Nursing PhD graduate studies health-care stigma surrounding body art

by | May 18, 2020

The road to Lacee Kaufmann's PhD started with a car crash that paralyzed a friend in their first year of nursing school.
Lacee Kaufmann graduated from the UMSL College of Nursing this weekend with her PhD. Her dissertation examined potential stigma surrounding body art in health care. (Photo courtesy of Lacee Kaufmann)

Lacee Kaufmann graduated from the UMSL College of Nursing this weekend with her PhD. Her dissertation examined potential stigma surrounding body art in health care. (Photo courtesy of Lacee Kaufmann)

Lacee Kaufmann was 17 and had no idea what she was going to do with her life.

She was working in a movie theater with a friend from community college, Heather, who announced that she was going to nursing school. The pay was great plus there was a $5,000 signup bonus.

Kaufmann was sold. They enrolled together.

Three months into the program, a driver ran a red light and struck Heather’s car while she was heading home from clinicals. The accident paralyzed her from the neck down, but she sustained no brain injuries.

“It’s a miracle she survived,” Kaufmann said. “She has been a huge inspiration for me to keep going and continue my education and become more than I ever thought I could be.”

The two remain friends, and Kaufmann continues to be inspired by Heather and the work she has done as a blogger. She has been one of many compelling reasons for Kaufmann to push herself further throughout her nursing career. After graduating with her licensed practical nurse certificate in 2004, Kaufmann started working on the medical-surgical floor at St. Anthony’s Hospital. She earned her associate degree in nursing in 2006, then her BSN in 2008 and her MSN in 2011 ­– and started teaching nursing fundamentals at St. Louis Community College in 2010.

This weekend marked the completion of that journey as Kaufmann graduated with her PhD from the College of Nursing at the University of Missouri–St. Louis.

“I wanted my friend to be proud of me, and I always thought I wanted a terminal degree,” she said. “I’m an extreme person. If I’m going to do something, I’m going to do it. Plus, now I can teach, if I want to, at a higher level. Also, I wanted my students to look at me as an example like, ‘Oh my gosh, she started where we are, but look where she’s at now.’”

For her dissertation, “A Descriptive Phenomenological Study of Body Art Patients and Their Health-Care Experience,” Kaufmann interviewed individuals with tattoos or piercings to see if there was a relationship between having body art and the medical care they received. She was interested in discovering if societal stigma around body art would trickle down to health care.

She first became interested in body art during her MSN program after reading an article by Myrna Armstrong. But when it came time to choose a PhD program, Kaufmann found herself facing some of the stigma her research subjects felt. During an interview with a different nursing school, she was taken aback when her interviewer recoiled at the idea of her unconventional topic and told her the school couldn’t help her.

That’s partially why her UMSL nursing interview was such a delight.

“I sat down with the dean at the time,” Kaufmann said. “She’s like, ‘Well, that’s different. We can work with that.’ I felt so at home after talking to her. I really grew at UMSL. When I started off, I didn’t know what I was doing or what I was getting myself into. By the end of the program – I don’t know how to explain it – I’m just more educated. I know research now. I know what I want to do.”

She found a mentor in Professor of Nursing Susan Dean-Baar, who was on Kaufmann’s dissertation committee along with Interim Dean of Nursing Roxanne Vandermause, Assistant Professor of Nursing Julie Bertram and Assistant Professor of Anthropology Anne Austin.

Kaufmann started her research with a call for participants placed in Missouri tattoo parlors and piercing shops. In order to qualify for her study, interviewees had to have at least 9 percent of their bodies covered by tattoos or seven piercings.

She’d gone into her interviews wondering if the social stigma around body art might make those who have it reluctant to seek treatment if they were sick or if something was wrong with the body art. That turned out not to be the case.

What she found was that individuals who perceived stigma from their providers would not return and that could negatively affect continuity of care.

“That therapeutic relationship was affected if stigma was perceived,” Kaufmann said. “Three participants that I talked to had a negative experiences with health care providers that were related to their body art. Because it meant so much to them, they were like, ‘If you can’t accept this part of me, a huge representation of who I am, then I don’t want you to take care of me.’”

A major takeaway from her interviews was that tattoos tell meaningful and powerful stories about those who choose to get them. Kaufmann believes that they should be used as alternative sources of medical history for providers.

“Some people just had awesome work,” she said. “They would tell me these lavish stories behind these art pieces; they represented this great, awesome time in their lives or this horribly sad time.

“Providers can use them to figure out things that patients may not discuss with us. I had this gentleman come talk to me about his tattoos and how they represented multiple miscarriages he and his wife had. There were people who had tattoos for Crohn’s disease and cancer, and the tattoos open up that health-care discussion. It’s a huge conversation starter, and it helps promote that therapeutic relationship and holistic care that we want to provide.”

She hopes to continue researching stigma in health care and pointed out those with neck and face tattoos or with a COVID-19 diagnosis as possible populations of interest.

Kaufmann’s two small tattoos wouldn’t have qualified her for her own study, but she’s thinking of getting a new one to honor her two children. She’s quick to point out that she completed her PhD while spending time with her family and holding down a full-time job.

“I don’t want people to think that because they have kids and they’re a mom that they can’t do it, because they totally can,” Kaufmann said. “Continuing my education has made me a better human. It’s made me smarter in all aspects of how I look at things in the world. Being in medicine, that’s what you have to do all the time. You have to learn more all the time because technology and medicine is changing so rapidly.”

Jessica Rogen

Jessica Rogen