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The ABNF Journal 25 Winter 2020

Thematic analysis
During a thematic analysis of the results from the

research studies included in the scoping review, four
themes emerged that provided insight into the perceptions
and experiences of African American male pre-licensure

registered nursing students. These themes were: (a)
deciding to pursue nursing, (b) being socially integrated,
(c) being the only one, and (d) achieving success (see
Table 3). Each theme is discussed in the following
sections.

Table 3. What is known about African American male registered nursing students? Assignments and projects

______________Theme_________________________________ Associated Factors___________________

Deciding to pursue nursing as a • Nurses as family members (Barren, 2013; Boruff,
career 2012)

• Observed nurses care for ill family members (Boruff,
2012)

Being socially integrated

Being the only one

Achieving success

Barriers to being socially integrated
• Lack o f culturally responsive campus events (Sweet,

2012)
• Being excluded (Barren, 2013; Dapremont, 2014)
• Experiencing racism (Barren, 2013; Dapremont, 2014)
• Feelings of inferiority (Sweet, 2012)

Facilitators to being socially integrated
• Belonging to the Student Nurses Association (Boruff,

2012)
• Feeling accepted/wanted (Barren, 2013; Boruff, 2012)
• Interacting with peers (Barren, 2013; Dapremont,

2011; Sweet, 2012)

• Being the only African American/Black male in class
(Boruff, 2012)

• No African American/Black males in the clinical
setting (Boruff, 2012)

• Few/No African American/Black faculty (Sweet,
2012)

• Few/No African American/Black role models/mentors
(Talley et al., 2016)

• Working as LPN provided preparation (Boruff, 2012)
• Flaving determination (Boruff, 2012)
• Being motivated (Barren, 2013; Going, 2016)
• Maintaining support systems (ie family, friends, peers)

(Barren, 2013; Boruff, 2012; Dapremont, 2011;
Goings, 2016; Sweet, 2012)

• Caring faculty – especially African American/Black
faculty (Barren, 2013; Boruff, 2012; Sweet, 2012)

o Caring faculty can also positively influence
social integration (Barren, 2013; Boruff, 2012)

• Positive institutional environment (Goings, 2016)
• Overcoming academic barriers (Boruff, 2012)
• Managing financial difficulty (Barren, 2013; Boruff,

2012)__________________

The ABNF Journal 26 W inter 2020

Deciding to pursue a nursing career
Despite the need to increase diversity in the nursing

profession, minority students may not be interested
in pursuing a career in nursing. Melillo, Dowling,
Abdallah, Findeisen, and Knight (2013) found that only
45% of middle and high school students from diverse
backgrounds expressed interest in a career in nursing.
Additionally, Olichwier (2014) found that African
American college students exhibited little interest in
pursuing nursing as a career. Males may be diverted
away from a career in nursing because of the profession’s
image as being work for females. Thus, to increase gender
diversity in nursing, it is imperative to understand what
prompts men to enter the profession.

Having nurses as family members and observing nurses
care for ill family members were identified as having
positively influenced the decisions of African American
males to pursue nursing as a career (Barren, 2013;
Boruff, 2012). Although nursing is a female-dominated
profession, men in nursing tend to earn more money
annually than their female counterparts (Potera, 2015).
Thus, nursing can offer stable employment and financial
opportunities for African American males, a group
that has historically been socioeconomically depressed
(Xanthos, Treadwell, & Holden, 2010).

Being socially integrated
Social integration, as it pertains to student retention

in higher education, refers to students’ feelings of being
included in the social structure of an academic institution
(Chang, Lerer, & Talley, 2010). Social integration can
facilitate student success by improving persistence and
retention (Tinto, 1975). Interactions with faculty and
peers outside of the classroom can positively influence
social integration (Chang, Lerer, & Talley, 2010; Wood &
Harris, 2014). Each of the African American male nursing
student participants discussed conditions that either
positively or negatively influenced their interactions with
peers and faculty members.

