number of nurses in the Hispanic category was estimated to be 3.6% of the total RN population. Compared to the U.S. population Hispanics are one of the most underrepresented groups. Minority representation in nursing is critical. Racial and ethnic agreement between a patient and the provider has consistently been linked with greater patient involvement in care processes, higher patient satisfaction scores, and greater compliance to treatment (Swinney & Dobal, 2008).

Significance of the study to leadership

Leadership is a relationship of power that is consistent with values, needs, and motives identified by both the leader and the follower. Transformational leadership is a positive relationship based on common needs, aspirations, and goals. Transformational leaders have the ability to inspire and develop individuals as resources moving them to a higher state of existence while transforming them in the process (Bromley, & Kirschner-Bromley, 2007). Swinney and Dobal (2008) noted, “If the nursing workforce is to reflect the population served today and in the future, nursing professionals must embrace the challenge of education and supply minority and disadvantaged students” (p. 203). Efforts need to be undertaken to encourage minority students to choose nursing as a profession with efforts being measured by outcome evidence of increases diversity of the nursing workforce (Swinney & Dobal, 2008). A solution is to identify factors that affect minority members’ decisions in choosing nursing as their career choice. Information obtained through research can be provided to high schools, vocational technical schools, community colleges, and college and university career counselors. The information can then be used to help provide students with career direction.

Nature of the Study

The number of minorities represented in the nursing profession remains low. Compared to the U.S. population, just 3.6% of all RNs are of Hispanic origin (HRSA, 2010). A qualitative phenomenological study was the research method used to explore the central phenomenon; Hispanic female student’s experiences and perceptions of nursing, leading up to their decision to disallow nursing as a career choice. Understanding the phenomenon can result in a deeper understanding of the central problem; the continued underrepresentation of the Hispanic RN in the United States Phenomenological research is a method of inquiry into one’s mental activity and lived experiences. The primary task is to give meaning to the phenomenon (Spinelli, 2006). Traditional research methods rely on the manipulation or isolation of specific variables to explain particular events. Qualitative research is appropriate for the study as qualitative research can expose social relations and social processes in specific settings. Specifically, phenomenological research employs exploratory strategies to describe a given phenomenon of one’s lived experience (Spinelli, 2006). Qualitative research emphasizes the human factor taking advantage of feelings and personal insights. A phenomenologist focuses on the nature of the experience from the participants’ perspective through interviews, observation, and stories.

To ensure the research accurately reflects the evidence detailed within, written notes were taken. Concepts were developed in the form of themes and generalizations. The focal point of phenomenological research is on the content of the conscious experiences such as emotions and perceptions (Connelly, 2010). Phenomenological psychology views all knowledge and experiences as meaningful, each providing a basis for behavior. In phenomenological research, the researcher attempts to enter the world of the participants to better understand the phenomenon of interest. The participants lived experiences are described in their own words and knowledge is gained through respectful listening (Amundson, Borgen, Iaquinta, Butterfield, & Koert, 2010). In a review of literature a majority of research on career decision making has focused on decision making strategies and the data quantified. Career decisions can have a variety of meaning and depend on cultural, social, and historical contents. Giving priority to the career decider’s subjective experiences concerning career decision making can foster a more relational meaningful career development theory (Amundson et al., 2010). A qualitative grounded theory design was considered for the study. Grounded theory draws from quantitative and qualitative inquires and is used for theory development (Greckhamer & Koro-Ljungberg, 2005). Grounded theory is used to develop theories and has four characteristics: fit, generality, understanding, and control (Suddaby, 2006). Two key concepts in grounded theory include constant comparison and theoretical sampling. Constant comparison consists of data collection and analysis simultaneously in the development of concepts, properties, and relationships. A theory develops around the core categories to explain the process (Skeat & Perry, 2007). In theoretical sampling, decisions are made regarding what type of data is collected (Suddaby, 2006). Grounded theory is less focused on subjective experiences of the individual and more focused on how subjective experiences can be abstracted into theoretical statements. A grounded theory explains the main concern and possible resolution (Skeat & Perry, 2007). The primary interest is not on stories and personal experiences themselves but merely a means by which to elicit and extract information of social situations (Suddaby, 2006).

