How lesbians recognize and respond to alcohol problems: a theoretical model of problematization

Transgender identity development as represented by a group of transgendered adults

The world of persons who identify as transgendered is complex making its representation in an article challenging. This article represents work done to raise awareness among all health professionals about the lives and experiences of transgendered persons, who receive little coverage in our textbooks, professional journals, or student experiences. Transgendered lives cannot be simply summed up as a community of people who feel like they are "in the wrong body." Their experiences, issues, and identities are complex, but worthy of the time, energy, patience, and caring it takes to learn about them. We took a postmodern feminist stance to explore transgendered adults' first-hand accounts of identity development. The research question guiding the analysis presented here was: How do transgendered individuals describe their experiences of recognizing, acknowledging, and developing their identity as transgendered? Participants' stories about how they came to recognize and experience their identity as transgendered, analyzed from a lifespan perspective, displayed a similar pattern of life experience, reflected in three prominent themes: an early sense of body-mind dissonance, negotiating and managing identities, and the process of transition. The process that participants describe, beginning with childhood and ending with transition and the resolution of bodily discomfort, appears to be staged and developmental in nature. Further exploration into this process and comparison with other developmental theories may yield a model of normal, non-pathological development as transgendered.

Identity shifts as turning points in health behavior change

The authors used a grounded formal theory approach to synthesize the findings of 14 studies, with the goal of identifying common elements in qualitative studies of individuals' efforts to change a variety of unhealthy behaviors. The combined sample of 399 participants had experiences of weight loss, smoking cessation, and alcohol and drug-abuse recovery. Data were extracted from published reports and analyzed using grounded-theory techniques. In the provisional model, a value conflict in response to distressing accumulated evidence prompts a small step toward behavior change. If successful, an identity shift begins. Increased self-awareness and self-confidence fuel continued change. Numerous constraints to success are noted at each step. The links to previous conceptions of identity shift are discussed.

Family responses to disclosure of self-as-lesbian

Disclosure or nondisclosure of self-as-lesbian to family is a difficult task. Eleven lesbians aged 25-47 years old described their experiences of disclosure or nondisclosure to family. The primary source of data collection was focus groups. Family disclosure was preceded by recognition of self-as-lesbian. Five story patterns of lesbians and their families related to disclosure or nondisclosure were derived from text analysis. The participants also described missing sociocultural landmarks and symbols for lesbian lives. Implications are included for lesbians who are contemplating disclosure and their health care providers.

Core issues for female child abuse survivors in recovery from substance misuse

Female survivors of childhood abuse have increased risk for substance misuse. Childhood abuse survivors describe current mental health and substance misuse services as not addressing central problems, the "heart of the matter." Negative core issues related to abuse events, contexts, substance use, and current problems were explored in open-ended interviews with 20 female abuse survivors. Most were marginalized because of cocaine use, poverty, and ethnic status. Narrative analysis involved within- and between-account comparisons through adequate paraphrasing of in vivo descriptions. Results include in-depth description of basic core beliefs, developmental core influences, and current core experiences. Implications for practice and policy include appreciation of the influence of negative core experiences on mental health, substance misuse recovery, and preparedness for adulthood demands.

Women survivors of childhood abuse: the impact of traumatic stress on education and work

A disempowering after-effect of childhood abuse that is not well-researched in nursing is the inability of many women abuse survivors to perform successfully in adulthood tasks such as working, managing money, and parenting. This inability often results from lack of family support, cultural impoverishment, limited formal education, and for some, illiteracy. By default, many women survivors engage in criminal, usually dangerous forms of work. A critical/feminist interview study involved 20 urban low income abuse survivors, who were mostly women of color. Participants were recovering cocaine misusers who had suffered multiple forms of childhood maltreatment. This article reports on a secondary analysis of narratives given by survivors, focused on learning and work difficulties. Findings were grouped into five broad domains: (1) school as problematic, (2) lack of adult life skills, (3) problems with academic and health literacy, (4) legitimate and illicit forms of work, and (5) means of help. In vivo quotes support these themes, and policy and practice implications are discussed.