Tinto (1975) acknowledged the positive relationship
between social integration and student persistence,
suggesting that students who exhibit higher levels of
social integration are less likely to drop out of college.
Naturally, a student who is less likely to drop out has
a greater chance of being retained in institutions of
higher education. Additionally, Harris and Wood (2013)
recognized the positive connection between social
integration and student success for men of color in
four-year institutions of higher education. Developing
friendships with peers, participating in study groups,
and belonging to student organizations promote social
integration (Harris & Wood, 2013). African American
males who participated in these seven research studies

perceived that faculty interactions and peer support
contributed to their success in nursing school (Barren,
2013; Boruff, 2012; Dapremont, 2011, Goings, 2016;
Sweet, 2012).

However, factors that hinder social integration also
emerged during analysis. For example, the African
American males shared their experiences with racism,
being excluded, and feelings of inferiority (Barren, 2013;
Dapremont, 2014; Sweet, 2012). Conditions such as
these can adversely affect social interactions with peers
and faculty members and weaken the social ties that
African American males may have to the social structure
of the college, adversely affecting social integration and
potentially student retention. Being African American
(Colville, Cottom, Robinette, Wald, & Waters, 2015;
Herrera, 2013) and being male (Herrera, 2013) have
been linked to a lower chance of being retained in a
pre-licensure nursing program. Thus, examining and
understanding the impact that social integration could
have retention for African American male nursing
students may be central to promoting their success in
nursing programs.

Being the only one
Some participants shared that they were the only

African American males in their class (Boruff, 2012).
They noted that there were no African American males
where they completed clinical rotations and few African
American faculty members to serve as mentors and role
models (Boruff, 2012; Sweet, 2012; Talley, Talley, &
Collins-McNeil, 2016). The lack of African American
male nurses and nursing students has implications for
recruitment and African American male nursing student
success. Concerning recruitment, the lack of African
American males in nursing may prevent other African
American males from pursuing nursing as a career, as
students are more inclined to pursue careers that include
individuals with backgrounds similar to theirs (Talley et
al., 2016).

Feeling isolated, lonely, or alienated is not uncommon
for African American and male nursing students; these
feelings have been identified in the nursing education
literature as being barriers to student success (Hodges et
al., 2017; Murray, 2015a; Murray, 2015b; White & Fulton,
2015). Thus, being the only African American male
in class may heighten feelings of isolation, loneliness,
and alienation, which in turn, can decrease their sense
of belonging (Sedgwick & Kellet, 2015; Sedgwick,
Oosterbroek, & Ponomar, 2014). Sense of belonging has
been associated with persistence and program success
for African American male collegians (Harris & Wood,
2013).

The ABNF Journal 27 W inter 2020

Achieving success
Most of the research studies included in this review

focused on what facilitated success for minority
nursing students in pre-licensure programs. African
American males enrolled in these studies identified many
circumstances that promoted their success in nursing
school, such as having determination (Boruff, 2012),
being motivated (Goings, 2016), and having support
from family and friends (Boruff, 2012; Dapremont, 2011;
Goings, 2016; Sweet, 2012). These men also suggested
that caring faculty members (Boruff, 2012) and a positive
institutional climate (Goings, 2016) also facilitated their
success. One participant credited his success in an ADN
program, in part, to working as a licensed practice nurse
(LPN) before enrolling and while enrolled in the program
(Boruff, 2012). While academic difficulty has been cited
as a barrier to success for minority students, only one
of the African American male nursing students reported
academic difficulty (Boruff, 2012), while another was
described by the researcher as being high achieving
(Goings, 2016).

LIMITATIONS
The primary limitation of this scoping review was the

small number of research studies included. Had a larger
number of research studies been included in the scoping
review, additional themes could have been identified,
providing even more insight into African American males
as pre-licensure nursing students. The limited number of
research studies that convey the perspectives of African
American male nursing students indicates a need for
additional research focused on this population of nursing
students.