Grounded theory could be viewed as a systematic and controlled qualitative approach with specified analytical procedures (Greckhamer & Koro-Ljungberg, 2005). The study was used to investigate and understand factors affecting Hispanic female undergraduate’s perception of nursing as a career choice. A phenomenological study was used to emphasize subjective experiences and to capture the rich lived experiences of the participants. The raw data collected demonstrates authenticity and permits holistic interpretation (Suddaby, 2006).

Research Method

The study used a qualitative research method to investigate the essential social cultural phenomenon associated with the study. For research problems in which the variables are unknown and need to be explored qualitative research is appropriate. A qualitative research approach is best suited for the study as phenomenological research is a collaborative between the participant and the researcher. Qualitative research emphasis the human factor and takes into consideration personal insights, feelings, and one’s perspectives. Qualitative data comes in the form of words and sentences, providing information about social processes (Neuman, 2003). The study explored the student’s experiences and perceptions of nursing, leading up to their decision to disallow nursing as a career choice at three universities/ colleges in Northwest Arkansas. The study’s participants served as the primary data source. Secondary sources included peerreviewed articles, doctoral dissertations, and scholarly texts from the cheapest writing services.

Design appropriateness

The target population for the study was female, undergraduate students, of Hispanic descent, under the age of 30 years and not presently enrolled in a nursing program. Data collection for the phenomological study was completed with a personal semistructured interview with each student. The interview addressed a variety of situations that may have influenced their career decision as it relates to the nursing profession. All perceptions and circumstances were deemed important as each event or situation may have influenced the participant’s behaviors. Identified factors may include their image of nursing, nursing responsibilities, academic advisement, family support, program availability, financial assistance, and potential financial benefits. The interview sessions were conducted after gaining permission from the selected university or college and selected participants. The interviews were recorded for later transcription and allowed for the tapes to be listened to repeatedly. Tape recorded interviews were later transcribed verbatim, once transcribed the transcript become the new raw data (Burns & Grove, 2005). Data analysis includes listening to the recorded interviews while reading the transcript. Voice tone, inflection, and pauses by the participant may indicate an item they felt strongly about or was emotionally upsetting. As the transcript is read and reread the process of analysis develops and evolves with the potential for multiply interpretations (Burns & Grove, 2005). To assist in identify a common theme memoing was used. Memos help to record insights or ideas as they relate to transcripts, codes, or notes. Memoing aided in linking specific pieces of data together and helped to provide a conceptual theory.

To draw a conclusion based on the data analysis clustering, counting, common themes identified, and plausibility was used. With the use of the root cause diagram the clustering of certain elements is the first step in inductive reasoning to help identify patterns or similar characteristics. According to Burns and Grove (2005) if a researcher states that a theme or a pattern occurs frequently or often, they are stating its importance. Counting can help the researcher confirm evidence. Identifying patterns of themes may be easy but what is important is seeking evidence of a pattern while remaining open to skepticism. Phenomenology focuses on people’s subjective interpretations. The researcher’s intuition must be supported with further examination of the data to certify validity (Burns & Grove, 2005). Qualitative research involves the compilation of a large amount of data. The study used a version of NVivo 9.0, a computerized data analysis software program to help organize and analyze the information gathered. During data analysis the researcher was able to draw a conclusion that was seen as plausible.

Research Questions

The proportion of the RN workforce that is of Hispanic origin has doubled since 1983 but the number of Hispanic RNs represented in the nursing profession remains low (3.6%) compared to the U.S. population (HRSA, 2010). Between 1990 and 2000 Arkansas had a population growth of 196% with Hispanics being the fastest growing minority represented 48% (Capps et al., 2007). The shortage of culturally competent registered Hispanic nurses has the potential to result in lower levels of compliance with patient care instructions and suboptimal patient care (Steefel, 2004). To better comprehend the central phenomenon the qualitative phenomenological study included two research questions. The research questions were used to explore the phenomenon: factors surrounding the phenomenon and varied perspectives held by the participants (Creswell, 2005). A need exists in understanding reasons behind the continued underrepresentation of Hispanics in the nursing workforce. The central research questions designed to guide the study were

R1. What are the processes and influences that led Hispanic female college students’ to make their current career choice?

