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Posts tagged ‘Ralph Klotzbaugh’

Caring for Gender Minority Persons

ANS is currently featuring the article titled “Gender Minority Persons’ Perceptions of Peer-Led Support Groups: A Roy Adaptation Model Interpretation” Ralph Klotzbaugh, PhD, FNP-BC and Jacqueline Fawcett, PhD, ScD (hon), RN, FAAN, ANEF. The article is available for free download while it is featured, and we welcome your comments here! Drs. Klotzbaugh and Fawcett each share their comments about this work here:

Ralph’s comments

This project required a methodological approach that I was not initially used to working with.  My prior research has utilized quantitative methods, but I knew given the substantial gaps in knowledge related to transgender and gender diverse (TGD) communities, that a quantitative approach to this project would not have been appropriate.  I could have taken what is known from the bit of existing literature specific to TGD communities that is out there (for example community support and its relation to resilience and effects on reducing depression, anxiety, etc.) and utilized standard depression and anxiety scales to measure the effect of support group attendance among TGD participants over a period of time.   However, this approach would have made a lot of assumptions about why people who identify as TGD attend support groups.  Might this assumption (in spite of supportive research findings as well as best intentions) disinterest, or possibly offend potential participants?  This was a moment in learning how to reign in one’s enthusiasms based on one’s academic knowledge and expertise, and to allow and encourage those who identify as TGD and who attend these support groups to discuss why they attend support groups. 

This approach necessitated a qualitative approach, and the data from this project were for me, infinitely more insightful than any existing quantitative instruments  could have revealed.  It was a time-consuming iterative process well worth all our efforts, particularly given the complexities of intersectional considerations within this project. For me, the approach to data through qualitative methodologies made me necessarily question the potential ‘messiness’ that might be true of more traditionally objective quantitative methods.  Checking one’s biases is expected as part of the iterative process in qualitative methods.  This however is not often, if ever, a focus of quantitative methods.  And yet, how are studies using quantitative methods constructed?  What questions are being asked?  What demographics collected and why?  What identities are we leaving in? Leaving out?  What are the potential findings that we may never know of if we are too busy constructing (knowingly or unconsciously and without thought) what we believe will be true, to be true, and/or insist on proving?  I recommend every nurse researcher make a deliberate effort to step outside of their usual methodologies and thus to become uncomfortable in the process. 

Jacqueline’s Comments

It was an honor to join Ralph as we wrote this paper. My contribution was to interpret the themes Ralph discovered in the data within the context of the Roy Adaptation Model (RAM).  As that occurred, Ralph and I discovered that the content of the RAM led us to review the data again and determine whether one or more other themes were missing. This was an excellent example of how use of an explicit nursology conceptual model can truly guide the analysis of qualitative data. We have to wonder what the initial data analysis would have revealed if we had started with the RAM as the guide for the design of the study and the analysis of the data.

Of course, we have to acknowledge that our selection of the RAM for this paper introduces a bias, namely that the study was about adaptation. What would the study design and data analysis looked like if we had selected a different nursology conceptual model, for example, Orem’s Self-Care Model or Levine’s Conservation Model or Johnson’s Behavioral System Model? Had we selected any one of these conceptual models, a bias would still have been evident. Thus, it is imperative for all researchers to recognize that bias always exists in the conduct of research and that bias goes beyond the ANS requirement to declare the cultural, racial, and gender perspectives of the author(s).

Moving toward LGBT Equality in Healthcare

The current ANS featured article explores the complex issues involved in overcoming homonegativity in healthcare.  The article titled “Cues-to-Action in Initiating Lesbian, Gay, Bisexual, and Transgender-Related Policies Among Magnet Hospital Chief Nursing Officers: A Demographic Assessment” is by Ralph Klotzbaugh, PhD, RN, APRN and Gale Spencer, PhD, RN. Dr. Klotzbaugh provided this background related to the article:

I started doing this research as a result of reviewing the Human Rights Campaign’s annual Healthcare Equality Index that looks at protective policies for patients and employees that identify as LGBT. The year I looked at must have been

Ralph Klotzbaugh

Ralph Klotzbaugh

around 2012. The end of the HEI puts together a list of participating medical institutions and their scores from the policy survey. I started perusing this list and began to notice two things that really surprised me. First, not all Magnet designated hospitals had responded to the survey (the survey is voluntary) and of those Magnet designated hospitals that had responded to the survey, many had few if any protective policies in place. I had assumed Magnet would require lgbt specific policies and was disappointed to find out that indeed they had not.

As I worked through the development and analysis of this study, I started thinking through some larger questions of the nursing profession and what it might mean to future nursing research. Mainly, how will nurses gain or improve administrative authority? Further, how might nurses use our insights to the social/political/economic conditions faced by the patients that we care for in influencing these administrative changes?

I believe these questions are of particular importance to nursing. Regardless of where our practice has taken us, we all started out at the bedside caring for patients. Caring for patients. It is time for our profession to recognize the value of caring, not only as it relates most importantly to the treatment of all patients as well as our colleagues, but to how this necessarily has to inform policy, politics, and administration.   I hope my research contributes toward developing a better sense of the problem and the directions that we might take as nurses. I look forward to continuing my research in my new position as Assistant Professor at University of Massachusetts, Boston. Finally, I would like to thank my coauthor Gale Spencer at Binghamton University who made the space for me to do LGBT specific work, and for others to follow.

This article is available for download at no cost while it is featured on the ANS web site, so read it now, and come back here to share your comments and responses!

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