How the strong survive: Health as expanding consciousness and the life experiences of Black Caribbean women

The purpose of this qualitative research study was to answer the research questions: What is the pattern of Health as Expanding Consciousness in Black Caribbean women living in the United States? What is the pattern of Health as Expanding Consciousness across members in a community of Black Caribbean Women?; Margaret Newman's Theory of Health as Expanding Consciousness provided the theoretical framework used to guide the study. Newman's hermeneutic dialectic methodology facilitated understanding of meaningful relationships and significant life events of individuals and across participants. This research method also illuminated the influence of culture on life patterns of individuals and across participants.; The study sample included fifteen Black women in Massachusetts who self-identified as Caribbean people. Participants migrated to the United States between 1 month and 40 years ago, from several different Caribbean islands. Individual patterns showed evolution to higher levels of consciousness in the mist of chaos, disorganization, and tragedy. Five themes emerged across participants (1) "Perseverance, Resilience, and Strength in the Face of Chaos, Disorganization, and Tragedy" describe the participant's ability to overcome, recover, and survive chaos, disorganization, and tragedy and the power with which participants are able to manage competing demand and tragedies in their lives. (2) "Being Raised by the Village: The Pattern of Connection, Disconnection, and the Caribbean culture" is indicative of the collective responsibility for child rearing that is demonstrated by members of the ethnic group. (a) "Learning to Live with Mom" (b) "Mom is in Charge" (c) "Driving Foolishness Out of the Heart of a Child" are the sub themes included in this theme to describe the influence of culture on the participants' childhood experiences (3) "Trusting in the Power of God: Seeing New possibilities and Accelerated Transformation" reflects the extraordinary faith that the participants have in God. (4) "Migration and Racism: The American Tragedy" depicts participant's introduction and experience with race and racism upon entering the United States. (5) "The Veil of Secrecy and Silence: Protecting my Abuser and Competing with the Other Woman" describes the secrets and pattern of infidelity that is influenced by culture and affects of the lives of participants directly or indirectly. Moreover this theme describes the value for privacy and confidentiality, and the secrets or unresolved issues that prevented several participants from evolving to higher levels of consciousness.; This study supports Newman's Theory of Health as Expanding Consciousness and extends the theory to use with a Black Caribbean female population. The study also provides a new way of understanding populations at risk for poor health outcomes and offers a new strategy to consider around managing racial health disparities. Findings from this research have important implications for nursing theory, practice, research, education, administration and healthcare policy.