Date of Award

2015

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Graduate Group

Nursing

First Advisor

Therese S. Richmond

Abstract

The intent of this ethnographic study of trauma care was to contextualize the etiologic factors that perpetuate disparities in survival and recovery among Black traumatically injured patients in the United States. Race-based disparities in trauma injury outcomes in the U.S. are perplexing given the legislative protections that require that all people, regardless of insurance status, are admitted to trauma centers and that accreditation of these centers requires adherence to strict standards of care. This dissertation offers an interpretive analysis of ethnographic data collected among twelve Black traumatically injured patients and the clinicians who provided their medical and nursing care between December 2012 and December 2013 in a Trauma I Medical Center in Philadelphia. Participants discussed their perceptions of injury care and the consequence of being injured in the context of their lived experiences, shaped by violence, poverty, underemployment, lack of health insurance, and disenfranchisement from local healthcare institutions. The socio-structural context of the trauma center and its clinical culture were similarly constituted by these racialized economic and political dynamics of the city-at-large. These findings prompt re-thinking of practice and processes in clinical trauma care to recognize and accommodate the lived experiences of socially marginalized patients in medical and public health responses to injury in the urban environment.

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