Defense Date


Graduation Date

Fall 2013


Immediate Access

Submission Type


Degree Name





School of Nursing

Committee Chair

Rick Zoucha

Committee Member

Lynn Simko

Committee Member

Chris Green


Appalachia, Cultural Congruent Care, Culture Care, Spinal Cord Injury


The purpose of this ethnonursing study was to discover and describe the culture care meanings and care expressions of men with a spinal cord injury from the Appalachian region of West Virginia. Spinal cord injury is a sudden, traumatic, and life altering event. The impact of this type of injury on the person and their family is devastating. The literature review revealed studies primarily focused on quality of life and life satisfaction. The nature of the phenomena required an open discovery method and the researcher selected the ethnonursing qualitative research method. The guiding framework, research method, and plan for data analysis were developed by Leininger (1991). The setting for the study was the Appalachian region of West Virginia. Approval from the Institutional Review Board was received and data collection commenced. The Four Phases of Qualitative Data Analysis developed by Leininger (1991) provided the plan and method for data management and data analysis. Recruitment was accomplished using the snowball method, was successful due to the promotion from informants participating in the study, and the researcher's continued presence at the monthly SCI support group meetings. Data collection and data analysis were conducted concurrently. Entry in to the field was accomplished via an established spinal cord injury support group in a large city in West Virginia. Twenty-three informants participated in the study: eighteen general informants and five key informants. Procedures to ensure the anonymity and confidentiality of the informants were developed and strictly adhered to during the course of the study. The informants chose the physical location for the interviews to be conducted. Informed consent was obtained and a pseudonym was chosen for use during the interview. A semi-structured interview guide based on the guiding framework of the study was used to facilitate the interview process. Interviews were digitally recorded and transcribed verbatim. Ethnodemographics were collected to describe the informants. Field notes and reflections from the etic view were documented for use by the researcher in the data collection and data analysis process. When saturation was evident from rigorous analysis of the data, thirteen categories were revealed during the second phase of analysis. Five patterns were derived during the third phase of analysis and in the fourth phase, the highest level of data analysis, three themes were abstracted. The categories, patterns, and themes were discussed with key informants to verify their emic view was reported accurately and to enhance the credibility and reliability of the findings. The themes were conceptualized pictorially to depict the essence of the findings of the study. The themes abstracted from the data were: 1. Caring and concern for family, friends, neighbors, and place combined with being inspired by other men with a SCI to promote a sense of belonging; 2. Belief in God, holding onto hope and keeping a positive attitude helps men remain focused on what they can do and not dwell on what they can't do; and 3. A spirit of independence, hard work, changing the environment, and believing you can figure things out are essential for getting back to living. Consistent with the literature, the informants did not identify themselves as Appalachian when asked about culture. A worldview of realism was validated by the informants. The informants exhibited a positive attitude, shared an optimistic narrative, and demonstrated a belief in God, faith, and hope with the realities of life and living with a spinal cord injury.