MINORITY STUDENT EXPERIENCES: BARRIERS AND BRIDGES IN NURSING
EDUCATION
Nassrine Noureddine
B.S.N., American University of Beirut, 1991
M.S.N, California State University, Sacramento, 2003
DISSERTATION
Submitted in partial fulfillment of
the requirements for the degree of
DOCTOR OF EDUCATION
in
EDUCATIONAL LEADERSHIP
at
CALIFORNIA STATE UNIVERSITY, SACRAMENTO
FALL
2012
Copyright © 2012
Nassrine Noureddine
All rights reserved
ii
MINORITY STUDENT EXPERIENCES: BARRIERS AND BRIDGES IN NURSING
EDUCATION
A Dissertation
by
Nassrine Noureddine
Approved by Dissertation Committee:
________________________________
Dr. Caroline S. Turner, Ph.D., Chair
________________________________
Nadeen T. Ruiz, Ph.D.
_________________________________
Kelly Tobar RN, MS, Ed.D.
FALL 2012
iii
MINORITY STUDENT EXPERIENCES: BARRIERS AND BRIDGES IN NURSING
EDUCATION
Student: Nassrine Noureddine
I certify that this student has met the requirements for format contained in the University
format manual, and that this dissertation is suitable for shelving in the library and credit is
to be awarded for the dissertation.
___________________________, Graduate Coordinator
Dr. Caroline S. Turner, Ph.D./Professor
iv
_________________
Date
DEDICATION
I, Nassrine M. Noureddine, would like first and foremost to thank Allah “God”
the Most Gracious and Merciful for giving me the means and strength to succeed and for
making my doctoral studies journey possible. Special thanks to our Prophet Muhammad,
peace be upon him, from whom I learned the value of advocacy and that it is our social
duty as human beings to advocate for the oppressed, weak, needy and old. With deep
appreciation for those who walked with me during my rigorous educational journey.
My family, to whom I dedicate this dissertation; My husband, Laith, for his
eternal patience, love, support, and encouragement over many long weekends and nights;
My parents, who provided me the opportunities for success. My deceased dad, may
God’s mercy be upon him, who instilled in me perseverance, determination and hard
work. My Mom, for her encouragement, prayers, and continued support, and my sister
Soha, who were both caring for my kids and providing me time to study. I count my
blessings to have been raised and surrounded by such loving, giving, and selfless people.
I would also like to dedicate this to my amazing children; Zainab, Fatima, and
Omran. I would like to thank them for; all the unconditional love they provided me with,
their patience and for giving up their time with me allowing me time to study. I would
also like to dedicate this work to my other two children Ali, and Muhammad whom I
have been unwillingly deprived from seeing for thirteen years. I would like you all to
remember you can accomplish anything if you work hard, stay focused and love Allah
with all your heart, mind and soul…with that you can conquer any challenge; I love you
all very much!!!
v
ACKNOWLEDGEMENTS
To my study participants and my nursing students; past, present, and future; you
were my aspiration, and the vision behind this research. A special thanks to you all!
I would like also to acknowledge the California State University, Sacramento
EdD Cohort III. Over the past three years we have all gone through some amazing times
of excitement and hardship; however, through it all we have supported each other and
that gave me the strength to continue. Hard as it was at times, this passage in my life has
been one of the most rewarding because it provided me with the chance to work with
great people like you!
I must also recognize the dedication and work of my dissertation committee. I am
very appreciative of my dissertation chair, Dr. Caroline Turner, who kept on encouraging
me when I was going through rough times and thought I will not be able to finish.
Thanks for your high expectations and your faith in me. In addition, my committee
members, Dr. Nadeen Ruiz and Dr. Kelly Tobar, who added great insight and direction
throughout my research and writing. I sincerely appreciate all of your help,
encouragement, and support throughout the entire process. Thank you!
Special thanks to Dr. Leon; for your guidance, for being a great advisor, and for
setting us up to success. Special thanks also, to Dr. Ann Haffer, for all the time you
invested in reading my work and giving me your constructive feedback. Thank you for
your dedication to nursing education and for modeling the educator role with excellence.
Your commitment to your students and to education has given you both a special place in
my heart.
vi
CURRICULUM VITAE
Education
CSU Sacramento, CA
Ed.D. in Leadership and Policy Studies
(2012)
CSU Sacramento, CA
M.S. in Nursing with Emphasis on Education (2003)
American University Of Beirut (AUB), Beirut Lebanon
B.S. in Nursing (1991)
Professional Employment In the U.S.
California State University of Sacramento (CSUS) Sacramento, CA.
(2004 – present)
Sacramento City College Main Campus and Extension Program
(2001 – 2006)
Professional Employment In Beirut, Lebanon
(1995 – 1999)
Lebanese University (LU), Faculty of Health Sciences
AlRassoul AlAazam Hospital Beirut, Lebanon
Al Makassed National College of Nursing Beirut, Lebanon
Professional Employment In Abu Dhabi, United Arab Emarites (UAE)
(1991 – 1995)
American University Beirut (AUB)“The Health man power Development Project”.
The project sponsored by “The Ministry of Health” in the United Arab Emirates.
Professional Affiliations
Member of the American Nurses Association \ California
Member of the American Association of Critical Care Nurses
Member of California Faculty Association
vii
Abstract
of
MINORITY STUDENT EXPERIENCES: BARRIERS AND BRIDGES IN NURSING
EDUCATION
by
Nassrine M. Noureddine
One of the most crucial issues facing the nursing profession today is the
underrepresentation of minority nurses as it contributes to the disparity in the delivery of
health care. The nursing work force is not keeping up with the pace of changing
demographics in the general population, resulting in lack of diversity in the nursing
profession. Consequently, the current nursing workforce is unable to meet the increasing
demand for ethnically, culturally, and linguistically appropriate and sensitive health care.
There is a pressing need to close the gaps in attainment for underrepresented groups in
nursing education. This can only be accomplished by increasing access, retention and
graduation rates of minority students from nursing schools. This qualitative
phenomenological study explored the perceptions of newly graduated African American,
Latino, and Muslim nurses about the challenges as well as facilitators that they
encountered during the course of their undergraduate nursing school at one Northern
California nursing baccalaureate program. It also examined institutional resources, social
capital (networks), cultural capital (beliefs, values, and skills), and habitus (aspirations)
that were necessary for their successful completion of the nursing program.
viii
TABLE OF CONTENTS
Page
Dedication ........................................................................................................................... v
Acknowledgements ........................................................................................................... vi
Curriculum Vitae ............................................................................................................. vii
List of Tables .................................................................................................................... xi
List of Figures .................................................................................................................. xii
Chapter
1. INTRODUCTION ........................................................................................................ 1
Background ............................................................................................................. 1
Statement of the Problem ........................................................................................ 3
Nature of the Study ................................................................................................. 7
Theoretical Framework ........................................................................................... 9
Operational Definitions ......................................................................................... 14
Assumptions, Delimitations, and Limitations ....................................................... 17
Significance of the Study ...................................................................................... 19
Conclusion ............................................................................................................ 19
2. REVIEW OF RELATED LITERATURE .................................................................. 22
Introduction ........................................................................................................... 22
Dropout Crisis in California.................................................................................. 23
Underrepresentation of Minorities in Nursing ...................................................... 26
Minority Students in Nursing................................................................................ 31
African American Nursing Students ..................................................................... 34
Latino and Mexican-American Students in Nursing ............................................ 36
The Need for Muslim Nurses ................................................................................ 41
Muslims in Nursing............................................................................................... 48
Theoretical Framework ......................................................................................... 49
Critical Race Theory ............................................................................................. 50
Summary ............................................................................................................... 62
ix
3. METHODOLOGY ..................................................................................................... 64
Research Design.................................................................................................... 66
Role of the Researcher .......................................................................................... 67
Context, Setting and Sample ................................................................................. 68
Instrumentation, Materials, Data Collection, and Analysis .................................. 69
Ethical Considerations .......................................................................................... 75
Pilot Study............................................................................................................. 76
Conclusion ............................................................................................................ 77
4. ANALYSIS OF DATA............................................................................................... 78
Introduction ........................................................................................................... 78
Participant Demographic Data .............................................................................. 81
Data Analysis ........................................................................................................ 87
General Research Findings ................................................................................... 90
Findings Specific to the Three Focus Groups ..................................................... 132
Analysis of Data .................................................................................................. 109
Conclusion .......................................................................................................... 147
5. SUMMARY, CONCLUSIONS, AND RECOMMENDATIONS ........................... 149
Participant Demographics at CSUS and the Literature....................................... 150
Findings............................................................................................................... 153
Interpretation of Research Findings in Relation to the Literature Review ......... 158
Recommendations ............................................................................................... 175
Decision-Making, Study Limitations and Suggestions for Future Research ...... 184
Limitations .......................................................................................................... 185
Recommendations for Future Study ................................................................... 185
Conclusion .......................................................................................................... 188
6. APPENDICES .......................................................................................................... 189
Appendix A. Consent to Participate in Research Form ...................................... 190
Appendix B. Interview Protocol ........................................................................ 192
REFERENCES ............................................................................................................... 193
x
LIST OF TABLES
Table
Page
1. Distribution of Registered Nurses and the US Population by Racial Ethnic
Background (USDHHS, 2010) ..................................................................................... 5
2. CA RNs’ Population Ethnic Distribution in Comparison to Ethnic Distribution of
CA General Population, US RN Population and the US General Population ............ 31
3. The Different Estimates of the Number of Muslims in the US .................................. 44
4. Participants’ Financial and Economic Status .............................................................. 86
5. CSUS Nursing Graduates Ethnic Distribution in Comparison to
Ethnic Distribution of CA RNs’ Population, CA General Population, US RN
Population and the US General Population .............................................................. 159
6. Ethnic Distribution of Sacramento State Nursing students....................................... 177
7. Ethnic Distribution of Sacramento State Nursing Faculty ........................................ 180
xi
LIST OF FIGURES
Figure
Page
1. Distribution of Registered Nurses and the US Population by Racial/Ethnic
Background ................................................................................................................... 5
2. Social Processes Integral to Academic Capital Formation (CFES, 2010) .................. 10
3. Percent of Education Attainment of Associate Degree or Higher
By Ethnicity (US Census Bureau, 2008) .................................................................... 24
4. US Adults with College Degree .................................................................................. 25
5. Ethnic Compositions of Muslims in the United States ............................................... 45
6. Steps of Qualitative Data Analysis ............................................................................. 71
7. Participants’ Ethnic Distribution................................................................................. 82
8. Participants’ Spoken Languages ................................................................................. 83
9. Participants’ College Experience ................................................................................ 84
10. Comparison of Participants’ GPAs ............................................................................. 84
11. Level of Education of Parents and Siblings ................................................................ 85
12. Research Findings ....................................................................................................... 89
13. Barriers for Success .................................................................................................... 93
14. Bridges to Success .................................................................................................... 116
15. Percentage of Minorities Graduating from CSUS Nursing Program
(Fall 2009-2011) ....................................................................................................... 151
16. Findings in Relation to Research Question 1 ............................................................ 156
17. New Conceptual Model: First Generation Low-income Nursing Students and the
Educational Pipeline ................................................................................................. 174
xii
1
Chapter 1
INTRODUCTION
Background
On June 4th, 1965, President Lyndon B. Johnson delivered the commencement
address at Howard University. The title of his speech was “To Fulfill These Rights”
…Freedom is not enough. You do not wipe away the scars of centuries by
saying: Now…“You are free to compete with all the others.” And still justly
believe that you have been completely fair. Thus it is not enough just to open the
gates of opportunity. All our citizens must have the ability to walk through those
gates. This is the next and the more profound stage of the battle for civil rights.
We seek not just freedom but opportunity. We seek not just legal equality but
human ability. Not just equality as a right and a theory, but equality as a fact and
equality as a result.
According to President Johnson, equity involves both opportunity as well as
results. After more than forty years, educational outcomes indicators still show racial and
ethnic disparities. The community college achievement gap is defined by Nevarez and
Woods (2010), as the “pervasive success disparities among students on academic
performance indicators (i.e., rates for enrollment, remediation, retention/ persistence,
graduation, and transfer)” (p. 73). There is an actual evidence-based achievement gap at
the community college level between students who are considered White Caucasian and
students of color (WICHE, 2008; McGlynn, 2009; Nealy, 2009; Nevarez & Woods,
2
2010; Mortenson, 2009; Lumina Foundation, 2009). In the United States’ higher
education system, Blacks, Hispanics and Native Americans are proportionally
underrepresented while Whites and Asians are over represented. This is also true for
minorities in the health sector.
A major issue in health care in the 21st century is the lack of diversity in the
nursing profession in general and in nursing education specifically. There is a growing
racial and ethnic population in the United States; however, minorities in nursing are
underrepresented (Sullivan Commission, 2004; American Association of College Nursing
[AACN], 2011; Taxis, 2002, 2006; Nugent, Childs, Jones, Cook & Ravenell, 2002a,
2002b; California Endowment, 2003; California Board of Registered Nursing [CBRN],
2011; National League of Nursing [NLN], 2009; Gardner, 2005; Wisneski, 2003; Jordan,
1996; Bond, Gray, Baxley, Cason & Denke., 2008; Sims-Giddens, 2000). This also holds
true for Muslim nurses (Marquand, 2006). This study explored the reasons behind the
high attrition rates among minority students in nursing programs, particularly students of
Latino, African American and Muslim descent in California. Some of the Latino or
African American nurses may also be of the Muslim faith. Based on my twenty years’
experience in nursing education, the author realizes that Muslim nurses are also a
minority of graduates from nursing programs. However, the major data sets such as the
2008 National Sample Survey of Registered Nurses (NSSRN) reporting the
demographics of nurses in the profession do not report Muslims among the categories
counted. Thus, information was totally lacking on the status of Muslim nurses in the
3
profession this is why an examination of their experiences was included in this study.
The National Sample Survey data indicated the following:
American Muslims come from various backgrounds, and are one of the most
racially diverse religious group in the United States according to the US
Department of state Muslims in America publication, 2009; Native-born
American Muslims are mainly African Americans who make up about a quarter
of the total Muslim population. The immigrant communities make up the
majority, including people of Arab and South Asian descent. (US Department of
Health and Human Service [USDHHS, 2010]
According to the Pew Research Center (2009), the growing Muslim population in
the United States represents two percent of the American population and in 2009
comprised close to one quarter of the religious discrimination claims filed with the Equal
Employment Opportunity Commission.
Statement of the Problem
The goal of this study was to explore the perceptions of newly graduated African
American, Latino, and Muslim nurses about the challenges as well as facilitators that they
encountered during the course of their undergraduate nursing school experience and what
helped them address challenges in order to successfully graduate.
In the 2010 United States Census, approximately 31% of the people in the United
States identified themselves as being a racial or ethnic minority (US Census Bureau,
2010). According to the latest data from the 2008 National Sample Survey of Registered
4
Nurses (NSSRN), nurses from minority backgrounds represented 16.8% of the registered
nurse (RN) workforce and nurses from minority African American, Hispanic and
American Indian/Alaskan Native backgrounds are the most underrepresented minorities
[Table 1; Figure 1] (USDHHS, 2010). No data were found on Muslim nurses. The
number of American minorities is projected to rise by 50% between the years 2000 and
2020 (US Census Bureau, 2010). The nursing profession needs to increase the number of
minority registered nurses if the profession is to keep pace with the changing
demographics of this nation (American Association of Colleges of Nursing [AACN],
2011). All national nursing organizations, the federal Division of Nursing, hospital
associations, nursing philanthropies, and other stakeholders within the health care
community agree that recruitment of underrepresented groups into nursing is a priority
for the nursing profession in the US (AACN, 2011; Inhorn & Serour, 2011; Hammoud,
White & Fetters, 2005; McDermott-Levy, 2009).
One factor contributing to the lack of minority nurses is the number of minority
students who drop out of nursing school before graduation. Exact numbers are not
available due to a lack of documentation among nursing programs, but the National
Advisory Council on Nurse Education and Practice (2000) acknowledged that the
attrition rates for minority students in nursing programs are very high. Therefore, the
retention of racial and ethnic minority students in nursing schools is essential in the
development of a diverse nursing workforce that is able to deliver ethnically, culturally,
and linguistically appropriate and sensitive health care.
5
Table 1
Distribution of Registered Nurses and the US Population by Racial Ethnic Background
(US DHHS, 2010)
Ethnicity
Figure 1
US Population
RN Population
White
65.6%
83.2%
Hispanic/Latino
15.4%
3.6%
African American
12.2%
5.4%
Asian/Hawaiian/PI
4.5%
5.8%
American Indian
0.8%
0.3%
Two or more races
1.5%
1.7%
Distribution of Registered Nurses and the US Population by Racial/Ethnic
Background
The Sullivan Commission (2004) examined the number of ethnically and racially
diverse students in health care education programs and concluded that “increased
6
diversity will improve the overall health of the nation” (p. 3). The quality of patient care
can improve with a greater proportion of nurses from different cultures. In addition,
patient outcomes and compliance rates are better when communication is not only
effective, but in the patient’s own language. A diverse nursing population can help
overcome language barriers and provide culturally competent nursing care. This is also
true for Muslim patients, since differences in the social and religious cultures of Arab
Americans and American Muslims raise challenges to healthcare access and delivery.
These challenges go far beyond language to encompass entire world views, concepts of
health, illness, and recovery and even death. Medical professionals need a more
informed understanding and consideration of the rich and diverse array of beliefs,
expectations, preferences, and behavioral makeup of the social cultures of these patients
to ensure that they are providing the best and most comprehensive care possible (Inhorn
& Serour, 2011; Hammoud et al., 2005; McDermott-Levy, 2009). Moreover, nursing
students who study and practice with a diverse student population are more likely to
comprehend the other person’s perspectives and provide more culturally competent care
to patients. Given the difficulties facing nursing schools today (e.g., faculty shortages,
applicant pools that are often unprepared for the rigors of nursing education, high attrition
rates), it is important for nursing educators and administrators reflect on their practices
concerning disadvantaged and diverse nursing student populations so that they can
maximize their outcomes.
7
Nature of the Study
The purpose of this narrative phenomenological study was to explore the lived
undergraduate nursing education experiences of newly graduating African American,
Latino, and Muslim nurses. Through analysis of data derived from individual interviews
detailing the lived experiences among these three ethnic/cultural groups, the study
intended to explore the nurses’ perceptions of the challenges they faced during the course
of their undergraduate nursing school and what helped them cross these barriers and
successfully graduate. Through this study the researcher was trying to answer the
following questions:
(1) What are the perceived challenges to success that Latino, African American,
and Muslim students face in a nursing program where they are in the
minority?
(2) What institutional resources (student services), social capital (networks),
cultural capital (beliefs, values, and skills), and habitus (aspirations) were
necessary for their successful completion of the nursing program?
Method
The research took place in the city of Sacramento, located in Northern California.
A purposeful sampling of participants was selected for in-depth interviews by the
researcher. Purposeful sampling is a non-random method of sampling where the
researcher selects information-rich cases for study in depth (Merriam, 2009). This
allowed the researcher to select individuals who met certain criteria for participation in
the study.
8
A total sample of nine newly graduated nurses was obtained. The sample was
limited to African American, Latino, Muslim nurses who: (1) have received their
undergraduate nursing education in the state of California, at Sacramento State
University, and (2) have graduated in the last two academic years (2009/2010 and
2010/2011) since their recollection of their experience in nursing school will still be
recent.
Access to the sample population was accomplished through contacting the
Alumni Center of the university where the researcher works and through professional
nursing associations. The school of nursing Alumni Association representative invited
the graduates meeting the researcher’s criteria to participate in the study via email. A list
of the graduates who expressed interest in participating in the study was provided to the
researcher to contact. Interviews were conducted, with the participants’ permission, in
private, neutral, nonthreatening settings in agreement with each participant.
Participants were interviewed once, for an average of 60 minutes. Participants
were individually interviewed with only the researcher and participant present. The
purpose of the study was reviewed with the participants and their consent to participate
was obtained (Appendix A). The researcher asked structured open-ended questions of
each participant (Appendix B). Interviews were audiotaped by the researcher. The
audiotapes were then transcribed by a professional transcriptionist and coded using
identifiers for confidentiality. The researcher listened to all recordings and reviewed all
transcripts for accuracy. To ensure that transcripts held the meaning intended by the
participants a copy of each transcript was emailed to each participant for their review.
9
The researcher then followed up with an email to each participant to make sure the
transcripts captured the meaning they intended.
Transcripts were then analyzed for common themes manually. The reliability was
accomplished through member checking; the researcher biases were documented before
the beginning of data collection using bracketing, and negative or discrepant information
is presented with the findings in Chapter Four. Peer debriefing was also used to enhance
accuracy, the chair of the dissertation committee acted as the peer debriefer.
Permission to conduct the study has been obtained through the Institutional
Review Board of California State University, Sacramento which the researcher was
attending (Appendix A). The researcher implemented specific procedures to provide the
participants with the least amount of risk possible and maintained their comfort
throughout the completion of the survey. Research methodology and ethical
considerations are discussed in further details in Chapter Three.
Theoretical Framework
Multiple theories were used as a foundation for this study. Below is an overview
of each theory; a more detailed discussion of each is provided in Chapter Two along with
a review of the relevant literature. The first theory discussed was Critical Race Theory
(CRT) which provided a frame work for the barriers facing minority students in nursing
education. The second theory used was the theory of Academic Capital Formation (ACF)
that was developed by Edward St. John through identifying claims about social processes
in human capital theory (Becker, 1993), social capital theory (Coleman, 1988), and social
10
reproduction (Bourdieu, 1977b) theories. ACF acted as a frame work or an umbrella that
highlighted the strategies necessary for students of ethnic minority origins to help
increase their access to and success in rigorous nursing education programs. Cultural
capital, social capital, and human capital (habitus) provided frames through which
success in nursing education can be reached (Figure 2).
Figure 2
Social Processes Integral to Academic Capital Formation (CFES, 2010).
ACADEMIC CAPITAL
FORMATION
 Human capital: Concern
about costs
 Social Capital
o
Supportive
Networks
o
Navigation of
systems
o
Trustworthy
information
 Cultural Transformation
o
College Knowledge
o
Family Uplift
This study examined the ways in which African American, Latino, and Muslim
students were able to overcome the challenges faced during their undergraduate nursing
education and what institutional, academic, cultural, social and personal factors helped
them persist in the nursing program, and successfully graduate.
Critical Race Theory (CRT)
CRT originated from the critical legal studies (CLS) movement. CRT analyzes
the role of race and racism in perpetuating social disparities between dominant and
marginalized racial groups (DeCuir & Dixson, 2004; Ladson-Billings, 2005; Ladson-
11
Billings & Tate, 1995). CRT’s purpose is to unearth what is taken for granted when
analyzing race and privilege, as well as the profound patterns of exclusion that exist in
US society (Parker & Villalpando, 2007). Therefore, CRT can play an important role
when higher education institutions work toward becoming more diverse and inclusive.
For example, in nursing programs, working toward increasing the number of students of
color enrolled is an insufficient goal if institutional change is a priority. Examining the
program’s climate efforts to have culturally competent and diverse staff, faculty, and
administrators is a more effective way of becoming more diverse and inclusive. CRT’s
framework is comprised of the following five tenets: counter-storytelling; the
permanence of racism; Whiteness as property; interest conversion; and the critique of
liberalism (DeCuir & Dixson, 2004; Ladson-Billings, 1998; McCoy, 2006). Fortunately,
the various tenets of CRT can be used to uncover the ingrained societal disparities that
support a system of privilege and injustice. This will be discussed in more detail in
Chapter Two.
Theory of Cultural Capital
Cultural capital (and other theories of capital) originally came from the economic
concept of capital, which refers to a person’s assets or funds, in this case funds of
knowledge. Cultural capital, specifically, was first conceptualized by Pierre Bourdieu in
1977. He explained that students bring with them a bank of knowledge, or academic
resources (cultural capital), which allows for understanding; however, without these
resources, the student is then at a disadvantage (Bourdieu, 1977a). Throsby (1999)
expanded on Bourdieu’s definition by including that cultural capital is the “set of ideas,
12
beliefs, and values set forth by the dominant culture” (p. 7). Bourdieu and Throsby’s
definitions conclude that if a student does not embody these intrinsic principles, it sets the
student at a disadvantage. However, they refer to the dominant culture as one that
defines the appropriate values necessary, which does not reflect the current demographic
environment of education.
While students who come from families who did not attend college might not
have the cultural capital defined by the dominant culture, they still maintain their own
beliefs and values which can translate to college success. Trueba (2002) examines the
original concept of cultural capital through a Critical Race Theorist lens, noting that in
validating the notion of a dominant culture’s values and beliefs, it takes away from those
whose values may differ. This can result in a disparity between those who hold the
power on a college campus and the individual student’s values, which can, in turn,
present itself as a loss of identity for the students; this may result in students feeling
forced to leave behind their home culture and assimilate to the dominant culture
presented through the system of higher education. Trueba (2002) tackled this cultural
conflict, recognizing that the theory of cultural capital marginalized the majority of the
population. He has defined a “new cultural capital” in which diversity is dominant,
focusing on diversity in the form of ethnicities, income level, sexual orientation, and
other such qualities in which people are often marginalized. Therefore, when discussing
the “dominant” culture, it includes the distinct values and beliefs with which students
enter education provided by their families and individual experiences. For the purpose of
this study, Trueba’s (2002) definition of cultural capital, which includes the values and
13
beliefs provided by the diverse population within the current educational system, will be
used. This includes understanding the processes and resources available through college,
as well as the college skills that allow students to be successful in the content classes.
Theory of Social Capital
Similar to cultural capital, social capital is yet another resource which aids in
college readiness. Coleman (1988) described social capital as a relational theory through
which individuals gain more social capital based on the people with whom they network.
For example, a cohort of nursing students supports each other through a rigorous program
by not only sharing their individual goals, but by encouraging each other as they work
toward a common goal through set norms. These students benefit from the social capital
gained through a cohorted program, just as others gain capital by networking with people
who have similar goals. Portes (1998) agreed, stating that involvement in a group can
have increased positive results. Most nursing programs embody this concept. The
students at the studied site form their own social networks within the nursing program.
The researcher aimed to study how this model translates into forming appropriate,
beneficial social groups that helps individuals gain more social capital through nursing
school.
Theory of Habitus
Habitus is a very similar concept to both cultural and social capital; however,
instead of gaining resources which will aid a person’s ability to successfully navigate
through college, habitus reflects a person’s desire. More specifically, McDonough
(1997) reintroduced Bourdieu’s (1977) concept of habitus and its effect on educational
14
attainment by defining it as the attitudes that shape a person’s expectations and
aspirations. One of most nursing schools’ main focus points is that students must commit
to their desire of a nursing college education before entering the program.
Social Learning Theory
While Bourdieu’s (1977) and Coleman’s (1988) definitions of social capital relate
to ways in which social structures can provide individuals with the capital that might not
have been developed through family networks, social learning theory builds upon this
idea. Although defined years prior to Bourdieu’s 1972 explanation of social capital,
Bandura’s (1969) research explained social learning theory as an occurrence of modeling
behavior based on “appropriate societal models” (p. 213). Much of Bandura’s research
addressed positive and negative childhood behaviors. Given that his research focused on
imitating modeled behavior, it can include an individual imitating the actions of or
decisions made by his or her peers. Relating the social learning theory to nursing
education, the lack of faculty, nurses, and students from minority background results in
the lack of role models which can have a significant impact on an individual’s decision to
work hard and succeed.
Operational Definitions
The following definitions are used throughout this study:
Arab Americans: Could be Muslims or Non-Muslims who identify themselves by
their ethnic origin (Hammoud et al., 2005).
15
American Indian or Alaska Native: Refers to a person having origins in any of the
original peoples of North and South America (including Central America) and who
maintains tribal affiliation or community attachment (US Census Bureau, 2010).
Asian: A person having origins in any of the original peoples of the Far East,
Southeast Asia, or the Indian subcontinent (US Census Bureau, 2010).
Attrition: Usually defined as departure from a nursing program without successful
completion of the program, but also can be defined to include students who are delayed in
their progress toward program completion.
Black or African American: A person having origins in any of the Black racial
groups of Africa (US Census Bureau, 2010).
Critical Race Theory (CRT): Analyzes the role of race and racism in perpetuating
social disparities between dominant and marginalized racial groups (DeCuir & Dixson;
Ladson-Billings, 2005; Ladson-Billings & Tate, 1995).
Cultural Capital: “[T]he set of ideas, practices, beliefs, traditions and values
which serve to identify and bind together a given group of people, however the group
may be determined” (Throsby, 1999, p. 7), while challenging the notion of the
traditionally dominant culture with one that emphasizes the value of diversity (Trueba,
2002).
Educationally Disadvantaged Students: Definitions of the educationally
disadvantaged may include students who are the first in their family to enter college (e.g.,
their parents have no college degree) or have come from backgrounds that were
educationally underserved. In addition, having inadequate high school preparation, using
16
ESL, being recipients of welfare or vocational rehabilitation programs, living in public
housing, or having a cultural heritage may also be considered disadvantaged (Zwerling &
London, 1992).
