A case study examination of the influence of cultural diversity in the multicultural nursing workforce on the quality of care and patient safety in a Saudi Arabian hospital

The purpose of the study: The purpose of this study is to investigate the influence of cultural diversity, in a multicultural nursing workforce, on the quality and safety of patient care and the work environment at King Abdul-Aziz Medical City, Riyadh region. Study background: Due to global migration and workforce mobility, to varying degrees, cultural diversity exists in most health services around the world, particularly occurring where the health care workforce is multicultural or where the domestic population comprises minority groups from different cultures speaking different languages. Further complexities occur when countries have a multicultural workforce which is different from the population for whom they care, in addition to the workers being from culturally diverse countries and with different languages. In Saudi Arabia the health system is mainly staffed by expatriate nurses who comprise 67.7% of the total number of nurses. Study design: This research utilised a case study design which incorporated multiple methods including survey, qualitative interviews and document review. Methods: The participant nurses were selected for the survey via a population sampling strategy; 319 nurses returned their completed Safety Climate Survey questionnaires. Descriptive and inferential statistics (Kruskal–Wallis test) were used to analyse survey data. For the qualitative component of the study, a purposive sampling strategy was used; 24 nurses were interviewed using a semi-structured interview technique. The documentary review included KAMC-R policy documents that met the inclusion criteria using a predetermined data abstraction instrument. Content analysis was used to analyse the policy documents data. Results: The data revealed the nurses‘ perceptions of the clinical climate in this multicultural environment is that it was unsafe, with a mean score of 3.9 out of 5. No significant difference was detected between the age groups or years of experience of the nurses and the perception of safety climate in this context; the study did reveal a statistically significant difference between the cultural background categories and the perception of safety climate. The qualitative phase indicated that the nurses within this environment were struggling to achieve cultural competence; consequently, they were having difficulties in meeting the patients‘ cultural and spiritual needs as well as maintaining a high standard of care. The results also indicated that nurses were disempowered in this context. Importantly, there was inadequate support by the organisation to manage the cultural diversity issue and to protect patients from any associated risks, as demonstrated by the policy documents and supported by the nurses‘ experiences. The study also illustrated the limitations of the conceptual framework of cultural competence when tested in this multicultural workforce context. Therefore, this study generated amendments to the model that is suitable to be used in the context of a multicultural nursing workforce. Conclusion: The multicultural nature of this nursing work environment is inherently risky due to the conflicts that arise from the different cultural norms, beliefs, behaviours and languages. Further, there was uncertainty within the multicultural nursing workforce about the clinical and cultural safety of the patient care environment and about the cultural safety of the nursing workforce. The findings of the study contribute important new knowledge to the area of patient and nurse safety in a multicultural environment and contribute theoretical development to the field of cultural competence. Specifically, the findings will inform policy and practice related to patient care in the context of cultural diversity.

Enhancing foreign language learning through listening strategy delivered in L1: an experimental study

Listening used in language teaching refers to a complex process that allows us to understand spoken language. The current study, conducted in Iran with an experimental design, investigated the effectiveness of teaching listening strategies delivered in L1 (Persian) and its effect on listening comprehension in L2. Five listening strategies: Guessing, making inferences, identifying topics, repetition, and note-taking were taught over 14 weeks during a semester. Sixty lower intermediate female participants came from two EFL classrooms in an English language institute. The experimental class (n = 30) who listened to their classroom activities performed better (t value = 10.083) than the control class using a methodology that led learners through five listening strategies in Persian. The same teacher taught the students in the control class (n = 30), who listened to the same classroom listening activities without any of the above listening strategies. A pre and post listening test made by a group of experts in the language institute assessed the effect of teaching listening strategies delivered in L1. Results gathered on the post intervention listening test revealed that listening strategies delivered in L1 led to a statistically significant improvement in their discrete listening scores compared with the control group.

