Concept Analysis Critique of Homophobia in Nursing Essays

Concept Analysis Critique of Homophobia in Nursing Essays Concept Analysis Critique of Homophobia in Nursing Essay Concept Analysis Critique of Homophobia in Nursing Essay Running Head: CONCEPT ANALYSIS CRITIQUE Concept Analysis Critique of Christensen’s Homophobia in Nursing Using Walker and Avant’s Framework NUR 701-90 Nursing Theory The Sage Colleges Lori Ciafardoni-Hawkes RN, MSN/MEd November 17, 2010 Concept Analysis Critique of Christensen’s Homophobia in Nursing Using Walker and Avant’s Framework Introduction Concept analysis is discussed by Walker and Avant (2005) as a way to describe phenomena in nursing practice, as it â€Å"allows the theorist, researcher, or clinician to come to grips with the various possibilities within the concept of interest† (Walker amp; Avant, 2005, pg. 3). Walker and Avant developed an eight step process of concept analysis, which includes selecting a concept, determining the aims or purposes of the analysis, identifying all uses of the concept that can be discovered, determining the defining attributes, identifying the model case, identifying borderline, related, contrary, invented , and illegitimate cases, identifying antecedents and consequences, and defining empirical referents (Walker amp; Avant, 2005). The following is an examination of the concept analysis procedure developed by Walker and Avant as applied to the article Homophobia in Nursing: A Concept Analysis by Martin Christensen. Selecting a concept is the first step in the 8-step analysis procedure. The chosen concept should be one that is important and interesting to you. Additionally, selection of the concept should be â€Å"useful to your research program or to further theoretical developments in your area of interest† (Walker amp; Avant, 2005, pg. 66). Christensen (2005) selected to analyze the concept of homosexuality in nursing because â€Å"†¦nurses draw mainly on their own experiences, experiences that may possess traditional and uncompromising attitudes about homosexuality and the health needs of patients†¦suggest(ing) that attitudes are linked to behavior and that certain predetermined beliefs and attitudes will prevent delivery of holistic and individualized care†( pg. 61). Christensen’s article holds relevance in today’s nursing practice as the definition of family as many have learned it has changed. This new, modern family often includes non-traditional and chosen families rather than blood relatives. People are choosing to define family for themselves and one subset of families is same-sex couples. Nursing professionals need to recognize the family as a patient defines it rather than how text or organizations define it and homophobia need not be part of that equation. As a labor and delivery nurse, I see every definition of family imaginable and as a female in a same-sex marriage; this is one phobia that I am faced with both personally and professionally on a regular basis. Defining this concept and redefining family are both important parts to changing how health care professionals think and are trained and educated. Defining the Concept, Related Terms and Differences Christensen clearly defined the concept of homophobia related to nursing. He explains that nurses often use their own experiences to dictate their care and that if they have issues with homosexuality for personal, religious or other reason that it may interfere with quality, individualized care which all patients and their families deserve (Christensen, 2005). In healthcare, sociology, education and psychology, much work has been done around homophobia (Neville amp; Henrickson, 2006; Richmond and McKenna, 1998; Rondahl, Innala, amp; Carlsson, 2004; Tate amp; Longo, 2004). Baker (1991) presented a paper at The Annual Meeting of the American Alliance for Health, Physical Education, Recreation and Dance and stated that â€Å"the impact of homophobia on health education practice had received little attention. As a profession, health educators had not yet adequately addressed lesbian and gay health issues†. Baker’s paper â€Å"defined homophobia and discussed the consequences of homophobia in health education and implications for practice. The health education needs of lesbians and gays are seldom met as a consequence of homophobia. Areas of particular relevance to health educators include heterosexual bias in sexuality education curriculum and textbook context, AIDS education, hate violence, adolescent suicide, and health education research on lesbian and gay topics. Strategies for eliminating homophobia include professional development of health educators and curriculum change at the university level† (Baker, 1991, np). Other researchers like Black, Oles and Moore (1998) â€Å"reported on a study of the relationship between students attitudes toward women and toward gay men and lesbians and changes in those attitudes during social work courses at two universities. The study found a significant relationship between students levels of homophobia and sexism. The relationship was stronger for female students than for male students and varied by race and academic major. The article also discussed the implications of the findings for changing social work curricula† (np). Barry (1998) explained â€Å"that a series of contemporary theories that had been used to explain homophobia. Structural, feminist, comparative, gender panic, queer, and socio-historical theories rely on the premises of a diverse set of scholarly disciplines, and in turn, generate their own objects of analysis, whether `homophobia, `heterosexism, or `heteronormativity. While