Focus Group: A group of nursing graduates belonging to the same racial/ethnic or
religious minority. Three focus groups were identifies in this study; African Americans,
Latinos and Muslim nurses.
Habitus: The attitudes that shape a person’s expectations and aspirations
(McDonough, 1997).
Hispanic or Latino: A person of Cuban, Mexican, Puerto Rican, South or Central
American, or other Spanish culture or origin regardless of race (US Census Bureau,
2010).
Minority: A group that differs from the majority of the population, particularly in
terms of religion, culture, ethnic background, race, sexual orientation or physical ability.
Muslims or American Muslims: Arab Americans or Non-Arab Americans who
identify themselves by their religious affiliation (Hammoud et al., 2005).
Native Hawaiian or Other Pacific Islander: A person having origins in any of the
original peoples of Hawaii, Guam, Samoa, or other Pacific Islands (US Census Bureau,
2010).
Rigor: Using inquiry-based, collaborative strategies to challenge and engage
students in content resulting in increasingly complex levels of understanding.
Social Capital: The norms and values provided by social networking groups
(Coleman, 1988; Portes, 1998).
17
Some Other Race: All other responses not included in the White, Black or African
American, American Indian or Alaska Native, Asian, and Native Hawaiian or Other
Pacific Islander race categories described above (US Census Bureau, 2010).
Success: For the purpose of this study, success is defined as the student’s ability
to graduate from his/her nursing program and pass the Nursing Licensure Exam.
Underrepresented Minority: Groups whose presence in different areas is
disproportionate when compared to overall population figures. The number of African
American, Hispanic American, Asian American, Hawaiian Native/Pacific Islander and
Native American/Alaskan Native students enrolled in nursing programs is significantly
lower than the percent of the population they comprise; generally, they are considered to
be the underrepresented groups in nursing schools.
White: A person having origins in any of the original peoples of Europe, the
Middle East, or North Africa. It includes people who indicated their race(s) as “White”
or reported entries such as Irish, German, Italian, Lebanese, Arab, Moroccan, or
Caucasian (US Census Bureau, 2010).
Assumptions, Delimitations and Limitations
Assumptions
The underlying assumption of this study is that the lived experiences in nursing
education of African Americans, Latinos, and Muslims may be recalled and shared
accurately through the use of structured interviews. The following is a list of other
assumptions of this research study.
18
1. African Americans, Latinos, and Muslims describe unique experiences in
nursing education that differ from those of Caucasians and members of other
ethnic groups.
2. The lived experiences of African Americans, Latinos, and Muslims in nursing
education can be identified through conscious recollection.
3. The lived experiences of African Americans, Latinos, and Muslims in nursing
education are related to the retention of minorities in nursing education.
4. Many factors, both external and internal, affect the lived experiences of
African Americans, Latinos, and Muslims in nursing education.
Delimitations
The major delimitation of this study lies in the fact that data were gathered only
from African Americans, Latinos, and Muslims who were successful in their nursing
education. The experiences and perhaps the perceptions of African Americans, Latinos
and Muslims who were unsuccessful in nursing education may have been very different.
Additionally, findings from this study are only relevant to the African American, Latino,
and Muslim nursing students, and not any other ethnic minority groups. The purposive
sample of African American, Latino, and Muslim nurses currently working in the city of
Sacramento, in Northern California, from which the participants were solicited, resulted
in a geographical delimitation.
Limitations
A limitation of the study was the use of the structured interview, which allowed
the author to only capture the experiences of a limited number of African American,
19
Latino, and Muslim nurses. The use of the structured interviews may have also created
the possibility that the participants may not recall their experiences accurately or feel free
to express their true recollections or interpretations of these experiences.
Significance of the Study
Explanations offered in the literature for the lack of success among Latinos, and
African Americans in predominantly White nursing programs include a number of
complex factors, such as feelings of loneliness, alienation, and isolation (Gardner, 2005a,
2005b; Suarez & Fowers, 1997), the English language (Abriam-Yago, Yoder & KataokaYahiro, 1999; Klisch, 2000), discrimination (Gardner, 2005a; Villarruel, Canales &
Torres, 2001; Yoder, 2001), peers' lack of understanding and knowledge about cultural
differences (Gardner, 2005a), and academics (Kirkland, 1998). Nothing was found in the
literature on the experiences of Muslim nursing students. The researcher’s personal
experience in nursing education validates the above mentioned reasons. The explanations
for attrition offered thus far, however, are not unique to African-American, Latino, or
Muslim students. The purpose of this study was to examine the lived experience of
African Americans, Latinos, and Muslim newly graduated nurses from an undergraduate
nursing program in which they represent minorities.
Conclusion
Students of racial/ethnic minority background has been historically underserved
and underrepresented in the United States’ higher education system. The nursing
20
profession in specific is dominated by White females and has fewer racial and ethnic
minority groups than the United States population at large. This has been linked to the
disparities in health care that ethnic minority people experience. Racial/ethnic minority
nursing students have lower admission and retention rates than White non-Hispanic
students. In the following chapter, the author will explore the causes of the college
attainment gap between Whites and students of racial/ ethnic minority. In addition, the
author will discuss the underrepresentation and high attrition rates among minority
students in nursing. Emphasis will be on students from African American, Latino, and
Muslim descent.
Chapter Two provides a detailed literature review which analyzes the following
themes: (1) Explain the college attainment gap of underrepresented groups in higher
education in general and how it reflects on California’s ability to meet international
benchmarks and the projected workforce needs. (2) Highlight the lack of diversity and
the high attrition rates of minority students in nursing at the national and state levels and
how these rates contribute to the disparity in delivery of health care. (3) Review of the
research on minority students in nursing. (4) Discuss the factors that are viewed as
supportive of or restrictive to academic success in the African American population. (5)
Explore the bridges and barriers that Latino nursing students face when pursing nursing
education. (6) Review of the relevant literature on Muslims in the US in general and in
nursing education in specific. (7) Review the relevant literature on different theories used
in the theoretical framework.
21
Chapter Three describes the research methodology, the research design including
a detailed description of the context, setting, and sample. Furthermore, this chapter
describes the qualitative protocol, process, and data analysis tools to be used to analyze
data. The chapter will also discuss the measures to be taken for ethical protection of
participants and participants’ rights. Finally, Chapter Three discloses the findings of the
pilot study conducted earlier by the researcher, followed by a conclusion.
Chapter Four will discuss the analysis of the data to be collected via semistructured interviews. Throughout this chapter, the research questions will be used as a
guide to interpret the findings.
Chapter Five continues the examination of the data by expanding on the findings
through a discussion of common themes that emerge from the data. This chapter will
conclude recommendations for programmatic improvements and suggestions for further
research.
22
Chapter 2
REVIEW OF RELATED LITERATURE
Introduction
The intent of this literature review is to show that underrepresentation of
minorities in higher education is a national problem. The review is organized into seven
sections. Section one, discusses the college attainment gap of underrepresented groups in
higher education in general and how it reflects on California’s ability to meet
international benchmarks and the projected workforce needs. Section two explores the
lack of diversity and the high attrition rates of minority students in nursing at the national
and state levels and how these rates contribute to the disparity in delivery of health care.
Section three, reviews the research on minority students in nursing. In section four, the
researcher investigates the factors that are viewed as supportive of, or restrictive to
academic success in the African American population. Section five, explores the bridges
and barriers that Latino nursing students face when pursuing nursing education. Section
Six, introduces the status of Muslims in the United States in general and in nursing in
specific. Finally, section seven will review the relevant literature on the different theories
used in the theoretical framework.
The data cited in this analysis have been compiled by the author from public
sources. The primary federal data sources include the National Center for Public Policy
and Higher Education, the National Center for Education Statistics (NCES), Census
Bureau, Bureau of Labor Statistics (BLS). Other national, regional and state data sources
23
include the American Council on Education (ACE) and the Western Interstate
Commission for Higher Education (WICHE). International data is from the Organization
for Economic Cooperation, and Development (OECD). Nursing data were compiled
from the National League for Nurses (NLN), the American Association for Colleges of
Nursing (AACN) and the California Board of Registered Nurses (CBRN). The author
also used the search engines: ERIC, CINHAL, Medline and the Academic Search
Premier to obtain relevant research articles.
Dropout Crisis in California
In California, only 37.7 percent of the state’s 23.5 million working-age adults (2564 years old) hold at least a two-year degree (US Census Bureau, 2010). The numbers
are even worse for young adults, with 30.6 percent of California’s 8.86 million young
adults (25-34 year-olds) holding degrees. According to the Organization for Economic
Cooperation and Development (OECD), California needs to increase its graduation rate
by 60% to meet the state’s projected need for more educated workforce by 2025.
Clearly, the overall percentage is far below the goal of 60 percent degree attainment. In
fact, a 60 percent rate in California today would represent more than 14.1 million degree
holders, a huge difference over the number reflected in the 2010 US Census data (about
8.86 million). In California, there is a pressing need to increase college degree
attainment in order to close the gaps in attainment for underrepresented groups, meet
international benchmarks and meet workforce demands.
24
Closing Attainment Gaps
Educational opportunity in the United States is not equally available to all
Americans. There is a real evidence-based achievement gap at the community college
level between students who are considered “White” and students of color (WICHE, 2008;
McGlynn, 2009; Nealy, 2009; Nevarez & Woods, 2010; Mortenson, 2009; Lumina
Foundation, 2009). In the United States, 35 out of hundred high school graduates will
attain at least an associate degree. Figure 3 below shows how college graduates are
disaggregated by racial ethnic groups. This chronic gap in educational attainment
contributes to the disparities in income between racial and ethnic groups (Mortenson,
2009). This issue is of growing importance as the proportion of the population from
groups traditionally underrepresented in higher education grows rapidly. The United
States is projected to become a majority minority country by 2050. Of the projected US
population growth of 56 million between 2000 and 2020, 46 million will be members of
minority groups (Lumina Foundation, 2009).
Figure 3
Percent of Education Attainment of Associate Degree or Higher By
Ethnicity (US Census Bureau, 2008).
25
Meeting International Benchmarks
The United States is slipping in international rankings of college attainment.
Several decades ago, the level of higher education attainment was the highest in the
world. Today, the United States ranks only 15th, in the percentage of the young adult
population with college degrees (Organization for Economic Co-operation and
Development [OECD], 2011). According to the Organization for Economic Cooperation
and Development (OECD), rates of college degree attainment are increasing in almost
every OECD country faster than in the United States.
Figure 4
US Adults with College Degree
Meeting Workforce Needs
Higher education attainment is increasingly important to the economy, as the
workforce demands higher levels of skills and knowledge. By 2025, there will be a
shortage of 23 million college-educated adults in the US workforce if current rates of
college graduation are maintained. The clearest evidence for this growing shortage is the
26
gap in earnings based on level of education which continues to widen (Lumina
Foundation, 2009).
In conclusion, there is a pressing need to increase college degree attainment at the
national level and at the same time close the gaps in attainment for underrepresented
groups, in order to meet international benchmarks and meet workforce demands.
Underrepresentation of Minorities in Nursing
At the National Level
One of the most crucial issues facing the nursing profession today, other than the
nursing shortage, is the underrepresentation of minority nurses as it contributes to the
disparity in the delivery of health care (Sullivan Commission, 2004; AACN, 2011; Taxis,
2002. 2006; Nugent et al., 2002a, 2002b; California Endowment, 2003; California
Endowment , 2008; CBRN, 2011; NLN, 2009; Gardner, 2005a, 2005b; Wisneski, 2003;
Jordan, 1996; Bond et al., 2008; Sims-Giddens, 2000).
The Sullivan Commission (2004) in their report titled, Missing Persons:
Minorities in the Health Professions, examined the causes and provides
recommendations on how to increase the representation of minorities in the nation’s
medical, dental, and nursing workforce. The commission was formed in response to the
2003 report by the Institute of Medicine (IOM) that warned of the “unequal treatment”
minorities face when encountering the health system and recommended increasing the
number of minority health professionals as a key strategy to eliminating health
disparities. The Sullivan Commission gathered testimonies from health, education,
27
religion and business leaders; community and civil rights advocates; health care
practitioners; and students across the country in a series of field hearings. Statistics
reviewed by this Commission highlighted the diversity gap. Together, African
Americans, Hispanic Americans, and American Indians make up more than 25 percent of
the US population but only nine percent of the nation’s nurses, six percent of its
physicians, and five percent of dentists. While some outstanding physicians, dentists, and
nurses are minorities, access to health professions remains largely separate and unequal.
The Sullivan Commission (2004) report concluded that “increased diversity will improve
the overall health of the nation” (p. 3) and that diversity in the health workforce will
strengthen cultural competence throughout the health system. Cultural competence
profoundly influences how health professionals deliver health care. The report
recommended that solving the cultural challenges posed by the changing patient
demographics can best be addressed by health professionals educated and trained in a
culturally dynamic environment.
Similarly, the American Association for the Colleges of Nursing (AACN)
conducts an annual survey on the schools of nursing at the national level looking at
enrollment, diversity and graduation rates at both pre-licensure and graduate levels. The
AACN (2009) report indicated that there has been a growth in the number of nursing
students’ enrollment and graduations over the past six years. But diversity among
enrolled pre-licensure nursing students is still an issue: Whites represented 74% of the
nation’s nursing students, African Americans 11%, Latinos 6.1%, Asian Hawaiian/
Pacific Islander, 8.2%, and American Indian/ Alaskan Native 0.7%. Growth was also
28
reported in the numbers of degree completions but there was no break down by ethnicity.
Therefore, one cannot tell the degree completion rates or attrition rates for minority
students.
In conclusion, looking at the above numbers, it is very clear Latinos are the most
underrepresented among all ethnic minority nursing students at the national level; they
are “missing!” It is obvious that the nation’s health professions have not kept pace with
changing demographics. This may result in greater disparities in health access and
outcomes than the persistent lack of health insurance for tens of millions of Americans.
In this study, the author tried to examine the barriers behind Latino students’ lack of
success in nursing programs.
California State Level
According to the California’s Endowment Report (2003), the Hospital
Association of Southern California (HASC) launched a Nursing Workforce Initiative
(NWI) to assess how hospitals could work with nursing schools to address the nursing
shortage and to examine diversity within the nursing population. The findings from the
second-year assessment revealed that California ranked 49th in the country in its nurse per
capita ratio. Its health care system faced a nursing workforce that is too small to meet its
staffing needs and not sufficiently diverse to meet its patients’ needs. It also highlighted
that California’s nursing education pipeline cannot meet the statewide demand for nurses.
By 2010, its nursing schools can graduate only 40,000 new nurses when estimates predict
that the state will need more than 125,000. Many California Nursing Schools have
waiting lists of qualified and ethnically/culturally diverse students (California
29
Endowment, 2003). About one in five students drop out primarily due to the demands of
family and work outside school. There is a lack of data documenting the major barriers
to increasing diversity in the nursing workforce. In addition, there is a shortage of data
documenting the educational experiences of different ethnic groups and support programs
available to these groups.
California’s Board of Registered Nurses (CBRN)
The California Board of Registered Nurses (CBRN) conducted the Nursing
Education Survey in 2009. They investigated the performance of minority students in
nursing programs. The report presented 138 pre-licensure programs data from the year
2007-2008, in comparison with data from previous years. Data items addressed included
the number of nursing programs, enrollments, completions, retention rates, student and
faculty census data, and the use of clinical simulation by nursing programs. All
participants responded to the survey. While there were more recent CBRN studies
available, the author did not use them since; those studies were not disaggregated by
racial/ethnic group.
For the sake of this paper, the author focused on the attrition and diversity rates
for both Associate (ADN) and Bachelor (BSN) degrees in nursing. Attrition rate in
California was 19% for ADN and 8.6% for BSN. The CBRN (2011) report failed to
describe reasons behind the difference in attrition rates among ADN and BSN programs
in the state. The author’s interpretation is that attrition rates in ADN programs are higher
than the attrition rates in BSN programs, because ADN programs have adopted a lottery
admission system, which potentially results in a more diverse student population.
30
Meanwhile, BSN programs admit students with the highest GPA, a selection process that
eliminates most students coming from low socioeconomic backgrounds.
The ethnic distribution of students who completed a nursing program in
California was 41.9% Whites, and 58.1% belonged to the following ethnic minorities:
Native American 0.6%, African American 6.2%, Hispanic 17.4%, Asian 15.9 %, Filipino
14.3%, other 3.7.0%. No statistics were available for Muslim Nurses.
Comparing the US Census (2010) data and CBRN (2011) data for racial/ethnic
minority representation in nursing at both the national and state levels (Table 2), it is
evident that in California, nurses from African American and Latino descent are the most
underrepresented in the nursing profession. According to the AACN (2009) report,
Latinos are the most underrepresented ethnicity at the national level (3.6%) while African
Americans represent 11% of the nurses nationally. For this reason the author was
interested in exploring the barriers facing both Latino and African American nursing
students.
31
Table 2
CA RNs’ Population Ethnic Distribution in Comparison to Ethnic Distribution of CA
General Population, US RN Population and the US General Population
US
General
Population
US
RN
Population
California
General
population
California
RN
Population
65.60%
83.20%
41%
56%
4.5%
3.6%
11%
30%
Hispanic/Latino
15.40%
3.60%
39%
8%
African
American
12.20%
5.40%
6%
4.30%
Ethnicity
White
Asian
Hawaiian /PI
Minority Students in Nursing
To identify stressors that may result in the decision of nursing students to depart
the nursing program, Gardner (2005a) conducted a qualitative phenomenological study to
explore racial and ethnic minority student nurses’ perspectives of their experiences in
predominantly White nursing programs. The study took place at three different four-year
public university campuses in California. All 15 participants were full-time
undergraduate students of a racial or ethnic minority group. The participants had been in
the United States for at least four years and had completed at least two semesters of their
baccalaureate program. The participants were distributed ethnically as follows: three
East Indians, two Hispanics, two Hmong (Laotian), two African Americans, two
Nigerians, one Filipino, one Nepalese, one Vietnamese, and one Chinese. The author
32
conducted semi-structured interviews and transcribed the audiotape verbatim. Gardner
then contacted the participants again to verify her interpretations.
Gardner (2005a) grouped the findings into eight themes: loneliness and isolation,
differentness, absence of acknowledgment of individuality from teachers, peers’ lack of
understanding and knowledge about cultural differences, lack of support from teachers,
coping with insensitivity and discrimination, determination to build a better future, and
overcoming obstacles. The author concluded that by understanding these students’
experiences and perspectives, nursing educators might be better able to meet minority
students’ educational needs and increase their graduation rates.
Limitations of this study lie in the fact that the results may not be generalized to
community college nursing students or students in other regions of the country. In
addition, not all ethnicities were represented in this study. It is possible that nursing
students of different ethnicities might respond in a different manner.
Wells (2007) utilized a grounded theory approach in a qualitative study to develop
a substantive theory of nursing student attrition and compare it to Tinto’s model of
student departure. The sample consisted of 11 nursing students (10 females and one
male) who left generic baccalaureate nursing programs located in an urban area of a
southeastern state. Wells examined the reasons that a sample of undergraduate
baccalaureate nursing students withdrew from their nursing programs. A semi-structured
interview guide was used to conduct taped telephone interviews with study participants.
Thematic data analysis was conducted using the constant comparative method. The
findings revealed that nursing student departure was the result of a cumulative effect of
33
multiple stressors in the academic, social, and/or external environments. Wells also
concluded that any combination of two or more stressors can result in the departure
decision; or if allowed to persist, these stressors may become manifested in academic
failure, which also results in student departure from the institution.
The findings from the Wells (2007) study suggested the need for early
intervention strategies to identify and address student stressors before they lead to
voluntary or involuntary institutional departure. Wells did not mention any limitations
for her study. It would be interesting to know the demographic data about the
participants and their ethnic and cultural background. The findings of Well’s study can
be a good indicator on the importance of supporting nursing students in their first
semester of study, during which most of the participants withdraw (8 out of the 11).
Both Wells (2007) and Gardner (2005a) reached similar findings in their studies.
They were able to identify multiple stressors that when they exist together may result in
students deciding to leave their program. In the first study, the students were still
enrolled in the program and were able to overcome the stressors and this was obvious in
their determination to build a better future and overcome obstacles as one of the findings.
In the second study, however, the findings showed that nursing student departure was the
result of a cumulative effect of multiple stressors in the academic, social, and/or external
environments, which when combined may lead to failure or the decision to depart. For
these reasons the author was interested in asking the participants in this study, what
barriers they can identify in their program of study and what helped them cross the
identified barriers and persist.
34
African American Nursing Students
According to the CBRN (2009), African Americans and Latinos are the most
underrepresented racial/ethnic minorities in California’s nursing programs. Through
analyzing the following studies, the author tried to explore the barriers faced by students
of African American descent in predominantly White nursing programs.
In her dissertation, Wisneski (2003) described the participants' perceptions of
their nursing programs as well as factors that supported or restricted their academic
success. Purposive sampling was used to collect data from a sample (N = 152) of selfidentified African-American (Black, non-Hispanic) junior baccalaureate nursing students,
enrolled in generic NLNAC accredited baccalaureate nursing programs (BSN). Three
instruments, the Minority Students' Perceptions of their Educational Programs (MSPEP),
the Student Perception Appraisal (SPA), and the Desirability for Control scale (DC), as
well as a researcher-designed demographic data sheet were used. Data were analyzed
using descriptive and inferential methods.
Wisneski (2003) identified seven academic and five environmental factors as
“greatly” to “moderately” supportive of the students' academic success. Four
environmental factors were identified as "moderately" restricting academic success.
Study participants provided written comments concerning the lack of minority faculty in
the classroom and clinical areas. There were few significant relationships found among
the variables in this study. The author described the following conclusion; there is a need
for minority faculty to provide students with role models and mentors. The results have
35
implications for the workforce, the delivery of culturally competent care, and nursing
education diversity.
In exploring the perceived barriers that African American nursing students face,
Jordan (1996) used Hermeneutic Inquiry as a design for her research. The author wanted
to investigate the meaning of being Black in a predominantly White nursing program.
No description of the setting was provided. Participants were recruited through members
of a Connecticut chapter of the National Black Nurse's Association. A three-page written
narrative of the researcher's positive and negative experiences as a Black student in White
academe was mailed to potential participants. The intent of the researcher was to unveil
her biases. The narrative was also an attempt to provide the participants the freedom to
speak to any issue. Informed consent was obtained and confidentiality was assured
before the interview. Participants were interviewed individually and asked to tell their
own stories and not to analyze what these stories meant. Probes were used, when
appropriate, to validate or clarify statements. The author transcribed the audio taped
interviews verbatim. After transcribing and reading each of the four texts, the author
selected one of the students to author the text for the inquiry. Jordan based her decision
on the richness of the student’s text. The selected student, identified as Ann, had stories
that embraced the themes of all four participants.
Ann was a 22-year-old senior student enrolled in a predominantly White
baccalaureate-nursing program in the state of Connecticut. Her graduating nursing class
consisted of 32 students (2 African- Americans and 30 Anglo-Americans). The findings
from Ann’s story yielded the following three constitutive patterns: (1) Seeking Identity:
36
Being Different/Being the same; (2) Student As Teacher; Toward a Surrogate Pedagogy;
and (3) Resoluteness: Hi See You at Graduation. The author concluded that this study
attempted to raise consciousness and help educators to view the attrition problem in a
different way. Achieving a pedagogy that is truly egalitarian and liberating is done only
when all are willing to examine assumptions, prejudices, and practices.
Since the participant in this study attended a predominantly White baccalaureate
nursing program in the state of Connecticut, the results of this study may not be
generalized to other regions of the country. In addition, only one student of African
American descent participated in the study; therefore, the findings from this study cannot
be generalized to students of other ethnicities. Furthermore, the author failed to include
non-confirming data found in the transcripts of the other three research participants.
In comparing both studies one highlighted environmental and academic variables
as enhancing or restricting to African American students’ progress in nursing education
while the second study emphasized personal overt and covert discrimination and personal
characteristics including determination to be successful despite obstacles. Both studies
emphasized the need to have minority faculty or nurses as role models.
Latino and Mexican-American Students in Nursing
Latinos are the fastest growing minority group in the US and the most
underrepresented in the US nursing workforce nationally. Although a body of knowledge
is growing regarding factors that foster academic success of undergraduate nursing
students of color, there is limited information about Latino students in general, and
37
Mexican American students in particular in both ADN and BSN programs. In
summarizing the following three research articles (Bond et al., 2008; Taxis, 2006; SimsGiddens, 2000), the author highlighted the major challenges encountered by Latino
nursing students described in these articles and discussed how these studies relates to the
author’s own study.
To unveil the perceived barriers that Mexican nursing students face, Bond et al.
(2008) conducted a descriptive qualitative study. Participants were selected from two
Hispanic-friendly baccalaureate nursing programs in Texas. Focus groups were used to
allow the voices of 14 Mexican-American nursing students from two Liberal Arts
universities to emerge. Content analysis of focus group transcripts revealed the following
themes: finances, emotional and moral support, professional socialization, mentoring,
academic advising, and technical support. Personal determination emerged as a theme
not identified earlier. The prominence of the personal determination theme among these
students warrants further study, but it suggested that success may be enhanced by helping
students capitalize on their personal determination. However, the findings may not be
generalized to other Hispanic subcultures or Hispanic-nursing students in other states.
Moreover, the experiences of the students on these Latino-friendly campuses may not be
generalized because the levels of support for Hispanic students differ among academic
campuses.
Taxis (2006) searched for bridges that may help Latino Mexican students achieve
academic success in nursing. The author conducted a qualitative interpretative case
study. The author used multiple sources of data including a demographic information
38
sheet, a written questionnaire, face-to-face individual audio taped interviews, and an
audio taped focus group. The purpose of the study was to explore factors that may aid in
increasing retention and graduation rates among Mexican American students in a BSN
program at a large, predominantly White university campus. A purposeful volunteer
sample of nine Hispanic nursing students was recruited via posting an email on the school
list-serve. Participation was limited to those who identified themselves from Mexican
American origin were enrolled in the last semester of the senior year, or graduated within
the last two years from the BSN.
The following themes were identified by the investigator and were validated by a
consultant and the participants in the focus group: (a) supportive relationships (feeling
cared for and respected) with family, peers, and faculty members; (b) securing adequate
financial support in the form of scholarships, loans, grants, and employment; and (c)
bicultural functioning by establishing and maintaining friendships with Mexican
American students on campus. The results from this study found, that both feeling cared
for and affiliating culturally with individuals within the institution played major factors in
the participants' academic success. This study called on nursing educators and
administrators to examine the curriculum, school policies, and programs for practices that
marginalize racially/ethnically diverse students. While the study revealed factors that
assisted Mexican-American students to succeed in the nursing program, the author did
not uncover the difficulties departing students faced, nor did the author examine the
reasons that directed some minority students to change their major from nursing to a
39
different major. Also, further research is needed to gain an understanding of the
experiences of Mexican American men in BSN programs.
In her descriptive study, Sims-Giddens (2000) used a mixed method. Her intent
was to evaluate and compare the graduation rates and National Council Licensure
Examination pass rates of students in associate degree nursing programs. Her focus was
on Mexican-American and English as first-language students. Additionally, this study
determined the perceived effects of the following on graduation rates and National
Council Licensure Examination pass rates of Mexican-American students: English as a
second language; non-academic English proficiency; non-English speaking parents; and
parental financial support. The conceptual framework of Imogene King, a nursing
theorist, was used.
The framework emphasized the importance of language and communication in
nursing. Archival data were gathered from all Mexican-American and English as firstlanguage student files between the years 1967 and 1997. Sub-sample groups from the
Mexican-American student study population were selected to participate in a focus group
interview and a mailed self-report survey. Information obtained from the focus group
interview and self-report survey was used to elaborate and validate quantitative archival
data. This study provided the number of Mexican-American students who graduated and
successfully passed the state licensure examination on the first attempt. Additionally,
information gained through a focus group interview and self-report survey identified
personal factors that contributed to academic achievement.
Overall, Sims-Giddens (2000) reached several conclusions:
40
1. There was no statistical difference between the percentage of MexicanAmerican students and English as a second-language students who complete
the associate degree nursing program.
2. There was a statistical difference between the percentage of MexicanAmerican Students and English as first-language students who pass the
National Council Licensure Examination on the first attempt
3. English as a second language is both a benefit and detriment for nursing
students.
4. Non-academic English proficiency hinders academic achievement in higher
education.
5. Non-English speaking parents and parental financial support can have an
effect on nursing program completion.
In conclusion, the three studies highlighted the following emergent common
barriers that Latino students encounter: finances and the need to be employed while
studying, language, lack of caring and support from faculty, peers and family, and
especially being bicultural. All these factors may act as obstacles and may hinder the
Latino students’ success in nursing programs. All these studies were conducted outside
of California: two in Texas and one in Arizona. The author’s study reveals interesting
findings since it took place in California where Latino population is highest in the
country and among minority nursing students.