Is language a barrier for quality care in hospitals? A case series from an Emergency Department of a teaching hospital in Brisbane

Aim: The aim of this pilot study is to describe the use of an Emergency Department (ED) at a large metropolitan teaching hospital by patients who speak English or other languages at home. Methods: All data were retrieved from the Emergency Department Information System (EDIS) of this tertiary teaching hospital in Brisbane. Patients were divided into two groups based on the language spoken at home: patients who speak English only at home (SEO) and patients who do not speak English only or speak other language at home (NSEO). Modes of arrival, length of ED stay and the proportion of hospital admission were compared among the two groups of patients by using SPSS V18 software. Results: A total of 69,494 patients visited this hospital ED in 2009 with 67,727 (97.5%) being in the SEO group and 1,281 (1.80%) in the NSEO group. The proportion of ambulance utilisation in arrival mode was significantly higher among SEO 23,172 (34.2%) than NSEO 397 (31.0%), p <0.05. The NSEO patients had longer length of stay in the ED (M = 337.21, SD = 285.9) compared to SEO patients (M= 290.9, SD = 266.8), with 46.3 minutes (95%CI 62.1, 30.5, p <0.001) difference. The admission to the hospital among NSEO was 402 (31.9%) higher than SEO 17,652 (26.6%), p <0.001. Conclusion: The lower utilisation rates of ambulance services, longer length of ED stay and higher hospital admission rates in NSEO patients compared to SEO patients are consistent with other international studies and may be due to the language barriers.

Front page schools, back page schools : a case study of factors perceived to affect academic performance in five Papua New Guinea secondary schools

Papua New Guinea has reformed its colonial established education system and made huge investments with the help of donors to achieve equal access and quality education for all its citizens. Despite this national aspiration and these policy reforms and investments, secondary schools that enrol grade 9 students who are relatively equal in education ability show huge disparities in their grade 10 academic performances. This study examined perceptions of students, teachers and principals regarding factors affecting the disparity in academic performance in the context of a developing country. The central question for the study is: What are the perceptions of students and teachers of the factors that affect disparities in secondary schools' academic performance? This qualitative case study involved two high and three low academic performing secondary schools in Western Highlands Province of Papua New Guinea. Primary data were collected through focus groups and semi-structured interviews involving 112 participants. Students and teachers are key participants in this study, as it intends to find out the realities of schools, yet they are an under-researched group. A postcolonial and sense of community conceptual framework was developed for the analysis of the participants. perceptions. In addition, scholarship on school effectiveness and equity in education informed the interpretation of the findings. Three themes were evident in participants. views. First, participants expressed their view that differences in academic performance were related to the adequacy and equitability of resources. The inequities in resource inputs led some of them to coin the metaphor of .back page and front page. schools. Second, many expressed the view that deficiencies in implementing bilingual education, given the difficulty of catering for 800 vernacular languages, contribute to poor English proficiency and subsequent poor academic performance. Finally, participants believed that, in order to have a positive school culture, it is necessary for educators to recognise and respect contemporary students. identities, communal/tribal membership and needs. This study has implications for national education policy on resource allocation to address equality and equity, bilingual education and teacher education. Moreover, as the study found that high academic performance in this context is also influenced by intra-school social relationships, these relationships need to be nurtured. When appropriately nurtured, they become an important factor in sustaining quality education for all secondary school students. This thesis has laid the foundations for further research and invites further investigations into policy and implementation of school reforms aimed at improving academic achievement.

The role of markup in the digital humanities

The digital humanities are growing rapidly in response to a rise in Internet use. What humanists mostly work on, and which forms much of the contents of our growing repositories, are digital surrogates of originally analog artefacts. But is the data model upon which many of those surrogates are based – embedded markup – adequate for the task? Or does it in fact inhibit reusability and flexibility? To enhance interoperability of resources and tools, some changes to the standard markup model are needed. Markup could be removed from the text and stored in standoff form. The versions of which many cultural heritage texts are composed could also be represented externally, and computed automatically. These changes would not disrupt existing data representations, which could be imported without significant data loss. They would also enhance automation and ease the increasing burden on the modern digital humanist.

Dynamic weaving of aspects for business process management systems

Reducing complexity in Information Systems is a main concern in both research and industry. One strategy for reducing complexity is separation of concerns. This strategy advocates separating various concerns, like security and privacy, from the main concern. It results in less complex, easily maintainable, and more reusable Information Systems. Separation of concerns is addressed through the Aspect Oriented paradigm. This paradigm has been well researched and implemented in programming, where languages such as AspectJ have been developed. However, the rsearch on aspect orientation for Business Process Management is still at its beginning. While some efforts have been made proposing Aspect Oriented Business Process Modelling, it has not yet been investigated how to enact such process models in a Workflow Management System. In this paper, we define a set of requirements that specifies the execution of aspect oriented business process models. We create a Coloured Petri Net specification for the semantics of so-called Aspect Service that fulfils these requirements. Such a service extends the capability of a Workflow Management System with support for execution of aspect oriented business process models. The design specification of the Aspect Service is also inspected through state space analysis.

