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Posts tagged ‘Donna Shambley-Ebron’

Unveiling Co-cultural Communicative Practices

We are now featuring the article by Cassie Wardlaw, PhD, MSW, PMHNP-BC; Donna Shambley-Ebron, PhD, RN, CTN-As titled “Co-cultural Communicative Practices of African American Women Seeking Depression Care.” In this article, the author’s report the outcome of their study, and in addition offer a model using two critical theories that can inform future research. Please share your comments and ideas related to the issues addressed in this article. Here is a message Dr. Wardlaw sent for ANS readers about this work:

Dr. Donna Shambley-Ebron hooding Dr. Cassie Wardlaw during graduation in April 2018

We are so honored to have our research study, “Co-cultural Communicative Practices of African American Women Seeking Depression Care” published in the current ANS issue featuring the topic of Culture, Race and Discrimination. This publication emanated from my PhD dissertation at the University of Cincinnati where I was a Substance Abuse and Mental Health Services Administration (SAMHSA) Minority Fellow. I had the privilege of presenting the preliminary findings of this study at the Transcultural Nursing Society annual meeting in 2017.  Moreover, for my dissertation work, I received the Outstanding PhD Student Award from the UC College of Nursing.

As a Psychiatric-Mental Health Nurse Practitioner, I was aware of data which indicate higher depression symptom severity and chronicity among African Americans.  I also understood that women of color face many challenges when seeking health care.  This led me to want to discover more about their experiences in the mental health care system, in order to improve care delivery for this population.  Moreover, I recognized that communication is a key factor in navigating within systems of care when attempting to achieve desired outcomes.  Dr. Mark Orbe’s theory, Co-Cultural Theory of Communication, explains the practices that people from traditionally marginalized groups use when communicating in dominant societal structures, which includes the health care system. This theory, in addition to Collins’ seminal work on Black Feminist Thought provided the theoretical underpinnings to support this study.

Dr. Wardlaw discussing the use of the frameworks used in the study at the University of Cincinnati

Dr. Donna Shambley-Ebron, my dissertation chair, mentor and co-author on this publication, is a certified Advanced Transcultural Nurse and a Transcultural Scholar. Her background in studying health issues facing African American women in addition to her experience in conducting ethnographies helped ensure the quality and integrity of this study.

African American women face unique challenges when seeking care, often related to past experiences with racism and subsequent distrust of providers. From the findings of this study which included interviews of 19 women who were receiving care for depression in community mental health agencies, we were able to develop a beginning theory about the influences that impact their communication practices. They were: intersectionality, system and structural impact, establishing trust, preserving self, and practice selection.  These findings demonstrated that African American women did indeed alter their communication in the mental health care setting. This was consistent with Orbe’s work. The implications of this study point to the need for nursing to move beyond basic assessment related to culture and examine the greater overarching issues related to power and dominant societal structures. Overall, we realize that the communicative practices of African American women who seek care for depression are complex and cannot be fully explained by the findings of this study. However, we believe that this study is an essential starting point in theory development regarding how African American women navigate the mental health care system.



Cultural Meanings of Mothering

Our current featured article describes a study that uses an intersectional approach to examine the simultaneous and cumulatie effects of gender, race and class.  The article, byDebora M. Dole, PhD, CNM; Donna Shambley-Ebron, PhD, RN, CTN-A, is titled “Cultural Meanings of Mothering Through the Eyes of African American Adolescent Mothers.”  Please visit the ANS website to download your copy of this important article at no coast while it is featured, then return here to share your responses and ideas!  Here is a message from Dr. Dole about her work in this area:

It is an honor to have this article featured in the Advances in Nursing Science blog.  I am thankful for the opportunity to share the work that has opened my own eyes in ways I was not prepared for. This article

Debora Dole

Debora Dole

represents a critical reflection as a researcher and practicing midwife of what inner strength, empowerment, humility and support looks like through the eyes of young African American mothers.  The use of Photovoice as a method to explore cultural meanings from the inside out invited critique and deconstruction of presupposed ideas of what mothering looked like, how it was perceived internally and externally, and how it was ultimately constructed by the mothers themselves.  Photovoice, a method using photography to represent and interpret the daily lives and concerns of participants, gives “voice” in a way that ethnography or qualitative inquiry alone could not provide.

As an experienced practitioner but a novice researcher, I struggled with how to explore the concept of cultural mothering from a perspective I had never experienced.  I am white, middle-aged, middle-class and live in a rural suburb.  While my clinical practice has been primarily in service of young, urban African American women, my experience did not provide the lens I felt was necessary to truly understand. The development of a theoretical framework representing the methodology as well as interpretation of study findings was necessary to understand more deeply the question, “What does mothering look like through the eyes of African American adolescent mothers?”

Intersectional Theoretical Framework

The theoretical framework for this study provided support for exploring mothering through the intersectional lens of gender, race and class.  It was important for my own understanding to have a framework that represented the process of deconstructing each of these.  No one theory alone seemed to fit.  Critical feminist, race and social theories represented the intersectional trifecta of being female, Black and poor.  It was my belief that mothering from what I viewed as a disadvantaged position would prove to be difficult in such a fragmented environment.

The interpretative nature of the study required a cultural lens constructed using concepts of Black Feminist Thought, Womanism, and Africana Womanism to bring meaning to the themes of building a network, sharing responsibilities, and seeing the future. Participant photography was accomplished in response to prompts such as: 1) What does mothering look like to you? 2) Who or what are the things that help you be a mother? 3) What makes it hard to be a mother? 4) What motivates you as a mother? 5) What does the future look like?   The cornerprocess of participant photography, discussion and analysis provided unique insight into a complex network of extended family, “other mothers”, friends and kin constantly under construction.  The power of a simple photograph cannot be overstated.   The photograph to the right is titled “Backed into a Corner”.  The photograph was taken and presented to the group for discussion by a participant who expressed her feeling of being trapped with few options.  It was through group discussion among the participants that the window represented a way out.

If the purpose of research is to uncover, explain or understand phenomena, the unexpected insight gained through this process has accomplished more than that.  This process has changed me.  It has made me a better midwife, a better researcher, a better learner, a better teacher and a better person.  I have a group of young, inexperienced, and “disadvantaged” mothers to thank for showing me what lies beneath the surface.  I hope you enjoy the article.  Maybe it will provide the reader another perspective.  Take a step back and “see”.  The clinical application of this research can be realized in how those that care for mothers and their children see their role, the power relationships that exist in healthcare and ultimately change how care is delivered.  The change has begun with the development and expansion of models of care that put mothers and their families at the center of their care such as CenteringPregnancy and CenteringParenting ®.

I would like to thank my co-author, Dr. Donna Shambley-Ebron for guiding me, sharing her wisdom, her insight and showing me the value of dwelling with the data.

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