the current flourishing of gay and lesbian studies had generated important insights into the workings of homophobia, analyses have also tended to be limited and fragmentary† (np). There are large gaps in the literature that span greater than ten years. The bulk of the studies seem to have happened when HIV/AIDS was at its height of awareness. While it appears easy to define homophobia, there has not been much research done on this concept in the social sciences. The Merriam-Webster Dictionary (2010) defines homophobia as â€Å"irrational fear of, aversion to, or discrimination against homosexuality or homosexuals†. Christensen’s concept analysis defines it similarly. Walker and Avant encourage the use of dictionaries, thesauruses, colleagues, and any available literature to identify multiple uses of the concept. Furthermore, all uses of the term must be considered. â€Å"This review of literature helps you support or validate your ultimate choices of the defining attributes† (Walker amp; Avant, 2005, pg. 67). Christensen thoroughly explored homosexuality, as defined by a variety of sources. Further research exposed the coining of homophobia, which is also extensively discussed by Christensen. Christensen examines fear of homosexuality in oneself, fear of contagion, fear of potential sexual advances, and fear of threat to established sex role identity as aspects of homosexuality that nurses may experience as a result of homophobic feelings (Christensen, 2005) Determining the aims of the analysis is the second step outlined by Walker and Avant. This second step helps focus attention on exactly what use you intend to make of the results of your effort. It essentially answers the question: â€Å"Why am I doing this analysis? † (Walker amp; Avant, 2005, pg. 66). Christensen has a clear and thorough rationale for choosing to analyze the concept of homosexuality and how the analysis will benefit nursing: â€Å"In seeking conceptual clarity, the analysis may make it possible to promote a single vocabulary for discussion, while allowing an understanding of what signifies the parameters of homophobia in nursing to be. More importantly, it may form the platform for future conjecture and critique within the context of nursing practice† (Christensen, 2005, pg. 61). Antecedents and Consequences The identification of antecedents and consequences are step seven in the concept analysis process presented by Walker and Avant. Antecedents are those events or incidents that must occur prior to the occurrence of the concept and consequences are those events or incidents that occur as a result of the occurrence. Antecedents and consequences help to shed light on the social context and help to define the attributes (Walker and Avant, 2005). In the concept analysis of homophobia, Christensen reports religion and medicine as antecedents; so much so that the emergence of homophobia in nursing on an individual basis may be related to â€Å"Supporting a religious ideology that determines the morality of same sex relationships as being sinful and non-procreative, and subscribing to a medical/nursing inference that homosexuality is a disease/illness that can be cured† (Christensen, 2005, pg. 69). The consequences as they relate to homophobias, identified by Christensen, include â€Å" An avoidance/reluctance of gay/lesbian social and/or professional interaction, heightened anxiety or revulsion when experiencing some gay/lesbian behavior, for example behaviors of affection, and heightened anxiety and fear of contagion when caring for gay/lesbian patients with a diagnosis of HIV/AIDS† (Christensen, 2005, pg. 69). Attributes â€Å"Determining the defining attributes is the heart of concept analysis† (Walker amp; Avant, 2005, pg. 68). This process should reveal the cluster of attributes that are the most frequently associated with the oncept and that allow the analyst the broadest insight into the concept (Walker amp; Avant, 2005). The cluster of attributes gathered may have a variety of different meanings, thus â€Å"a decision is clearly necessary regarding which will be the most useful and which will provide you the greatest help in relation to the aims of your analysis† (Walker amp; Avant, 2005, pg. 68). Christensen identifies internalized feelings and portrayal of those feelings within clinical practice as distinctive attributes related to the concept of homophobia in nursing. Furthermore, Christensen states the defining attributes that may characterize the concept of homophobia within nursing to be â€Å"there must be an internalized awareness of anti-homosexual feelings towards homosexual individuals, and that here must be manifestations of those anti-homosexual feelings by the corresponding behavior patterns, which occur when providing care to gay individuals† (Christensen, 2005, pg. 65). Model Cases A model case is the identification of a case that clearly demonstrates the defining attributes. â€Å"That is, the model case should be a pure case of the concept, a paradigmatic example, or a pure exemplar. Basically, the model case is one that we are absolutely sure is an instance of the concept† (Walker amp; Avant, 2005, pg. 69). Model cases can be constructed from the analyst, found in literature, or in the best-case scenario, actual examples from real life (Walker amp; Avant, 2005). Christensen describes a model case that clearly identifies the defining attributes, which allows the concept to be tested. The subject, Nurse Mary, in the case model is described as â€Å"exhibiting the internalized feelings of homophobia and expressed these in her behaviors toward Jackie, the patient, and Karen, the