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.

Managers' Perception of Alcohol Service Training Programs

In order to serve alcoholic beverages in a responsible manner, most managers turn to alcohol server training programs to provide effective standardized training for the alcohol server. Whether or not the programs are perceived by hospitality managers as effective has not been established. The author presents the results of a study of Oklahoma hospitality managers who perceive alcohol server training as becoming less effective.

The effects of attribute quality information and sources of information on consumers' perceptions and behavior: A model of Pre-purchase Information Utilization in Service Physical Environments

The search-experience-credence framework from economics of information, the human-environment relations models from environmental psychology, and the consumer evaluation process from services marketing provide a conceptual basis for testing the model of "Pre-purchase Information Utilization in Service Physical Environments." The model addresses the effects of informational signs, as a dimension of the service physical environment, on consumers' perceptions (perceived veracity and perceived performance risk), emotions (pleasure) and behavior (willingness to buy). The informational signs provide attribute quality information (search and experience) through non-personal sources of information (simulated word-of-mouth and non-personal advocate sources).^ This dissertation examines: (1) the hypothesized relationships addressed in the model of "Pre-purchase Information Utilization in Service Physical Environments" among informational signs, perceived veracity, perceived performance risk, pleasure, and willingness to buy, and (2) the effects of attribute quality information and sources of information on consumers' perceived veracity and perceived performance risk.^ This research is the first in-depth study about the role and effects of information in service physical environments. Using a 2 x 2 between subjects experimental research procedure, undergraduate students were exposed to the informational signs in a simulated service physical environment. The service physical environments were simulated through color photographic slides.^ The results of the study suggest that: (1) the relationship between informational signs and willingness to buy is mediated by perceived veracity, perceived performance risk and pleasure, (2) experience attribute information shows higher perceived veracity and lower perceived performance risk when compared to search attribute information, and (3) information provided through simulated word-of-mouth shows higher perceived veracity and lower perceived performance risk when compared to information provided through non-personal advocate sources. ^

Enabling adaptability in service aggregates using transparent shaping techniques

Distributed applications are exposed as reusable components that are dynamically discovered and integrated to create new applications. These new applications, in the form of aggregate services, are vulnerable to failure due to the autonomous and distributed nature of their integrated components. This vulnerability creates the need for adaptability in aggregate services. The need for adaptation is accentuated for complex long-running applications as is found in scientific Grid computing, where distributed computing nodes may participate to solve computation and data-intensive problems. Such applications integrate services for coordinated problem solving in areas such as Bioinformatics. For such applications, when a constituent service fails, the application fails, even though there are other nodes that can substitute for the failed service. This concern is not addressed in the specification of high-level composition languages such as that of the Business Process Execution Language (BPEL). We propose an approach to transparently autonomizing existing BPEL processes in order to make them modifiable at runtime and more resilient to the failures in their execution environment. By transparent introduction of adaptive behavior, adaptation preserves the original business logic of the aggregate service and does not tangle the code for adaptive behavior with that of the aggregate service. The major contributions of this dissertation are: first, we assessed the effectiveness of BPEL language support in developing adaptive mechanisms. As a result, we identified the strengths and limitations of BPEL and came up with strategies to address those limitations. Second, we developed a technique to enhance existing BPEL processes transparently in order to support dynamic adaptation. We proposed a framework which uses transparent shaping and generative programming to make BPEL processes adaptive. Third, we developed a technique to dynamically discover and bind to substitute services. Our technique was evaluated and the result showed that dynamic utilization of components improves the flexibility of adaptive BPEL processes. Fourth, we developed an extensible policy-based technique to specify how to handle exceptional behavior. We developed a generic component that introduces adaptive behavior for multiple BPEL processes. Fifth, we identify ways to apply our work to facilitate adaptability in composite Grid services.

The effects of the use of technology in mathematics instruction on student achievement

The purpose of this study was to examine the effects of the use of technology on students’ mathematics achievement, particularly the Florida Comprehensive Assessment Test (FCAT) mathematics results. Eleven schools within the Miami-Dade County Public School System participated in a pilot program on the use of Geometers Sketchpad (GSP). Three of these schools were randomly selected for this study. Each school sent a teacher to a summer in-service training program on how to use GSP to teach geometry. In each school, the GSP class and a traditional geometry class taught by the same teacher were the study participants. Students’ mathematics FCAT results were examined to determine if the GSP produced any effects. Students’ scores were compared based on assignment to the control or experimental group as well as gender and SES. SES measurements were based on whether students qualified for free lunch. The findings of the study revealed a significant difference in the FCAT mathematics scores of students who were taught geometry using GSP compared to those who used the traditional method. No significant differences existed between the FCAT mathematics scores of the students based on SES. Similarly, no significant differences existed between the FCAT scores based on gender. In conclusion, the use of technology (particularly GSP) is likely to boost students’ FCAT mathematics test scores. The findings also show that the use of GSP may be able to close known gender and SES related achievement gaps. The results of this study promote policy changes in the way geometry is taught to 10th grade students in Florida’s public schools.

