Publication Date


Document Type


First Advisor

McElmurry, Beverly J. (Beverly Jane)

Degree Name

M.S. (Master of Science)

Legacy Department

Department of Nursing


Medical personnel and patient; Sick--Psychology; Nurse and patient; Nursing--Psychological aspects


This was a descriptive study, with a philosophical orientation, of the phenomenon of exclusion in health care. Exclusion is the name the researcher has given to any interaction between one or more health care providers and a client, or patient, in which the client feels shut out or excluded as a person from the situation. A phenomenological description of exclusion was put together from interviews with hospital patients who recognized the researcher's concept of exclusion as something they had experienced. The study was conducted at a 52-bed rural community hospital. A convenience sample of 15 medical-surgical patients was chosen using the following criteria: (1) ambulatory or able to use a wheelchair, (2) 25 years or older, (3) English-speaking, (4) not a health care provider, (5) not on public aid, and (6) hospitalized for at least 72 hours. The tape-recorded interviews were structured with a schedule of questions developed by the researcher for this study. The primary question was: Have you, as a patient, ever been aware of feeling shut out of a situation involving you and one or more health care givers? The rest of the questions were designed to elicit information about the excluding behavior of the care-givers, the feelings and response of the patient, the patient's health status and expectations about roles in health care. The interview material was organized into six categories which were abstracted from the schedule of interview questions. Two basic components of exclusion are identified in this study: I-It relating and the face-to-face situation. The mechanism of exclusion is identified by the researcher as emotional distancing in which the care-giver, through use of eyes, tone of voice, facial expression, touch, speech, and silence, shuts the client or patient out of their interaction. The subsequent response of the patient is categorized into two areas: feelings and action taken. The feelings most frequently cited by those who have experienced exclusion as patients are: helplessness, anger, self-consciousness, feeling "out of place," and insignificance. The author believes that exclusion is potentially damaging and discusses the effects of exclusion on the wholeness and health of the excluded patient. In addition, the paper discusses providing support for the excluded patient and the need for future research into the area of intersubjectivity in nursing.


Includes bibliographical references.||Includes illustrations.


v, 82 pages




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