41
The Need for Muslim Nurses
Differences in the social and religious cultures of Arab Americans and American
Muslims raise challenges to healthcare access and delivery. These challenges go far
beyond language to encompass entire world views, concepts of health, illness, and
recovery and even death. Medical professionals need a more informed understanding and
consideration of the rich and diverse array of beliefs, expectations, preferences, and
behavioral makeup of the social cultures of these patients to ensure that they are
providing the best and most comprehensive care possible. Improved understanding will
enhance a provider's ability to offer quality healthcare and to build trusting relationships
with patients. In this section, the author discussed how Muslims as a minority are
growing in number and how it is important to increase health care providers’ awareness,
particularly nurses, about Islam so that they can provide appropriate and effective care to
the growing sector of Muslim patients. The author discussed the status of Muslims in the
world in general and in the United States in specific, then moved to discuss Muslims in
nursing education and also explained reasons behind the why there is a need for more
Muslim nurses.
Muslims in the World
Muslims form the largest religious group in the world after Christians. Islam is
the dominant faith in many countries of the Middle East, Africa and Asia, and there are
minority Muslim communities throughout the rest of the world. Islam is a universal
religion comprising all nationalities of the world, and makes no distinction based on
42
color, race or ethnicity. One must not confuse ethnic traditions and customs with Islam.
All healthcare providers may have to care for a Muslim patient at some time in practice.
As of mid-2010, the total number of Muslims in the world was estimated to be
approximately 1.57 billion (Pew Research Center, 2008) as the most reliable estimate.
With that number, they represent about 22% of the world's population. They are the
second largest religion in the world. Only Christianity is larger, with 33% of the world's
inhabitants which is a little over two billion. Islam is growing about 2.9% per year. This
is faster than the total world population which increases about 2.3% annually. It is thus
attracting a progressively larger percentage of the world's population.
History of Muslims in the US
The history of Muslims in the US, in its roots, is related to the history of slavery.
Many of the slaves brought to colonial America from Africa were Muslims. In the
1800s, some 500,000 Africans arrived in what became the United States. Historians
estimate that between 15 to 30 percent of all enslaved African men, and less than 15
percent of the enslaved African women, were Muslims. Substantial numbers originated
from Senegambia, a region with an established community of Muslim inhabitants
extending to the 11th century (Curtis, 2009). These enslaved Muslims stood out from
their compatriots because of their resistance, determination and education (Hill, Lippy &
Wilson, 2005).
Small-scale migration to the US by Muslims began in 1840, with the arrival of
Yemenites and Turks, and lasted until World War I. Most of the immigrants, from Arab
areas of the Ottoman Empire, came with the purpose of making financial gains and
43
returning to their homeland. However, the economic hardships of 19th-Century America
prevented them from prospering, and as a result the immigrants settled in the United
States permanently. These immigrants settled primarily in Dearborn, Michigan; Quincy,
Massachusetts; and Ross, North Dakota. Ross, North Dakota is the site of the first
documented mosque and Muslim Cemetery, but it was abandoned and later torn down in
the mid-1970s. A new mosque was built in its place in 2005 (M’Bow & Kettani, 2001).
Demographics of Muslims in the US
There is no accurate count of the number of Muslims in the United States, as the
US Census Bureau does not collect data on religious identification. Various institutions
and organizations have given widely varying estimates about how many Muslims live in
the US. These estimates have been controversial, with a number of researchers being
explicitly critical of the survey methodologies that have led to the higher estimates
(Smith, 2001). According to Smith, the higher numbers have been inflated for political
purposes.
On the other hand, the Council on American-Islamic Relations (CAIR) claimed
that no scientific count of Muslims in the US has been done, but that the larger figures
should be considered accurate and blame the lower estimates on Islamophobia in order to
"marginalize" Islam and the fact that many Muslims do not attend mosques. CAIR is a
nonprofit civil rights and advocacy group, with regional offices nationwide and in
Canada. As the largest Islamic civil liberties’ group their national headquarters is located
on Capitol Hill in Washington DC (CAIR, 2011). Estimates of the number of Muslims in
44
North America range from over one million adults, to seven million adults and children
(Table 3).
Table 3
The Different Estimates of the Number of Muslims in the US
Source
Year
American Religious Identification
Survey
2008
Estimated Number of US
Muslims
1.3 million
CIA World Fact Book
Pew Research Center
2010
2009
1.8 million
1.3 million
U.S. New and World Report
2008
5 million +
Council on American-Islamic
Relations CAIR
2011
7 million
The largest ethnic groups of American Muslims are those of South Asian, Arab
and African-American descent. Figure 5 shows the ethnic composition of Muslims in the
United States, according to the United States Department of State based on the
publication of Being Muslim in America as of March 2009. American Muslims speak
different languages like, American English, Arabic, Persian, Turkish, and Urdu. Since
the arrival of South Asian and Arab communities during the 1990s, there has been
divisions with the African Americans due to the racial and cultural differences, however
since post 9/11, the two groups joined together when the immigrant communities looked
towards the African Americans for advice on civil rights (Elliot, 2007).
45
Figure 5
Ethnic Compositions of Muslims in the United States
Socioeconomic Status of Muslims in the US
Contrary to popular perceptions, according to the publication, Muslims in
America, the condition of Muslims in the US is very good (US Department of State,
2009). Among South Asians in this country, the large Indian American community
stands out as particularly well educated and prosperous, with education and income levels
that exceed those of US born Whites. Many are professionals, especially doctors,
scientists, engineers, and financial analysts, and there are also a large number of
entrepreneurs. The 10 states with the largest Muslim populations are California, New
York, Illinois, New Jersey, Indiana, Michigan, Virginia, Texas, Ohio, and Maryland.
Forty-five percent of immigrant Muslims report annual household income levels of
$50,000 or higher. This compares to the national average of 44 percent. Immigrant
Muslims are well represented among higher-income earners, with 19 percent claiming
annual household incomes of $100,000 or higher (compared to 16 percent for the Muslim
46
population as a whole and 17 percent for the US average). This is likely due to the strong
concentration of Muslims in professional, managerial, and technical fields, especially in
information technology, education, medicine, law, and the corporate world (US
Department of State, 2009).
According to Stephens and Rago (2005), a 2004 telephone survey of a sample of
1846 Muslims was conducted by the polling organization Zogby, the respondents were
more educated and affluent than the national average, with 59% of them holding at least
an undergraduate college degree. Bret Stephens and Joseph Rago expressed the tendency
of American Muslims to report employment in professional fields, with one in three
having an income over $75,000 a year. The editorial also characterized American
Muslims as role models both as Americans and as Muslims (Stephens & Rago, 2005).
American Muslims have also been politically active. Keith Maurice Ellison (born
August 4, 1963) was the first Muslim to be elected to the United States Congress as a US
Representative for Minnesota’s fifth congressional district, serving since 2007. He was
also the first African American elected to the House from Minnesota.
Muslims and Discrimination
In 2009, Pew Research Center released a report noting that nearly six in ten
American adults see Muslims as being subject to discrimination more so than Mormons,
Atheists, or Jews. While Muslims comprise less than two percent of the American
population, they accounted for approximately one quarter of the religious discrimination
claims filed with the Equal Employment Opportunity Commission during 2009. On a
small number of occasions, Muslim women who wore distinctive hijab were harassed,
47
causing some Muslim women to stay at home, while others temporarily abandoned the
practice.
A nationwide survey conducted in 2003 and published in 2004 by the Pew
Research Center and the Pew Forum on Religion and Public Life reported that the
percentage of Americans with an unfavorable view of Islam increased by one percentage
point between 2002 and 2003 to 34%, and then by another two percentage points in 2005
to 36%. At the same time, the percentage responding that Islam was more likely than
other religion to encourage violence fell from 44% in July 2003 to 36% in July 2005
(PEW Research Center, 2004).
After the September 11, 2001 attacks, America saw an increase in the number of
hate crimes committed against people who were perceived to be Muslim, particularly
those of Middle Eastern and South Asian descent. In a 2007 survey, 53% of American
Muslims reported that it was more difficult to be a Muslim after the 9/11 attacks. Asked
to name the most important problem facing them, the options named by more than ten
percent of American Muslims were discrimination (19%), being viewed as a terrorist
(15%), public's ignorance about Islam (13%), and stereotyping (12%). Fifty-four percent
believed that the US government's anti-terrorism activities single out Muslims. Seventysix percent of surveyed Muslim Americans stated that they were very or somewhat
concerned about the rise of Islamic extremism around the world, and 61% expressed a
similar concern about the possibility of Islamic extremism in the United States. While
51% of American Muslims expressed worry that women wearing hijab will be treated
48
poorly, 44% of American Muslim women who always wear hijab expressed a similar
concern (PEW Research Center, 2007).
Criticism of Muslims Treatment in the US
A 1998 United Nations report on Civil and Political Rights, including Freedom of
Expression in the United States sharply condemned the attitude of the American media,
noting “very harmful activity by the media in general and the popular press in particular,
which consists of putting out a distorted and indeed hate-filled message treating Muslims
as extremists and terrorists” (Amor, 1998, p. 34), adding that “efforts to combat the
ignorance and intolerance purveyed by the media, above all through preventive measures
in the field” (Amor, 1998, p. 34).
Muslims in Nursing
While searching for data on Muslims in nursing the author was not successful in
finding any research on Muslim nurses or Muslims in nursing education. The only
information found was on the Muslim population in the US, in general. Nothing was
found about Muslim Nursing students despite trying all available search engines for
nursing. The author also searched the Department of Health, HERSA website, the
Census Bureau, and the American Association of Muslim Nurses. She also researched the
websites of the schools of nursing accrediting bodies, the AACN, and the CBRN, with no
success.
Through the author’s research on Muslims in the US, it was evident that some of
the Latino or African American nurses may also be of the Muslim faith. Based on the
49
author’s extensive experience in nursing education, she acknowledged that Muslim
nurses are also a minority of graduates from nursing programs. However, the major data
sets such as the 2008 National Sample Survey of Registered Nurses (NSSRN) reporting
the demographics of nurses in the profession do not report Muslims among the categories
counted (USDHHS, 2001). Thus, information is totally lacking on the status of Muslim
nurses in the profession which is why the author included an examination of their
experiences in this study. However, as mentioned earlier that national data indicate that
American Muslims come from various backgrounds, and are one of the most racially
diverse religious groups and that native-born American Muslims are mainly African
Americans who make up about a quarter of the total Muslim population. Following
September 11, 2001 events, American Muslims were subject to religious discrimination.
Despite the growing of Muslim population, they represent less than two percent of the
general US population and accounted for approximately one quarter of the religious
discrimination claims filed with the Equal Employment Opportunity Commission during
2009. This is why the author became interested in studying Muslim students in nursing
education.
Theoretical Framework
This literature review presented a review of the relevant literature addressing the
following themes: the history of Critical Race Theory (CRT) and how its five tenets
contributed to inclusivity and diversity in higher education, the importance of social
capital, cultural capital, and habitus on a student’s college success.
50
Critical Race Theory
In 1994, Critical Race Theory (CRT) was first used as an analytical framework to
assess inequity in education (Decuir & Dixson, 2004; Ladson-Billings & Tate, 1995).
Since then, scholars have used CRT as a framework to further analyze and critique
educational research and practice (Ladson-Billings, 2005). This study further explored
how the five tenets of CRT can be used to analyze the different forms of social inequities
reinforced through the institution of higher education especially in nursing education.
First, the author provided an explanation of CRT. Second, she discussed how each CRT
tenet contributes to inclusivity and diversity in higher education.
Historical Overview of Critical Race Theory
During the mid-1970s, CRT emerged from the early work of Derrick Bell and
Alan Freeman, who were discontented with the slow pace of racial reform in the United
States (Delgado, 1995; Ladson-Billings, 1998). According to Gordon (1990), CRT
originated from the critical legal studies (CLS) movement (as cited in Ladson-Billings,
1998), which failed to address the “effects of race and racism in U.S. jurisprudence”
(DeCuir & Dixson, 2004, p. 26). As a result, CRT analyzed the role of race and racism in
perpetuating social disparities between dominant and marginalized racial groups (DeCuir
& Dixson; Ladson-Billings, 2005; Ladson-Billings & Tate, 1995). CRT’s purpose was to
unearth what is taken for granted when analyzing race and privilege, as well as the
profound patterns of exclusion that exist in US society (Parker & Villalpando, 2007).
CRT can play an important role when higher education institutions work toward
becoming more diverse and inclusive. For example, in a predominantly White nursing
51
program, working toward increasing the number of students of color enrolled is an
insufficient goal if institutional change is a priority. Examining the program’s climate
efforts to have culturally competent and diverse staff, faculty, and administrators is a
more effective way of becoming more diverse and inclusive. Fortunately, the various
tenets of CRT can be used to uncover the ingrained societal disparities that support a
system of privilege and oppression.
The Five Tenets of CRT
CRT’s framework is comprised of the following five tenets: counter-storytelling;
the permanence of racism; Whiteness as property; interest conversion; and the critique of
liberalism (DeCuir & Dixson, 2004; Ladson-Billings, 1998; McCoy, 2006).
Counter-storytelling.
Counter-storytelling is a framework that legitimizes the racial and subordinate
experiences of marginalized groups (DeCuir & Dixson, 2004; Ladson-Billings, 1998;
Parker & Villalpando, 2007). DeCuir and Dixson stated that counter-stories are a
resource that both expose and critique the dominant (male, White, heterosexual)
ideology, which perpetuates racial stereotypes. Counter-stories are personal, composite
stories or narratives of people of color (Delgado Bernal & Villalpando, 2002). The use of
counter-stories in analyzing the climate in nursing education provides faculty, staff, and
students of color a voice to tell their narratives involving marginalized experiences.
Counter-stories can assist in analyzing the climate of a nursing program and provide
opportunities for further research in the ways which an institution can become inclusive
and not simply superficially diverse. This goal is important to keep in mind when
52
institutions work toward creating a diverse educational community. An institution can
aim to increase diversity by increasing the number of students of color. However, if the
institution does not make the necessary changes to make the program climate inclusive,
the institution will have a difficult time maintaining diversity. In many cases, counterstories support the permanence of racism, which is the second tenet of CRT.
The permanence of racism.
The permanence of racism suggests that racism controls the political, social, and
economic realms of US society. In CRT, racism is seen as an inherent part of American
civilization, privileging White individuals over people of color in most areas of life,
including higher education (DeCuir & Dixson, 2004; Delgado, 1995; Ladson-Billings,
1998; Ladson-Billings & Tate, 1995) and hence nursing education. In higher education,
racism may be analyzed through a lens that examines the structural impact. When higher
education ignores the existence of systematic racism, diversity action plans become
ineffective (Iverson, 2007). Instead, these initiatives work to propel and reinforce
structural and institutional racism (Ladson-Billings & Tate, 1995). Therefore, it is
important to consider how well-intended institutional processes and procedures can
potentially promote racism when working toward improving an institution’s plan for
diversity and inclusion.
Whiteness as property.
The third tenet of CRT is Whiteness as property. Due to the embedded racism in
American society, Whiteness can be considered a property interest (DeCuir & Dixson,
2004). As a result, this notion operates on different levels. These include the right of
53
possession, the right to use and enjoyment, the right to disposition, and the right of
exclusion (DeCuir & Dixson, 2004; Ladson-Billings & Tate, 1995; Ladson-Billings,
1998). Historically, the idea of Whiteness as property has been perpetuated as an asset
that only White individuals can possess (Ladson-Billings & Tate). During enslavement,
African men, women, and children were objectified as property (Ladson-Billings, 1998).
This historic system of ownership and the reverberations from it further reinforce and
perpetuate the system of White supremacy because only White individuals can benefit
from it. Particularly in higher education, the division between student affairs and
academic affairs perpetuates the notion of race as property rights (Patton, McEwen,
Rendón & Howard-Hamilton, 2007). This is evident when research shows how the
majority of African Americans who earn their PhD in education earn them in education
administration, therefore continuing as practitioners and rarely becoming faculty
(Ladson-Billings, 1998). As a result, the majority of African Americans do not become
part of the driving force in higher education: faculty. This is true in the case of nursing
education, according to 2010 data from AACN member schools, only 12.6% of full-time
nursing school faculty come from minority backgrounds.
Professors are seen as owners of the curriculum. Therefore, they have the
autonomy of designing courses according to their own understanding of their philosophy
of knowledge, which can work against students of color (Patton et al., 2007). This
institutional power further reinforces the notion that being White is more valuable and
important than being a person of color (Patton et al., 2007). This systemic reality works
against building a diverse and inclusive nursing education environment because it
54
supports the imbedded hierarchical racist paradigms that currently exist in society. On
higher education campuses, diversity tends to be more visible within divisions of students
affairs, although the power of the institution tends to be centralized within academic
affairs where there is less representation of women and people of color (Patton et al.,
2007).
Interest convergence.
Interest convergence is the fourth tenet of CRT. This tenet acknowledged White
individuals as being the primary beneficiaries of civil rights legislation (Ladson-Billings,
1998; DeCuir & Dixson, 2004; McCoy, 2006). DeCuir and Dixson argued, “Early civil
rights legislation provided only basic rights to African Americans, rights that had been
enjoyed by White individuals for centuries. These civil rights gains were in effect
superficial ‘opportunities’ because they were basic tenets of U.S. democracy” (LadsonBillings, 1998, p. 28). An example of this is affirmative action. Although under constant
attack as a benefit for people of color, research shows that the major recipients have been
White women. Ladson- Billings argued that because White women potentially support
households where White men and children live, affirmative action ultimately benefits
White individuals in general. Therefore, White individuals benefit from a structure that
was initially implemented to offer equal opportunity to people of color.
Critique of liberalism.
The fifth tenet of CRT, critique of liberalism, stems from the ideas of
colorblindness, the neutrality of the law, and equal opportunity for all (DeCuir & Dixson,
2004). Colorblindness is a mechanism that allows people to ignore racist policies that
55
perpetuate social inequity (DeCuir & Dixson, 1999). The lack of inclusivity in the
academic curriculum (Ladson-Billings, 1998) and student development theory used by
student affairs professionals (Patton et al., 2007) supported the notion of colorblindness
that works against dismantling social inequities. In order to take a closer step towards
eradicating racism on college campuses, and hence in nursing programs, student and
academic affairs need to incorporate dialogues around race throughout the curriculum
and student activities (Patton et al.). Institutions of higher education must recognize and
work toward dismantling colorblind policies (Iverson, 2007).
Academic Capital Formation Theory (ACF)
The second theory used was the theory of Academic Capital Formation (ACF)
that was developed by Edward St. John through identifying claims about social processes
in human capital theory (Becker, 1975), social capital theory (Coleman, 1988), and social
reproduction (Bourdieu, 1972) theories. ACF theory is a complex set of social processes
and behavioral patterns. The four social processes engage students in overcoming
barriers.
1. Easing Concerns about costs: Concerns about college costs could act as a
barrier for low-income families, especially when parents have no college
experience. Financial aid helps ease financial concerns and fears.
2. Supportive networks in schools and communities: Mentors, teachers, and
community leaders can help students and their parents overcome fears about
pursuing an education and paying for it.
56
3. Navigation of systems: Navigation through barriers requires the ability to deal
with classism and racism. It builds knowledge that is transferable across
educational transitions and can be conveyed through mentorship and social
networks.
4. Trustworthy information: accurate information received from people at critical
times emerges as important in the process of overcoming educational barriers.
These ACF social processes are rooted in core concepts in human and social capital
theory. These concepts are largely post positivist constructs. The mechanisms can exist
in social groups and can even be created through successful educational and social
interventions. According St. John, Hu and Fisher (2011), “These processes generally are
not present in communities with little family and community history of educational
success; Educational failure, like educational success can reinforce replication patterns”
(p. 15). ACF theory also identified two transformation patterns. These patterns of social
behavior help students build academic capital resulting is social uplift. The two behavior
patterns are:
1. College knowledge: A form of cultural capital that includes the capacity to
envision one’s self and family members as college students, building
understanding of the roles of courses and majors in preparation for graduate
education and the workforce, and the ability to use human information
resources to determine and follow appropriate pathways through educational
systems.
57
2. Family Uplift: A pattern of behavior within family systems and extended
networks that supports the acquisition of college knowledge, navigation and
education and employment systems, and expansion of educational opportunity
across generations.
According to St. John et al. (2011), “By definition, first-generation college
students are making a first-time transition in family education, which can lead to social
and economic class transformation” (p. 17).
ACF acted as a frame work or an umbrella that highlighted the strategies
necessary for students of ethnic minority origins to help increase their access to and
success in rigorous nursing education programs. The definition used by the researcher
for cultural capital differed from the classical definition used in Eduard St. John’s ACF
theory. This will be explained in the following section.
Funds of Knowledge, Social Capital, Cultural Capital, and Habitus
Students’ home lives have a significant impact on their educational experiences,
goals, and achievement. The Funds of Knowledge Theory explains that the activities and
information provided to a student can either add to the student’s fund of college
knowledge; however, a lack of this information can provide a gap from which the
knowledge must be attained elsewhere (Andrews & Yee, 2006; Ares & Buendia, 2007;
Moll, Amanti, Neff & Gonzalez, 1992; Rubenstein-Arila, 2006; Velez-Ibanez &
Greenberg, 1992). A quantitative study of 1,100 K-12 students indicated that the Latino
students’ household activities, the educational experiences within the home, and the
home language development all positively impacted the students literacy related
58
achievement (Rios-Aguilar, 2010). Furthermore, the researcher summarized that the
knowledge gained from the home must be integrated into curricula to truly enhance all
students’ understanding of the material, not only that of Latina/o students. Included in
these funds are cultural capital, social capital, and habitus, all of which can have a
significant impact on students’ educational experiences and achievement. This can also
be applied to the cultural beliefs and values passed down through a family. As the
culture of higher education may differ from students’ home culture, students must
incorporate both belief and value systems into their own.
Social and cultural capitals, most often described in the fields of sociology, are
very applicable to the discussion of college success as well. Social capital is described as
the ways in which value is placed on a given idea by networks of people (Portes, 1998).
This definition, originally explained by Bourdieu (1994), is further illustrated by the
notion “that involvement and participation in groups can have positive consequences for
the individual and the community” (Portes, 1998, p. 2). Not only are undergraduate
nursing programs and higher education systems filled with networks with which to
intermingle, but students must understand the importance of these networks in navigating
through the college system. These include study groups and friend groups who have
similar aspirations and motivation. In addition, being part of a network, such as CNSA
(California Nursing Students Association) in nursing school could provide students with
an advantage when it comes to providing this capital to students when in nursing school.
Along with social capital, a supply of cultural capital also produces a positive
outcome for students. Throsby (1999) defined cultural capital as a “set of ideas,
59
practices, beliefs, traditions, and values which serve to identify and bind together a given
group of people” (p. 7). Following the cohort system in nursing education brings
students together and instills a value of education that students may not receive from
other areas.
Also included in the concept of cultural capital are the skills students acquire in
high school that can then be applied to college, such as note-taking and study skills. In
addition to the impact of social and cultural capital on students’ experiences and success
in higher education, the related idea of habitus also has a significant impact on college
success.
Habitus is defined as the attitudes that shape a person’s expectations and
aspirations (McDonough, 1997), and this can be limited by the networks and values
placed by these networks (e.g., social capital), and students’ aspirations.
Social capital, cultural capital, and habitus have only been researched in relation
to the state of Texas’10th and 12th grade Hispanic students’ aspiration for a postsecondary education (Lozano, Watt & Huerta, 2009); therefore, this current research
study sets out to document that these values have a direct impact on students’ success
once in nursing school.
Students’ funds of social capital, cultural capital, and habitus all may have a
significant impact on their education, including retention and success. Tinto’s (2006)
Theory of Retention explained that both institutions of higher education and the students
themselves are responsible for prioritizing student success. Tinto explained that while
students must have the habitus (aspirations) to succeed in college and the social capital to
60
form appropriate networks which will provide them with the support to do so, universities
must also hold the students to high expectations in order to encourage students to reach
their academic potential. In addition, a students’ connection to their campus and its
culture through a surplus of cultural capital will aid in their educational experience and
ultimately, success. However, student’s background may dramatically impact his or her
supply of social capital, cultural capital, and habitus. For example, first-generation,
minority, and low-income students could come to post-secondary educational systems
without the necessary reserves of these capitals which need to be provided by other
means.
Criticism to the Theory of Cultural Capital
While cultural capital has proven to influence a students’ success in college, it is
often viewed by Critical Race theorists as a way to force minority students, who are often
underrepresented in higher education, to assimilate to the traditionally White culture.
Yosso (2005) examined this theory as it intersects with Critical Race Theory and
postulates that universities are perpetuating racism by viewing students of color as having
a deficit in cultural capital since their family beliefs, values, and traditions might differ
from those of the majority culture of both students and professors in higher education. In
contrast, Yosso (2005) believed that students of color have a wealth of cultural capital
that adds to, rather than subtract from, the educational environment. Furthermore, other
researchers have concluded that the current educational system gives power to the
dominant culture while devaluing people of color’s culture and experiences. Instead,
these must be recognized, appreciated, and included in the culture of the educational
61
system in order to create “educational equity and social justice” (Yosso & Solorzano,
2005, p. 117).
Along similar lines, Trueba (2002) examined a “new” form of cultural capital, one
which puts immigrants and people of multiple ethnicities at an advantage and provides an
increasing fund of cultural capital. He contended that in the modern society in which
people are constantly acquiring new knowledge, those who speak multiple languages,
have overcome obstacles, and have mastered code-switching between settings; therefore,
bilingual students are less challenged in new situations, such as in college, compared to
their peers who have not had to learn such knowledge. In a poignant way, Trueba stated
that diversity in many of today’s businesses, schools, and industries is dominant;
therefore, diversity is the new culture. Additionally, Ogbu (1992a, 1995) noted through
his research that different minority groups often face different academic challenges.
However, since the culture of American universities and colleges is changing and
becoming more diverse, the “cultural frame of reference” (Ogbu, 1992b, 1995) must be
adjusted to include all students. Additionally, by providing a curriculum that reflects the
diverse student communities within nursing programs, students would feel that their
cultures were being represented and are an equal part of the educational experience,
instead of an aside. Other researchers agreed with Ogbu’s suggestion of infusing the
curriculum with multiple cultures to reflect the country’s diverse culture and promote
academic achievement for all students (Gilliard & Moore, 2007; Ogbu, 1992) while also
encouraging high academic goals and aspirations (Mehan, Hubbard & Villanueva, 1994).
62
This research study included questions that allowed nurses to share how their
cultural capital, social capital, and habitus affected their performance in nursing school.
Furthermore, following the philosophy of Freire (1987), nursing faculty recognize that
they must challenge the set ideals of the dominant culture and respect the diversity of
their students’ cultures in order to empower students and show the importance of
maintaining their own beliefs instead of assimilating to the dominant culture which
resides in higher education.
Summary
The nursing work force is not keeping up with the pace of changing demographics
in the general population, resulting in lack of diversity in the nursing profession.
Consequently, the current nursing workforce is unable to deliver ethnically, culturally,
and linguistically appropriate and sensitive health care. There is a pressing need to close
the gaps in attainment for underrepresented groups within the field of nursing in order to
meet national and international benchmarks and meet workforce demands. In order to
change the cultural face of nursing to be reflective of the country’s population, it is
imperative that the retention of minority students be a major focus once they have been
accepted into nursing school programs. To successfully achieve this goal, there must be a
systematic commitment to improve the retention and graduation rates of students from
different racial and ethnic backgrounds. To ensure success, this commitment must be
grounded in rationale and integrated into a systematic plan of implementation. Obstacles
associated with retention of students from different ethnic backgrounds have to be further
63
explored and documented in the literature. Specifically, the obstacles rendering African
American and Latino nursing students as the most underrepresented minority in the state
of California and barriers rendering Latino nursing students as the most underrepresented
nationwide.
The author was hoping to add to the current body of literature on African
American, Latino, and Muslim (no current body of literature exists documenting this
group’s experiences) nursing students through this study and to help unveil some of the
challenges and barriers that minority nursing students face in California.
In the following chapter, the author discussed the methodology she used in
conducting this study. Emphasis will be on qualitative phenomenological methodology.
64
Chapter 3
METHODOLOGY
The researcher has been teaching nursing for the past twenty years, eleven of
which were in the State of California. With each academic semester, she observed
students from racial/ethnic background struggle their way through the nursing program.
Admission to nursing school is highly competitive with the number of qualified
applicants exceeding demand. The average GPA of students enrolled in the program
where the researcher teaches ranges from 3.7-3.8 on a scale of four points. These
students are the “cream of the crop”. They are intelligent and highly competitive, but
when they are admitted to the program they struggle much more than students from a
White background. Consulting with the literature validated the researcher observations.