Workflow patterns put into context

In his paper “Approaches to Modeling Business Processes. A Critical Analysis of BPMN, Workflow Patterns and YAWL”, Egon Börger criticizes the work of the Workflow Patterns Initiative in a rather provocative manner. Although the workflow patterns and YAWL are well established and frequently used, Börger seems to misunderstand the goals and contributions of the Workflow Patterns Initiative. Therefore, we put the workflow patterns and YAWL in their historic context. Moreover, we address some of the criticism of Börger by pointing out the real purpose of the workflow patterns and their relationship to formal languages (Petri nets) and real-life WFM/BPM systems.

Virtually real : Suzanne Collins's the Hunger Games Trilogy

The Hunger Games trilogy by Suzanne Cololins deals with a dystopian future society in which a punitive ruling elite provide 'entertainment' for the masses in the form of mediatised 'games' featuring young people who must fight to kill one another until there is only one winner. The purpose of these games is to remind the populace of the power of the government and its ability to dispose of any who dare defy it. In acknowledging violent 'games' as virtual entertainments which can be used to political effect, Collins suggests that they possess a disturbing capacity to undermine ethical perspective on the human,the humane and the real. Drawing on Baudrillard's ideas about simulation and simulacra as well as Elaine Scarry's and Susan Sontag's concerns for media representations of the body in pain, this paper discusses the ways in which the texts highlight the dangers of virtual modes while also risking perpetuating their entertainment value.

The acquisition of an artificial logographic script and bilingual working memory : Evidence for L1-specific orthographic processing skills transfer in Chinese-English bilinguals

Studies of orthographic skills transfer between languages focus mostly on working memory (WM) ability in alphabetic first language (L1) speakers when learning another, often alphabetically congruent, language. We report two studies that, instead, explored the transferability of L1 orthographic processing skills in WM in logographic-L1 and alphabetic-L1 speakers. English-French bilingual and English monolingual (alphabetic-L1) speakers, and Chinese-English (logographic-L1) speakers, learned a set of artificial logographs and associated meanings (Study 1). The logographs were used in WM tasks with and without concurrent articulatory or visuo-spatial suppression. The logographic-L1 bilinguals were markedly less affected by articulatory suppression than alphabetic-L1 monolinguals (who did not differ from their bilingual peers). Bilinguals overall were less affected by spatial interference, reflecting superior phonological processing skills or, conceivably, greater executive control. A comparison of span sizes for meaningful and meaningless logographs (Study 2) replicated these findings. However, the logographic-L1 bilinguals’ spans in L1 were measurably greater than those of their alphabetic-L1 (bilingual and monolingual) peers; a finding unaccounted for by faster articulation rates or differences in general intelligence. The overall pattern of results suggests an advantage (possibly perceptual) for logographic-L1 speakers, over and above the bilingual advantage also seen elsewhere in third language (L3) acquisition.

Adaptation and empathy : intercultural communication in a choreographic project

The tricky terrain of intercultural communication within the pressure-cooker environment of creating new performance work is explored through the experiences of five Australians working with 55 artists in Hanoi, Vietnam on a project called Through the Eyes of the Phoenix. Key cultural communication issues such as the concept of ‘face’, identity, translation, adaptability, ambiguity tolerance, empathy, enmeshment and the development of shared understandings are examined in relation to theories of high and low context cultures and individualist collectivist frameworks. The experiences of both Australian and Vietnamese artists are foregrounded, revealing the importance of other intercultural communication modes such as visual, kinaesthetic and tactile languages as well as the languages of their art forms. Immersion in social activities and the importance of the emotional domain are also highlighted as essential factors to survive and thrive in intense creative collaborations across cultures. These dance perspectives, embedded in practice, provide alternative contributions to the messy complexities of intercultural communication.

Developing a creative cluster in a post-industrial city : the Creative Industries Development Service (CIDS) and Manchester

This article takes the establishment and demise of Manchester’s Creative Industries Development Service (CIDS) as an exemplary case study for the ways in which creative industry policy has intersected with urban economic policy over the last decade. The authors argue that the creative industries required specific kinds of economic development agencies that would be able to act as “intermediaries” between the distinct languages of policymakers and “creatives.” They discuss the tensions inherent in such an approach and how CIDS attempted to manage them and suggest that the main reason for the demise of the CIDS was the domination of the “economic” over the “cultural” logic, both of which are present within the creative industries policy discourse.