Womanism: a methodologic framework for African American women

Although nurse scholars have become increasingly engaged in feminist research and theory development, only a few have included important feminist thoughts expressed by African American womanist theorists. This article presents an abbreviated review and synthesis of Afrocentric ways of knowing, which includes Black feminist, womanist, and Afrocentric perspectives. A developing methodology for use with African American women is also described.

Truthful self-nurturing: a grounded formal theory of women's addiction recovery

This grounded formal theory study was designed to develop a midrange theory of women's addiction recovery from multiple substantive reports. Ten research reports from diverse contexts were analyzed using theoretical sampling and constant comparison. The basic problem of addiction was found to be self-destructive self-nurturing. The basic process of recovery was truthful self-nurturing, which required a painful awareness shift in which addiction gained meaning as a problem. Subsequent recovery involved three areas of social-psychological change: abstinence work, self-work, and connection work. Consequences were enjoying simple pleasures, growing self-understanding, self-acceptance, and sense of belonging, and empowered connectedness. The theory was supported by findings of other qualitative studies of the same phenomenon.

Lesbians surviving childhood sexual abuse

Abstract This qualitative, feminist study is focused on lesbians' experiences growing up in multiproblem families, surviving aftereffects of trauma, and struggling with alcohol problems. A multi-racial sample of 20 lesbians narrated life stories in a series of three in-depth interviews. The research report opens with one woman's narrative about surviving childhood sexual abuse and continues with explication of how differences and similarities within and between accounts pivot on the issues of sexual orientation, gender, and race. Results suggest that early in their lives, overwhelming violence and intrusive expectations were imposed, negating a clarity of experience about their authenticity. No participant expressed a belief that her sexual orientation was a result of childhood sexual abuse. The societal presumption of sexual abuse as an etiological factor in determining lesbian sexual orientation, nevertheless, was pivotal for these survivors because they had to constantly protect themselves from others' judgements about whether they were "real lesbians." They described a multi-faceted, ingenious strategy, gender-blurring, that helped them garner a place of some value in the family and stave off some of the violence, but this protective stance made them question whether they were "real women." Women also indicated that they grew up in families empty of cultural affiliation. Instead of knowledge and pride about connection with community, they experienced a gaping void about racial identification, ethnicity, parentage, and personal history. All in all, they survived a series of social identity exclusions. Conclusions call into question the usefulness and adequacy of theories about static psychological and social identities and suggest the importance of specific, localized analyses that explore narrative selves.

Reframing women's health in nursing education: a feminist approach

To operate from a feminist paradigm is a new way of thinking for nurse educators. Feminist perspectives in nursing provide a new stage of consciousness--one that values women's voices, their way of knowing, and their life experiences, and, most important, one that challenges traditional patriarchal practices. Furthermore, nursing curricula with feminist perspectives provides a biopsychosocial approach that encourages the full recognition of variables that can influence women's health, such as socioeconomic status, racial and ethnic background, and biobehavioral factors. The debate in medicine over a specialty in women's health is not unique. The history of academia abounds with descriptions of struggles to establish new fields and disciplines. Recent specialties, such as pediatrics and gerontology, which are distinguished by age rather than specific organ or system, struggled for establishment and recognition. Historically, nursing curricula has emulated the biomedical model that is reductionistic and contradictory to nursing's holistic mission. Rather than classifying women's health into a separate entity, women's health may be introduced into present curricula by employing feminist ideals and pedagogy throughout the curriculum. This approach would provide a mechanism to explore women's health issues that were previously minimally addressed at best, or not addressed at all. More important, students would be provided with an opportunity to examine the societal effects of racism, sexism, and classism, and this education would potentially lead to a growing awareness of concerns specific to women and minorities.