Additional limitations are that the scoping review
included only qualitative research studies that reflected
the perspectives of only twelve men. It is probable that
other African American male nursing students would not
hold these perspectives. Descriptive quantitative data
could be useful in determining how frequently the themes
identified in this review reflect the perspectives of other
African American male nursing students.

Results of this scoping review were also limited
because studies published before 2010 were excluded.
This criterion excluded the only available research study
that focused on African American male baccalaureate
nursing students (Dorsey, 2005). In this quantitative
research study, nursing education administrators reported
their perceptions of effective strategies for recruiting
and retaining African American male students in
baccalaureate degree nursing programs (Dorsey, 2005).
These administrators perceived that financial aid was
the most effective strategy for recruiting and retaining
African American male nursing students (Dorsey, 2005).

Lack of adequate financial resources can hinder nursing
program completion for minority nursing students (Bond
et al., 2015). However, the issue of financial difficulty
was referenced just twice in the findings from this review
(Barren, 2013; Boruff, 2012). Far more prevalent in the
findings for this scoping review were the factors that
affected social integration.

IMPLICATIONS FOR NURSE EDUCATORS
No studies about African American male nursing

students were generated by the search strategies employed
in the scoping review. While results of this review have
provided valuable insight into what is known about
African American male pre-licensure students, these
findings only represent perspectives of a few African
American males. Therefore, this is an area that requires
further scientific inquiry.

First, it is essential to identify which identified
themes are most salient to the experience and success of
African American male pre-licensure nursing students.
For example, items related to social integration were
discussed more frequently than those associated with
academic or financial struggles. However, academic
and financial struggles are two frequently cited barriers
to minority nursing student success. Is it possible that
experiencing racism, exclusion, and other factors that
pose barriers to social integration are more of a threat
to African American male nursing student success
than the potential for poor academic performance and
financial constraints? Or, is it possible that academic
and financial issues did not pose as much of a barrier
for African American men in these studies because they
were older than the traditional age student and were able
to balance work obligations with academic obligations?
For example, Jeffreys (2012) noted that older students
might be able to manage their time better and possess
study skills that facilitate their success. Could this have
been true for the African American men included in
the research studies for this review? To answer these
questions, research designs other than descriptive
qualitative need to be employed in future studies.

Another question that arose during the thematic
analysis was related to experiences with discrimination.
African American nursing students and male nursing
students often encounter discrimination and bias. Pham’s
(2011) study of minority male nursing students, none of
whom identified as African American, revealed that this
group encounters bias related to both their race and their
gender. These study participants reported encountering
more bias related to their gender than their race/ethnicity
(Pham, 2011). Conversely, Black male teachers perceived
that they encountered more bias regarding race than their
gender, as these teachers believed that being male still

The A BN F Journal 28 W inter 2020

afforded them some privilege in a female-dominated
profession (Brockenbrough, 2012).

Studies included in the scoping review focused on
student success, which supports the need for shifting
attention away from examining factors that pose barriers
to minority student success to exploring factors that
describe how minority pre-licensure nursing students
overcome barriers to achieve success. Further inquiry
into African American male nursing students should
also explore how program type (ie online or accelerated
master’s entry) and institution type (eg proprietary)
influence student success.

CONCLUSIONS
Retaining African American male students in pre-

licensure nursing programs can address issues related
to the lack of diversity in the nursing workforce.
Unfortunately, nursing education literature offers little
evidence on this topic. Further exploration can guide
nurse educators in implementing initiatives that can
increase the representation of African American males in
the nursing profession.

REFERENCES
American Association of Colleges of Nursing (2015). Enhancing

diversity in the workforce. https://www.aacnnursing.org/News-
Information/Fact-Sheets/Enhancing-Diversity.

American Association of Colleges of Nursing (2017). The changing
landscape: Nursing student diversity on the rise. http://www.
aacnnursing.org/Portals/42/Diversity/Student-Diversity .

Arksey, H., & O ’Malley, L. (2005). Scoping studies: Towards a
methodological framework. International Journal o f Social
Research Methodology, S (l), 19-32. https://doi.org/10.1080/136
4557032000119616

Barren, L. S. (2013). The experience and persistence o f African
American nursing students through the lens o f critical race
theory (Publication No. 3614391) [Doctoral dissertation,
Oklahoma State University]. CINAHL.

