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.

Social identification dimensions as mediators of the effect of prototypicality on intergroup behaviours

Cameron (2004) proposed a three-dimensional model and measure of social identification consisting of cognitive centrality, in-group affect, and in-group ties. This approach has received growing theoretical and empirical support; however, little research has examined how these dimensions of social identification may relate differentially to intergroup outcome behaviors. The current research sought to address this question by examining the possible mediating role the dimensions of social identification on the relationship between prototypicality of group members and the intergroup outcome behaviors of in-group favoritism, out-group derogation, and collective self-esteem. The current study examined university students’ (N = 235) feelings towards students from their own and another local university. Structural equation modeling was used to identify the most appropriate and parsimonious models of these pathways. The results showed support for the utility of measuring social identification using a multidimensional approach with unique meditational pathways emerging for the distinct intergroup behaviors.

Risk management and injury prevention : competencies, behaviours, and attitudes to safety in the construction industry

Work in the Australian construction industry is fraught with risk and the potential for serious harm. The industry is consistently placed within the three most hazardous industries to work along with other industries such as mining and transport (National Occupational Health and Safety Commission, 2003). In the 2001 to 2002 period, construction work killed 39 people and injured 13,250 more. Hence, more effort is required to reduce the injury rate and maximise the value of the rehabilitation/back-to-work process.

Coping with aggressive driving : driver accounts of how they manage themselves and others to reduce conflict on the road

Dealing with the aggression of other drivers on the road is an important skill given that driving is a common activity for adults in highly motorised countries. Even though incidents of extreme aggression on the road (such as assault) are reportedly rare, milder forms, some of them dangerous (such as tailgating or deliberately following too closely) are apparently common, and may be increasing. At the very least, this is likely to render the driving environment more stressful, and at worst elevates the risk of crashing by increasing both the level of risky driving behaviours and the likelihood of responses that escalate the situation. Thus the need for drivers to manage incidents of conflict is likely to become increasingly important. However, little research examines how drivers manage their own or others’ aggressive driving behaviour. Recently greater attention has been paid to driver cognitions, especially the attributions that drivers make about other drivers, that then might influence their own driving responses, particularly aggressive or risky ones. The study reported below was the first in a larger exploration of aggressive driving that focussed on driver cognitions, emotions and underlying motivations for aggressive behaviours on the road. Qualitative, in-depth interviews of drivers (n = 30, aged 18-49 years) were subjected to thematic analysis to investigate driver experiences with aggressive driving. Two main themes were identified from these accounts: driver management of self; and driver attempts to influence or manage other drivers. This paper describes the subthemes falling under the management of self main theme. These subthemes were labelled ‘being magnanimous’, ‘chilling out’, ‘slowing down’, and ‘apology/acknowledgment’. ‘Being magnanimous’ referred to situations where the respondent perceived him/herself to be a recipient of another’s aggressive driving and made a deliberate choice not to respond. However, a characteristic of this sub-theme was that this choice was underpinned by the adoption of morally superior stance, or sense of magnanimity. ‘Chilling out’ was a more general response to both the milder aggressive behaviours of other drivers and the general frustrations of driving. ‘Slowing down’ referred to reducing one’s speed in response to the perceived aggressive driving, often tailgating, of another. This subtheme appeared to consist of two separate underlying motivations. One of these was a genuine concern for one’s own safety while the other was more aimed at “getting back” at the other driver. ‘Apology’ referred to how drivers modified their more negative reactions and responses when another driver made gestures that acknowledged their having made a mistake, indicated an apology, or acknowledged the recipient driver. These sub-themes are discussed in relation to their implications for understanding aggressive driving and intervening to reduce it.

Factors influencing health behaviours of younger women after menopause-inducing cancer treatment

Objective To investigate the health promotion and risk reduction behaviors of younger women previously treated for cancer. Design and Sample Guided by the Precede-Proceed framework, a mixed-method descriptive investigation of the health behaviors of younger women with cancer treatment-induced menopause in one health jurisdiction in Australia was undertaken. Measures This article reports the results of the qualitative interview component of the study. Results Of the 85 women who responded to surveys that quantified their health behaviors, 22 consented to interviews that explored how and why these behaviors might occur. Conclusions Several predisposing, enabling and reinforcing factors that influenced participants will or ability to engage with health-promoting behaviors after cancer treatment were identified in the interviews. These include entrenched precancer diagnosis health behaviors, the disabilities resulting from cancer treatments, perceptions of risk, focused intervention by health professionals and the nature of participants social support. The results indicate a need for flexibility when planning public health initiatives to prepare this cohort for a healthy life after cancer, which accounts for their developmental, knowledge and posttreatment needs.