R2. What are the Hispanic female college students’ perceptions of nursing as a career?

In a phenomenological study the participants set the direction and the researcher learns from their viewpoint. Five interview questions were designed to further guide the study. The questions changed during the interview process based on the participant’s responses and feedback (Creswell, 2005).

Theoretical Framework

The theoretical framework used to guide the study is based on Vygotsky’s sociocultural theory and Ajzen’s theory of planned behavior. Vygotsky has come to be known as one of the most influential psychologist of the twentieth century. Vygotsky’s psychological theory considers human beings as the subjects of their culture. Vygotsky believed there was a social/cultural explanation for human activity. The role played by culture in human development is an essential component of Vygotsky’s framework. Social learning considers the role of social relations, community and culture as they relate to cognition and learning. According to Wang (2007), “Learning, thinking and knowing are relations among people in activity, in with and arising from the socially and culturally structured world” (p. 151). Vygotsky believed learning was embedded in social events, social interaction, and cultural context. Children are encircled by family members who communicate and interact with them daily. As the child grows and matures, he or she becomes a part of a social network (e.g., school, church). Thought processes, learning, and development continue to be shaped through social interaction (Wang, 2007).

A psychological model was used to help better understand why individuals perform particular behaviors. Ajzen’s theory of planned behavior helped to explain human action and the process of behavioral change. Theory of planned behavior takes into consideration beliefs about the consequences of the behavior, the standard expectations of others, and factors that could facilitate performance of the behavior. Three considerations influence one’s decision to participate in a given behavior: the positive and negative consequences of the behavior, the approval or disapproval of the behavior by respected individuals, and factors that may facilitate or impede performance of the behavior (Ajzen & Fishbein, 2005). These beliefs produce a positive or negative attitude toward performing the behavior. Normative beliefs are based on the approval or disapproval of the behavior by family and friends. Normative beliefs can lead to perceived social pressures. Control beliefs are the presence or absence of factors that make the behavior to be performed easier or more difficult (Ajzen & Fishbein, 2005).

Definition of Terms

Definitions are often not uniform, so key and controversial terms are defined to establish positions taken in the research process. The following are key terms used throughout the study.

Culture: The term defines behavior patterns that are maintained, practiced, and transmitted in a given society, guiding decision making (Cole, Stevenson, & Rodgers, 2009).

Ethnic group: The term used to indicate a group of individuals who have a common background and share beliefs, values, habits, customs and norms (Kattak & Kozaitis, 2008).

Hispanic: The term used for individuals who have indicated their origin of descent as Mexican America, Puerto Rican, Cuban, Central or South American (U.S. Census Bureau , 2000). The term refers to the Hispanic population of the U.S. Hispanic origin definition and explanations.

Lived experience: The phenomenological term used as an insightful description of the way we experience the world (Van Manen, 1990). Experience and development are intertwined. “Using one’s lived experience is the text for self-discovery and learning” (Zachary, 2000, p. 16).

Assumptions

Phenomenological research uses a naturalist approach to understand phenomenon in a specific setting. The researcher’s actions are based on the underlying assumptions of the different inquiring paradigms resulting in knowledge gained (Hoepfl, 1997) and do not assume “there is a single unitary reality apart from our perceptions” (Krauss, 2005, p. 760). College students were chosen as subjects because the assumption is college students are a group typically concerned with choosing a career and are actively involved in the career choice process. The study assumes the college students volunteering to participate in the research study have made conscious career choices which guided their curriculum and choices have been both made and rejected or changed. Understanding of the phenomenon involves continuously processing and changing as new experiences emerge (Vis, 2008). It is assumed that the sampling of information about career decision making among young female Hispanic college students shared their lived experiences openly and completely. In addition it is assumed the participants are truthful and honest in their responses, while themes that emerge from data analysis are in agreement with the research questions and expectations.