Bond, M. L., Cason, C. L., & Baxley, S. M. (2015). Institutional
support for diverse populations: Perceptions of Hispanic
and African American students and program faculty.
Nurse Educator, 40(3), 134-138. https://doi.org/10.1097/
NNE .0000000000000126

Boruff, S. M. (2012). Experiences o f success by minority students
attending a predominantly Caucasian nursing program
(Publication No. 1282657487). [Doctoral dissertation, East
Tennessee State University |. ProQuest, LLC.

Brockenbrough, E. (2012). Emasculation blues: Black male
teachers’ perspectives on gender and power in the teaching
profession. Teachers College Record, 114(5), l-43.http://www.
tcrecord .org/Content .asp?ContentId= 16417

Bureau of Labor Statistics (2018). Employed persons by detailed
occupation, sex, race, and Hispanic or Latino ethnicity, https://
www.bls.gov/cps/cpsaatl 1 .

Campaign for Action. (2019). Future o f nursing: Campaign fo r
action dashboard, https://campaignforaction.org/wp-content/
uploads/2019/07/Dashboard-Indicator-Updates_7.9.19 .

Chang, Y., Lerer, N., & Talley, K. (2010). Considering leaving before
they’ve even started: An examination of freshmen at risk
for transfer. On the Horizon, 18(4), 346-354. http://dx.doi.
org/10.1108/10748121011082644

Christensen, M., & Knight, J. (2014). “Nursing is no place for men”
– A thematic analysis of male nursing students experiences of
undergraduate nursing education. Journal o f Nursing Education
and Practice, 4(12), 95. http://dx.doi.org/10.5430/jnep.
v4nl2p95

Colquhoun, H. L., Levac, D., O ’Brien, K. K., Straus, S.,Tricco, A. C.,
Perrier, L., Kastner, M., Moher, D. (2014). Scoping reviews:
Time for clarity in definition, methods, and reporting. Journal
o f Clinical Epidemiology, 67(12), 1291-1294. http://dx.doi.
org/10.1016/j .jcl inepi .2014.03.013.

Colville, J„ Cottom, S„ Robinette, T., Wald, H„ & Waters, T. (2015).
A community college model to support nursing workforce
diversity. Journal o f Nursing Education, 54(2) ,65-71. https://
doi .org/10.3928/01484834-20150119-12

Dapremont, J. (2011). Success in nursing school: Black nursing
students’ perception of peers, family, and faculty. Journal
o f Nursing Education, 50(5), 254-260. https://doi.
org/10.3928/01484834-20110317-03

Dapremont, J. A. (2014). Black nursing students: Strategies for
academic success. Nursing Education Perspectives, 35(3), 157-
161. https://doi.org/10.5480/! 1-563.1

Dorsey, M. T. (2005). Nursing education administrators’
perceptions o f the recruitment and retention o f African
American male nursing students [Doctoral dissertation,
Georgia Southern University]. Digital Commons, http://
digitalcommons.georgiasouthem.edu/cgi/viewcontent.
cgi?article=l 209&context=etd.

Goings, R. B. (2016). (Re)defining the narrative: High-achieving
nontraditional Black male undergraduates at a Historically
Black College and University. Adult Education Quarterly: A
Journal o f Research and Theory, 66(3), 237-253. https://doi.
org/10.1177/0741713616644776

Herrera, C. (2013). Quantitative analysis of variables affecting nursing
program completion at Arizona State University. Research in
Higher Education Journal, 21, 1-18. https://www.aabri.com/
manuscripts/131607

Harris, F. I., & Wood, J. L. (2013). Student success for men of color
in community colleges: A review of published literature and
research, 1998-2012. Journal o f Diversity in Higher Education,
6(3), 174-185. https://doi.org/10.1037/a0034224

