Dissertation/Thesis Abstract

Caught in the middle: Nurses responding to a hospital's strategy of culturally competent care
by Ellis, Theresa Anne, Ph.D., Fielding Graduate University, 2014, 264; 3627604
Abstract (Summary)

Leaders of organizations continually experience challenges when attempting to implement new strategies by aligning staff at various organizational levels to the new strategies. The effectiveness of alignment to strategy is demonstrated especially in how strategy manifests on the front line as staff respond to the mandate of the strategic changes. Organizational dynamics analyzed through a psychodynamic "lens" further explain the challenges of alignment to strategy. The health care industry experiences pressure to adjust their strategies to ensure quality patient care, especially because hospitals are under scrutiny to reduce hospital readmissions and address health disparities for disadvantaged groups of patients in surrounding communities. One strategy adjustment that hospitals are implementing is improving culturally competent care, which requires transformational changes in practice, especially at the front line: nurses. This qualitative, single-case study at a hospital in the eastern United States focuses on exploring nurses' experiences as they respond to a hospital's mandate of changes related to providing culturally competent care. Data were collected through 25 semistructured interviews, two focus groups, and historical and archival data. The findings from this study support literature on the challenges and tensions related to this transformative change in how care is delivered. The findings also reveal the anxiety that these challenges and tensions trigger at the institutional and individual levels and the resulting behaviors, interpreted by psychodynamic theory of basic assumption, where nurses fluctuated between approach and avoidance of the work.

Indexing (document details)
Advisor: Hirschhorn, Larry A.
Commitee: Guilarte, Miguel G., Houskamp, Beth Smith, Willis, David Blake, Woollen, Byron
School: Fielding Graduate University
Department: The School of Human and Organization Development
School Location: United States -- California
Source: DAI-A 75/11(E), Dissertation Abstracts International
Subjects: Nursing, Organizational behavior
Keywords: Culturally competent care, Nursing, Organizational behavior, Organizational change, Psychodynamics, Strategy alignment
Publication Number: 3627604
ISBN: 9781321030044
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