patient’s significant other. The feelings and behaviors expressed in this case are fear, anger, disapproval, contempt, avoidance, and disgust† (Christensen, 2005, pg. 67). Identifying additional and different cases is suggested by Walker amp; Avant (2005). â€Å"Examining cases that are not exactly the same as the concept of interest but are similar to it or contrary to it in some ways will help you make better judgments about which defining attributes or characteristics have the best fit† (Walker amp; Avant, 2005, pg. 70). Additionally, cases include those that are borderline, elated, contrary, invented, or illegitimate. â€Å"The basic purpose for these cases is to help you decide what â€Å"counts† as a defining attribute for the concept of interest and what doesn’t count† (Walker amp; Avant, 2005, pg. 70). The Christensen concept analysis effectively utilizes a borderline case that only contains some of the defining attributes held within the definition of the concept. In th e borderline case, â€Å"the person described still experiences the internalized feelings of disgust and fear towards homophobia. However, in this case, he does not allow these feelings to cloud his clinical judgment in providing care to this patient, which is evident in the thank you letter† (Christensen, 2005, pg. 68). Additionally, Christensen utilizes a contrary case, which demonstrates none of the defining attributes outlined in the wording of the definition. â€Å"The individual described shows no internalized fears or behaviors and consequently has established an excellent rapport with her brother’s partner† (Christensen, 2005, pg. 68). Implications for Measurement The final step in the concept analysis is determining the empirical referents of the defining attributes. â€Å"Empirical referents are classes or categories of actual phenomena that by their existence or presence demonstrate the occurrence of the concept itself† (Walker amp; Avant, pg. 73). How does one measure homophobia? Christensen clearly shows the â€Å"observable phenomena and highlights the presence of homophobia in some individuals as: â€Å"Avoidance of homosexual patients, reluctance to provide care to homosexual patients, and speaking negatively about homosexuals and homosexuality† (Christensen, 2005, pg. 9). Application to Nursing Theorist-Madeleine Leininger Leininger is the founder of the transcultural nursing movement in education research and practice. In 1995, Leininger defined transcultural nursing as â€Å"a substantive area of study and practice focused on comparative cultural care (caring) values, beliefs, and practices of individuals or groups o f similar or different cultures with the goal of providing culture-specific and universal nursing care practices in promoting health or well-being or to help people to face unfavorable human conditions, illness, or death in culturally meaningful ways â€Å"(p. 8). The practice of transcultural nursing addresses the cultural dynamics that influence the nurse–client relationship. Because of its focus on this specific aspect of nursing, a theory was needed to study and explain outcomes of this type of care. Leininger creatively developed the Theory of Culture Care: Diversity and Universality with the goal to provide culturally congruent wholistic care. Her theory is appropriate in homophobia because healthcare professionals need to be able to treat each client as an individual without bias or judgment. Application to Nursing Practice Henrici (2007) in her paper on homophobia in healthcare states: â€Å"According to the American Nurses’ Association (ANA) (2001), nurses have a history of working with vulnerable populations and fighting for social justice. Providing substandard care to lesbian, gay, and bisexual populations is negating that history. High standards of ethics are expected so that all populations and clients receive the same level of care. If nurses counteract the rights of the patient by letting their attitudes toward homosexuality influence the type of care the patient receives, then the negative influence leads to an ethical issue. The first Provision of the ANA Code of Ethics for Nurses (2001) indicated that foremost, the patient should be treated with respect and dignity for human life. The nurse must show compassion and deliver health care in a non-judgmental manner, regardless of individual lifestyle and religious beliefs. Caring for a patient as a person with unique needs and differences should be upheld in every patient-nurse relationship. Refusing to treat a patient on behalf of difference in religious thought or lifestyle, and incorporating prejudice statements is unacceptable ethical behavior in the eyes of the ANA Code of Ethics for Nurses Provision three of the ANA Code of Ethics for Nurses (2001) takes into account patient confidentiality, maintaining patient’s rights, and advocating for the patient. Information shared between the nurse and the patient that need not be reported by law, should be kept confidential and not shared with individuals that are outside of the patient’s care. This is necessary to build a trust in the nurse/patient relationship. As an advocate, the nurse fights to defend the patient’s rights. Impaired practice and unethical care need to be addressed in order for the patient to receive the best care. When confidential information is spread to others, and if the nurse is part of the unethical care of the patient, then trust is diminished and advocacy becomes non-existent. According to the ANA Code of Ethics for Nurses, these acts are considered unethical to the nature of nursing. Provision seven of the ANA Code of Ethics for Nurses (2001) addresses the idea that nursing, as a profession, needs to refine and advance the scope of nursing through continuing education. In order to advance in the field of nursing, nurses need to didactically embrace new knowledge, evaluate the knowledge, publicize the information, and put the new knowledge into clinical practice. Without furthering education, the field of nursing becomes stagnant in the ethical treatment of patients. Society is dynamic; therefore, nursing must change in order to progress with the social changes of the patients. If further education is impeded, it is considered unethical practice, according to the ANA Code of Ethics for Nurses† (pg. 59-61). Application to Research â€Å"Concept analysis clarifies the symbols (words and terms) used in communication. The main advantage of concept analysis is that it renders very precise theoretical as well as operational definitions for use in theory and research† (Walker amp; Avant, pg. 74). Walker and Avant developed an 8-step concept analysis procedure that allows for analysts to easily understand and master the process without overlooking any of the critical components of concept analysis. The steps are not necessarily sequential. However, Christensen’s concept analysis of homophobia in nursing systematically uses all of Walker and Avant’s steps, as detailed in the body of this paper. Christensen’s concept analysis of homophobia in nursing is thoroughly discussed. Yet, greater research could have been conducted into identifying additional cases, as only borderline and contrary cases were considered. Tackling and debating related, invented, and/or illegitimate cases could have further supported the concept analysis. Ultimately, Christensen effectively convinces readers that homophobia in nursing may hinder the patient’s right to receive adequate, professional, and compassionate care (Christensen, 2005). Conclusion Christensen (2005) stated, â€Å"homophobia in nursing may undoubtedly be an extreme violation of the individual’s right to receive adequate, professional, and compassionate care† (p. 70). Henrici (2007) sums it up best by saying â€Å"Even though at times we as nurses may not agree with patients’ lifestyles, religious beliefs, or cultural upbringings, every patient deserves the most competent and compassionate care we can provide. By avoiding the patient, limiting therapeutic touch and communication, speaking unkindly of the patient’s sexuality with others, and not furthering education and understanding of cultural diversity the nurse has breached provisions one, three and seven of the ANA Code of Ethics for Nurses (2001). There is a lack of research in the U. S. on the topic of homophobia in health care. More education on the topic of non-judgmental care relating to lesbian, gay and bisexual patients is necessary. Nurses should be held responsible for actions that are not in compliance with the ANA Code of Ethics for Nurses (2001) particularly where patient care is sacrificed due to disagreement of lifestyle and sexual preferences. Homophobia is real. Judgmental comments occur and do affect quality of care. Realizing that the health care needs of to lesbian, gay and bisexual patients are unique must be addressed through education and cultural diversity training† (pg. 61) . References American Nurses Association. (2001). Code of Ethics for Nurses with Interpretative Statements. Retrieved November 14, 2010, from nursingworld. org/ethics/code/protected_nwcoe303. htm. Baker, J (1991) Homophobia in Health Education: Implications for Practice. Paper presented at the Annual Meeting of the American Alliance for Health, Physical Education, Recreation and Dance (San Francisco, CA, April 2-6, 1991). Retrieved November 16, 2010 from http://searcheric. org/ericdb/ed332964. htm. Barry, A. (1998) Theorizing Homophobia. Sexualities, Vol. 1, No. 4, 387-404. Retrieved November 7, 2010 from EBSCOhost. Black, B. Oles, T; amp; Moore, L (1998) The Relationship Between Attitudes: Homophobia and Sexism Among Social Work Students. Affilia, Vol. 13, No. 2, 166-189. Retrieved November 12, 2010 from EBSCOhost. Christensen, M. , (2005). Homophobia in Nursing: A Concept Analysis. Nursing Forum. 40 (2) Retrieved October 30, 2010, from: EBSCOhost. Henrici, R (2007) Homophobia: Does it Affect Quality of Care. Journal of Undergraduate Nursing Writing. Vol 1 (1). 56-62. Retrieved November 17, 2010 from EBSCOhost. Leininger, M. (1995) Transcultural Nursing: Concepts, Theories, Research and Practices. McGraw-Hill. 1995. Merriam-Webster’s Medical Dictionary. (n. d. ) Retrieved November 16, 2010, from http://dictionary. reference. com/browse/homophobia. Neville, S. , amp; Henrickson, M. (2006). Perceptions of lesbian, gay and bisexual people of primary healthcare services. Journal of Advanced Nursing, 55, 407-415. Retrieved November 3, 2010 from EBSCOhost. Richmond, J. , amp; McKenna, H. (1998). Homophobia: An evolutionary analysis of the concept as applied to nursing. Journal of Advanced Nursing, 28, 362-368. Retrieved November 1, 2010 from EBSCOhost. Rondahl, G. , Innala, S. amp; Carlsson, M. (2004). Nurse’s attitudes towards lesbians and gay men. Journal of Advanced Nursing, 47, 386-392. Retrieved November 12, 2010 from EBSCOhost. Tate, F. , amp; Longo, D. (2004). Homophobia: A challenge for psychosocial nursing. Journal of Psychosocial Nursing amp; Mental Health Services, 42, 26-33. Retrieved November 16, 2010 from EBSCOhost. Walker, L. O. , amp; Avant, K. C. , (20 05). The Strategies for Theory Construction in (4th ed. ). Upper Saddle River, New Jersey: Pearson Prentice Hall. 10. Potential Application to Research