Hodges, E. A., Rowsey, P. J., Gray, T. F., Kneipp, S. M., Giscombe, C.
W., Foster, B. B ., … Kowlowitz, V. (2017). Bridging the gender
divide: Facilitating the educational path for men in nursing.
Journal o f Nursing Education, 56(5), 295-299. http://dx.doi.
org/10.3928/01484834-20170421-08

Institute of Medicine (2011). The future o f nursing: Leading change,
advancing health. The National Academies Press. https://www.
nap.edu/catalog/12956/the-future-of-nursing-leading-change-
advancing-health

Jeffreys, M. R. (2012). Nursing student retention: Understanding the
progress and making a difference (2nd ed.). Springer Publishing.

Jeffreys, M. R. (2015). Jeffreys’s Nursing Universal Retention and
Success Model: Overview and action ideas for optimizing
outcomes A -Z. Nurse Education Today, 35(3), 425-431. https://
doi .org/10.1016/j .nedt .2014.11.004

Ke, F., & Kwak, D. (2013). Constructs of student-centered online
learning on learning satisfaction of a diverse online student
body: A structural equation modeling approach. Journal o f
Educational Computing Research, 48(1), 97-122. https://doi.
org/10.2190/EC .48.1 .e

Kelly, R. (2015). 2015 Kelly Report: Health disparities in America.
https://robinkelly.house.gov/sites/robinkelly.house.gov/
files/2015%20Kelly%20Report .

Marks, S. A., & Bevan, J. L. (2013). Men in nursing: Historical career
perspectives. In C.L. Coleman (Ed.), Man up! A practical guide
fo r men in nursing (pp. 51-64). Sigma Theta Tau International.

Melillo, K. D., Dowling, J., Abdallah, L., Findeisen, M., & Knight, A.
(2013). Bring diversity to nursing: Recruitment, retention, and
graduation of nursing students. Journal o f Cultural Diversity,
20(2), 100-104.

The ABNF Journal 29 W inter 2020

Murray, T. A. (2015a). Culture and climate: Factors that influence the
academic success of African American students in pre-licensure
nursing education. Journal o f Nursing Education, 54(12), 704-
707,1-2. http://dx .doi .org/10.3928/01484834-20151110-07

Murray, T. A. (2015b). Factors that promote and impede the academic
success of African American students in pre-licensure nursing
education: An integrative review. Journal o f Nursing Education,
54, S74-S81. https://doi .org/10.3928/01484834-20150814-14

National Advising Council on Nurse Education (2013). Achieving
health equity through nursing workforce diversity. https://www.
hrsa.gov/advisorycommittees/bhpradvisory/nacnep/Reports/
el e venthreport .

National League for Nursing (2016). Achieving diversity and
meaningful inclusion in nursing education: A living document
from the National League fo r Nursing, http://www.nln.org/
docs/default-source/about/vision-statement-achieving-diversity.
pdf?sfvrsn=2.

Olichwier, K. K. (2014). African American college students’
perceptions o f nursing as a career choice. [Doctoral dissertation,
Walden University]. ProQuest Information & Learning.

Palacios, A., & Wood, J. L. (2016). Is online learning the silver bullet
for men of color? An institutional-level analysis of the California
Community College System. Community College Journal o f
Research and Practice, 40(8), 643-655. https://doi.Org/10.1080/l
0668926.2015.1087893

Pham, T. (2011). Stressors experienced by male minority student
nurses while completing a baccalaureate program. | Doctoral
dissertation,Texas Women’s University]. CINAHL.