Listening skill requires a further look into second/foreign language learning

Current English-as-a-second and foreign-language (ESL/EFL) research has encouraged to treat each communicative macroskill separately due to space constraint, but the interrelationship among these skills (listening, speaking, reading, and writing) is not paid due attention. This study attempts to examine first the existing relationship among the four dominant skills, second the potential impact of reading background on the overall language proficiency, and finally the relationship between listening and overall language proficiency as listening is considered an overlooked/passive skill in the pedagogy of the second/foreign language classroom. However, the literature in language learning has revealed that listening skill has salient importance in both first and second language learning. The purpose of this study is to investigate the role of each of four skills in EFL learning and their existing interrelationships in an EFL setting. The outcome of 701 Iranian applicants undertaking International English Language Testing System (IELTS) in Tehran demonstrates that all communicative macroskills have varied correlations from moderate (reading and writing) to high (listening and reading). The findings also show that the applicants’ reading history assisted them in better performing at high stakes tests, and what is more, listening skill was strongly correlated with the overall language proficiency.

Malay Kingship in Kedah : Religion, Trade, and Society

The book probes and examines traditional sources of royal power and control, as well as indigenous socio-political systems in the Malay world. It is focused on the north-western Malaysian Sultanate of Kedah which is acknowledged as the oldest unbroken independent kingship line in the ‘Malay and Islamic world’ with 1,000 years of history. Little scholarly attention has been paid to its pre-modern history, society, religion, system of government and unique geographic situation, potentially controlling both land and sea lines of communication into the remainder of Southeast Asia. It will thus provide the first comprehensive treatment in English, or other languages, on Kedah’s pre-modern and nineteenth century historiography and can provide a foundation for comparative studies of the various Malay states which is presently lacking. The proposed book also sheds much needed light on a range of important topics in Malay history including: Kedah and the northern Melaka Straits history, colonial expansion and rivalry, Southeast Asian history and politics, interregional migration and the influence of the sea peoples or orang laut, traditional Malay socio-political and economic life, Islamic influences and the course of Thai-Malay relations. The book attempts to offer a new understanding, not only of Kedah, but of the political and cultural development of the entire Malay world and of its relationships with the broader forces in both its continental and maritime settings. It argues that Kedah does not seem to follow, and in fact, often seems to contradict what has been commonly been accepted as the “typical model” of the traditional Malay state. Thus it concludes that the ruling dynasty has historically exploited a wide range of unique environmental conditions, local traditions, global spiritual trends and economic forces to preserve and strengthen its political position. The scope and theme of book The Kedah Sultanate is the oldest unbroken independent kingship lines in the “Malay world” with 1,000 years of history, and arguably one of the oldest in the Islamic world. In this study I examine key geopolitical and spiritual attributes of Malay kingship that have traditionally cemented the ruler, the peoples, and the environment. Brief description of the primary audience for the book: There is little written in English or Malay on Kedah’s pre twentieth century history. The available sources only look at certain aspects of Kedah’s history, are outdated or are confined to a specific period often outside the scope of the book. It is therefore anticipated that the readership and market for the book includes: • Scholars of Southeast Asian history, Islam, kingship, trade. • Academics & Historians (including: Asian, Thai history, Islamic, Maritime, Persian, South Asian, Southeast Asian and Colonial) • Libraries • Students, particularly those in Malaysia (especially the states of Kedah, Perlis and Penang), Thailand and Singapore. • Universities • Scholars and students in Political Science & International Relations

Porno? Chic!: how pornography changed the world and made it a better place

Porno? Chic! examines the relationship between the proliferation of pornography and sexualised culture in the West and social and cultural trends which have advanced the rights of women and homosexuals. Brian McNair addresses this relationship with an analysis of trends in sexualised culture since 2002 linked to a transnational analysis of change in sexual politics and sex/gender relations in a range of societies, from the sexually liberalised societies of advanced capitalism to those in which women and homosexuals remain tightly controlled by authoritarian, patriarchal regimes. In this accessible, jargon-free book, Brian McNair examines why those societies in which sexualised culture is the most liberalised and pervasive are also those in which the socio-economic and political rights of women and homosexuals have advanced the most.