The role of the health care organization in supporting nurses in the delivery of culturally competent care

This study was designed to explore ways in which health care organizations (HCOs) can support nurses in their delivery of culturally competent care. While cultural competence has become a priority for the federal government as well as the major health professional organizations, its integration into care delivery has not yet been realized. Health professionals cite a lack of educational preparation, time, and organizational resources as barriers. Most experts in the field agree that the cultural and linguistic needs of ethnic minorities pose challenges that individual care providers are unable to manage without the support of the health care organizations within which they practice. While several studies have identified implications for HCOs, there is a paucity of research on their role in this aspect of care delivery. Using a qualitative design with a case study approach, data collection included face-to-face interviews with 23 registered nurses, document analysis, and reports of critical incidents. The site chosen was a large health care system in South Florida that serves a culturally diverse population. Major findings from the study included language barriers, lack of training, difficulty with cultural differences, lack of organizational support, and reliance on culturally diverse staff members. Most nurses thought the ethnic mix was adequate, but rated other supports such as language services, training, and patient education materials as inadequate. Some of the recommendations for organizational performance were to provide the expectations and support for culturally competent care. Implications and recommendations for practice include nurses using trained interpreters instead of relying on coworkers or trying to "wing it", pursuing training, and advocating for organizational supports for culturally competent care. Implications and recommendations for theory included a blended model that combines both models in the conceptual framework. Recommendations for future research were for studies on the impact of language bathers on care delivery, develop and test a quantitative instrument, and to incorporate Gilbert's model into nursing research.

Examining argumentative coherence in essays by undergraduate students of English as a foreign language in Mainland China and their English speaking peers in the United States

I conducted this study to provide insights toward deepening understanding of association between culture and writing by building, assessing, and refining a conceptual model of second language writing. To do this, I examined culture and coherence as well as the relationship between them through a mixed methods research design. Coherence has been an important and complex concept in ESL/EFL writing. I intended to study the concept of coherence in the research context of contrastive rhetoric, comparing the coherence quality in argumentative essays written by undergraduates in Mainland China and their U.S. peers. In order to analyze the complex concept of coherence, I synthesized five linguistic theories of coherence: Halliday and Hasan's cohesion theory, Carroll's theory of coherence, Enkvist's theory of coherence, Topical Structure Analysis, and Toulmin's Model. Based upon the synthesis, 16 variables were generated. Across these 16 variables, Hotelling t-test statistical analysis was conducted to predict differences in argumentative coherence between essays written by two groups of participants. In order to complement the statistical analysis, I conducted 30 interviews of the writers in the studies. Participants' responses were analyzed with open and axial coding. By analyzing the empirical data, I refined the conceptual model by adding more categories and establishing associations among them. The study found that U.S. students made use of more pronominal reference. Chinese students adopted more lexical devices of reiteration and extended paralleling progression. The interview data implied that the difference may be associated with the difference in linguistic features and rhetorical conventions in Chinese and English. As far as Toulmin's Model is concerned, Chinese students scored higher on data than their U.S. peers. According to the interview data, this may be due to the fact that Toulmin's Model, modified as three elements of arguments, have been widely and long taught in Chinese writing instruction while U.S. interview participants said that they were not taught to write essays according to Toulmin's Model. Implications were generated from the process of textual data analysis and the formulation of structural model defining coherence. These implications were aimed at informing writing instruction, assessment, peer-review, and self-revision.

An Institutional, Socio-economic, and Legal Analysis of Fisheries Co-management and Regulation in the Gulf of Nicoya, Costa Rica

Marine Areas for Responsible Artisanal Fishing (AMPR) have emerged as a new model for co-managing small-scale fisheries in Costa Rica, one that involves collaboration between fishers, government agencies and NGOs. This thesis aims to examine the context for collective action and co-management by small-scale fishers; evaluate the design, implementation, and enforcement of AMPRs; and conduct a linguistic analysis of fisheries legislation. The present work relies on the analysis of several types of qualitative data, including interviews with 23 key informants, rapid rural assessments, and legal documents. Findings demonstrate the strong influence of economic factors for sustaining collective action, as well as the importance of certain types of external organizations for community development and co-management. Additionally, significant enforcement gaps and institutional deficiencies were identified in the work of regulating agencies. Legal analysis suggests that mechanisms for government accountability are unavailable and that legal discourse reflects some of the most salient problems in management.

The use of computer technology to compare and analyze community college dissertations

A purpose of this research study was to demonstrate the practical linguistic study and evaluation of dissertations by using two examples of the latest technology, the microcomputer and optical scanner. That involved developing efficient methods for data entry plus creating computer algorithms appropriate for personal, linguistic studies. The goal was to develop a prototype investigation which demonstrated practical solutions for maximizing the linguistic potential of the dissertation data base. The mode of text entry was from a Dest PC Scan 1000 Optical Scanner. The function of the optical scanner was to copy the complete stack of educational dissertations from the Florida Atlantic University Library into an I.B.M. XT microcomputer. The optical scanner demonstrated its practical value by copying 15,900 pages of dissertation text directly into the microcomputer. A total of 199 dissertations or 72% of the entire stack of education dissertations (277) were successfully copied into the microcomputer's word processor where each dissertation was analyzed for a variety of syntax frequencies. The results of the study demonstrated the practical use of the optical scanner for data entry, the microcomputer for data and statistical analysis, and the availability of the college library as a natural setting for text studies. A supplemental benefit was the establishment of a computerized dissertation corpus which could be used for future research and study. The final step was to build a linguistic model of the differences in dissertation writing styles by creating 7 factors from 55 dependent variables through principal components factor analysis. The 7 factors (textual components) were then named and described on a hypothetical construct defined as a continuum from a conversational, interactional style to a formal, academic writing style. The 7 factors were then grouped through discriminant analysis to create discriminant functions for each of the 7 independent variables. The results indicated that a conversational, interactional writing style was associated with more recent dissertations (1972-1987), an increase in author's age, females, and the department of Curriculum and Instruction. A formal, academic writing style was associated with older dissertations (1972-1987), younger authors, males, and the department of Administration and Supervision. It was concluded that there were no significant differences in writing style due to subject matter (community college studies) compared to other subject matter. It was also concluded that there were no significant differences in writing style due to the location of dissertation origin (Florida Atlantic University, University of Central Florida, Florida International University).