Date on Master's Thesis/Doctoral Dissertation

8-2020

Document Type

Doctoral Dissertation

Degree Name

Ph. D.

Department

Nursing

Degree Program

Nursing, PhD

Committee Chair

Polivka, Barbara

Committee Member

Christian, Becky

Committee Member

Nash, Whitney

Committee Member

Mallinson, R. Kevin

Author's Keywords

Trust; deaf culture; patient-provider relationships; American sign language; focus group; scoping review

Abstract

Trust is an integral part of the patient-provider relationship, responsible for influencing several key aspects of healthcare behaviors and patient perceptions of health outcomes. Though the topic has previously been discussed by scholars, little evidence exists to support the application of our understanding of trust in culturally Deaf populations. As such, this dissertation seeks to lay the necessary groundwork for further investigations on the topic by first understanding the nature of trust in patient-provider relationships from the perspectives of culturally Deaf people. The dissertation is comprised of five chapters. The first chapter provides an introduction to salient terms and concepts used throughout the dissertation. It also provides a brief history and description of the literature dedicated to both general trust and trust within the context of healthcare relationships. The second chapter identifies a gap in the patient-provider trust literature by presenting a scoping review of the literature from nursing and allied health fields. The findings of this review highlight a lack of literature regarding patient-provider trust in relation to Deaf culture and those who identify as Deaf. The third chapter discusses unforeseen challenges faced by the primary researcher while conducting cross-cultural research in American Sign Language (ASL) as a conversationally fluent individual. Issues establishing linguistic equivalence between English and ASL as well as challenges securing and working with licensed ASL interpreters were described. The fourth chapter examines the perspectives of individuals who are culturally Deaf in regard to patient-provider trust. Using a qualitative descriptive design, findings from a single focus group discussion and one-on-one interview are presented. The fifth, and final chapter, provides a synthesis of the findings from all previous chapters and makes recommendations for future nursing research, practice, education, and policy. The primary findings of this dissertation were a large degree of congruence between current models and conceptualizations of trust in patient-provider relationship when compared to the conceptualizations of study participants. General attributes such as ability, integrity, and benevolence appear relevant to participants when discussing the nature of trust in patient-provider relationships. However, the weight and importance of each attribute appears unique for members of Deaf communities. In particular, the themes of sameness, power dynamics, professionalism, and culture clash were evident in transcripts. Likewise, communication was a key overarching theme, containing a unique set of subthemes more prominent for individuals who rely on visual forms of communication than those who predominantly rely of oral forms of communication. Collectively, this dissertation supports claims made by others regarding the lack of Deaf voices in the healthcare literature and fills a small portion of this gap by focusing on the experiences of Deaf people in patient-provider relationships. In addition, this dissertation highlights the need for researchers and healthcare providers to consider the unique needs of Deaf communities and offers a guidance to achieve this goal.

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