Minority students lack success in undergraduate nursing programs, particularly
students from Latino American, and African American descent. The nursing profession
needs to increase the number of minority registered nurses if the profession is to keep
pace with the changing demographics of this nation (Sullivan Commission, 2004;
American Association of College Nursing [AACN], 2011; Taxis, 2002, 2006; Nugent et
al., 2002a, 2002b; California Endowment, 2003; CBRN, 2011; NLN, 2009; Gardner,
2005; Wisneski, 2003; Jordan, 1996; Sims-Giddens, 2000). No literature was found on
Muslim nursing students.
The purpose of this qualitative phenomenological study was to explore the
perceptions of newly graduated African American, Latino and Muslim nurses.
65
Examining the challenges as well as facilitators they encountered during the course of
their undergraduate nursing school experience and what helped them address the
identified challenges in order to successfully graduate. Through this study, the researcher
was trying to answer the following questions:
1. What are the perceived challenges to success that Latino, African American,
and Muslim students face in a nursing program where they are in the
minority?
2. What institutional resources (student services), social capital (networks),
cultural capital (beliefs, values, and skills), and habitus (aspirations) were
necessary for their successful completion of the nursing program?
While participants in this study were limited to graduates from one nursing
program in the city of Sacramento in Northern California, the outcome can provide
similar nursing programs with data that may help them identify the barriers of success for
minority students in their programs and how to improve the odds of success for this
growing sector of the nursing student population. Additionally, state policy makers could
use the data which highlights the need to diversify the nursing profession and assess the
barriers to success for minority students to potentially increase funding for nursing
programs that admits students from diverse backgrounds and of low socioeconomic
status. Finally, the data will provide the researcher and other nursing educators with
information with which to focus areas of improvement to empower students from diverse
backgrounds and facilitate their success in nursing.
66
Chapter Three will describe the research design, including the role of the
researcher, followed by a detailed description of the context, setting, and sample.
Furthermore, this chapter describes the qualitative protocol, process, and data analysis
tool used to analyze data. The chapter will also discuss measures taken for ethical
protection of participants and participants’ rights. Finally, this chapter will disclose the
findings of the pilot study conducted earlier by the researcher, followed by the
conclusion.
Research Design
A qualitative design was selected to explore the phenomenon of the lived
experiences of African Americans, Latinos, and Muslims in nursing education. This
design allowed the researcher to focus on participant perspectives, their meanings, and
their subjective views (Creswell & Plano-Clark, 2007). Qualitative methodology is most
appropriate for this study because the goal was to understand the meaning of a
phenomenon from the perspective of African American, Latino, and Muslim nurses. The
phenomenon studied was the experiences of African Americans, Latinos, and Muslims in
nursing education. The researcher attempted to elicit the voices of African American,
Latino and Muslim nurses regarding their experiences in nursing education through
reflection. This study design allowed and encouraged participants to reflect on the
meaning of their experiences through their own personal, racial/ethnic, and cultural
lenses. Creswell and Plano-Clark (2007) stated qualitative research is used because it
tells us “why people responded as they did, the context in which they responded, and
67
their deeper thoughts and behaviors that governed their responses” (p. 40). Through
reflection, the narrative stories elicited helped explain how participants responded, as
well as why they responded in a particular way. Understanding the meaning of the
phenomenon required rich descriptions of participants’ experiences and a consideration
of the context of these experiences. The rich description of experiences from several
viewpoints allowed an overall picture of the phenomenon to emerge.
This study aimed to explore the common experiences of African Americans,
Latinos, and Muslims in nursing education. A narrative approach was utilized to allow
the voices of participants to be heard regarding their individual experiences, as well as
personal meanings of those experiences, the impact on them as individuals, their families,
and the nurses they have become. Stories provided by the participants shed the light on
the extent their experience as undergraduate nursing students provided them with the
academic preparation, social capital, cultural capital, and habitus necessary to graduate
and be successful in passing the NCLEX exam and become registered nurses.
Role of the Researcher
The researcher may be a former teacher of some of the study’s participants. The
researcher was aware that this could present a conflict of interest since nursing programs
foster a mentoring relationship between students and teachers, and the participants may
want to respond in a way that would positively highlight their undergraduate nursing
experience, when their true feelings might have differed. To alleviate a potential conflict
of interest, the researcher established a degree of separation between the participants by
68
interviewing only nursing program alumni and not current students. The researcher
clearly explained to the participants that there are no correct responses and that they will
not personally benefit or receive compensation from participating in this research. The
benefit that they were going to gain was acquiring additional insight into factors that
affect student success in undergraduate nursing education. The information from this
study will be shared with them. This information was also provided in the survey consent
form (Appendix B).
Context, Setting and Sample
The research took place in Sacramento city in Northern California. Interviews
were conducted, with the participants’ permission, in private, neutral, nonthreatening
settings in agreement with the participants.
A purposeful sampling of participants was selected for in-depth interviews by the
researcher. Purposeful sampling is a non-random method of sampling where the
researcher selects information-rich cases for study in depth (Merriam, 2009). This
allowed the researcher to select those individuals who met certain criteria for
participation in the study.
All African American, Latino and Muslims who graduated from Sacramento State
between Fall 2009-Fall 2011 a total of forty six participants were originally invited to
participate in this study. The 46 potential participants were divided into five African
Americans, 37 Latinos and four Muslims. Five were males and the rest were females.
The original goal was to recruit four African Americans, four Latinos and four Muslims,
69
a total of twelve participants but only four participants initially volunteered. The
invitation was then sent two more times and a snow-balling technique was used where
participants who responded to the invitation and volunteered to participate helped recruit
other study participants. All efforts resulted in recruiting five more participants. The
sample consisted of nine registered nurses all females, none of the males contacted
volunteered to participate. Participants were divided into One African American, four
Latinos and four Muslims. All efforts to recruit more African Americans nurses were in
vain. The African American Nurses Association Sacramento Chapter was even contacted
and the only African American Nurse that they had and who was a graduate of
Sacramento State was the participant interviewed.
Access to the sample population was through contacting the Alumni Center of
Sacramento State, a four-year university where the researcher works and through
professional nursing associations. The school of nursing Alumni representative invited
the graduates meeting the researcher’s criteria to participate in the study via email. A list
of the graduates who expressed interest in participating in the study were provided to the
researcher to contact.
Instrumentation, Data Collection, and Analysis
Survey Instrument
The survey tool was developed and piloted by the researcher. The final survey
consisted of open-ended questions (Appendix C). The open-ended questions allowed
participants to describe their experiences in their own words. Probing questions were
70
utilized to elicit more specific descriptions and also to guide the participant to think
deeper about an experience. The use of the qualitative research tool of interviewing was
appropriate for this study since, the methodology allowed the individual stories of
participants to be told in order to gain insight into the personal experiences of African
Americans, Latinos, and Muslims in nursing education.
Procedure for Data Collection
An electronic version of the consent was emailed by the researcher to the
participants before the interview was scheduled. When contacting individuals the
researcher specifically noted that the individual had the option to decline. If the option to
decline participation was chosen it would not affect them in any way. Structured
interviews averaged around 60 minutes and were conducted at a mutually agreed upon
location. The purpose of the study was reviewed with each participant and their consent
was obtained. Each participant was interviewed once with only the researcher and
participant present. The researcher asked structured open-ended questions of each
participant (Appendix B). Interviews were audiotaped by the researcher. The audiotapes
were transcribed by a professional transcriptionist and coded using identifiers for
confidentiality. The researcher then reviewed all transcripts while listening to the
recordings to check for accuracy of transcription. To ensure that the transcripts held the
meaning intended by the participants a copy of the transcripts was emailed to participants
for their review. The researcher then followed up with an email to each participant to
confirm that the transcripts captured the meaning they intended.
71
Analysis and Data Quality Check
Transcripts were then analyzed manually looking for common themes, using
Auerbach and Silverstein’s (2003), Qualitative Data: An Introduction to Coding and
Analysis. Analysis was not focusing on the interpretation of the researcher, but on the
description by the participants. Data were analyzed by reducing the transcriptions to
significant statements or quotes and identifying emerging themes. The analysis focused
on capturing the textual description or what participants experienced, as well as the
structural description or how they experienced it in terms of conditions, situations, or
context.
The central idea of coding is to move raw text to research concerns in small steps
each step building on the previous one. The steps of coding is more like a staircase
moving you from lower to higher more (more abstract) level of understanding, following
inductive reasoning model (Figure 6).
Figure 6
Steps of Qualitative Data Analysis
72
A hard copy of the theoretical frame work and research questions was available as
reference for the researcher to look at while analyzing transcripts. This helped keep the
researcher focused on what she wanted to know and why (Auerbach & Silverstein, 2003).
It also became the blue print or guide for making coding decisions.
Transcripts.
With each transcript, the researcher would read the text and highlight pieces that
are relevant to the broad research concerns. Then, she would copy highlighted text into a
separate Word file. Relevant text was then tabulated along with the researcher’s idea
about the chosen text in bold font. The ideas were hints used to remind the researcher
why she thought the selected text was important. Two documents were created for each
individual, one for the barriers identified and one for the bridges identified. A file for
each of the three focus groups, African American, Latinos and Muslims was also created.
Text that did not seem directly related to the research questions or theoretical frame
work, but seemed important, were coded under miscellaneous in order to save these
pieces of text that may be useful in later analytical and writing processes.
This analytical approach, informed by Auerbach and Silverstein (2003) was used
for all nine transcripts. They used a three-level coding approach that begins with bottomup coding (i.e., starting with the text itself, making the text manageable through reading
raw text and highlighting relevant text). The second level is called hearing what was said
and this is accomplished through grouping repeating ideas into coherent themes. The
third level proceeds to a top-down approach which links data from the study to the
theoretical frame work.
73
Focus groups.
In the second step, the selected text for all participants of each focus group was
read. Repeating ideas were identified and copied into a separate file. The selected text
with the repeating ideas was then tabulated with a heading in bold font. More details
about the process of deciding on the headings will be presented in the following section.
The process was then repeated with all members of each focus group and a document
specific for each focus group was organized based on repeating ideas was created.
Horizontalization of data was accomplished as the researcher worked to develop a list of
“no repetitive, no overlapping statements” (Creswell & Plano-Clark, 2007, p. 159). The
process was repeated for all three focus groups.
Creating the master list.
In the third stage of data analysis, all documents having repeating ideas for all
three focus groups were examined to compare repeating ideas among the three groups.
Text on repeating ideas across groups were then copied into a separate file and tabulated
with the repeating idea as the heading. After creating the repeating ideas list for all focus
groups, the researcher read through the list several times and did some changes and
regrouping which resulted in the final “Master List” of repeating ideas.
In naming repeating ideas, the researcher used participants’ words like “have
hope,” “Be aware,” “come find us,” or, “program demand.” These themes were further
grouped into more abstract levels like “Structural Borders”, “Cultural Borders”, “Cultural
Capital”, “Social Capital” and “Habitus.” These in turn, were grouped into broader
theoretical constructs like “Barriers, and Bridges.” Theoretical constructs moved the
74
analysis from the description of subjective experience found in repeating ideas and
themes to a more abstract and theoretical level (Auerbach & Silverstein, 2003). Only
themes with at least three narrative citations were considered significant (Appendix D).
Triangulation was accomplished through member checking. The researcher
biases were documented before the beginning of data collection using bracketing.
Negative or discrepant information were presented with the findings in Chapter Four.
Peer debriefing was also used to enhance accuracy, the chair of the dissertation
committee acted as the peer de-briefer. Research committee members also served as peer
de-briefers playing devil’s advocate by asking hard questions of the researcher about
methods, meanings and interpretations of the researcher. A data audit trail was
completed by the dissertation committee members. Themes were identified through
saturation of coding. The use of detailed examples allowed readers to make decisions
regarding transferability of study results.
Methodological Limitations
The use of only one researcher to conduct coding of the study constituted a
limitation of the study methodology. This prohibited the researcher from performing
inter-rater reliability. Although the researcher utilized bracketing to prevent personal bias
from interfering with data collection, it may be impossible to guarantee this state was
perfectly achieved (Moustakas, 1994). The use of the interview tool although appropriate
for the research design, precludes the researcher’s ability to authenticate data. Creswell
and Plano-Clark (2007) raised similar concerns as identified in the following quotation:
75
Are your interviewees able to articulate the forces that interrupt or suppress or
oppress them? Do they erase their history, approaches, and cultural identity? Do
they choose not to expose their history or go on record about the difficult aspects
of their lives? (p. 140)
Ethical Considerations
Permission to conduct the study was obtained through the Institutional Review
Board of California State University, Sacramento which the researcher was attending
(Appendix A). Therefore, the researcher implemented specific procedures in order to
provide the participants with the least amount of risk and maintained their comfort
throughout the completion of the survey.
The following protection measures were taken: (1) Participants were contacted by
the school of nursing Alumni representative who emailed them inviting to participate in
the study. (2) Contact information of the individuals who expressed interest in
participating in the study was then given to the researcher by the school of nursing
Alumni representative. (3) An electronic version of the consent letter was emailed to
participants before the interview was scheduled. (4) When contacting individuals the
researcher specifically noted that the individual had the option to decline from
participation in the study at any time, and if they chose to decline participation in the
study that this would not in any way adversely affect them. (5) Participants were
informed prior to the interview of their rights to end the interview at any time and that the
interview would be audio-taped, transcribed and analyzed. (6) Participants were asked to
76
sign an informed consent after having expressed understanding of their rights pertaining
to participation in the study. (7) Confidentiality was maintained by using individual
identifiers and the omission of names of colleges attended in the audiotapes, transcripts,
notes and reports. (8) Audiotapes, transcriptions and informed consent forms were
secured in the researcher’s possession, in a locked desk drawer in a locked office on
CSUS campus. (9) The audio tapes will be destroyed within nine months of the
interview.
To avoid researcher’s bias, and since the researcher belongs to a minority group,
bracketing will be used in an attempt to set aside her own personal experiences in nursing
education (Creswell & Plano-Clark, 2007). Prior to data collection, the researcher
delineated her biases and preexistent opinions about her own experiences in nursing
education. Writing her own biases helped the researcher be more aware of personal
beliefs and better able to bracket them, by “putting aside one’s own beliefs, not making
judgments about what one has observed or heard, and remaining open to data as they are
revealed” (Streubert & Carpenter, 1999, p. 21). To minimize researcher effects neutral
settings for interviews were used.
Pilot Study
The pilot study was a micro-ethnography, qualitative research that examined the
lived experience of an African American senior student enrolled in a predominantly
Eurocentric Baccalaureate nursing program. The understanding of the following
concerns was sought. (1) What are the perceived barriers that ethnically diverse students
77
“minority students” in this case African American students face in a predominantly
Caucasian or White nursing program? (2) Does coming from an African American
descent hinder or enhance a student’s ability or desire to continue toward his/her
educational goal? A micro ethnography was employed due to physical and time
constraints. Critical Race Theory was used as the philosophical framework. Field notes
and an audio taped interview were transcribed and subsequently analyzed by the
researcher. Open and focused coding were used as the procedure for qualitative analysis
to identify themes. The findings of this pilot study identified three themes; (1) Structural
barriers; (2) Psychosocial barriers; and (3) Cultural and curricular transformation plea.
Conclusion
In summary, this chapter has presented a description of the research design with
supporting rationale. A qualitative survey method was determined to be the most
beneficial method to gather both depth and breadth of newly graduated African
American, Latino and Muslim nurses’ perceptions of their experience in undergraduate
nursing school. Identification of population sample, ethical considerations, demographics
and the setting for the study were discussed. Lastly, this chapter included a description of
the study instrument, procedure and limitations of the methodology. In addition, it
revealed the findings of the pilot study conducted earlier by the researcher. Chapters
Four and Five will provide greater detail on these perceptions, as well as other significant
findings.
78
Chapter 4
ANALYSIS OF THE DATA
Introduction
There is a real evidence-based achievement gap at the community college and in
higher education system in general between students who are considered White and
students of color (WICHE, 2008; McGlynn, 2009; Nealy, 2009; Nevarez & Wood, 2010;
Mortenson, 2009; Lumina Foundation, 2009). In the United States’ higher education
system, Blacks, Hispanics and Native Americans are proportionally underrepresented
while Whites and Asians are over represented. This is also true for minorities in the
health sector.
A major issue in health care in the 21st century is a general lack of diversity in the
nursing profession, and in the nursing education system specifically. While there is a
growing racial and ethnic population in the United States, minorities in nursing are
underrepresented (Sullivan Commission, 2004; AACN, 2011; Taxis, 2002, 2006; Nugent
et al., 2002a, 2002b; California Endowment, 2003; CBRN, 2009; NLN, 2009; Gardner,
2005a, 2005b; Wisneski, 2003; Jordan, 1996; Bond et al., 2008; Sims-Giddens, 2000).
This also holds true for Muslim nurses (Marquand, 2006).
The purpose of this narrative phenomenological study was to explore the minority
nurses’ perceptions of the challenges they faced during the course of their undergraduate
nursing school and what helped them overcome these barriers and successfully graduate.
The study attempted to describe the lived undergraduate nursing education experiences of
79
newly graduated African American, Latino, and Muslim nurses. This was accomplished
through analysis of data derived from semi-structured individual interviews detailing the
lived experiences among these three ethnic/cultural groups. This chapter reports the
findings of a phenomenological qualitative research study designed to provide a better
understanding of the perceptions of newly graduated African American, Latino, and
Muslim nurses about the challenges as well as facilitators that they encountered during
the course of their undergraduate nursing school experience and what helped them
address challenges in order to successfully graduate. Thus, the participant’s semistructured one-on-one interviews served to answer the following research questions:
1. What are the perceived challenges to success that Latino, African American,
and Muslim students face in a nursing program where they are in the
minority?
2. What institutional resources (student services), social capital (networks),
cultural capital (beliefs, values, and skills), and habitus (aspirations) were
necessary for their successful completion of the nursing program?
In this study, the theoretical framework was guided by multiple theories. Critical
Race Theory (CRT), which provided a frame work for the barriers facing minority
students in nursing education. The second theory, used was the theory of Academic
Capital Formation (ACF) that was developed by Edward St. John through identifying
claims about social processes in human capital theory (Becker, 1975), social capital
theory (Coleman, 1988), and social reproduction (Bourdieu, 1977a) theories. ACF acts
as an umbrella that highlights the strategies necessary for students of ethnic minority
80
origins to help increase their access to and success in rigorous nursing education
programs. Cultural capital, social capital, and human capital (habitus) provide frames for
which success in nursing education can be reached.
Explanations offered in the literature for the lack of success among Latino, and
African American students in predominantly White nursing programs include a number
of complex factors, such as feelings of loneliness, alienation, and isolation (Gardner,
2005a, 2005b; Suarez & Fowers, 1997), the English language (Abriam-Yago et al., 1999;
Klisch, 2000), discrimination (Gardner, 2005a; Villarruel et al., 2001; Yoder, 2001),
peers' lack of understanding and knowledge about cultural differences (Gardner, 2005a)
and academics (Kirkland, 1998). Nothing was found in the literature on the experiences
of Muslim nursing students which makes this study unique in this aspect. Upon
reflection on the author’s personal experience, she concurs with the above mentioned
reasons. The explanations for attrition offered thus far, however, are not unique to
African-American, Latino, or Muslim students.
The participants in this study shared their undergraduate experience from the
perspective of an alumnus of Sacramento State. Their undergraduate experience lies in
the past and they are now part of a group of success stories. In their own words, they
shared their undergraduate college experiences; the barriers they faced and the success
strategies utilized throughout their journey, and made institutional recommendations
based on their own perception of what facilitated their degree completion. Under the
category “Nursing school experience,” participants were asked to describe their overall
experience in the nursing program. Under the category “Barriers” participants were
81
asked to describe their negative experiences in the nursing program and what they
perceive as boarders they needed to cross during their nursing education journey in order
to be successful and graduate. Under the category “Bridges” participants were asked to
describe what helped them graduate including the different types of support they received
whether financial, emotional, social or academic. Under the fourth category “A call for
hope and change,” based on their experience in Sacramento State nursing program,
participants were asked to provide suggestions for faculty, program directors and
prospective nursing students which they believe, will cultivate and provide a better
environment in the nursing program to ensure successful graduation of future generations
of African Americans, Latinos and Muslim nursing students.
Chapter 4 analyzes and presents the collected data in four sections. Section one
presents the demographics of the participants. Section two explains the process of data
analysis. In section three, the general discussion of the research findings are presented
based on themes guided by Auerbach and Silverstein (2003) in their book An
Introduction to Qualitative Coding and Analysis. General findings applicable to all focus
groups will be presented first, followed by section four which will report specific findings
to each focus group. This chapter will end with a concluding summary of the findings.
Participant Demographic Data
All African American, Latino and Muslim nurses who graduated from
Sacramento State between Fall 2009-Fall 2011 a total of forty-six participants were
originally invited to participate in this study. The 46 potential participants were divided
82
into five African Americans, 37 Latinos and four Muslims. Five were males and the rest
were females. The original goal was to recruit four African Americans, four Latinos and
four Muslims for a total of twelve participants but only four participants initially
volunteered. The invitation was then sent two more times and a snow-balling technique
was used where participants who responded to the invitation and volunteered to
participate helped recruit other study participants. All these efforts resulted in recruiting
five more participants. The sample consisted of nine Registered Nurses all females, none
of the males contacted volunteered to participate. Participants were divided into one
African American, four Latinos and four Muslims (Figure 7). All efforts to recruit more
African American nurses were in vain. The African American Nurses Association
Sacramento Chapter was contacted and the only African American Nurse that they had
was a graduate of California State and was interviewed.
Figure 7
Participants’ Ethnic Distribution
83
Participants were 100% females, all born in the US except for one born in Afghanistan.
Eight out of the nine participants spoke other languages (Figure 8). Participants’ age
ranged from 23 to 43 with a mean age of 31. Fifty five percent were married with
children living in the same house, the number of children ranged from one to four. All
participants attended nursing school as full-time students.
Figure 8
Participants’ Spoken Languages
None of the participants attended school overseas. Eight of the participants had
other degrees; eight attended community college before coming to Sacramento State
(Figure 9). One out of the nine (11%) was a traditional freshman student. Time spent at
CSUS campus ranged from two to five years.
84
Figure 9
Participants’ College Experience
The majority of participants reported having an average GPA of 3.5 to 4.0 in high school,
when admitted to the nursing program and upon graduation from Sacramento State, see
(Figure 10).
Figure 10
Comparison of Participants’ GPAs
Eighty percent of the Latina participants are the first in their family to graduate from
college, including one Muslim/Latina. The parents of one Latina graduated from college
85
in Mexico, but worked as custodians in the US so they did not have the college
experience in the United States. Muslims not from a Latino descent are second and third
generation going to college. The African American participant was first generation
graduating from college in her family but she has a sister who has a bachelor’s degree
too. Participants were influenced by their parents (mostly their mothers) in deciding to
pursue college education and graduate. In looking at (Figure 11) below, it is evident that
mothers are the least educated in the family, fathers are more educated than mothers but
less educated than children. The new generations of siblings are still in school, but more
of them are graduating from college. All participants (100%) passed their licensure exam
NCLEX from the first attempt of the examination.
Figure 11
Level of Education of Parents and Siblings
Participants’ household annual income ranged from $17,000 to $80,000, with an
Average Annual Income of $39,000. More than half (55%) qualified for free or reduced
86
lunch during high school, 78% received financial aid and just two of the cases (22%) had
parents who were able to afford their education expenses (Table 4).
Table 4
Participants’ Financial and Economic Status
Qualified for
Free
Annual
Received
/Reduced
Case
Lived During
Employment During
Family
Financial
Lunch in
#
School With
School
Income
Aid
HS
M1
parents
Part time/ 20hrs/week
$60,000
Y
No
Did not work
$30,000
Y
Y
Spouse/
Children and
M2
In-laws
M3
Parents/spouse
Part time/ 20hrs/week
$30,000
No
No
M4
Spouse
Did not work
$17,000
Y
No
HL1
Parents
Part time/8hrs/week
$80,000
No
No
HL2
Friend
Did not work
$10,000
Y
Y
Did not work
$65,000
Y
Y
Did not work
$29,000
Y
Y
$30,000
Y
Y
Boy friend
HL3
Child
Spouse &
HL4
children
Spouse and
AA1
children
Did not work
87
Data Analysis
Analysis was done by hand. A hard copy of the theoretical frame work and
research questions were available as reference for the researcher to look at while reading
transcripts. This helped to keep the researcher focused on what she wanted to know and
why (Auerbach & Silverstein, 2003). It also became the blue print for making coding
decisions.
Transcripts
With each transcript, the researcher would read the text and highlight pieces that
are relevant to the broad research concerns. Then, she would copy highlighted text into a
separate Word file. Relevant text was then tabulated along with the researcher’s idea
about the chosen text in bold font. The ideas were hints used to remind the researcher
why she thought the selected text was important. Two documents were created for each
individual, one for the barriers identified and one for the bridges identified. A file for
each of the three focus groups, African American, Latinos and Muslims was also created.
Text that did not seem directly related to the research questions or theoretical frame
work, but seemed important, were coded under miscellaneous in order save these pieces
of text that may be useful in later analytical and writing processes. This analytical
approach, informed by Auerbach and Silverstein (2003) was used for all nine transcripts.
They used a three-level coding approach that begins with bottom-up coding (i. e., starting
with the text itself, and proceeds to a top-down approach which links data from the study
to the theoretical frame work).
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Focus Groups
In the second step, the selected text for all participants of each focus group was
read. Repeating ideas were identified and copied into a separate file. The selected text
with the repeating ideas was then tabulated with a heading in bold font. More details
about the process of deciding on the headings will be presented in the following section.
The process was then repeated with all members of each focus group and a document
specific for each focus group was created based on repeating ideas. Horizontalization of
data was accomplished as the researcher worked to develop a list of “nonrepetitive,
nonoverlapping statements” (Creswell & Plano-Clark, 2007, p. 159). The process was
repeated for all three focus groups.
Creating the Master List
In the third stage of data analysis, all documents having repeating ideas for all
three focus groups were examined to compare repeating ideas among the three groups.
Text on repeating ideas across groups were then copied into a separate file and tabulated
with the repeating idea as the heading. After creating the repeating ideas list for all focus
groups, the researcher read through the list several times and did some changes and
regrouping which resulted in the final “Master List” of repeating ideas.
In naming repeating ideas, the researcher used participants’ words like “have
hope,” “Be aware,” “come find us,” or, “program demand.” These themes were further
grouped into more abstract levels like “Structural Borders,” “Cultural Borders,” “Cultural
Capital,” “Social Capital” and “Habitus.” These in turn, were further grouped into
broader theoretical constructs like “Barriers, and Bridges” (Figure 12). Theoretical
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constructs moved the analysis from the description of subjective experience found in
repeating ideas and themes to a more abstract and theoretical level (Auerbach &
Silverstein, 2003). Only themes with at least three narrative citations were considered
significant (Appendix D).
Data analysis resulted in identification of the following four constructs which
were: overall experience in the nursing program, barriers, bridges and a call for change
and hope. Under the barriers construct three themes emerged; structural borders,
academic borders and cultural borders, from which five subthemes emerged (Figure, 12).
Under bridges, four theoretical constructs emerged; habitus, social capital, cultural capital
and institutional resources. Participants’ suggestions for prospective nursing students,
faculty and nursing program directors were grouped under the construct “A call for
change and hope.” Themes are described in this chapter along with examples from
participant narratives.
Figure 12
Research Findings
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General Research Findings
Construct I: Overall Experience in Sacramento State Nursing Program
There was a consensus among participants that their overall experience at
Sacramento State nursing program was positive, but highly demanding. They perceived
the program as a good program that prepared its graduates to be successful nurses, as
evidenced in the 100% passing rate of all the participants in the Nursing Licensure Exam
from the first try. Despite that, in the excerpts listed below, graduates felt that the
program was difficult, challenging, rigorous, highly demanding and stressful.
1. “It was very stressful, but I’m very proud that I got through all of it. Finally
graduated! ” -M2
2. “It was very rigorous. Starting from scratch, in my knowledge base, and building
every semester, and feeling that sense of accomplishment, the whole learning
process was very positive for me… I just think it was a good journey. I am so
glad that I did it. I feel a very much empowered person in my community, and I’d
like to move on up and continue my education in nursing.” -M4
3. “My overall education in nursing school was pretty thorough. I got a good
foundation of nursing skills… it was hard but it was all worth it.” -M1
4. “Nursing school is hard. And, you just have to get through it, and do what’s
expected of you in order to be done with it, and become successful.” -HL1
5. “I wouldn’t really say overall the experience was negative because I think I made
the most of it, but it was very difficult.” -HL2
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6. “My experience in the nursing program, overall, I would have to say was a good
one. Being one year out of the program, I feel that I had a very good foundation,
as far as nursing goes, in that I was prepared well. I feel that it was stressful. It
was for me, personally.” -AA
Participants resented the high demand of the program since it made them feel
socially isolated, which resulted in them feeling lonely and alienated. The high level of
stress that they experienced is evident in the excerpts listed below where they explain
how they did not have time, having to give up their social life and just study to be
successful, which created an imbalance in their lives.