Transport injury risks in Queensland adolescents of Pacific Islander descent

Ethnicity is rarely considered in the development of injury prevention programs, despite its known impact on participation in risk behaviour. This study sought to understand engagement in transport related risk behaviours, patterns of injury and perceptions of risk among early adolescents who self-identify as being from a Pacific Islander background. In total 5 high schools throughout Queensland, Australia were recruited, of which 498 Year 9 students (13-14 years) completed questionnaires relating to their perceptions of risk and recent injury experience (specifically those transport behaviours that were medically treated and those that were not medically treated). The transport related risk behaviours captured in the survey were bicycle use, motorcycle use and passenger safety (riding with a drink driver and riding with a dangerous driver). The results are explored in terms of the prevalence of engagement in risky transport related behaviour among adolescents’ of Pacific Islander background compared to others of the same age. The results of this study provide an initial insight into the target participants’ perspective of risk in a road safety context as well as their experience of such behaviour and related injuries. This information may benefit future intervention programs specific to adolescents’ of Pacific Islander background.

Behavioural beliefs concerning gender and high-risk sexual behaviours in the context of HIV/AIDS in PNG : views from within teacher education

Education is often viewed as a key approach to address sexual-health issues; the current concern is the burgeoning HIV/AIDS epidemic. This ethnographic study investigates the gender practices associated with high-risk sexual behaviour in Papua New Guinea as viewed by educators there. A number of practices, including gender inequality and associated sexual behaviours have been highlighted by male and female participants as escalating PNG’s HIV/AIDS epidemic. The study finds that although participants were well-informed concerning HIV/AIDS, they had varying beliefs concerning the prevailing gender/sexual issues involved in escalating highrisk behaviour and how to address the problem. The study further examines the behavioural beliefs and intentions of the educators themselves. Subsequently, within the data a number of underpinning factors, pertaining to gender, education and life experience, were found to be related to the behaviour beliefs and intentions of participants towards embracing change with regard to behaviours associated with gender equality in PNG. These factors appeared to encourage participants to adopt healthier gender and sexual behavioural intentions and, arguably, could provide the basis for ways to help address the gender inequality and high-risk behaviours associated with HIV/AIDS in PNG.

Improving health behaviours during pregnancy: A new direction for the pregnancy handheld record

Obstetric documentation processes may influence the clinical, behavioural, and psychological outcomes of pregnancy, although recent alterations to integrate obstetric documentation with pregnancy handheld records have been unsuccessful. Woman-held records as a companion to usual obstetric documentation have the potential to improve pregnancy-related health behaviours with a demonstrated association with maternal and infant health outcomes, and recommendations for their format and content are provided.

Is it time to revisit the problem young driver?

For decades there have been two young driver concepts: the „young driver problem‟ where the driver cohort represents a key problem for road safety; and the „problem young driver‟ where a sub-sample of drivers represents the greatest road safety problem. Given difficulties associated with identifying and then modifying the behaviour of the latter group, broad countermeasures such as graduated driver licensing (GDL) have generally been relied upon to address the young driver problem. GDL evaluations reveal general road safety benefits for young drivers, yet they continue to be overrepresented in fatality and injury statistics. Therefore it is timely for researchers revisit the problem young driver concept to assess its potential countermeasure implications. Personal characteristics, behaviours and attitudes of 378 Queensland novice drivers aged 17-25 years were explored during their pre-, Learner and Provisional 1 (intermediate) licence as part of a larger longitudinal research project. Self-reported risky driving was measured by the Behaviour of Young Novice Drivers Scale (BYNDS), and five subscale scores were used to cluster the drivers into three groups (high risk n = 49, medium risk n = 163, low risk n = 166). High risk „problem young‟ drivers were characterised by self-reported pre-Licence driving, unsupervised Learner driving, and speeding, driving errors, risky driving exposure, crash involvement, and offence detection during the Provisional period. Medium risk drivers were also characterised by more risky road use behaviours than the low risk group. Interestingly problem young drivers appear to have some insight into their high-risk driving, and they report significantly greater intentions to bend road rules in future driving. The results suggest that in addition to broad countermeasures such as GDL which target the young driver problem, tailored intervention efforts may need to target problem young drivers. Driving behaviours and crash-involvement could be used to identify these drivers as pre-intervention screening measures.