Minority Workforce Issues in Athletic Training

Certified Athletic Trainers belonging to ethnic minority groups have many issues in the profession. This paper addresses workforce issues including distribution of minorities, recruitment and retention of minority Certified Athletic Trainers, and support systems for minority Certified Athletic Trainers.

Women in Athletic Training: Striving for Equity

The demands of athletic training are unique to the profession and many of the concerns of women in the NATA are similar to those of female executives in other professions. The purpose of this paper is to identify challenges for women in athletic training and reveal areas of inequity.

Evaluation of the Scent Collection System for Its Effectiveness in Volatile Organic Compound Collection and Use in Canine Training

As a result of increased terrorist activity around the world, the development of a canine training aid suitable for daily military operations is necessary to provide effective canine explosive detection. Since the use of sniffer dogs has proven to be a reliable resource for the rapid detection of explosive volatiles organic compounds, the present study evaluated the ability of the Human Scent Collection System (HSCS) device for the creation of training aids for plasticized / tagged explosives, nitroglycerin and TNT containing explosives, and smokeless powders for canine training purposes. Through canine field testing, it was demonstrated that volatiles dynamically collected from real explosive material provided a positive canine response showing the effectiveness of the HSCS in creating canine training aids that can be used immediately or up to several weeks (3) after collection under proper storage conditions. These reliable non-hazardous training aids allow its use in areas where real explosive material aids are not practical and/or available.

The Effects of the Use of Technology In Mathematics Instruction on Student Achievement

The purpose of this study was to examine the effects of the use of technology on students’ mathematics achievement, particularly the Florida Comprehensive Assessment Test (FCAT) mathematics results. Eleven schools within the Miami-Dade County Public School System participated in a pilot program on the use of Geometers Sketchpad (GSP). Three of these schools were randomly selected for this study. Each school sent a teacher to a summer in-service training program on how to use GSP to teach geometry. In each school, the GSP class and a traditional geometry class taught by the same teacher were the study participants. Students’ mathematics FCAT results were examined to determine if the GSP produced any effects. Students’ scores were compared based on assignment to the control or experimental group as well as gender and SES. SES measurements were based on whether students qualified for free lunch. The findings of the study revealed a significant difference in the FCAT mathematics scores of students who were taught geometry using GSP compared to those who used the traditional method. No significant differences existed between the FCAT mathematics scores of the students based on SES. Similarly, no significant differences existed between the FCAT scores based on gender. In conclusion, the use of technology (particularly GSP) is likely to boost students’ FCAT mathematics test scores. The findings also show that the use of GSP may be able to close known gender and SES related achievement gaps. The results of this study promote policy changes in the way geometry is taught to 10th grade students in Florida’s public schools.

A review of Taiwan's technological five-year junior college mechanical engineering curriculum development: 1948 to 1994

Taiwan's technological five-year junior college (TFYJC) was founded in 1948 to train technicians to meet the demand coming from national construction. Site level professionals never were trained in curriculum development as this was under strict national control. The purpose of this study is to present an accurate narrative of Taiwan's TFYJC mechanical engineering curriculum development history in order to display the focus, rationale, and influencing forces of the evolving curriculum. This study employed historical research methodology and used document analysis as the primary approach.^ This analysis revealed that the target FYJC curriculum was manufacturing-oriented. The range of government control shifted from little, to full, then to partial control of the curriculum, from autonomy to uniformity then to partial autonomy. The intention of the target curriculum development was always to advance domestic economic development. Voices from the academia and government also influenced curriculum development decisions. Currently, the government has instituted a shift in focus and content causing individual institutions to develop curriculum responses addressing the challenge of advancing Taiwan's position in a global economy.^ Considering the shift in policy and practice, individual institutions intending to design curriculum are advised to implement empirical needs assessments of students, graduates, and employers and to engage in critical studies of emerging resources in order to provide effective in service training. To accomplish this end, TFYJC faculty and administration need training in curriculum theory and practice and evaluation. ^

Forging professional public health nursing in a southern state: Florida's public health nurses, 1889-1934

From 1889 to 1934, Florida's nurses belonging to a new group of professional women ushered in a pioneering phase of public health nursing in Florida. During this era, the nurses' ability to confront health and professional issues varied a great deal but in quiet and forceful ways they tackled cultural and environmental problems to assist people who were ill or help prevent people from becoming ill. This dissertation places the development of professional public health nursing in its social context by uncovering the relationships public health nurses formed with clubwomen, the medical profession, city leaders, midwives, and others. In 1888, there were few graduate nurses in the state, no state board of health and no organized nursing service to respond to Jacksonville's great yellow fever epidemic. By 1934, national and state leaders of public health nursing had built up the profession to become an essential part of the State Board of Health's service to the community. Between these milestones, in the era of white supremacy and Jim Crow, public health nurses combined their professional training with a pioneer spirit of innovation and risk-taking. In the predominately rural state, the public health nurses' resolve to overcome environmental hazards and cultural obstacles stands out as they attempted to reach those who were unserved or underserved by modern medicine.