1. ”You should give up your life to the nursing program, which is pretty much
what you have to do.” -HL3
2. “Lack of social life. That was really hard. It’s so demanding in the nursing
program, and I consider myself a dedicated student.” -M4
3. “I did feel very lonely… at school, too.” I just put my nose more in the books,
than sit around and mope about it. Yeah, sometimes even during the program,
I felt that way.” -M4
4. “That was really difficult sometimes. That made it hard. It always felt like
spending three years just studying, having no friends, and nobody to talk to;
no social life was straining sometimes. I just kept reminding myself, it’ll be
over soon, and you’ll be done.” -M4
5. “I think our professors understand how much work we have on our plate, but
don’t truly understand how much time it’s taking us.” -M3
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6. “The complexity of the program, I really had to commit 100%, it took up a lot
of my time. The fact that I had to be so committed and I felt a little bit of an
imbalance in my life because I didn’t always have time to go and escape, to
have fun.” -HL2
In the excerpt below one of the participants HL3 outlined the effective coping
mechanisms she followed to overcome the rigor of the program.
It’s very doable. With the right structure, the right support at home, and believing
in yourself, I think you can do it, I felt the material we learned was very relevant,
and what we need to be successful nurses. I just feel like I couldn’t have gone any
other better place. -HL3
More elaboration on different support systems that helped participants effectively
cope with the rigor of the nursing program, graduate and become successful nurses will
be discussed in the bridges construct. The following section describes the general
findings under the second construct “Barriers” (Figure 13).
The construct, barriers, is divided into three themes identified by most
participants: structural borders, academic borders and cultural borders. Each border is
subdivided into subthemes as you can see in (Figure 13).
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Figure 13
Barriers for Success
Repeating
Ideas
Theoretical
Construct
Theoretical
Narrative
Construct II: Barriers
Academic borders.
In this section, the researcher will examine the academic borders that were
discussed by the participants. The themes that emerged were in relation to having to
study a Eurocentric curriculum, utilizing books that marginalized minorities, in addition
to having to be tested using standardized tests that are culturally biased. Furthermore,
this section discussed how faculty was, in some instances, negatively contributing to
students’ success in the program through their unrealistic expectations and the high
volume of assignments that they required from the students to complete. Finally, this
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section addresses how participants perceived lack of diversity in the program among both
faculty and students.
Curriculum.
Issues discussed under this subtheme were related to having to study within a
Eurocentric curriculum. Participants perceived that lectures were geared to one
population, addressing mainly the need and care of White Caucasian population. In
addition, the same problem was encountered in the nursing books used. The books
overly addressed the needs of one patient population (Caucasian). Other cultures or races
were isolated and discussed in the book in a separate table or in a different chapter.
1. “It was very frustrating, it didn’t make me angry, just frustrated. Because it
wasn’t like, it was an intentional thing. It was more of an oversight... In
lecture you would get a sense that they were speaking to an all-White, female
audience. Or that they were speaking about a patient population of one
culture. And they didn’t really address that people came in many different
colors.” -AA
2. “Often in our curriculum, even in the textbooks, it referred to, or it talked to
one culture. A lot of the things in there only covered Caucasian patients,
culture or assessment. It didn’t really address the different cultures. And
when it did, it was separated out.” -AA
Furthermore, participants discussed how standardized tests were difficult for
them. Especially for those to whom English is a second language. They perceived these
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tests as a challenge and resented the fact that tests were used to determine their success as
nurses.
1. “There was another exam to get into Sac State. Hispanic people are bad at
standardized test taking, I know standardized testing, is hard. These tests are
biased a little. And also, for me, personally, English is a second language.
So, me reading in English was a weakness.” -HL1
2. “The ATI test, was a real challenge…I’m not a really good test taker at all… it
just felt like they were like a real challenge for me, and maybe that shouldn’t
be a determining factor to whether or not a student should go on to the next
semester because that doesn’t say anything about how great a nurse they’re
going to be at all.” -M1
3. “All the tests were difficult.” -HL3
Faculty as barriers to learning.
The curriculum was not the only barrier identified under academic borders.
Faculty were portrayed both negatively and positively in this study findings. This is why
faculty were included under both borders and bridges. Faculty were perceived as barriers
to learning for many reasons. One of the main reasons was faculty’s lack of awareness
about how much work they were asking their students to perform in regard to readings
and assignments. The students felt that the amount of work demanded cannot be
accomplished with the time frame of a regular college student studies, unless they
dedicate all their time to studying.
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1. “I think our professors understand how much work we have on our plate, but
don’t truly understand how much time it’s taking us.” -M3
2. “Well, it’s just really demanding educationally, you have these eight hour
write-ups, and you have to visit the hospital the day before, and you take all
these exams, and you’re just constantly studying, preparing for something.
That’s just hard for anyone, that’s why I thought it was tough. I compared us
nursing students, to other college students, I feel like we were extremely busy
all the time with something.” -HL1
3. “I’m not saying the material was really hard material but it was just a lot of
material that our program is giving us, quickly. That required me to really
dedicate a lot of time to it. Every week I probably put 50, 60 hrs. a week into
my program, every week.” -HL2
4. “It was very challenging to be a fulltime parent of four, and be a fulltime
student. You have a lot of demands, a lot of assignments need to be done, a
lot of studying that needs to be done, in order for you to get the concepts, and
do well on your exams. I think that was the biggest barrier for me.” -HL4
5. “Lots of group work, it was difficult because we had to really find the time to
meet with everyone else to just get our work done. And lots of presentations.”
-M1
6. “All the reading and maybe English as a second language was a barrier to
wanting to read more, and study.” -HL2
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Lack of voice.
Another subtheme that emerged under the faculty theme was the students’ lack of
voice and fear of challenging faculty’s authority. Students felt that faculty were
demanding a lot of assignments and readings beyond students’ capacity, which they had
to bear because they felt that they did not have a voice and could not challenge faculty’s
authority. They expressed their fear of faculty’s retribution if they criticize them.
1. “I feel like the students don’t have a voice sometimes. They’re so scared that
someone will fail them in clinical and that’s the end for them.” -M1
2.
“Students are terribly afraid that they’re going to get spited by the professors
if they say the truth. I would never dream to say this when I was in the
program.” -M3
3. “It’s just the fear of getting into trouble, the fear of challenging authority…
you feel like it’s a lose-lose either way. Everybody was like that.” -M3
4. “I, overall, had a pretty good relationship with my faculty. If I had questions,
if I couldn’t get them answered through peers, then I would go to the faculty,
because I just didn’t want to ask for help. And I didn’t want them to think that
I didn’t know what I was doing. It was scary.” -HL1
Participants felt helpless and could not do anything to change things that they did
not like or felt unfair. They expressed their fear of faculty’s retribution which would
reflect negatively on their grades. They perceived themselves as powerless and
defenseless. They recognized that they had to bear the conditions and move on with their
education.
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1. “I just lived through it. I just did it, and put up with it. I don’t think I did
anything to actually solve it.” -M4
2. “I’ve always been a really good student, maybe not the best test-taker, but a
really good student. But we just had to suck it up and move forward.” -M1
Lack of diversity among faculty.
Lack of diversity was the third theme that emerged under academic borders which
participants identified in relation to the nursing program. Diversity was further
subdivided into the need to have more diverse faculty and students in the program. The
following quotes demonstrate the lack of minority faculty as perceived by participants.
They verbalized the need to have role models, faculty of color or faculty from their same
racial/ethnic background, who they can identify with and who can better understand their
needs and minimize their feelings of isolation and alienation.
1. “We live in a diverse world, our patient population is diverse, and they want
to see people who look like them. Everyone wants to see other people who
look like them. No one wants to be in an environment where they are the only
one, whatever it is.” -AA
2. “I would have loved to see a professor, a faculty that was African-American.
That would have been awesome. Someone that you feel you could relate to,
not that I didn’t feel accepted by my other faculty, but …there are things that
you’re going to share with people of the same culture that other cultures may
not understand. That’s just the way that it is.” -AA
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3. “It’s really big to see another Muslim that’s wearing hijab. That’s your
professor. It feels really nice because it’s like, wow what a great
representation to show incoming nursing students that are not even nurses yet.
They start to build the respect for people that wear hijab or just Muslims, and
minorities in general, from nursing school. They realize that these people
know what they’re talking about. They’re educated. They’re good professors.
It sets up everybody else in the hospital that wears hijab for success.” M3
4. “It would have helped to have a Latina professor.” -HL4
5. “We do need more diversity and role models.” -M4
Lack of diversity among students.
The following quotes reveal how the lack of minority students in the nursing
program was perceived by participants. They perceive that they were under-represented
in the program and in the profession in general. They voiced their concern regarding how
lack of diversity among nursing students is going to reflect negatively on meeting the
health care needs of their own people. They also voiced the need to have more people of
their own cultural background in the program with whom they could identify which
would decrease their feelings of isolation and alienation.
1. “I was one of the few so then I couldn’t really look up to someone, and I
didn’t really know, or follow someone’s example because there was no one
around.” -HL1
2. “…our parents, our grandparents, eventually, they’re going to have to be taken
care of. They can’t be taken care of more successful than from someone from
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their own culture, who understands what their needs are. We need more
people to take care of our people.” -HL3
3. “I just know in this field there is a very limited amount of us that are pursuing
an education.” -HL4
4. “…it’s always just kind of a comfort to have one of your own kind of people
there with you. You both are the same person. You can talk about like
everything, you’re the same culture, race, so you can kind of relate to each
other somehow, and just having that little support system there.” -HL1
Cultural Borders
The next theme under barriers is cultural borders. Two subthemes emerged under
this theme. The first sub theme is alienation and the second subtheme is lack of academic
culture. Under alienation two subthemes emerged and they were stereotyping and
marginalization.
Alienation, feeling different, lonely and isolated.
As it is expressed in the following quotes, lack of diversity among faculty and
students resulted in the participants’ identified feelings of being different, lonely and
separate from other students. These feelings were identified by five of the nine
participants. Specific participant comments demonstrated that as African American,
Latino and Muslim nursing students, they felt isolated due to few minority students in
their classes. This was very apparent in the African American participant quote where
she expressed how she is expected to assimilate but could not because she cannot change
the color of her skin. These feelings of participants may reflect what Tinto (1987) stated
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as he revised his model of student retention: “what one thinks is real, has real
consequences” (p. 127).
1. “I was a minority, one of two Muslims in my class. We were about 60 which
made me feel different.” -M1
2. “I did feel very lonely.” -M4
3. “I was Muslim, and already kind of like the odd one out.” -M1
4. “I don’t blend into the crowd.” -M3
5. “I did feel very lonely…I did feel very lonely… at school, too.” -M4
6. “Throughout college, in all of my classes, I was basically one of the few
Hispanic, and especially Hispanic girls. There wasn’t peers like me, to kind
of support each other. I was on my own…it makes you feel alone, because
you don’t know who to go to. So, it makes you feel kind of lonely.” -HL1
7. “This made me feel separated, very separated. Being one of three AfricanAmericans in a class of 60, you already feel a little separated…In your college
education, you learn about acculturation, and assimilation. So, when other
cultures come to America how it’s expected that they’ll assimilate and
acculturate, and mesh, and when you can’t change your skin color, you can’t
really do that. So, you’re always going to be different.” -AA
Feeling marginalized.
Feelings of marginalization were expressed by participants when talking about
how some of them were mistreated, stereotyped or referred to in an unfavorable way or
even when not mentioned at all, specifically when they talk about the curriculum.
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1. “…in lecture you would get a sense that they were speaking to an all-white,
female audience. Or that they were speaking about a patient population of one
culture. And they didn’t really address that people came in many different
colors.” -AA
2. “.…in the history of nursing we talked about all of the different contributions
made by the White population in nursing, and then everyone else were
addressed in one lecture including what African-American contributions were,
and it wasn’t inclusive, and it wasn’t very equal in discussion.” -AA
3. “I just feel that, as a student, you should, to make people feel like they’ve
done a good job, you should make sure you don’t make mistakes like that
because it makes people feel like, what’s different in me that I couldn’t be
invited to an honor society like that, because I worked just as hard. It kind of
makes you feel bad that you had to go jump through so many ropes to get an
invitation that you deserved the whole time.” -HL3
4. “When you’re in a class where the majority are Caucasian, and there’s not a
good representation of all the different cultures here, you already feel
separated. When everything about you, and your culture, is separated out, in
the things that you are learning, it just makes you feel like you stand out more,
like you can’t really fit in as well.” -AA
Stereotyping.
Marginalization and alienation were feelings that participants had to deal with in
addition to dealing with the different cultural stereotypes that they had to face. Some of
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the stereotypes faced were more cultural in nature, an example, when stereotyping Latina
as having lots of kids and not accomplishing things in life, or when labeling one of the
students as lazy. On the other hand, one of the Muslim participants was working hard to
change the negative image faculty and students had about Muslim women by becoming
an over achiever to prove that Muslim women can do things and can be successful.
1. “I would want my faculty to be there for me, and be treated equally in every
respect.” -M1
2. “Just because I wear hijab, doesn’t mean I can’t be quote” quote” cool, and
that I can’t be in the popular crowd.” -M3
3. “There’s always these stereotypes: we have kids early, and then that’s it. We
don’t go anywhere with our lives.” -HL4
4. “My preparation for my clinicals was really bad, so one of the teachers was
giving me a really hard time, and at one point I came and talked to her. I said,
I really want to do a good job. I’m having a hard time right now, and her
response to me was oh, o.k. so it’s not just that you’re lazy. You really do
want to try. That made me feel like, well did you assume that I was lazy?
Why would you say that? I don’t think that anybody who got into this
program is lazy. It’s a very rigorous program. It was a bad assumption on her
behalf. After that I rejoined the program, and I graduated with a 4.0, and she
came to me afterward, and said, oh, you did very well. So, no, I wasn’t lazy.
I was just under a lot of stress. When I had teachers making some comments
like that to me that would just make me feel like, wow, maybe I don’t know
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what I’m doing, or maybe I’m not going to do good in this, just self-doubt.” M4
5. “We also talked about cultural awareness, and that was even more offensive.
It really made assumptions…things that were being discussed about the
African-American culture, in that the end result of teaching it may be
opposite of what they were trying to do….For example, it was supposed to
teach us that we deal with the other cultures. When we see other things, we
shouldn’t be offended by it, we should know that it is a part of their culture.
When you deal with an African-American, they tend to speak with their
hands, and be louder, and these different things. So, you may take that as
they’re angry, but they’re not. They’re just very expressive. Or things like
that. And in the end, if a person who wasn’t familiar with the culture went
into their interactions with that culture making assumptions, based on what we
learned out of a textbook, then that may be offensive to the patient vs. just
knowing that we’re all different.” -AA
Lack of cultural capital.
In addition to having to deal with the psychological aspects of being a minority in
the program, participants’ expressed their frustration about not knowing how to maneuver
around the educational system. It was hard for them since they were first generation
going to college. Their parents didn’t have the academic culture capital necessary to help
them be successful. They had to learn the system the hard way through trial and error.
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1. “As far as asking for, like, college advice, or like if I was struggling, I
couldn’t ask my parents because they didn’t know. They didn’t go to college.
When I ask my parents for help, they can’t really help me because they didn’t
go to college.” -HL1
2. “It had been instilled in me, at such a young age, that you have to go to
college. And in my culture, that’s what we’re taught…. My mom went to
some college, but she didn’t finish. She always wanted to but she didn’t. She
had children, prior to being married, and didn’t have that support network for
her to finish, so she didn’t finish, and she wanted us to go to college. She
didn’t teach us how to determine what you’re going to go to college for.” -AA
Structural Borders
Lack of cultural capital was perceived by the participant as the direct result of the
inherent problems in California’s educational system. Under structural borders three
themes emerged and these were, California K through 12 Educational system,
California’s higher education system and the state’s social services resulting in class
reproduction. These were; discrepant cases and non-confirming data. Only two out of
the nine participants hinted to these borders. I decided to include these, since these
findings are well supported by the literature.
California’s K-12 school system.
Under California’s K-12 system two themes emerged; the first was on how in
poor neighborhoods’ schools have no or minimal expectation of students. The second
was the disparity in learning experiences among schools in K-12 based on social classes.
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Participants interpreted that as social reproduction, where those born to parents who are
educated and who have a good income and who attend middle-higher class schools are
better prepared to succeed in college than students going to poor neighborhood’s schools
and who will end up falling out of the system and hence, going to labor and blue collar
job.
No or low expectations of students.
1. “I would like to add something about the American school system. Some kids,
depending on their parent’s income or their parent’s education, are selected
out of the school system to actually be successful, and the others are just
geared through trade school, community college or blue collar jobs. For
example, my boyfriend’s son is a sophomore in high school. When I help him
write papers, he can write a paper o.k., like a C quality paper, but there’s
nothing spelled right. Things are spelled wrong, all over the place, and I tell
him, you have to fix the spelling. Why do you spell everything wrong? And
he says, oh my teacher doesn’t care about spelling. I said, what do you mean
she doesn’t care about spelling? Nobody knows how to spell, so she doesn’t
mark us off for spelling. I think that’s very sad because by the time, hopefully
this child makes it to either community college or a 4-year university, his selfesteem is going to be so bad because teachers in college do care about
spelling. They do pay attention to the minor details, and these kids are just
going to…they’re just set up to fail the school system. They’re not going to
do well in community college. They’re not going to do well in the 4-tear
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university because they don’t know how, or they’re put in remedial classes for
years and years, which make them feel even worse about themselves to the
point where they just give up. They’re being set up for failure.” -HL3
2. “There were certainly not expectations. Some of my teachers allowed us to do
homework in the classroom because they felt if the students did their
homework at home, they wouldn’t get it back, which the teacher was then
punished for. The school was then disciplined by the government. It trickled
down. Much was not expected of us at all. I never knew I could get an A,
because I was never expected to get an A. I was never pushed to get an A, or
even taught that I could. The grades that I got were average because I just did
the average. That was what was going on around me. That’s what was
expected of us. If you were in the academy, then maybe that was different.
That wasn’t the norm.” -AA
Disparity in learning experiences among schools in K-12 based on social classes.
The disparity in expectations among middle-high class neighborhood schools and
poor neighborhood schools’ was not the only problem identified in the educational
system. The theme of disparity in life experiences, and educational experiences between
low socioeconomic and middle class schools was also discussed. Both African American
and Latina felt this way. Participants did not know how poor their school preparation
was until they were in college and were able to compare what they learned at school with
what other students who attended schools in a middle class neighborhoods came with.
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1. “I was a cheerleader, and I was in ROTC. That’s great, but how do I use that
in college? It doesn’t really translate. Running for student body in high
school, things like that are naturally a part of middle class schools, that aren’t
in lower class schools. It’s not part of the curriculum. It’s not built in. These
are inner city children where the teachers just want them to make sure they
turn their homework in so they meet standardized testing type things. It’s not
really taught. It’s expected that those students are going to graduate and
become part of the workforce. They’re going to go get jobs at MacDonald’s
or the local grocery store, things like that.” -AA
2. “I contribute my academic indebtedness to the wide difference or disparity...
between inner city schools and middle class schools in the public school
system. There are things that are taught, even the way in which it is taught, is
so different. If you don’t have the foundation from high school, even though I
was determined, I had to learn some things as I went along. Whereas, the
students that I was sitting next to in class, already knew those things, so they
didn’t have to go home and study to learn what they already knew.” -AA
Lack of academic foundation not well prepared to succeed in college education.
Lack of meaningful educational experiences together with the lack of high
expectations of minority students in the K-12 school system resulted in the participants’
perception that they were not well prepared for college, and that they lacked the academic
foundation necessary for success at college. The study participants felt that the system
set them up to failure!
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1. “As an African-American, raised in America, I didn’t realize until I went to
college that I wasn’t really given a very strong educational foundation. That
was the first thing that made the biggest impact because prior to nursing, I
wasn’t really taught how to study, how do you manage time. There are still so
many things that I don’t have a good grasp on, different concepts that affect
me in my education. So, a lot of not having that initial foundation affected me
a lot.” -AA
2. “They’re being set up for failure.” -HL3
Higher education system.
The K-12 system is not the only system to blame for the problems that minority
students faced in their college education journey. Participants identified California’s
higher education system as a second structural border they had to face. Under this theme,
two subthemes emerged; one was the lack of guidance in the community college system
that does not prepare the student for success. The second barrier was the admission
requirements at Sacramento State that acted as a barrier to access for minority students.
Lack of Guidance in college.
The other subtheme that emerged under higher education was the lack of guidance
in higher education. Participants voiced that since a young age, they were motivated to
pursue college education by their parents, specifically their mothers, but they did not
know the “why” and “how.” Their families did not have either the higher education
experience necessary to guide their kids in their college pursuit, nor the academic
institution. This resulted in the participants wasting years of their life in college with no
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purpose trying to figure out the system. This was perceived by both African Americans
and Latinos.
1. “I came from a background where nobody really has a strong education, but
my mom always pushed it. She didn’t have it, she always wanted me to have
it….I think that a lot of my college years were more about searching for who I
was, or who I wanted to be, so ….I would take classes here and there. Many
of them didn’t count towards any kind of degree… now that I’ve been through
this, the plans for my children, or my son, are very different.” -M4
2. “When I started nursing I was already kind of behind. I didn’t make very good
choices in the beginning as a student. My major was psychology at the time.
Even then, my freshman year in college, I declared a major, when I totally
was not ready to declare a major. I didn’t really understand what any of
professions that I thought I was interested in, what they really did. I declared
a major, and started studying towards that major, which I hated, and didn’t
really understand that it wasn’t a good fit for me. I just kept going back
because I knew I wanted to obtain my degree. I acquired student loans. I
didn’t understand how to attend college so I didn’t know that you needed to
withdraw from classes, instead of just stop going, so I would get incompletes
that would turn into Fs, and it just really messed up my transcripts. So, not
only was I now financially in debt for something that I would never use, I was
academically in debt because I didn’t really understand how the grades would
affect my GPA.” -AA
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Admission Requirements and Meritocracy as a barrier to access.
In the following section, the researcher will explain my findings on how
participants perceived that not only the community college system was hard to navigate
and some of them had to learn it the hard way, but also how the admission requirements
for Sacramento State nursing program were even harder. This was mainly due to the high
demand on the program and the merit based admission, which unintentionally locked the
gates of access in the face of many deserving minority students.
1. “ To get into the program I took the GRE and scored well and I had a GPA of
3.9 with all my pre-reqs.” -M2
2. “I was enrolled at Sac State, and I maintained good GPA, worked really hard
actually, getting my prerequisites done, and maintaining a GPA that was at
3.93 coming into the program...I know with Sac. State, that’s based on that
point system. So, I worked really hard prior to that doing everything right to
get a lot of points so I could get into the program. And the first time I applied,
I actually got in. I felt fortunate.” -HL2
3. “It’s very difficult to get into the nursing program, and I got into three
programs the first try. My grades are excellent. Obviously, I deserve to be
here.” -M4
4. “It’s hard to get into nursing school, like I was saying. You have to get really
good grades on your exams.” -HL1
In the following excerpt, M3, the only Sacramento State freshman participant who
did not attend community college before getting into the university, explains how getting
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into the nursing program required a lot of hard work on her part to overcome the
competition and meet admission requirements.
At first when I started, at Sacramento State, the overall general feel was ‘Is it
impossible? No one can ever get into the Nursing Program. It’s so hard. So, I
worked very hard to get straight As. I looked at what I need to do to get into this
program that everyone says is so impossible to get into. I quickly realized that it’s
really competitive. I had to add-on into every single one of my classes. I realized
by looking at everybody else when I walked into class, there were 20 people just
waiting to add-in. Every single one of those people were pre-nursing. I was a
freshman, and everyone else was juniors or seniors. Well, I’m never going to get
into this class because they have seniority. What I realized was I made school my
priority over work, over family, over friends, and if there was five different labs, I
would show up to every single lab that first week of school, and really reiterate to
the teacher, I don’t care if I have to come to lecture at 7:30 in the morning, and go
to lab at 10:00 at night, I’ll do it. I just need to get in this class. Surprisingly, I
added into every single one of my pre-requisites as a freshman. All those 20
people just disappear because they didn’t make school their priority. Even though
they said they wanted to be in nursing, I quickly realized that the competition was
pretty slim because only so few people would try very hard to get their classes. I
got into all my classes, got good grades, and I got into the nursing program my
first try. The only place I applied was Sac. State because that’s the only place I
wanted to go. I didn’t apply anywhere else..-M3
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Admission requirements promoting Meritocracy. Meritocracy in the admission
requirements and the high competition in the nursing program were perceived as a barrier
to access for many students of color as stated by one of the participants in the following
excerpt. She eloquently explains that people came with different backgrounds and
different capitals, economically, socially and educationally. They also came exposed to
different life challenges. Some overcame the hardships and were very successful, but
these are the exception, and some did try hard but did not make it and they should not be
blamed for not being successful, when they did not come with the same capital or
background like others. People come to college with disparate experiences in the
educational system, the social system and in the support system that they have, and
should not be expected to perform at the same level, when they all did not start from the
same level.
When people talk about hardships, and how people go through life, and how some
people have it harder than other people, I’ve found that a lot of the Caucasian
people would say, oh anybody can do this, if you really want to. But I figured
that it was always easier said than done, if you haven’t lived that experience.
Like if you were born into a certain social status, per se. Because a lot of people
have that whole saying, pull yourself up from your boot straps. It doesn’t matter
where you come from. If you really want something, you can do it. I believe part
of it is true. There are people that lived in terrible situations, and there’s people
that come here from different countries, and different languages, and are very
successful. I think that it’s hard to understand different cultures, and different
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societies, if you haven’t lived there, because you just don’t know it. You don’t
know what it’s like. Those are the exception. There’s always exceptions to every
rule. You can’t judge everybody by some experience you have with some other
person, who maybe was lazy and didn’t want to do anything. And there are some
people that really try and do it, and they just have more challenges. -HL3
Admission Requirements A Barrier to Access. In the following excerpt, one of
the participants articulately expresses how merit based admission requirements at
Sacramento State nursing program acted as a barrier closing doors of access in the face of
too many deserving students of color. Also, how these students were unintentionally
pushed out of the university back to the community college to pursue an associate degree,
instead of a bachelor degree and achieve their dream to be a nurse. Furthermore, she
explained how they did not have a chance and felt they were not good enough to get
accepted at Sacramento State nursing program. Their odds of getting into the community
college nursing program were higher since it is lottery based.
There are a lot of students that are here at Sac. State that are pre-nursing that are
students of color, that have had to change their majors to something else because
they weren’t able to get into their own school’s nursing program. And, I think
that speaks volumes. When you have students that are able to come from other
states, other schools in different states, and get into the program, and not even the
students here in their own school, are able to get into the nursing program. There
are a lot of good candidates right here on campus that are B students. There’s
nothing wrong with Bs. And I don’t think that grades fully capture a person’s
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integrity, which nursing is based on a lot; a person’s contribution that they can
make to nursing. So, a lot of my fellow classmates that were African-American
chose to apply to associate degree programs because they felt like that was where
they could get in because they’re lottery based systems. They don’t just take 4.0
GPAs. They take people who have….these students, it’s not that they’re poor
GPAs – they have 3.0s and higher. It’s just that they’re not 3.9 and higher, or 2.0s
and higher, or 2.5s. Some of different programs take different GPAs. -AA
State social services.
This is one of the discrepant findings where one of the participants’ who was a
single mom, working part time and going to school with the hope of making a better
future for herself and her son faced obstacles from the state’s social system. She felt that
the system was not helping her achieve her goal. On the contrary, she was facing
obstacles which made her journey much harder. She felt that the system was creating
social reproduction and wanting people to stay poor and not work to improve their
economic status. This was included this finding in my analysis since there is literature
that validates her perceptions.
It was straining. I think that’s a negative experience. I‘d think to myself, here
you have somebody who is trying to do something with their life. I paid taxes for
10 or 11 years. I’ve been a tax paying citizen. I just want to go back to school
and better myself, and now you’re giving me all of these problems. I may need
Medi-Cal for my son, and he’s just one son. I said, I may need all these services
at this point, but you don’t want to help. It makes me think, no wonder people
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don’t make it because when they try, you can’t do it because you don’t get the
services that you may need, even if they’re temporary. It makes people stay at a
poverty level because then you get everything. How do you better yourself, if by
bettering yourself, you’re in a worse financial situation than if you just don’t do
anything? -HL3
In the general findings all focus groups identified four constructs; overall
experience in the nursing program, barriers, bridges and the call for hope and change.
The first two constructs were discussed in the previous sections. In the following section,
the author discusses the third construct which is bridges. This construct was identified by
all participants. Under the construct of bridges four themes emerged: habitus, social
capital, cultural capital and institutional support (Figure 14).
Figure 14
Bridges to Success
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Construct III: Bridges
Habitus.