Scope and Limitations

To aid in data collection interview questions were specifically developed for the study. A pilot test of the interview questions was conducted to determine the effectiveness of the instructions, the clarity of the questions asked, response time, and evaluate data collection techniques. To have the process of administration as uniform as possible, plans were made with the appropriate representatives at each of the identified schools. The researcher provided and obtained consent, provided instructions prior to each prescheduled individual student interview, and maintained control over the way the interview sessions were conducted.

The findings of the study may not be generalized. The sample for data collection was one of purposive sampling. The assumption is dependent upon the extent in which other settings are similar to those used in the study. The group selected for data collection consisted of undergraduate Hispanic women enrolled at three universities/colleges in Northwest Arkansas. The identified ethnic group may not be well represented at the participating schools.

Delimitations

The study was confined to interviewing female, Hispanic, undergraduate students enrolled in nonnursing majors at three colleges/universities in Northwest Arkansas. The study focused on their perception of nursing as a professional career choice. Only Hispanic female students under the age 30 years participated in the study. The researcher being a nurse by profession did not insert bias into the research process.

Summary

Chapter 1 described the nursing shortage as a continued problem; especially the shortage of Hispanic RNs. The U.S. Bureau of Labor Statistics (2007) shows the current supply of qualified nurses is not adequate. Only 16.8% of the RN population in the United States is represented by a racial or ethnical minority groups. Approximately 3.6% of all RNs are of Hispanic origin (HRSA, 2010). The Hispanic population has a large disparity between its representation in the U.S. population and the population of RNs. The purpose of the qualitative phenomenological study was to understand the phenomenon from the viewpoint of young Hispanic female college students.

Understanding identified factors can have important implications as they relate to the recruitment of Hispanic females to the nursing profession. The study used a qualitative phenomenological approach to explore the central phenomenon. The study is significant in the fact that the continued nursing shortage has the potential to increase the number of patient deaths, and jeopardize the economic base of a healthcare service organization. The shortage of culturally competent registered Hispanic nurses has the potential to result in lower levels of compliance with patient care instructions and suboptimal patient care (Steefel, 2004).

Finally, Vygotsky’s sociocultural theory and Ajzen’s theory of planned behavior was introduced as the theoretical framework for the study. Vygotsky’s sociocultural approach considers the relationship and the interdependence between individual mental processes taking place in the individual and the social processes taking place in society as they related to the construction of knowledge. An individual’s general knowledge is based on past knowledge, experiences, and skills. By gaining an understanding of the learning process educators can refine prior knowledge, anticipate a long-term process and shape the content of concepts based on social interaction. Chapter 1 further explains Ajzen’s theory of planned behavior. A psychological model was used to help better understand why individuals perform particular behaviors. The theory of planned behavior helps to explain human action and the process of behavioral change by taking into consideration beliefs about the consequences of the behavior, the normative expectations of others, and the presence of factors that could facilitate performance of the behavior.

Perceptions and attitudes are influenced by personal experience, the media and socio-demographics factors. There has been an increased interest in nursing but the nursing shortage remains a problem. Chapter 2 reviews society’s perception of nursing and the continuing nursing shortage. As our society moves from a Caucasian majority to a multicultural reality, future incentives need to consider professional development and the complexity of a diverse workforce. Over the last 4 decades there has been an increase in workforce participation and incomes of American women. During different developmental stages, career choice decisions occur. Research in career development has identified the importance of positive reinforcement by significant others during these developmental stages. For example, women who chose a female-dominated profession made career decisions based on early developmental experiences, strong messages sent by their parents during early educational years and the strong influences of their mother and other female relatives.

The number of Hispanic women entering the labor force is rapidly growing. The proportion of the Hispanic RN workforce has doubled since 1983 but continues to be underrepresented relative to their presence in the population and the national workforce (Buerhaus, 2008). Chapter 2 further aids in understanding identified factors that can have important implications as they relate to the recruitment of Hispanic women to the nursing profession.

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