Best practices in exemplary service delivery: A multiple case study of service quality

The purpose of this study was to explain how exemplary service providers in luxury hotels provide consistently excellent service. Using a case study framework, the study investigated the service provider's strategies and concepts of service delivery, the importance and implementation of organizational and individual controls, and the role of training and learning. The study identified barriers to service provision and characteristics of the exemplary individuals that affect their ability to deliver luxury service. This study sought to better understand how exemplary service providers learn, think about, and do their work. The sample population of three Five-Diamond-Award winning resorts was selected for their potential for learning about the phenomenon of interest. The results demonstrate that exemplary service providers possess individual characteristics that are enhanced by the organizations for which they work. Exemplary service providers are often exemplary communicators who are emotionally generous and genuinely enjoy helping and serving others. Exemplary service organizations treat their employees as they treat their customers, as suggested by the Service-Profit Chain (Heskett, Sasser & Schlesinger, 1997). Further, they have systems and standards to guarantee satisfactory service experiences for every guest. They also encourage their service providers to personalize their service delivery and to seek opportunities to delight their guests, using a combination of controls, traditions and cultural values. Several customer service theories are discussed in relationship to whether they were or were not supported by the data. The study concluded that the delivery of exemplary service is a complex phenomenon that requires successful interactions between guests, service providers and the organization. A Model of Exemplary Service Delivery is presented and discussed that demonstrates the components of service quality as shown in the data. The model can be used by practitioners seeking to create, enhance, or evaluate their service quality, and by researchers seeking insights into the complex concepts in service quality research. Implications for future research are discussed.

An Examination of Quality Service Perceptions in a Hotel

Perceptions of managers and employees on topics related to quality and quality service in a hotel were studied to define the term “quality” and the activity of "quality service" delivery, looking at differing definitions of the terms and the activity and the identification of problem issues relating to training, communication, recognition, and department coordination. Recommendations for action included changes in the training program, a reemphasizing of the incentive programs, the development of Quality Improvement Teams, improved communication, and increased service delivery leadership.

Evaluation of a six-week professional education curriculum designed to retain registered psychiatric nurses

During the past few years there has been a drastic shortage of registered nurses in the field. The shortage appears to have affected the field of psychiatric mental health nursing most intensely. The psychiatric nursing shortage is a multifaceted problem grounded in decreasing federal funds for advanced clinical training, inadequate undergraduate psychiatric experiences, lack of a well prepared articulate role model, the integrated curriculum and the confusion and blurring associated with the roles and functions of the psychiatric mental health nurse.^ This dissertation will describe the current nursing shortage; the decline in enrollment to nursing programs; the history of psychiatric nursing as a discipline; the shortage of psychiatric mental health nurses; factors contributing to the psychiatric nursing shortage and a plan for a solution to the nursing shortage in psychiatry.^ The paper focuses on an evaluation conducted on an internship curriculum designed to facilitate effective nursing care in the treatment of clients who exhibit emotional problems. The purpose of this study was to attract and retain nurses to employment opportunities in four Hospital Corporation of America (HCA) facilities, using a six week internship program.^ The study will yield an analysis of the effect of combining psychodynamic principles and knowledge with skills in the clinical area. The demands of educational practice have been merged with the discipline of psychiatric nursing in the development of this curriculum. ^

Mindmapping as an adult learning notetaking strategy to increase the encoding of information in a corporate training course

A study was conducted to investigate the effectiveness, as measured by performance on course posttests, of mindmapping versus traditional notetaking in a corporate training class. The purpose of this study was to increase knowledge concerning the effectiveness of mindmapping as an information encoding tool to enhance the effectiveness of learning. Corporations invest billions of dollars, annually, in training programs. Given this increased demand for effective and efficient workplace learning, continual reliance on traditional notetaking is questionable for the high-speed and continual learning required on workers.^ An experimental, posttest-only control group design was used to test the following hypotheses: (1) there is no significant difference in posttest scores on an achievement test, administered immediately after the course, between adult learners using mindmapping versus traditional notetaking methods in a training lecture, and (2) there is no significant difference in posttest scores on an achievement test, administered 30 days after the course, between adult learners using mindmapping versus traditional notetaking methods in a training lecture. After a 1.5 hour instruction on mindmapping, the treatment group used mindmapping throughout the course. The control group used traditional notetaking. T-tests were used to determine if there were significant differences between mean posttest scores between the two groups. In addition, an attitudinal survey, brain hemisphere dominance survey, course dynamics observations, and course evaluations were used to investigate preference for mindmapping, its perceived effect on test performance, and the effectiveness of mindmapping instruction.^ This study's principal finding was that although the mindmapping group did not perform significantly higher on posttests administered immediately and 30 days after the course, than the traditional notetaking group, the mindmapping group did score higher on both posttests and reported higher ratings of the course on every evaluation criteria. Lower educated, right brain dominant learners reported a significantly positive learning experience. These results suggest that mindmapping enhances and reinforces the preconditions of learning. Recommendations for future study are provided. ^