Habitus is a very similar concept to both cultural and social capital; however,
instead of gaining resources which will aid a person’s ability to successfully navigate
through college, habitus reflects a person’s desire. More specifically, McDonough
(1997) reintroduced Bourdieu’s (1977) concept of habitus and its effect on educational
attainment by defining it as the attitudes that shape a person’s expectations and
aspirations. As one of most nursing schools’ main focus points, students must commit to
their desire of a nursing college education before entering the program. All nine
participants shared the passion to learn and become nurses.
Determination.
In examining the following participants’ excerpts it is very clear that
determination was a common theme that all successful minority nursing students had in
common. They all had this inner drive that geared them to persist and not give up despite
obstacles and hardships. They were adamant; they did not veer away from moving
toward their goal of becoming a nurse even when they were told that they could not make
it. They knew what they wanted and they worked towards their goal.
1. “Determination was a big one. Ever since I was in high school, and before, I
always wanted to achieve more, and push myself to do more. I think that my
drive was even more. I was pushed more to do better when everyone kept
telling me you’ll never get into the Nursing Program. It’s so difficult. That
was just one more reason for me to prove to everyone, yeah, you can get into
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the Nursing Program. Yes, you can graduate…I got into all my classes, got
good grades, and I got into the Nursing Program my first try. The only place I
applied was Sac. State because that’s the only place I wanted to go. I didn’t
apply anywhere else.” -M3
2.
“I get really excited, and I want to start something, and then I never finish
it… This was the one thing I knew that I had always wanted to do, and I knew
that I would finish…I wasn’t going to let it go.” -M4
3. “Just my motivation. I wanted to be a nurse.” -HL1
4. “I’m very dedicated. When I tell myself I’m going to do something, I do it. I
feel that the kind of person I am was helpful.” -HL3
5. “I think that you have to go past negative stereotype, and not listen to others.
Reach toward your goal.” -HL4
6. “I think that my determination helped me in finishing, getting my bachelor’s
because there were times that I was told often that I couldn’t. You can’t do
that. There were times that I feel I was misled, when it came to the financial
aspect of it. I had to sit and fight with financial aid a lot – told one thing, and
it turned out to be something else. I do think that if it wasn’t for my
determination I would not have even been allowed in the program because
when I came, I was told by the director, ‘you should change. You should
think of a different major. There’s other things you can do’, especially
looking at my GPA, and my transcripts. I wouldn’t have thought, based on
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paper. But I knew it’s what I wanted to do. So, definitely determination”. AA
Proud of accomplishment.
Determination, building good studying habits and making school a priority, all
these factors helped minority nursing students be successful in reaching their goals and
becoming successful nurses. All participants expressed their sense of pride with their
accomplishment. They also wanted to make their loved ones who supported them
through their journey proud of them too. They wanted to have a positive influence and
be the role model for their younger siblings and kids, let them know that they can go to
college, they can achieve and they can be successful.
1. “My father…I wanted to make him proud.” -M3
2. “I was progressing and was going to be done, and making my parents feel
proud. Making myself feel proud. I’m the oldest of two younger siblings, so I
just wanted to establish like a positive path, so they could follow, too. That’s
one of the main things that kept me going.” -HL1
3. “You feel like, culturally, you want to please your parents. That was a big
help getting through, in making it.” -HL3
4. “My family was very supportive of me, and they’re very proud I was getting
somewhere. I was the first person in my family to ever go to college.” -HL4
5. “Having to deal with the different adversities that I dealt with earlier on in my
college career helped a lot, because I knew that I didn’t not want to finish
getting/obtaining my degree. And I knew that I wanted to have a career, not a
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job, and I knew I wanted to have it in something I could be proud of, and feel
some sense of achievement, or worth.” -AA
Cultural capital.
Determination was not the only quality that helped minority nursing student
become successful in such a rigorous nursing program, their cultural capital helped them
reach their goals. The classical definition of Cultural Capital: “[T]he set of ideas,
practices, beliefs, traditions and values which serve to identify and bind together a given
group of people” (Throsby, 1999, p. 7). Trueba (2002) challenged the classical definition
of cultural capital and the notion of the traditionally dominant culture with one that
emphasizes the value of diversity. In the excerpts below participants identified the
following factors of success that they used: making school a priority, building good study
habits, putting in the time and effort, good organization and time management. In
addition, to focusing on their goal, they were reminding themselves of why they wanted
to go to college to become a nurse.
1. “What I realized was I made school my priority over work, over family, over
friends.” -M3
2. “I was very dedicated to studying, so all I did was school, and study, and
school and study.” -M4
3. “I think my study habits. And, just being really conscientious with my
work…and putting the [my effort] contributed to the nursing school
experience.” -HL1
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4. “I have four kids, and I want to provide a better life for them. Show them that
they need to go to school, too. I feel that if I have an education maybe that
will motivate them…to go to college, and go beyond what I’ve done. They’ll
have a better opportunity, and see that they can get somewhere…They were
my motivation all the way through.” -HL4
Social capital.
In addition to habitus, social capital is yet another resource which aids in college
readiness and success. Coleman (1988) described social capital as a relational theory in
that people gain more social capital based on the people with whom they network. For
example, a cohort of nursing students supports each other through a rigorous program by
not only sharing their individual goals, but by encouraging each other as they work
toward a common goal through set norms. These students benefit from the social capital
gained through a program cohort, just as others gain capital by networking with people
who have similar goals. As explained in the following quotes, under social capital three
subthemes emerged and they were; family support, peer support, and the support they got
from faculty. These subthemes were identified by all nine participants.
1. “My family, my friends, and just wanting the goal of being a nurse, and
wanting to get there.” -M1
2. “For me personally, I had a lot of support from my husband, and my mom.
Without that I would not have been able to complete the nursing program. I
had the support of a lot of the faculty that would help me as far as giving me
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opportunities to do things that would help me to better learn the different
curriculum.” -AA
3. “I would say my peers, having someone there for you, a few people there for
you to study, to get things done…working in groups, we formed bonds. And
we were able for take that to the next semester. That definitely worked…. not
everybody has that in nursing school. You kind of have to work for that.” M1
4. “Group work. I have a very close knit group of four students, and we’ve been
together since Day One. Just every day, weekends, nights, holidays, just
having that support – not just for studying, just like for venting, and
expressing, ‘Ok, this is what happened to me. This is what happened to me.’
Having that social network.” -M2
5. “I had support from my friends, and we all supported each other. I feel like it
made nursing school a more positive experience. It helped me get through,
and become successful, since I’m done.” -HL1
6. “Feeling like I was in a group of people who were all on the same kind of
mission, and working together towards it was a good experience.” - 4
7. “I think during a program like nursing school you need support, and I think
that I found a group of support within the school that was able…like we
helped each other. I don’t know if I would have made it without them. That
was positive, just reaching out to people from similar backgrounds that
understood where you were coming from. A lot of us also had families, and
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had to work, or some of us were a little bit older, second careers. I think that
was a positive experience as well.” -HL3
8. “My study habits, my parents, and my family, and friends in nursing school,
too. We all were going through the same thing at the time, so we all kind of
helped each other, and supported each other.” -HL1
Building bridges and getting advantage from studying with Caucasian students.
Participants’ expressed that they were able to build support groups with everyone
regardless of their ethnic minority, culture, faith or race. They also conveyed how
studying with other Caucasian students coming from middle-higher class high schools
helped them be more successful, through building on each other experiences.
1. “Everyone in nursing school wasn’t the same race as me, but I didn’t think
that was like a huge factor in my ability to get through. I was able to make
friends, build a support system with other people that weren’t Hispanic, and
get through.” -HL1
2. “I have to say that studying with the other Caucasian students. Being three of
us, there wasn’t much room to separate or segregate yourself from others. I
studied with a lot of the Caucasian students that did study in middle class
schools that had the knowledge, so I learned from them. A lot of things I
didn’t know, specific to our program, obviously. That helped a lot.” -AA
Institutional support.
Under institutional support two themes emerged one was on financial support and
one was on faculty support. Based on the findings, 78% of the participants were low
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income and received some form of financial support. The following excerpts below
indicate that participants’ financial support came in different forms, as grants,
scholarships, student loans and the GI bill.
1. “Financial aid helped me a lot. I was able to cover the majority of my
expenses while working part time through school.” -M1
2. “Since I was second Bachelor's I didn't receive any grants. I applied for
financial aid before school started and I was eligible for loans. I took out
loans for all four semesters.” -M2
3. “Financially, that was going to be a barrier but somehow I just kept qualifying
for grants, so that was a barrier that I thought would be present, but really it
wasn’t.” -M4
4. “I did receive financial support from the university. That was very helpful for
me because I haven’t worked throughout the whole program. So, that was a
huge help for me.” -HL2
5. “As far as financial hardships, I had financial aid so I was able to just pretty
much get through my bills, and the minimum. I wasn’t able to do other
things, but nothing went into fault. I still paid my car payment. But now I’m
left with the loans to pay back… not having to work was a big thing because I
can dedicate my time to studying.” -HL3
6. “I didn’t really have a financial barrier, because I had a GI bill, and that
helped with my education.” -HL4
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7. “When I went back to school for nursing I could barely get financial aid
because I had so many different student loans, and my GPA was horrible. I
was denied. I had to appeal. I had to pretty much beg the administrators in
financial aid for financial aid. Literally, it was an interview with this person,
and I’m pleading, and telling them how I really deserved, this time, to have
financial aid.” -AA
Faculty as facilitator of learning.
Another theme that emerged under institutional support was faculty. Participants
perceived faculty as highly positive contributors to their success in eight out of the nine
cases because they were; accepting of students’ differences, available, and highly
supportive of their students. They were perceived as setting students up for success in the
program.
1. “I think nursing school, and the faculty, and everyone overall, are really
accepting regardless of what race you are.” -HL1
2. “Some faculty were really, really great. I felt like they were learning with us,
too. They set us up for success.” -M1
3. ” I also feel that I was supported by a lot of great faculty that would answer
questions, be available, that were actually very good instructors, and made the
curriculum easy to learn, I feel that my experience was really great.” -HL2
4. “I thought the faculty were very, supportive: very open to helping students,
meeting after hours, or anytime. They were there to support us.” -HL3
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5. “My professors were amazing. Whenever I needed help or I didn’t understand
something, it was as simple as setting up an appointment or going to the office
and talking with the instructors. They’re always willing to stay longer to help
me understand a concept that I didn’t understand. Or go over simulation lab
again to really practice how to start an IV or how to place a Foley…just very
anxiety provoking procedures for me, as a student. The professors were really
there to help. That’s why I have a lot of respect for Sac. State’s Nursing
Program. The professors really want to be there. They really love what
they’re doing. They’re not just doing it because it’s a job... Some professors
just really made you feel like they were available for you day and night.” -M3
It is clear from the above quotes that participants highly appreciated their
faculty’s support and dedication to their success in the program and perceived faculty as
an asset to the program. Faculty were also viewed positively in two of the nine cases in
their attempt to reach out to a wider base of students through teaching to different
learning styles. Faculty use different modes of teaching using technology such as; video
streaming of lectures, on-line Sac-CT learning modules, online case studies, discussion
boards and simulation labs to go over different patient case scenarios in the lab. Some of
these courses were offered in a traditional face-to-face format with the instructor, while
some employ a blended format with students learning from online material and face-toface.
1. “Because I’m like a visual, audio learner –more than of a written learner. And
in nursing school, for example, a lot of the teachers, lectured on video, and
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you’d go to class and they’re lecturing and they have Power Points. And to
me the way of that kind of learning was, like, perfect.” -HL1
2. “I think that it’s a really great program, actually. I know students learn at
different levels, and at different speeds. We all learn in different ways, some
people are visual. Some people need to get their hands in there, to do things
in order to learn. Some people read. I think that there’s a lot of successful
people right now that finish this program.” -HL2
Construct IV: A Call For Change And Hope
Taking into account all the barriers and bridges that participants were able to
identify. They were asked to provide advice for prospective nursing students and to
provide recommendations to both faculty and program directors to help make Sacramento
State nursing program a better home for students coming from different
ethnic/racial/cultural and religious backgrounds. In the following section the author
discusses the construct; a call for change and hope. In this section three themes emerged:
advice to prospective students, recommendations for faculty and recommendations for
program directors.
Advice to prospective students.
All participants perceived the need to share the wisdom they built while in the
nursing program with future nursing students. They were trying to give them hope that it
is not impossible as perceived by most people, it is doable. They were encouraging by
discussing how not to give up and to be determined to reach their goal, and not to listen
to negative voices that might try to keep them from reaching their goals.
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1. “Don’t let people tell you what you can and cannot do.” -M1
2. “The best thing is just to go ahead and do it, and have the confidence in
yourself to do it.” -M2
3. “We need to take action and be the role models.”- M4
4. “Using the faculty as a resource, because if reading is an issue for you, and
lectures weren’t adequate, go up to them, and ask for help. Like hey, reading
all this is not going to help me learn. And, what is it that you want me to
focus on in these chapters that can be useful for the exam, kind of thing. If
reading is an Issue, because it was for me.” -HL1
5. “Work hard and make connections with peers and faculty to gain their
support.” -HL2
6. “The advice I would say is regardless of what people tell you, And some say,
you can’t do that. They discourage you. I would just say, surround yourself
with positive people, people who believe in you. Find yourself a good sense
of social support, and get through it. Just do it. Keep at it, and use the fact
that you’re a minority to your advantage because it really helps out other
people.” -HL3
7. “Set your goal and reach it... You just have to know it’s for a cause, so you
have to try your best, even if it’s way in the beginning with your pre-reqs. It
all counts, and it’s all going to be worth it. Try your best if you really want to
reach your goal, you have to always strive for it. No matter what course it is.
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If it’s Art class, it counts. Any class you just always have to try your best at
it.” -HL4
Recommendations to faculty.
In their recommendations, it was pointed out that some faculty are culturally
aware and others are not. For those faculty who were not culturally aware, participants
voiced three recommendations. First, they wanted faculty to be aware and considerate of
their cultural differences and cultural needs. Second, they voiced their need for faculty’s
validation. They wanted faculty to find them and check on how they are doing. Finally,
they asked to have cultural awareness as a theme running across the curriculum and not
just a one lecture or one day content.
1. “It totally varied from faculty to faculty. You have different people with
different levels of knowledge and understanding and awareness of different
cultures and faiths around them. Some people really know, and some people
are so ignorant.” -M1
2. “I guess just being considerate of that person’s values…Just being aware.” M2
3. “My best advice to faculty is to be culturally sensitive. Just being culturally
sensitive is a big thing.” -M3
4. “I would advise faculty to approach students, more like hey how are you
doing? That would be helpful because it would also give you sense of oh they
know I’m here. It would help not feeling alone.” -HL2
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5. “Those of us with children, who have to work, have to go home, do
homework with kids, we don’t have time to come find you, and sometimes it
would be nice to have them come and find us sometimes, and see how we’re
doing. That would be nice.” -HL3
6. “First and foremost, for faculty, that to try their best not to separate the
different cultures. In that, it should be congruent. In their lectures.
Everything they may talk about should address the entire patient population –
all the different cultures that we will serve, as nurses. That’s really kind of the
foundation of nursing today. I don’t think that it should be separate. I don’t
think that there should be a cultural awareness specific type separate lecture.
Cultural awareness should be throughout their teaching. It just makes it more
natural, I think it should be throughout the curriculum. I don’t think it should
be a day’s lecture. It needs to be in everything that they teach us. When
they’re talking about everything, they should address the differences, all the
time, not just in one specific lecture. I don’t think it gives cultural awareness
justice. You can’t be culturally aware on one day, in one lecture. It just
doesn’t work that way. You have to talk about it so that it’s a natural thing.
Students, that we should learn naturally, that our patients come in every shape,
color, size, sex. And that we need to be aware of that, and we need to address
it all the time. That’s what you do on a daily basis as a nurse. You don’t get
99% Caucasian, and one day get a male, or one day you get an AfricanAmerican, or one day you get a Latino, or one day you get a Muslim. It’s not
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like that. It’s all the time. I don’t think it appropriately prepares the students
who aren’t familiar with the different cultures. I think it needs to just be a part
of the curriculum. Period. Not just a separate thing that we address on – the
next two lectures are going to be culture awareness. In what they’re teaching,
they need to include the different cultures, and the differences.” -AA
Recommendations to nursing program directors.
The quote below summarizes all the recommendations provided by all nine
participants to nursing programs directors. This quote was part of what the very eloquent
African American participant had to say.
For the administration, they need to address the lack of diversity in their student
population, as well as in their staff. I don’t know what the problem is with the
diversity in faculty. If their answer is there aren’t a lot of applicants, then maybe
we need to make sure that there are more students because perhaps there aren’t
enough nurses of different racial/ethnic groups to begin with, to become faculty.
You go back to the root of that problem, which would be students. The student
population in nursing, for Sac State; I’m not sure I can’t speak to other bachelor
programs, but here is that there is not enough diversity in students. Whatever that
means. I would say, Administration, really look at those things because you’re
keeping it, maybe not intentionally, but you’re keeping it a non-diverse student
population. If you really want to change it, you have to change your entry
requirement. It’s not that you’re going to get a less deserving population of
students. You’re just going to get a more diverse student population…and your
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patients need that. Our patients need that. The nursing profession needs that. It
would be awesome. -AA
All the material presented so far describes the general findings, the constructs,
themes and subthemes that emerged from the research analysis process of all focus
groups. Subthemes are repeating ideas in relevant text by two or more research
participants. According to Auerbach and Silverstein (2003),
A theme is an implicit idea or topic that a group of repeating ideas have in
common” while a theoretical construct is defined as “an abstract concept that
organizes a group of themes by fitting them into a theoretical framework (p. 67).
In the following sections the author presents the themes that were specific to each
focus group, Muslims, Latinos and African Americans. These findings were not part of
the general findings.
Findings Specific to the Three Focus Groups
Muslims as a Focus Group
Muslim participants shared with other participants all the general findings of both
barriers and bridges. In this section the author discusses the findings that are specific to
Muslim participants. In looking at the demographics of this focus group we come across
the following findings: They were all coming from different ethnic backgrounds, from
different parts of the world. One originally coming from Afghanistan in Southwestern
Asia, one from Yemen in the Middle-East, one from Libya, in North Africa and one is
from Mexico in South America. They all spoke second languages, all women abiding by
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the Islamic dress code. The Islamic dress code or "hijab" refers to both the head covering
traditionally worn by Muslim women and modest Muslim styles of dress in general. In
Islam, the word hijab embraces the wider meaning of modesty, privacy, and morality.
Socioeconomically, they were all coming from low-income families and qualified
for financial aid, except for one who belonged to a middle class family. The Muslim
focus group is distinguished from the Latino and African American focus groups in that
all the participants were second or third generation graduating from university except for
the Latina Muslim she was the first in her family to graduate.
When asked how their experience were in the nursing program as Muslim
women, all but one expressed that they did not feel discriminated against or identified
any barriers in relation to being a Muslim woman following the Islamic dress code or
wearing the head scarf except for the feelings of alienation, marginalization and
stereotyping discussed in the general findings under cultural borders. One participant
perceived that she was discriminated against, treated unfairly and with cruelty by two
part-time faculty. One common theme that emerged was the need for accommodations.
1. “I was a minority, one of two Muslims in my class. We were about 60 which
made me feel different…I was Muslim, and already kind of like the odd one
out…It was a battle in my mind, bringing religion to school. I felt my prayer
was personal, but my desire to be open and honest about my beliefs was also
my right.” -M1
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2. “The program itself, the students were very friendly, very accepting towards,
like a Muslim woman wearing a scarf, I didn’t feel any type of discrimination
from the students or from the faculty.” -M2
3. “Honestly, I cannot recall or remember that anyone ever treated me any
different. Not my classmates or my professors...no one ever said anything
about my scarf.” -M3
4. “I found that most of my classmates were very receptive. Some of them
would even remind me, hey, isn’t it time for you to pray now? I think that
they were mostly receptive. I didn’t encounter any negative experiences
because of it.” -M4
Needing accommodations.
One common theme that emerged specific to all Muslim participants was their
need for accommodations. It was something they all expressed. As practicing Muslims
they had to abide by the Islamic dress code and to do their five prayers every day, no
matter where they are or what they were doing. They expressed their understanding of
the surrounding environment at school and the need to be flexible in requesting
reasonable accommodations.
1. “Being Muslim, there is the five prayers that we do. So, that’s really
important to me, and I always, made it a point, to find time to pray, five
times…This is very personal, it’s part of my day, part of going to school. It’s
just my lifestyle. It’s what I do…it would have been nice to have a, a place
designated for prayer.” -M1
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2. “As Muslims we have different needs: mostly prayer and dress. Those are the
two big ones. Yes, I think that we should, from the beginning, make clear
what those needs are, but also, we have to realize that we work, and go to
school, and live in a place that is not primarily Muslim. We have to also be
able to work with the people that are trying to accommodate us.” -M4
Advice to prospective nursing students in relation to Hijab.
The other theme specific to the Muslim focus group was in their call on
prospective Muslim nursing students to have faith in themselves and not to worry about
blending in. It is obvious in the quotes below that they also warned prospective Muslim
nursing students not to let the fear of being stereotyped or harassed for wearing Hijab
hold them back and encourage them to pursue leadership position because by wearing
their Hijab they no more represent just themselves they represent all Muslim Women.
They felt that this is a big responsibility on their shoulders.
1. “You’re worried about blending in, trying to be like everyone else when you
really don’t have to be, at all. Be your own person. Don’t let people tell you
what you can and cannot do.” -M1
2. “Don’t let hijab hold you back. If you project yourself in a very positive,
confident, open way, people will respond to that.” -M4
3. “Don’t let hijab hold you back. You’re no different than anybody else. You
should be proud of what you’re doing, and you’re wearing hijab because you
want to wear it, and you’re proud of it…You’re a red flag. You stand out like
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a sore thumb that you’re Muslim. And I feel like we have a lot of
responsibility to step up and take positions of leadership.” -M3
Recommendation to faculty in relation to dealing with Muslim students.
Muslim participants’ recommendations to faculty were that they wanted faculty to
be aware of their religious needs and restrictions and be considerate of that when
planning classes and learning experiences. For example, not to couple a female student
with a male partner in the lab, how they can work together and do physical assessments if
they were religiously prohibited from establishing physical contact with strange males.
Be aware and be considerate, they are calling on them to be culturally sensitive.
1. “I would want all the faculty, from the very beginning, to know my faith, and
that I pray five times a day, and I’d like prior permission to walk out for five
minutes during class, and want a designated place to pray. I would want my
faculty to be there for me, and be treated equally in every respect.” -M1
2. “There are things like …patient care for Muslims that were never brought up.
And I feel like you could put it all on one piece of paper.” -M1
3. “I guess just being considerate of that person’s values. Muslims don’t shake
hands. Women don’t shake hands with men, so that’s just like common
knowledge almost. Just to apply that in the class structure or in the
curriculum… Just being aware.” -M2
4. “My best advice to faculty is to be culturally sensitive. Just being culturally
sensitive is a big thing.” -M3
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The need to prove self.
All participants were success stories that one cannot but admire. In one of the
Muslim participants cases the participant was over achieving and feeling the burden to
prove self and prove that Muslims in general and Arabs/Middle Eastern in particular are
successful people and achievers. As if she was trying to change a negative image. In the
following quotes she told her story every time she was exposed to a traumatic or stressful
event she over achieved and tried to prove that she can be “cool” and can be the holder of
all the awards and that she was the one that stands out. She did not care if people
remember her name or not but what she cared about was that they remembered that she
was the girl with the scarf. She saw herself representing all Muslim women not just
herself and wanted all her accomplishments to be attributed to the girl with the scarf
because that will change the image of all Muslim women. The author was interested in
discussing this case because in the literature there is a lot mentioned about discrimination
against Muslims especially after September 11. In Chapter 5 the author discusses the
scientific explanation behind this girl’s reaction to traumatic incidents. The author
personally identified with this participant because she experienced similar reactions to
traumatic incidents through her journey as a Muslim woman and a nurse.
First negative incident: The effect of September 11.
I think being in high school, two weeks into high school, 9/11 happened. My
sister and I were the only ones that wore hijab. I immediately thought, Oh my
gosh, this is going to be crazy. How much are we going to get harassed in high
school? High school people are relentless. You’re 13, 14, all the way up to 18,
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and everyone is ignorant. Nobody knows anything better than what they hear
their parents say. We had a few students just really attack my sister and I.
Response.
That felt great because who would have thought out of a school of 3400 students,
over 1500 seniors, the two girls that wore hijab were going to be the ones…there
was only going to be six people elected for homecoming princess, and out of the
six two of them wore hijab. It felt great because if you asked me that freshman
year, I probably would have never thought that would happen.
Attitude.
“Just because I wear hijab, doesn’t mean I can’t be quote” quote” cool, and that I
can’t be in the popular crowd.” -M3
Subsequent negative incidents.
On campus, yes; not specifically from my classmates in Nursing…On campus,
yeah; you’re on a campus with 30,000 people, and 30,000 opinions on what
people think you are. So, yeah, I did get negative looks, but no one ever had the
confidence to actually say something to my face. What do you do when
somebody looks at you funny? You just let it go.” -M3
Response.
I remember when I was at my nursing orientation, and they were talking about
Pinning Ceremony, and they were talking about the awards. They were talking
about you get these awards only if you achieve them. I remember I told myself, I
want to get an award. I want to be one of the people that get an award, so I’m
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going to work hard to make sure that I stand out on my Pinning Ceremony. And I
did whatever I could. I got involved in CNSA. I was the Undergraduate
Representative. I did a lot of volunteering and tutoring, and it worked out in my
favor. I was excited because it makes you feel good that your hard work paid off,
and it was recognized by the faculty because they’re the ones that choose who
gets the awards. I think that was a big thing for me, a big thing for me in the
Nursing Program was to show that, out of all these people in my program, I
graduated in a class of 100, because we weren’t the average class of 60 students, I
wanted to show all the thousands of people that came to our Pinning Ceremony,
that out of all these 100s of students, it was me. I was the only Muslim girl. I
was the only one wearing hijab. I’m the one that is the student speaker. I am the
one getting the award. I’m the one that’s getting a cord from CNSA. I remember
when I left; so many people were congratulating me that I didn’t even know. I
was the only one that got called up four different times, out of a 100 people that
graduated. It felt nice to show all these people that, look, you don’t have to be the
typical, whatever you picture a nurse to look like, to be able to achieve these
things. It’s me that achieved all these things. -M3
Attitude.
I feel like I have to prove that we are successful, as a religion. We are successful
as an ethnically being middle-eastern that we do accomplish big things in life.
We do impact people. If anyone put the pressure, I put it on myself, the most.
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I don’t think anybody really made me feel like I have to prove myself, but
I feel that.as just being a Muslim, and being an Arab. I feel like I have to prove
that we are successful, as a religion. We are successful as an ethnically being
middle-eastern that we do accomplish big things in life. We do impact people. If
anyone put the pressure, I put it on myself, the most. -M3
Being a minority and subject of harassment made her stronger.
1. “When somebody challenges me that I don’t know what I’m doing, or I can’t
do it, my initial reaction is to prove them wrong.” -M3
2. “I’m not afraid to ask questions. I’m not afraid to be vulnerable because to
move up and progress, you shouldn’t be afraid. I think maybe that’s just the
way I was raised, and maybe hijab gave me that confidence. I had to build it.
I had to build it faster than everybody else because I don’t blend into the
crowd, so I had to learn to have a thick skin, and not let little things get to me,
just understand people are ignorant, and they’re going to say things when they
probably don’t even know what they’re talking about. I learned to let things
roll off of my shoulders, so a lot of the time when you get weird looks or
negative comments, it’s too much to dwell on.” -M3
3. “I’m proud of wearing this scarf. I don’t mind if people don’t know my name,
and say, Oh, it’s the girl with the scarf. It actually works in my favor.” -M3
4. “I grew up in a Muslim community here where it’s a very active community.
All my friends that I grew up with, it was instilled in us that we have to have a
voice in everything we do. If there is something that is wrong, or it’s not
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right, you have to have a voice and speak up and say this is not right. You’re
not going to treat me like this. I’m worth more than this.” -M3
Latina Focus Group
Latina participants shared with the other participants all the general findings of
both barriers and bridges. In this section the author discusses the findings that were
specific to Latina participants. In looking at the demographics of this focus group we
come across the following findings: They all came from Latin American countries. Two
were originally from Salvador one of whom was half European half Latino. Three came
originally from Mexico, of which one was a convert to Islam. They all spoke Spanish as
their second languages.
All were women; first generation going to college except for one, her parents
went to college in their country of origin but not in the US. Socioeconomically they were
all coming from low-income families and qualified for financial aid, except for one who
belonged to a middle class family.
When asked about their experiences in the nursing program as Latina women, all
participants expressed that they did not feel discriminated against or identified any
barriers in relation to being a Latina except for the feelings of alienation, marginalization
and stereotyping discussed in the general findings under cultural borders.
1. “No one was like racial, or against me and I didn’t have a moment where I
was like in danger of failing, that I would consider like negative.” -HL1
2.
“I don’t feel like I was targeted in any way for being a Latina.” -HL2
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3. “I had a good experience. I didn’t feel like I got discriminated against, or
anything like that.” -HL4
Time away from family.