Potera, C. (2015). In nursing it still pays more to be a man. American
Journal o f Nursing, 115(6), 14. https://doi.org/10.1097/01.
N AJ .0000466300.61755,7d

Sedgwick, M. G., & Kellett, P. (2015). Exploring masculinity and
marginalization of male undergraduate nursing students’
experience of belonging during clinical experiences. Journal
o f Nursing Education, 54(3), 121-129. https://doi.org/
doi: 10.3928/01484834-20150218-15

Sedgwick, M. G., Oosterbroek,T., & Ponomar, V. (2014). “It all
depends”: How minority nursing students experience belonging
during clinical experiences. Nursing Education Perspectives,
35(2), 89-93. https://doi.Org/doi:10.5480/l 1-707.1

Smiley, R. A., Lauer, P , Bienemy, C., Berg, J. G., Shireman, E.,
Reneau, K. A., & Alexander, M. (2018). Supplement: The
2017 National Nursing Workforce Survey. Journal o f Nursing
Regulation, 9(3), S1-S88. https://doi.org/10.1016/S2155-
8256(18)30131-5

Smith, A., & Smyer, T. (2015). Black African nurses educated in the
United States. Journal o f Nursing Education, 54(2), 72-79.
https://doi .org/10.3928/01484834-20150120-05

Sturgis, I. (2012). The online frontier. Diverse: Issues in Higher
Education, 29(3), 16-19.

Sweet, L. H. (2012). A phenomenological study o f culturally diverse
baccalaureate nursing students’ persistence to graduation
(Publication No. 1039643064) [Doctoral dissertation,
Northcentral University|. ProQuest, LLC.

Talley, C.,Talley. H., & Collins-McNeil, J. (2016). The continuing
quest for parity: HBCU nursing students’ perspectives on
nursing and nursing education. Nurse Education Today, 4 3 ,23-
27. https://doi.org/10.1016/j .nedt.2016.04.006

Tinto, V. (1975). Dropout from higher education: A theoretical
synthesis of recent research. Review o f Educational Research,
45(1), 89-125.

U. S. Census Bureau (2018). Quick facts, https://www.census.gov/
quickfacts/fact/table/US/PST045218

Villarruel, A., Washington, D., Lecher. W. T. & Carver, N. A. (2015).
Advancing health through nursing progress o f the Campaign for
Action. American Journal o f Nursing, 115(5), 57-62.

White. B. J., & Fulton, J. S. (2015). Common experiences of African
American nursing students: An integrative review. Nursing
Education Perspectives,36(3), 167. https://doi.org/10.5480/14-
1456

Whittemore, R., Chao, A., Jang, M., Minges, K., & Park, C. (2014).
Methods for knowledge synthesis: An overview. Heart & Lung,
43(5), 453-461.

Williams, S. D., Hansen, K., Smithey, M., Burnley, J., Koplitz, M.,
Koyama, K., Young, J., & Bakos,A. (2014). Using social
determinants of health to link health workforce diversity, care
quality and access, and health disparities to achieve health
equity in nursing. Public Health Reports, 129, 32-36. https://
www.jstor.org/stable/23646783

Wood, J. L. & Harris, F. (2014). The five domains: A conceptual
model of Black male success in the community college. In F. A.
Bonner II (Ed.), Building on resilience: Models and frameworks
o f Black male success across the P-20 pipeline (pp. 173-187).
Stylus.

Xanthos, C., Treadwell, H. M., & Holden, K. B. (2010). Social
determinants of health among African American men. Journal
o f M en’s Health, 7(1), 11-19. https://doi.Org/10.1016/j.
jomh.2009.12.002

LaDonia D. Patterson, EdD, RN, CNE, practices as a
Registered Professional Nurse fo r the Wellness Center at
Agnes Scott College in Decatur, GA. Dr. Patterson may
be reached at: 141 E. College Ave., Decatur, GA 30030
or at: ladonia.patterson@gmail.com.

Acknowledgments
This manuscript is a component o f a doctoral dissertation
entitled “Achieving Success in Pre-licensure Registered
Nursing Programs: An Explanatory Case Study o f
African American M ales.” The author would like to
acknowledge Drs. Christy Berding, Cynthia Brown,
Cynthia Epps, and Tammy McClenny fo r their support
and insight during the writing and editing process.
The author would also like to acknowledge the African
American male students she has had the pleasure o f
teaching throughout her career as a nurse educator.
Thank you fo r allowing me to be a part o f your journey.

The ABNF Journal 30 Winter 2020

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