Latinas perceived their culture as one that values family and social relations. One
of the themes that emerged as a common finding specific to Latina participants was the
lack of time to spend with family and friends. Not meeting their cultural obligations
created an imbalance in their lives. This also created feelings of guilt for Latinas who
had children and who felt that the time they were dedicating to their education was taking
away from their time with their kids, which was perceived as negative.
1. “A negative experience is the time away from family. My culture’s very
family-oriented, and I just wasn’t able to participate in a lot of things for two
years. But my family understood. It made it hard. I’m a single parent, so my
son as well. There were a lot of times that he was on vacation or out of
school, and I wasn’t. Since I wasn’t home or I was at school he would have to
spend the weeks with my parents, which is like two hours away. A lot of
times I didn’t get to see him during the time that he wasn’t busy with school.
That’s negative.” -HL3
2. “I really had to commit 100%; it took up a lot of my time…The fact that I had
to be so committed and I felt a little bit of an imbalance in my life because I
didn’t always have time to go and escape, to have fun…I had to continuously
tell people that I couldn’t do things because I had to study for hours on end.” HL2
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3. “Lack of social life. That was really hard.” -M4
4. “I do have four children, and it was very hard to be a fulltime mom, be a
fulltime student, fulltime wife. I couldn’t study whenever I wanted because I
had to take care of my kids, and make sure they did their homework, wait for
them to go to sleep before I could actually start studying. My kids were the
ones that were not seeing me as much. I felt bad, but I was doing it for them,
so they could have a better life in the future. When I had extra time, I’d tell
them I’m going to school for you guys, so we can have a better life.” -HL4
Advice to prospective Latinas.
It was mentioned earlier in the general findings section that the participants’
advised prospective students to have hope in that it is possible to get into the nursing
program and be successful. They also emphasized the need to encourage more Latino
nurses, to be determined to reach their goals and not listen to negative voices that prevent
them from reaching their goals. One advice that came across as specific to Latinas was
the need to get over one’s pride and ask for help from faculty when needed. Latinas
identified asking questions and asking for help as a sign of weakness in their culture and
which they thought will stand in the way of Latino students’ success.
1. “It can be done. It just takes a lot of hard work from everybody else on your
behalf.” -HL4
2. “If you need something you need to ask. You can’t wait for someone to ask
you if need help. You need to get over your sense of pride, just ask.” -HL1
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3. “Find yourself a good sense of social support, and get through it. Just do it.
Keep at it, and use the fact that you’re a minority to your advantage because it
really helps out other people…We need more people to take care of our
people.” -HL3
Recommendation to faculty.
In the following quotes, Latina wanted faculty to be aware and considerate of
their cultural difference and cultural needs. They also wanted time for cultural and
religious practices to be considered when planning the program because students need
that time to meet the demands of the program and be successful besides maintaining the
family support system they had. The second theme that emerged was their need for
faculty’s validation, they wanted faculty to find them and check on how they were doing
because culturally it was hard for them to ask for help since it is a sign of weakness.
They did not want faculty to think that they were incompetent if they asked questions.
The last thing was the need to have cultural awareness a theme running across the
curriculum and not just a one lecture or one day content.
1. “I would advise faculty to approach students, more like hey how are you
doing? That would be helpful because it would also give you sense of oh they
know I’m here. It would help not feeling alone.” -HL1
2. “Those of us with children, who have to work, have to go home, do
homework with kids, we don’t have time to come find you, and sometimes it
would be nice to have them come and find us sometimes, and see how we’re
doing. That would be nice.” -HL3
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3. “if I asked for help, I didn’t want the teachers to think, she’s not doing good,
or she’s struggling… it’s a sense of pride. You don’t want to show
weakness.” -HL1
4. “It is a sign of like weakness to ask questions…like you can’t accomplish
something on your own. There’s a big sense of pride in our culture, so that
gets in the way of things…. I think it’s cultural because we offer help, we
don’t like to ask for help.” -HL1
5. “There’s a strong family bond in the Latino community, and sometimes it felt
like you don’t have time for anything else. You should give up your life to
the nursing program, which is pretty much what you have to do. Time for
cultural beliefs or religious practices needs to be allotted into the program, if
people are going to make it through and be successful and supported by their
family.” -HL3
African American Focus Group
In this study, there was only one African American participant so there were no
other African American participants available to establish comparison. The experience of
this participant was included when comparing her experience to all the other participants
in the nursing program in the general findings of both barriers and bridges. In this
section the author discusses the findings that are specific to her as African American. In
looking at her demographic data it was found that she was an involuntary immigrant,
English was her only language.
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She was first generation to graduate but not the first in her family, as her sister
graduated before her. She is married, a mother of four and socioeconomically coming
from a low-income family and qualified for financial aid. When asked about her
experience in the nursing program as an African American woman, she did not feel
personally discriminated against in the program but was able to identify feelings of
alienation, marginalization and stereotyping discussed in the general findings under
cultural borders. She was also able to identify all the academic and structural borders that
she had to overcome to be successful in the nursing program and graduate. One theme
that emerged was feeling different (we vs. them), and the mistrust that was obvious when
she was talking about some of the incidents that she experienced in the program.
1. “…in lecture you would get a sense that they were speaking to an all-white,
female audience. Or that they were speaking about a patient population of one
culture. And they didn’t really address that people came in many different
colors.” -AA
2. “Often, things would always be described as ‘you’ll see pink skin, or you’ll
see pink nail beds or pink whatever it was. I was frustrated because we’re not
all pink, so…It really hadn’t been addressed that we’re not all pink…it was
like we’re all this one color, or all of our patients would be this one color. So
it never been addressed how would we assess patients of color. Whatever
color that may be.” -AA
3. “We also talked about cultural awareness, and that was even more offensive.
It really made assumptions…For example, when you deal with an African-
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American, they tend to speak with their hands, and be louder, and these
different things. So, you may take that as they’re angry, but they’re not.
They’re just very expressive. And in the end, if a person who wasn’t familiar
with the culture went into their interactions with that culture making
assumptions, based on what we learned out of a textbook, then that may be
offensive to the patient vs. just knowing that we’re all different.” -AA
4. “…you can’t assume that that person, just because they’re part of that culture,
participates in that. Or behaves in that manner.” -AA
5. “Often in our curriculum, even in the textbooks, it talked to one culture. A lot
of the things in there only covered Caucasian patients, culture or assessment.
It didn’t really address the different cultures. And when it did, it was
separated out. Even in the text, there were chapters on different cultures.
Even in our first semester, we talked about the history of nursing. So, in the
history of nursing we talked about all of the different contributions made by
the White population in nursing, and then everyone else were addressed in one
lecture about what African-American contributions were, and it wasn’t
inclusive, and it wasn’t very equal in discussion.” -AA
Conclusion
The findings in this Chapter reaffirm the fact that minority students; African
Americans, Latinos and Muslims have been historically underserved by the educational
system in the United States. This sets them up to failure during their college education
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years. In addition, to qualify for admission in the rigorous nursing program at
Sacramento State they have to cross more structural borders in the form of admission
requirements that act as gate keepers limiting their access to the program. If they succeed
in passing the gates and getting into the program they are then faced with new borders in
the form of academic and cultural borders. This was a very stressful process for the
participants in this study. What kept them going was the great support systems they were
able to establish through their families, peers and through establishing connections with
supportive faculty. In the following chapter, Chapter Five, the author continues the
examination of the data by expanding on the findings through a discussion of common
themes that emerged from the data. This chapter will conclude in recommendations for
programmatic improvements and suggestions for further research.
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Chapter 5
SUMMARY, CONCLUSIONS AND RECOMMENDATIONS
The purpose of this narrative phenomenological study was to explore the lived
undergraduate nursing education experiences of newly graduating African American,
Latino, and Muslim nurses. The study attempted to describe the lived experiences of
African Americans, Latinos, and Muslims in nursing education through analysis of data
derived from individual semi-structured interviews detailing the lived experiences of
these three ethnic/cultural groups. The overall aim of the research study was to explore
the nurses’ perceptions of the challenges they faced during the course of their
undergraduate nursing school and what helped them bypass these barriers and
successfully graduate. Through this study the researcher was trying to answer the
following questions:
1) What are the perceived challenges to success that Latino, African American,
and Muslim students face in a nursing program where they are in the
minority?
2) What institutional resources (student services), social capital (networks),
cultural capital (beliefs, values, and skills), and habitus (aspirations) were
necessary for their successful completion of the nursing program?
This chapter presents findings of the research in the following manner: Section
one will discuss participants’ demographic data in relation to the literature. Section two
will present findings in relation to the research questions accompanied by an
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interpretation of data related to each question. Interpretations of data are presented in
section three in relation to the literature. Section four, will discuss findings in relation to
Muslim participants. In Section five, the author discusses the relation of the findings to
the conceptual framework of the study and the emergence of a new conceptual model.
The author’s recommendations and implications for nursing education and the nursing
profession, Sacramento State school faculty and leaders, university administration and
policy makers are included in section six. Section seven, will include suggestion to
promote data driven decision making, dissemination of the study findings, limitations and
recommendation for future research. The chapter will conclude with the author’s
reflections on her experience with the research process and summary of findings.
Participant Demographics at CSUS and the Literature
This study examined all African Americans, Latinos and Muslims who graduated
from Sacramento State nursing program over a period of five semesters, from Fall 2009 Fall 2011. The percentage of African Americans and Muslims constituted each one
percent of the 362 total graduates. Latinos constituted nine percent, Caucasians 63%,
Asians 18%, and the remaining eight percent is for others including those who declined
to state their ethnicity (Figure 15).
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Figure 15
Percentage of Minorities Graduating from CSUS Nursing Program (Fall
2009-2011)
In looking at the demographics of the participants in this study 100% were
underserved minorities, 67% were first generation to graduate from college of which are
100% Latina, since the only Latina whose parent’s attended college in Mexico fits the
definition of first generation college student. According to the USA Government’s
Educational Opportunities Program, “first-generation college students” are students with
neither parent having completed a four-year college degree in the USA by the time that
student entered college. Statistical data show that the concerns are well-founded. First
generation students are less likely to graduate than peers who have at least one parent
with a college education (NCES, 2005). This poses notable retention concerns.
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It is evident in the literature, that underserved students are more likely to delay
college attendance, start their postsecondary education at a two-year institution, and
attend college part-time or sporadically (Chen, 2005). All but one participant attended
community college before transferring to Sacramento State. Participants were 100%
females, all except one, spoke other languages. Participants’ were 80% over the age of
27 years. Fifty five percent were married with children living in the same house, the
number of children ranged from one to four.
Participants were mostly low income first generation to graduate. More than half
(55%) qualified for free or reduced lunch during high school, 78% received financial aid
at the university, which means they were low income students during college and only
33% were considered ESL students and had language barriers. According to the
literature, low-income students face many challenges; they grow up in poverty and
usually attend resource-poor schools. Many are first to attend college and grow up in
environments where nobody they know has attended college. In schools, low
expectations are usually set for this class of students. They are generally typically into a
less challenging high school curriculum that does not lead to college. It is necessary to
remember that these factors are also applicable to low income Whites (Rendón, Garcia &
Person, 2004; Terenzini et al., 1994; Rendón, Jalomo, & Nora, 2000; Zwerling &
London, 1992; Rendón, 1998).
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Findings
In Relation to Research Questions
In looking at the findings of this study, there were more similarities than
differences found among the three racial/ethnic groups; African Americans, Latinos and
Muslims. This was true for both the barriers and the bridges. What was evident as a
common factor is being low income and first generation to attend college. This was valid
in the case of Latino and African American participants, and it was also true for Muslims
coming from Latino descent. In the following section the author will analyze the
research findings in light of the research questions.
In Relation to Perceived Challenges to Success
In looking at their overall experience in the program all participants viewed it as a
positive experience that was difficult, challenging, rigorous, highly demanding and
stressful. From the findings listed in Chapter 4, participants identified three sets of
borders that they needed to bridge and cross to be successful and graduate. The three
borders were Structural/systemic borders, academic borders and cultural borders (Figure
16).
Participants’ expressed their frustration at not knowing how to maneuver around
the educational system when they first started their college education. It was hard for
them since they were first generation going to college. They had to learn the system the
hard way through trial and error. Lack of cultural capital was perceived by the
participants as the direct result of the inherent problems in California’s educational
system. Structural borders were linked to the K through 12 system that was perceived as
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underserving students coming from low- income, poor neighborhood schools and who
were mostly minorities. Consequently, students reach college lacking the cultural capital
necessary to be successful in college education and hence, were more prone to failure. In
the K through 12 school system, there was a disparity noted among middle/high class
schools and inner city poor neighborhood schools. The disparity was in regards to
expectations from students’ and the quality of the educational foundation the students
received in preparing them to college. In addition, the system was perceived as
promoting social reproduction via selective streaming. According to Adelman (1999,
2006), the strongest predictor of college matriculation and degree attainment is a rigorous
high school curriculum. However, studies consistently show that underserved students
frequently do not complete a college preparatory curriculum, and often take lower-level
reading and math courses (Noeth & Wimberly, 2002; Twigg, 2005).
As for higher education, participants perceived that the system perpetuated
meritocracy, where the burden of success was all on the students, regardless of their
resources or background. Furthermore, underserved students were often not as prepared
as their Caucasian and higher-income peers and were more likely to need remedial
courses; as a result, they are required to remain in college longer, which possibly
discourages them from completing their program of study (Chen, 2005; Twigg, 2005;
Venezia, 2005). The social services system was also perceived as promoting social
reproduction by not providing students with necessary services, like medical insurance,
while going to school to earn an education and improve their socio-economic status.
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Academic borders resulted in minority students’ feeling marginalized due to
studying a Eurocentric curriculum, using books that marginalized minorities and getting
tested using standardized tests that are culturally biased. In addition, the culture and
climate of college environment that have traditionally catered to White students and those
from wealthier backgrounds required minority, low-income, and first-generation students
to negotiate many unfamiliar cultural norms, both in and outside of the classroom (Laden,
2004; Rendon, 1996; Twigg, 2005).
In addition, to having to deal with different cultural norms, the lack of diversity
among faculty and students in the higher education system made underserved and low
income students feel isolated and alienated. These feelings created new cultural borders
that participants had to cross. The cultural borders identified by the study participants
were; the lack of diversity among faculty and students, feelings of marginalization, when
they recognized that their culture was not incorporated as part of the curriculum, in
addition to, having to deal with the different cultural stereotypes that some of them were
faced with. The literature supports that underserved students’ “transition to college can
be a time of great disequilibrium” (Rendon, 1996, p. 19). Adjusting to the academic and
social demands and responsibilities of college poses many challenges for underserved
students (Rendon, 2006).
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Figure 16
Findings in Relation to Research Question 1
Findings In Relation To Resources
The data pertaining to this question were presented under the findings bridges
section. Four factors of success were identified: habitus (aspirations), social capital
(networks), cultural capital (beliefs, values, and skills), and institutional support.
Data revealed that determination was a common theme that all successful minority
nursing graduates had in common. They all had this inner drive that geared them to
persist and not give up despite obstacles and hardships. Determination was not the only
quality that helped minority nursing student become successful in such a rigorous nursing
program, their cultural capital helped them reach their goals. Data disclosed that
participants used the following factors of success: making school a priority, building
good study habits, good organization and time management.
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Social capital is yet another resource which aids in college readiness and success.
Coleman (1988) described social capital as a relational theory in that people gain more
social capital based on the people with whom they network. Three forms of networking
were important for the participants’ success, and they were; family support, peer support,
and the support they got from faculty. Data showed that the nursing collaborative cohort
model was effective in providing social capital to students by stressing the importance of
forming appropriate study groups and associating with people who have similar goals and
aspirations. They all felt secure in forming study groups in order to be successful in their
classes. Participants’ expressed that they were able to build support groups with
everyone regardless of their ethnic minority, culture, faith or race. In some cases,
studying with other Caucasian students coming from middle-higher class high schools
helped minority nursing students be more successful, through building on each other’s
experiences.
Under institutional support two themes emerged; financial support and faculty
support. Based on the findings, 78% of the participants were low income and received
some form of financial support. During nursing school, participants’ financial support
came in different forms such as grants, scholarships, student loans and the GI bill.
As for faculty, participants perceived faculty as highly positive contributors to
their success in eight out of the nine cases because they were accepting of students’
differences, available, and highly supportive to their students. They were perceived as
setting students up to success in the program.
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All participants expressed their sense of pride with their accomplishment. They
also wanted to make their loved ones who supported them through their journey proud of
them. They wanted to have a positive influence and be the role model for their younger
siblings and kids, let them know that they can go to college, achieve and be successful.
Interpretation of Research Findings in Relation to the Literature Review
In comparing the data of racial/ethnic minority representation in nursing at both
the national and the state level we reach the following conclusion: California Board of
Registered Nurses (CBRN, 2009) reports that African Americans are the most
underrepresented in the nursing students’ pool (6.7%) while Latino’s represent (17.7%).
According to the (HERSA, 2008) report, Latinos are the most underrepresented ethnicity
at the national level (6.1%) while African Americans represent 11% of the nursing
students nationally.
The percentage of African Americans and Muslims each constituted one percent
of the total Sacramento State’s nursing graduates sample population, which totaled 362
graduates, over the period of five semesters. Latinos constituted nine percent while
Caucasians constituted 63% (Table 5). This table compares racial/ethnic disaggregation
of the general population and the nurses population at; the national, state and Sacramento
State levels.
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Table 5
CSUS Nursing Graduates Ethnic Distribution in Comparison to Ethnic Distribution of
CA RNs’ Population, CA General Population, US RN Population and the US General
Population
Ethnicity
White
US
Census
2010
US
HERSA
2008
California
Census
2010
California
CBRN
2011
CSUS
Graduates
Fall 09Fall 011
65.60%
83.20%
41%
56%
63%
Asian
Hawaiian /PI
4.5%
3.6%
11%
30%
18%
Hispanic/Latino
15.40%
3.60%
39%
8%
9%
African
American
12.20%
5.40%
6%
4.30%
1%
Muslims
1-2.00%
NA
NA
NA
1%
Looking at the numbers in the table above we come to the following conclusions:
The most under-represented group among CSUS graduates are African Americans and
Latinos. Muslims seem to be equally represented in comparison to the national and state
population. There is a big demand to have more African American and Latino nurses.
Barriers
Explanations offered in the literature for the lack of success among Latino, and
African American students in predominantly White nursing programs include a number
of complex factors, such as; feelings of loneliness, alienation and isolation (Gardner,
2005a, 2005b; Suarez & Fowers, 1997), the English language (Klisch, 2000; SimsGiddens, 2000), discrimination and marginalization (Gardner, 2005a; Villarruel et al.,
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2001; Yoder, 2001; Jordan, 1996; Taxis, 2006), peers' lack of understanding and
knowledge about cultural differences (Gardner, 2005a, Wells 2007), academics
(Kirkland, 1998; Wells, 2007), and presence of multiple stressors in both internal and
external environments (Wells, 2007; Wisneski, 2003). The explanations for attrition
offered thus far, are not unique to African-American, and Latino nursing students.
Nothing was found in the literature on the experiences of Muslim nursing students.
The research findings of this study matched the findings in the literature on
nursing education with regards to identifying cultural borders and academic borders. One
finding that does not concur with the literature is relating students’ hardships in nursing
programs to the structural borders found in the educational system especially for
underserved, low-income populations. These findings were also applicable to low
income Muslim nursing students.
The deficit model and underserved students.
In the literature presented, there is an over reliance on a deficit model, in which
minority, low-income, and first-generation college students are characterized as lacking
the skills and abilities necessary to succeed (Green, 2006). This focus on deficits
emphasizes students’ inabilities rather than their abilities, and encourages policies and
programs that view underserved students as less than their peers who have traditionally
populated colleges and universities.
The deficit model has too often biased our thinking about underserved students
and provided the framework through which both K through 12 and postsecondary
systems have addressed transition problems (Christensen, 2004; Sautter, 1994). For
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many years, the deficit model approach has dominated policy makers’, scholars’, and
educators’ thinking and prompted them to focus on academic or cultural deficits that
hinder underserved students’ adequate adaptation to the college environment (Green,
2006). This focus on the students’ deficits distracted policymakers, researchers and
educators from examining the structural problems overwhelming the educational system
and precipitating these deficits. In turn, policies, programs, and educational services have
been created to alleviate these students’ deficits.
Green (2006) reports that attempts to fix students’ deficits have shown some
positive results, but many underserved students continue to demonstrate negative
educational outcomes. However, the deficit model still frames many educational
reforms, despite research demonstrating the negative effects of deficit thinking on
underserved students and evidence of persistent, inequitable educational outcomes
(Christensen, 2004; Stanfield, 1999). Furthermore, the public began to recognize that its
citizenry comprises many peoples with varying cultures and values and agrees with the
notion that all students should be aided in reaching their greatest potential. A critical
examination of the educational pipeline is needed to detect which structural policies,
programs, or common practices needs to be fixed.
Bridges
Several factors of success were identified in the literature. These factors helped
nursing students be successful during their nursing education. Determination was a big
indicator of success (Gardner, 2005a; Bond et al., 2008; Jordan, 1996; Taxis, 2006).
Another factor of success was building social support through reaching out to family,
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peers, and faculty members (Taxis, 2006; Wells, 2007; Bond et al., 2008). Adequate
financial support in the form of scholarships, loans, grants, and employment was also
identified as enhancing success (Taxis, 2006; Sims-Giddens, 2000; Bond et al., 2008).
The findings in the literature concurs with the findings of this study, in which, Habitus or
determination was identified as the main driving force gearing participants toward
academic success despite hardships. Securing financial support was also identified as a
big contributor to success. Finally, social capital was also a great contributor to success
of all participants. One theme that emerged in this study and was not in the literature is
cultural capital.
Cultural capital.
The condition that contributes to being incorporated or rejected into a new society
is cultural capital. Cultural capital has to do with the general cultural background,
knowledge, disposition, and skills that are passed down from one generation to the next.
It includes ways of talking, modes of style, acting and socializing, understanding
expected behaviors, forms of knowledge, values, and language practices. The more
cultural capital one acquires, the easier it is to blend into a new society. Bourdieu was
the most influential sociologist in determining the meaning of the modern use of
cultural/social capital in the context of academic achievement.
Trueba (2002) argued that whereas Latino immigrants have often been seen as
lacking the necessary cultural capital to succeed in the mainstream population, they, in
fact, possess more cultural capital through their ability to master different languages,
cross racial and ethnic boundaries, and through their general resiliency to endure and
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negotiate social, political, and economic hardships. Immigrants from many nations come
to the United States hoping that their children will realize dreams that they themselves
could not achieve in their native countries. They are usually left with the task of
asserting their language, culture, and race and at the same time challenging the
categorization of people by language, culture, national origin, or skin color. This positive
interpretation of cultural capital, lead to the emergence of the theme of resiliency.
Resiliency.
Almedom et al. (2008) stated that the bulk of literature on resilience and related
psychological constructs of ‘hardiness’, ‘mastery’ or ‘thriving’ in the face of adversity is
historically located in social and developmental psychology, mainly focusing on
strategies of mental and social defiance among children and youths living in sub-optimal
home and neighborhood environments. The concept has only recently emerged in studies
focusing on students’ learning contexts and experiences in higher education. Walker et
al. (2006) defines resiliency as the “…ability to recover rapidly from difficult situations”
and “…capacity to endure ongoing hardship in every conceivable way” (p. 251).
Participants in this study demonstrated a high level of resiliency.
Trueba (2002) defines transnational people as; minorities coming from a different
country speak two languages and can function effectively in two or more cultural
environments. In addition, their struggles to move up the socioeconomic ladder are
guided by traditions and ethical principles that they have acquired from their parents and
extended family. The values and virtues that enhanced the survival of the parents in a
host country, by working very tough jobs and adapting to a lifestyle often in oppressive
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and difficult working conditions subject to discrimination and abuse, this, have enriched
their social and cultural capital and provided transnationals with a unique resilience. This
resilience is the basis for the superior social and cultural capital of transnationals. This
proved to be true based on the findings of this study where eight out of the nine
participants’ parents came from a different country and spoke other languages.
Findings in Relation to Muslim Participants
In reflecting at the findings of this study, all focus groups had similarities more
than differences. The main indicator for struggling or success in the educational system
was not belonging to a certain racial/ethnic or religious group, but rather the socioeconomic status of the participants and whether they were first generation to graduate
from college or not. The two main findings specific for Muslim nurses were the need for
certain religious accommodations and the consequences of Islamophobia.
The accommodations that Muslim nursing students demanded were all related to
their religious practices; for example; the need to have a place designated for prayers on
campus, be allowed to modify the nursing clinical uniform to meet the requirements of
the Islamic dress code; and requesting not to be paired with male colleagues in labs to
practice skills. As for the consequences of Islamophobia the concept of post traumatic
growth emerged.
Islamophobia post September 11
Islamophobia (2006), via Webster’s Online Dictionary, refers to prejudice or
discrimination against Islam or Muslims. The term itself dates back to the 1980s, but
came into common usage after the September 11, 2001 attacks. In 1997, the British
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Runnymede Trust defined Islamophobia as, “dread or hatred of Islam and therefore, to
the fear and dislike of all Muslims,” stating that it also refers to the practice of
discriminating against Muslims by excluding them from the economic, social, and public
life of the nation. It includes the perception that Islam has no values in common with
other cultures, is inferior to the West and is a violent political ideology rather than a
religion. Professor Roald writes that steps were taken toward official acceptance of the
term in January 2001 at the “Stockholm International Forum on Combating Intolerance,”
where Islamophobia was recognized as a form of intolerance alongside Xenophobia and
Anti-Semitism.
Arab and Muslim Americans were traumatized three-fold, after the 9/11 attacks,
the devastation of the attack itself, the backlash from individuals and new government
policies targeting this population, such as the Patriot Act. That trauma only added to
people's existing trauma, many people come from conflicted areas, like Iraq, Lebanon,
Palestine and Afghanistan. Immigration itself can be traumatic. Arabs and Muslims lost
their sense of security, they were fearful of hate crimes and threats to their safety. They
also suffered anxiety about the future, isolation and loss of community and
stigmatization. Abu-Raiya and Pargament (2011) reported anxiety, depression and even
post-traumatic stress disorder among Arab and Muslim Americans. But they have also
found effective coping and resilience, especially among young Muslim Americans.
There is a strong sense of American-ness among young Muslims in the United States,
which gives them resilience. The fact that young Muslims can experience high levels of
discrimination and still identify as Americans is a unique phenomenon (Sirin, 2007).
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The rhetoric has not softened since then, thanks to anti-Muslim campaign
messages from political candidates, hearings on Muslim radicalization on Capitol Hill
and the controversy over a proposed Islamic center near Ground Zero. According to the
Pew Research Center (2009), the number of Americans with favorable views of Islam
dropped from 41 percent in 2005 to 30 percent in 2010. In addition, there are things that
are said in the media about Arabs and Muslims that would never be tolerated or said
about any other group. Muslims receive constant messages about how their community
is full of terrorists, ignorant people, and oppressive people.
Muslims Coping Methods
The coping methods Muslim Americans choose play a crucial role in how well
they handle ongoing discrimination and harassment. They used both religious and nonreligious means of coping with these stressful events. The non-religious coping strategy
of reaching out to others, both Muslims and non-Muslims, resulted in positive changes,
such as personal strength and an appreciation of life. Those who isolated themselves
from others experienced greater depression and anger. Researchers found that positive
religious coping was associated with greater post-traumatic growth, while negative
religious coping was associated with higher levels of depression (Abu-Raiya &
Pargament, 2011).
Post Traumatic Growth
Post Traumatic Growth (PTG) was another theme that emerged from the study
findings and it was specific to Muslim participants. PTG as defined by Tedeschi and
Calhoun (2004) as the experience of positive change that occurs as a result of the struggle
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with highly challenging life crises. It is manifested in a variety of ways, including an
increased appreciation for life in general, more meaningful interpersonal relationships, an
increased sense of personal strength, challenged priorities, and a richer existential and
spiritual life. Posttraumatic growth describes the experience of individuals whose
development, at least in some areas, has surpassed what was present before the struggle
with crises occurred. The individual has not only survived, but has experienced changes
that are viewed as important, and that go beyond what was the previous status quo.
Posttraumatic growth is not simply a return to baseline-it is an experience of
improvement that for some persons is deeply profound (Tedeschi & Calhoun, 2004).
This is the explanation behind what happened to three of the Muslim women in
this study. Their posttraumatic growth occurred with an attempt to adapt to the aftermath
of September, 11. They demonstrated the following characteristics: greater appreciation
of life, changed sense of priorities, warmer more intimate relationships, greater sense of
personal strength, and recognition of new possibilities or paths for one’s life and spiritual
development. They were all extravert and open to experience. Also, their optimism
made them better able to focus their attention and resources on the most important
matters, and disengage from uncontrollable or unsolvable problems. Their high level of
confidence also played a role in their ability to persist into growth.
Findings in Relation to the Conceptual Framework
The Relevance of the Five Tenets of CRT within Higher Education CRT’s
framework is comprised of the following five tenets: counter-storytelling; the
permanence of racism; Whiteness as property; interest conversion; and the critique of
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liberalism (DeCuir & Dixson, 2004; Ladson-Billings, 1998; McCoy, 2006). All but one
tenet were true per the findings of this study. The educational system was found to have
institutionalized discrimination leading to social reproduction and maintaining status quo.
Counter-Storytelling.
Is a framework that legitimizes the racial and subordinate experiences of
marginalized groups (Ladson-Billings, 1998; Parker & Villalpando, 2007)? DeCuir and
Dixson stated that counter-stories are a resource that both expose and critique the
dominant ideology, which perpetuates racial stereotypes. Counter-stories are personal,
composite stories or narratives of people of color (Delgado Bernal & Villalpando, 2002).
The use of counter-stories in analyzing the climate in nursing education provides faculty,
staff, and students of color a voice to tell their narratives involving marginalized
experiences. Counter-stories can assist in analyzing the climate of a nursing program and
provide opportunities for further research in the ways which an institution can become
inclusive and not simply superficially diverse. This goal is important to keep in mind
when institutions work toward creating a diverse educational community. An institution
can aim to increase diversity by increasing the number of students of color. However, if
the institution does not make the necessary changes to make the program climate
inclusive, the institution will have a difficult time maintaining diversity. In many cases,
counter-stories support the permanence of racism, which is the second tenet of CRT.
The permanence of racism.
It suggests that racism controls the political, social, and economic realms of US
society. In CRT, racism is seen as an inherent part of American civilization, privileging
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White individuals over people of color in most areas of life, including higher education
(DeCuir & Dixson, 2004; Delgado, 1995; Ladson-Billings, 1998; Ladson-Billings &
Tate, 1995) and hence, nursing education. In higher education, racism may be analyzed
through a lens that examines the structural impact. When higher education ignores the
existence of systematic racism, diversity action plans become ineffective (Iverson, 2007).
Instead, these initiatives work to propel and reinforce structural and institutional racism
(Ladson-Billings & Tate). Therefore, it is important to consider, how well intended
institutional processes and procedures can potentially promote racism when working
toward improving an institution’s plan for diversity and inclusion.
Whiteness as a property.
Professors are seen as owners of the curriculum. Therefore, they have the
autonomy of designing courses according to their own understanding of their
philosophy of knowledge, which can work against students of color (Patton et al.).
This institutional power further reinforces the notion that, being White is more
valuable and important than being a person of color (Patton et al.). This systemic
reality works against building a diverse and inclusive nursing education environment
because it supports the imbedded hierarchical racist paradigms that currently exist in
our society.
Critique of Liberalism.
It stems from the ideas of colorblindness, the neutrality of the law, and equal
opportunity for all (DeCuir & Dixson, 2004). Colorblindness is a mechanism that allows
people to ignore racist policies that perpetuate social inequity (DeCuir & Dixson, 1999).
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The lack of inclusivity in the academic curriculum (Ladson-Billings, 1998) and student
development theory used by student affairs professionals (Patton et al., 2007) supports
the notion of colorblindness that works against dismantling social inequities. In order to
take a closer step towards eradicating racism on college campuses, and hence in nursing
programs, student’s affairs and academic affairs need to incorporate dialogues around
race throughout the curriculum and student activities (Patton et al.). Institutions of higher
education must recognize and work toward dismantling colorblind policies (Iverson,
2007).
Academic Capital Formation (ACF) Theory
The second theory, that was used is the theory of Academic Capital Formation
(ACF), which was developed by Edward St. John through identifying claims about social
processes in human capital theory (Becker, 1975), social capital theory (Coleman, 1988),
and social reproduction (Bourdieu, 1972) theories. ACF was the frame work used to
highlight the strategies necessary for students of ethnic minority origins to help increase
their access to and success in rigorous nursing education programs. Cultural capital,
social capital, and human capital (habitus) provided frames for which success in nursing
education can be reached (Figure 2). Based on the findings outlined in chapter four, a
new conceptual model emerged.
A New Conceptual Model of the Findings
The educational pipeline is defined as; the continuous progression from high
school to college and into the workforce. The educational pipeline was originally
designed with middle class Caucasian students in mind, who were the majority at the
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time. All students, including those who have been historically underserved in institutions
of higher education, are expected to progress through the educational pipeline and
ultimately become productive citizens who contribute to national, state, and local
economies (Ewell, Jones & Kelly, 2003; National Center for Public Policy and Higher
Education, 2004).
In the new conceptual model titled First Generation Low-income Nursing
Students and the Educational Pipeline (Figure 4). The top arrow titled Middle and Upper
Class Students represents the educational journey of students belonging to this specific
social economic class. This path is very simple, easy to anticipate, and relatively easy to
plan for. These students can navigate their way easily through the educational system
without encountering significant borders, since they share the same world of the
educational system. This is why they were given the same color.
The red arrow at the bottom titled First Generation Low Income Students
represents the educational journey of students belonging to this specific social economic
class. There are many borders that separate them from the educational system.
Historically, underserved students continue to face difficulties as they attempt to progress
through the educational pipeline, and leaks at critical points of transition are leaving them
vulnerable. The structural borders are encountered in both K-12 and higher education
systems. Problems encountered in the K-12 school system lies in the disparity among
middle/high class schools and inner city poor neighborhood schools. The disparity is in
regards to expectations from students’ and the quality of the educational foundation the
students receive in preparing them to college, in addition to promoting social
172
reproduction via selective streaming. As for higher education, the system did perpetuate
meritocracy, where the burden of success is all on the student regardless of their
resources or background. Academic borders were also identified; these borders included
lack of academic capital, Eurocentric curriculum, lack of students’ voice and the fear of
challenging authority. In addition, there was the lack of diversity and role models among
faculty and fellow students. Moreover, students had to deal with feelings of
marginalization, alienation and in some cases discrimination. All these factors resulted in
students experiencing academic and cultural incongruity.
According to a 2005 special report issued by the National Center for Public Policy
and Higher Education (NCPPHE), “the educational attainment of young Americans is
declining” (p. 1A), and degree attainment for Latinos and African Americans of collegegoing age is less than half that of Whites and Asians. The educational pipeline has
become increasingly problematic for underserved students due to misalignments between
K–12 and postsecondary curricula, graduation requirements, and college admissions
requirements that focus heavily on high school courses taken and performance indicators,
including class rank and achievement test scores. Because minority student populations
are emerging as the majority in two-year colleges (Laden, 2004) and are currently the
majority in many large urban school systems, they are more affected by pipeline leaks
and misalignment than other students.
The incongruity of the college world and the world of underserved students and
the dissimilarity and disconnectedness of both worlds creates barriers and transitional
problems when crossing the academic border. Academic incongruity occurs when
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students are unable to fully function in an academic environment where they have few
faculty role models, the curriculum is Euro-centered, and the perspectives of students are
silenced or marginalized (Rendon, 2006). The academic incongruity, in addition to lack
of diversity among students, staff and faculty leads to the rise of cultural borders, feelings
of alienation and marginalization. In the presence of cultural stereotyping, this results in
cultural incongruity and dissonance. This was evident in the participants’ of this study,
with two participants feeling discriminated against.
To deal with cultural and academic incongruity, many students turn to their
families and siblings for support if they happen to have attended college themselves.
Others form peer groups on campus to maintain their own cultural identities (Rendon,
2006). With lots of resiliency, habitus and support from their families, peers and faculty;
low income first generation students can then build the bridges necessary to cross the
borders between both worlds and successfully graduate. This is how the participants of
this study were able to persist and be successful. This is when the color of the arrow
changes to resemble that of the academic pipe line. If they surrender to the incongruity
between the two worlds, it is when they filter out of the system.
In the following section the author discusses her recommendations to solve the
issues identified in the findings of this study.
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Figure 17
New Conceptual Model: First Generation Low-income Nursing Students
and the Educational Pipeline
Middle and Upper Class Students
First Generation Low Income Students
Academic Incongruity
Cultural Incongruity
Filtered Out of the
Educational System
Habitus, Cultural Capital
Social Capital (Family, Peers, &
Faculty)
Institutional Support
Family Support
Peer Support
Recommendations
The more educators, nursing programs’ leaders, university leaders, and
policymakers understand about the structural barriers faced by underserved students, the
closer the educational system will come to developing workable strategies for improving
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students’ educational attainment. The following are recommendations for nursing
faculty, program administrators, university administrators and the legislature.
Recommendations for Faculty
To improve the retention and graduation rates of African-American, Latino and
Muslim students, there needs to exist an educational environment conducive to learning
for all students, regardless of cultural, ethnic, or racial background.
Faculty needs to broaden their cultural awareness; this can be achieved through
cultural awareness or sensitivity training workshops that allow faculty to gain some
understanding of problems faced by minority students (Yoder, 1996).
Faculty need to question cultural biases in the curriculum they teach. Many
nursing programs are based on a Eurocentric educational model that forces minority
students into the “mainstream so that they will acquire the knowledge, skills, and abilities
valued” (Coleman, 1998, p. 56) by the majority population. Faculty also do not question
the effects that biased curricula may have on minority students (Tanner, 1996).
It is crucial for faculty to integrate cultural beliefs and practices into the nursing
curriculum. Incorporating cultural variations into the schema would challenge all
students to take into consideration the differences between people of other racial and
ethnic groups, thus improving the quality of care provided to culturally diverse
populations (Nugent et al., 2002a; Childs, Jones, Nugent & Cook, 2004).
Faculty need to reach out to students from under-represented and underserved
backgrounds. Scholars focusing on student success usually point to the notion that
students must get involved/engaged in institutional life. However, literature supports that
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many low-income, first generation students benefit from validation. According to
Rendon (2006), validation and involvement are two different constructs. The notion of
involvement requires students taking the initiative to get engaged on a campus that offers
services and programs for students to get involved. However, validation requires college
faculty and staff to take the initiative in reaching out to students to assist them to learn
more about college, believe in themselves as learners, and have a positive college
experience. While involvement in college and getting engaged in institutional life are
certainly important activities that can promote retention and student development,
underserved students who have experienced invalidation in the past (e.g., being called
lazy; or being told “you will never succeed” or “you are a failure”) are not likely to ask
for help, get involved and/or utilize campus services easily (Rendon, 2006).
Recommendations to Sacramento State Nursing Program Leaders
There is a call for Sacramento State nursing program leaders to be become
transformational change leaders. According to Bess and Dee (2008) transformational
change produces a major change in the current organization’s strategy. Transformational
change can be best achieved through planned change in an effort to improve
organizational processes. Successful leadership is to maintain equilibrium between
organizational stability and ongoing change and development. This equilibrium can be
achieved through the utilization of feedback sources both external and internal. One
external feedback source that leaders need to respond to is represented in the change in
population and students’ demographics.
177
In looking at the external feedback through comparing the demographic data of
the Sacramento region to the student population at Sacramento State it is concluded that
the student population at Sacramento State is a good representative of the region’s
population. On the other hand, when comparing the student population in the nursing
program to that of Sacramento State campus and the Sacramento region we will find a
big discrepancy. In the nursing program the student population is not a good
representative of the regions or the university’s demographics in three areas, gender
distribution, African American and Latino’s ethnic populations (Table 6).
Table 6
Ethnic Distribution of Sacramento State Nursing Students
Ethnicity/ Gender
In Sacramento
2008
CSUS Students
2009
Nursing Students
2009
White
64%
42%
50%
African American
7%
7%
3%
Asian
11%
10%
25%
Latino
17%
16%
5%
Native American
1%
1%
1%
Hawaiian /Pacific Is.
0%
1%
1%
-
42%
15%
50.8%
57.4%
90%
Unknown
Female
Table 6. Compares the distribution of population by ethnicity and gender among CSUS students, Nrusing
students and Sacramento population at large. Data on nursing students taken from CSUS (Tobar & Wall,
2009) website and Census Bearue, 2008.
178
Unlocking gates of access.
The school of nursing leaders needs to reconsider their admission requirements;
unlock the gates of access to the nursing profession in the face of more well deserving,
underserved minority students to attend the school. This commitment should be based on
what is in the best interest of the population for whom we provide health care. Diversity
is one of the core values of Sacramento State’s nursing program. Program leaders have
an obligation to be committed to diversifying student and faculty populations.
Three years ago, the school of nursing applied for a grant called “Scholarships
for Disadvantaged Students” sponsored by the US Department of Health and Human
Services, Health Resources and Services Administration (HERSA). As a result of getting
this grant the school of nursing revised its admission criteria and added three extra points
to the application of students coming from low socioeconomic status or attending a
disadvantaged high school. In addition, students who speak a second language receive
three additional points too. Eligible students are those who speak Spanish, Chinese,
South East Asian Languages, Indian Languages (e.g. Hindi, Punjabi), Tagalog
(Philippines), Russian, Farsi, Arabic or American Sign Language. These languages were
chosen based on census data and the needs of the regional clinical facilities. Giving these
extra points on the application ended up increasing the number of minority students, and
those who are socioeconomically disadvantaged. Even though, the number of minority
students in the program have increased in the past two years, it still does not resemble
Sacramento State student population or the Sacramento region population at large.
179
More role models.
The shortage of minority faculty within the institution also needs to be addressed
by the administration. According to the AACN (2009), 8.7 percent of all full-time faculty
are from different racial and ethnic groups: African- American, Asian/Pacific Islander,
American Indian/Alaskan Native, and Hispanic (Williams, 2001). “An all-white, allfemale teaching staff” (Williams, 2001, p. 14) within a school of nursing is not likely to
attract large numbers of minority students. Therefore, the administration must strive to
increase the representation of minority groups within the faculty ranks. However, the
number of minority faculty in higher education is dependent on the number of minority
students graduating from schools of nursing that pursue graduate degrees and then return
to institutions of higher learning as faculty. Consequently, retention efforts targeting
students from diverse backgrounds are not only important to increasing diversity within
the nursing workforce but are also important within the academic arena.
Faculty at Sacramento State nursing program lack diversity both ethnically and
gender wise (Table 2). Therefore, the goal for transformational change is to recruit more
males as well as African American and Latino students and faculty.
180
Table 7
Ethnic Distribution of Sacramento State Nursing Faculty
Faculty distribution
In Sacramento State at large
The Nursing Program
Total number
787
64
% Females
48%
95%
% Whites
72%
95%
% Minorities
27%
4.6%
Table 7. Compares the distribution by ethnicity and gender among CSUS faculty and the Division of
Nursing faculty. Data on faculty taken from CSUS website and (Tobar & Wall, 2009).
McKee (1998) provides an interesting insight into change management by
reflecting on the difference between change and transition. He states that changes are
successfully made by organizations, but they fail in the process of transition. Change is
physical, like moving from point A to point B, but transition is a psychological process
that people need to go through to come to terms with the new situation and this takes
time. Transition starts with an ending. For people to successfully make a change, they
must leave the past. Transition, as an inward psychological process, happens much more
slowly than the outward physical change. Unless transition takes place, change will not
work.
Recommendation to the University
1. Sacramento state should provide realistic and specific training to faculty and
students to improve the success of students from all ethnic groups. This
training might include communication across cultures, strategies for
identifying students who are having difficulty, counseling and mentoring
181
techniques, and developing unbiased course material and tests. Ideally, such
training should be offered to all faculty at the university, not just nursing
faculty.
2. The university should provide the financial support needed to increase their
recruitment efforts for minority faculty.
Recommendations for Policy Makers
1. The ideal solution involves improving primary and secondary education so that all
high school graduates are adequately prepared for their future studies. This can
be achieved through the following:
 Aligning high school curricula, graduation standards, and assessments with
the expectations of postsecondary educational institutions and employers.
 Holding high schools accountable for increasing the percentage of graduates
who complete a curriculum that prepares them for postsecondary education
and today’s information-based workforce demands.
 Creating governance mechanisms and financial incentives to align K-12 and
postsecondary planning and budgets.
 Providing feedback to high schools by creating a system for tracking students
across the K-12 and postsecondary education systems and into the workplace.
2. The Governor and Legislature should provide nursing programs with additional
funds for support services. For example, nursing programs should offer ESL
students remedial support services, and tutoring programs. Remedial support
services can help address deficiencies in the basic preparation of nursing students.
182
3. The Governor and Legislature should increase the amount of need-based financial
aid available to nursing students, so fewer students have to work to support their
studies. Nursing is a demanding rigorous major and it is very hard for the
students to work and meet the demands of the program at the same time.
Financial aid allows students the time to focus on their coursework, and thus can
increase the productivity of the nursing program. Such financial aid should be
based on the financial need of students. Currently existing programs, such as
those administered by the Health Professions Education Foundation in the Office
of Statewide Health Planning and Development, could efficiently increase the
amount of aid available if given sufficient funding. Develop financial aid policies
that provide incentives not only to attend but also to complete nursing education.
4. The Governor and Legislature should target funding increases to programs that
have high minority completion rates and high NCLEX pass rates. Additional
funds also should be targeted to programs that have significant improvement in
their minority completion and NCLEX pass rates. California faces a large budget
deficit and must spend its limited funds in the most efficient manner possible.
Thus, the author recommends that any additional state funds allocated to nursing
education be targeted at the programs that can produce the most diverse nurses.
Recommendations for Nursing Education to Move to Resilient Thinking
The author would highly recommend moving from multicultural education into
global education based on building resilient thinkers and pedagogy that can survive the
increased diversity and meet the demands for globalization. The interest in resilience
183
stems from our concerns with social justice, equality and diversity policies and practices
across increasingly complex and globalized higher education environments. This is also
an interest in the context of adult learning within university settings as it may relate to the
growing economic and emotional challenges and high levels of competitiveness students
face in nursing education (Caruana & Ploner, 2010; Leask, 2006).
Drawing on Gould’s (1995) critique that multicultural education tends to teach
students to look at rather than into the lives of the other, De Vita and Case (2003) argue
for a more open-ended form of pedagogy which ensures that cultural differences and
worldviews are heard and explored and hence allows conversations among different
voices and the discovery of cultural perspectives that are too often absent in traditional
academic narratives. Students’ benefits from cross-cultural encounters tend to be
incidental in the absence of the conscious use of difference in the curriculum which is
resilience-based and meaning-orientated (Harrison & Peacock, 2009).
With the new innovative technology and media, there is a move in education
towards globalization to meet the needs of the new diverse, multicultural student body
and prepare them to face the challenges and survive in a global society. To accomplish
that it is necessary to stop focusing on building critical thinking in our students and move
towards building resilient thinking. Winder (2006) describes resilient thinking as a form
of ‘creative problem solving’, the capacity to be at once ‘flexible’ and ‘accurate’, the
ability to see and consider different points of view and to continue with daily life despite
obstacles. Folke et al. (2010) argue that besides persistence and adaptability,
transformability is a defining component of resilient thinking and relates to the capacity
184
to create new ‘stability domains’ and to cross “…thresholds into a new development
trajectory. Deliberate transformation requires resilient thinking…” (Folke et al., 2010, p.
25).
Decision Making, Study Limitations and Suggestions for Future Research
Data Driven Decision Making
For successful implementation of all the recommendations listed above, we need
data to drive decision making at all levels. A state-wide data system or a data bank
should be created to enable tracking of students from K-12 to the post-secondary and into
the workplace. The fact that records in the K–12 and postsecondary systems are not
linked impedes creation of a high-quality data system spanning the K-16 continuum. If
such a system is created researchers can then easily track students’ performance
throughout the system and better specify areas in the educational system that needs
improvement.
Dissemination of the Study Findings
Results of this study will be disseminated at the university level, the state level
and nationally. At the university level the findings of the study will be presented to the
faculty and staff of Sacramento State School of Nursing, and the university’s Scholarly
Activities Committee. At the state level, the author is planning to present the findings of
her study to the Office of Statewide Health Planning and Development (OSHPD), and the
Health Workforce Development Council and other legislative committees dealing with
diversity issues in higher education and the health sector. Nationally, the author is
185
planning to publish the findings of her study in national journals on higher education and
diversity.
Limitations
In addition to the limitations mentioned earlier, more limitations of the study
should be mentioned. The present study has only considered Latino, African American,
and Muslim nurses in analysis, yet there are other minority groups in the population that
deserve attention. Participants in this study came from one main source, they were all
graduates of Sacramento State nursing program, these participants were self-selected, and
therefore, generalizations of the findings to the general nursing students’ population
should be made with caution.
Recommendations for Future Study
Follow up studies are needed to examine more closely the factors contributing to
success of underserved and under-represented minority nursing students in particular
African Americans, Latinos and Muslims. The author recommends a bigger scale study
that targets African American nurses at the state level. It is important to know why this
population is severely under-represented in the nursing profession in California.
The author would also recommend repeating this study on a larger scale
incorporating minorities from other ethnic groups and low-income Caucasians, including
graduates from other nursing programs. This will help identify any disparity in academic
performance between low-income minorities and low-income Caucasians.
186
Author’s Reflections on the Experience with the Research Process
I will start by introducing myself. I came originally from the Middle East. Both
of my parents are Lebanese coming from south Lebanon, a very small country in the
Middle East. I was born in Kuwait; my parents loved traveling and seeking better life
opportunities. I was raised between Kuwait, Lebanon, Nigeria, Saudi Arabia, and Egypt.
As for academics, I attended schools in all of these countries so I was exposed to
different educational systems. I also had the chance to work with many people of diverse
backgrounds through my profession as a nursing faculty in Lebanon, the United Arab
Emirates and here in the United States. I see myself as having a universal identity; I do
not belong to a certain ethnicity. My ethnicity is a Human Being with no ethnic/racial
borders. My home is Earth with no geographical borders. I see myself as an extremely
resilient human being who survived the civil war in Lebanon and finished my bachelor
degree despite of that, studying in bunkers and on candle lights.
I am also a practicing Muslim and I abide by the Islamic dress code. I came to
this country two years before September 11th, attacks. I have witnessed how the
sentiment of the public changed towards Muslims especially Muslim women. I
personally was the victim of hate on several occasions. I survived the aftermath of
September 11, while I was attending graduate school at Sacramento State and
successfully graduated. On the other hand, I have seen people extending their hands and
reaching out to me. I did experience Post Traumatic Stress several times in my lifespan
as a result of my struggle with highly challenging life crises, similar to what happened
with Muslim participants in my study.
187
The research process was my journey to discover the perceptions of few underrepresented nurses. During the process I found out that I was discovering myself, too.
When I first wrote down my own biases before I even started my research, I wrote down
my feelings of isolation, alienation and discrimination as part of my experience in the
educational system in this country. Being a minority myself and coming from overseas
to pursue higher education in this country, I identified with my research participants. I
saw myself in these women, who worked very hard competing with mainstream students
to accomplish themselves and to secure a better future for them and their loved one.
When I first started my study, I had the perception that I will be meeting people
who are frail, and insecure, I caught myself making assumptions about my participants,
before I even met them. After listening to them I knew that I was wrong. What really
amazed me during this process is how articulate, strong and resilient were these women.
The way they expressed themselves, analyzed their experiences in the nursing program,
and advocated for future nursing students was really an eye opener for me.
In looking at the findings of the study, I too see myself as first generation to go to
college, my parents never went to college but I did together with my other six siblings,
the seven of us are university graduates with four finished a master’s degree and I am the
only one pursing a doctoral degree. Despite all hardships and borders, I would not have
made it without my strong faith, habitus and the support of my loving family, friends and
professors. I was honored to be able to work with such great women and I hope that
together we can help make nursing school experience easier for future nursing students.
188
Conclusion
With the changing face of the US population, minorities are under-represented in
the nursing profession. According to the literature, this is negatively reflecting on
patients’ health. Therefore, it is imperative that the nursing workforce be reflective of the
patient population for which it provides care. This can be achieved by increasing access,
retention and graduation rates of minority students from schools of nursing. The first
step starts with understanding that success of underserved students requires a deepened
awareness of educational and social inequalities, unspoken assumptions about students
who do not seem to match traditional postsecondary institutional environments, and the
unique factors that form their success. Policy makers, K through 12 and postsecondary
institution leaders should be engaged in transforming the academic, social, and cultural
structures in the educational pipeline to foster success of all students. Currently,
postsecondary institution leaders are challenged with serving a student population that is
resilient, values diversity and seeks to realize an education that values them as capable
learners and views them as whole human beings. Transforming the existing educational
system will facilitate graduating more diverse nurses, who are capable of meeting the
demands of our growing diverse population, and help eliminate health disparities among
the different ethnic groups.
189
APPENDICES
190
Appendix A
Consent to Participate in Research Form
(Purpose of the Research) You are being asked to participate in a research study which
will be conducted by Nassrine Noureddine, a student in the Independent Doctoral
Program at California State University, Sacramento. The study will explore the
perceptions of nursing program experiences for African American, Latino, and Muslim
nurses who have graduated from a 4-year university nursing program. Challenges as well
as facilitators they faced during the course of their undergraduate nursing school program
are of interest in this study as well as what helped them overcome challenges to
successfully graduate from their program. The reason for doing this research study is to
gain a better understanding of nursing school experiences from the perspective of African
American, Latino, and Muslim nursing graduates.
(Research Procedures) The following procedure will be followed during this research
study:
1. You will be asked to answer a series of questions from a prepared questionnaire
during an individual interview conducted by the researcher. The interview will be 60
minutes long.
2. With your permission, the interviews will be audio-taped.
3. The researcher will take notes during the interview.
4. The audiotapes will be transcribed for analysis.
5. Your interview transcript will be shared with you to make sure that it holds the
meaning you intended to convey.
6. The audiotapes and the transcriptions will be destroyed within nine months of the
interview.
(Risks) There may be a minimal risk as a result of participating in this study. Some of the
items in the questionnaires may seem personal, and may bring uncomfortable feelings or
memories of unpleasant incidents that may have happened to you. You don’t have to
answer any question if you don’t want to. You may choose not to participate if you wish
at any time. If you feel the need for counseling, Sutter Health provides fee for service
counseling services at their Counseling center (916) 929-0808. The center is located at
855 Howe Ave. #1 Sacramento, CA 95825. The center’s working hours are Monday to
Friday, 8:30am to 5:00pm.
(Personal Benefits & Compensation) You will not personally benefit or receive
compensation from participating in this research. The benefit that you will gain is
acquiring additional insight into factors that affect student success in undergraduate
nursing education. The information from this study will be shared with you.
(Benefit to Others) The information obtained in this study is intended to provide a better
understanding of the experiences of African American, Latino, and Muslim students in
191
nursing education. Therefore, it may be helpful to nursing educators and/or African
Americans, Latinos, and Muslims pursuing or planning to pursue a nursing education.
(Confidentiality) Steps will be taken to protect your privacy and the confidentiality of
your study data. The only persons who will have access to your research records are the
researcher, a professional transcriptionist, and the three members of my dissertation study
committee. Your identity will be kept confidential through the use of a pseudo-name on
the transcripts. Each transcript of the audiotape will be identified only by use of a pseudoname. The audiotapes will be destroyed within nine months of the interview. Until that
time, they will be stored under lock and key in the researcher’s office on the CSUS
campus.
(Contact Information) If you have any questions about this research study, you may
contact the researcher Nassrine Noureddine via phone at (xxx) xxx-xxxx or by email at
Noureddinen@csus.edu OR you may contact the researcher’s advisor Dr. Caroline
Turner by email at csturner@saclink.csus.edu Your participation in this research is
entirely voluntary.
Your signature below indicates that you have read this page and agreed to participate in
the research study.
______________________________
Signature of Participant
____________________
Date
Your signature below indicates that you have read this page and agreed to allow the
researcher to audiotape the interview.
I agree to be audio-taped:
_____ Yes
_____ No (Please check one)
______________________________
____________________
Signature of Participant
Date
192
Appendix B
Interview Protocol
MINORITY STUDENT EXPERIENCES:
BARRIERS AND BRIDGES IN NURSING EDUCATION
Time of Interview:
Date:
Location of Interview:
I would like to thank you for agreeing to participate in this research study. In this
research study you will be interviewed using a series of questions related to your
perceptions about your experience in nursing education. As stated in the consent form,
your comments will remain confidential and your identity will remain anonymous. A
pseudo-name will be used instead of your actual name. Throughout the interview, please
feel free to request to take a break or to ask me any questions you might have. You can
expect the interview to last 1 hour. You may stop the interview at any time or skip any
question that you do not wish to answer.
1. Please tell me about your overall experience in nursing education.
2. Tell me about the most positive experience you had during your nursing
education.
3. Tell me about the most negative experience you had during your nursing
education.
4. Please describe experiences, if any, that you believe affected your self-esteem?
5. What factors do you think contributed positively to your successful completion of
your nursing education?
6. What factors do you think contributed negatively to your successful completion of
your nursing education?
7. From your nursing education experience, what advice or recommendations would
you give to others pursuing nursing education?
8. From your nursing education experience, what advice or recommendations would
you give to faculty and directors of nursing education programs?
9. Is there something more you would like to add about your experience in nursing
education?
193
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