Impacts of Cultural Differences

Hunan Information Science Vocational College Graduation Thesis Subject: Impacts of Cultural Differences on International Business Negotiation Name: Chen Xiujuan Student No. : 0 8 5 1 0 3 4 0 Specialty and Class: Business English, Class 3 Department: Department of Humanities and Arts Supervisor: Liu Mifan Date: 2011-3-02 Contents Introduction1 1. Types of Cultural Differences2 1. 1Value View2 1. 2. Negotiating Style2 1. 3. Thinking Model2 2. Impact Of Cultural Differences on International Business Negotiations4 . 1Impact of Value Views Differences on International Business Negotiations4 2. 1. 1Impact of Time View Difference on Negotiation. 4 2. 1. 2Impact of Equality View Difference on Negotiation. 5 2. 1. 3 Impact of Objectivity Difference on Negotiation. 6 2. 2 Impact of Negotiating Style Differences on International Business Negotiations. 7 2. 3 Impact of Thinking Model Differences on International Business Negotiation. 8 3. Coping Strategy Of Negotiating Across Cultures. 9 3. 1 Ma king Preparations before Negotiation. 9 3. 2 Overcoming Cultural Prejudice. 10 3. Conquering Communication Barriers. 10 Conclusion11 Bibliography12 Acknowledgements13 Abstract The business negotiations under different cultural conditions come to cross- cultural negotiations. With the economic globalization and the frequent business contacts, cultural differences seem to be very important; otherwise they could cause unnecessary misunderstanding, even affect the result of the business negotiations. This means it is very important to know the different culture in different countries and the ways to avoid the culture conflicts in the international business negotiations.The article commences from the types of culture differences, then it explains the impacts of these culture differences on international business negotiation and finally it analyzes how to deal with the problem of the cultural differences correctly in negotiation process. Such a standpoint is emphasized: In the business ne gotiations between different countries, negotiators should accept the other party’s culture, and try to make him be accepted; then make a correct evaluation with the help of valid communication and discover their real benefits between them.Besides, we should know clearly and try to accept the culture differences as possible as we can. It is very important for the success of culture negotiations. Key words: Culture; Cultural differences; Business negotiation; Impact Introduction Along with the advancement globalization and China’s WTO entry, business enterprises in China have to face more and more business negotiations with foreign enterprises, especially with American enterprises. In these negotiations, Chinese negotiators sometimes feel uncomfortable, puzzled, lost, irritated and the alike, because of unfamiliar custom and behaviors demonstrated by American negotiators.Meanwhile, American negotiators confront the same situation. Cult rural differences between China an d west countries could cause many problems. Therefore, understanding cultural differences and overcoming them is crucial in international business negotiations. Although the definition of culture is numerous and vague, it is commonly Recognized that culture is a shared system of symbols, beliefs, values, attitudes and expectations. Culture is a major determinant in business negotiation. So have a clear picture of culture differences if of great significance. . Types of Culture Differences The east countries and west countries have produced different cultures on the different continents. Among the different cultures, value views, negotiating style and thinking model appear more obvious. 1. 1Value View Value view is the standard that people use to asses objective things. It includes time view, equality view and objectivity. People may draw a different or even contradictory conclusion about the same thing. Value view is one of the most important differences among the many factors.It ca n influence the attitude, needs and behavior of people. The value view varies from nation to nation, people know that the eastern person focus on collectivism, while the western people pay more attention to individualism. 1. 2. Negotiating Style Negotiating style refers to the tolerance and graces which the negotiator shows in the negotiation. The negotiators show their negotiating style through behavior, manners and the method of controlling negotiation process during the negotiation.The negotiator’s negotiating style has a bearing on their culture background. According to the culture differences, negotiating style falls into two types: the east negotiating style pattern and the west negotiating style pattern. 1. 3. Thinking Model Thinking model reflects the culture. Because of the influences of history background, continents, words and living method, different nations generate different thinking models. Surely, there is more than one thinking model of a nation, but one is m ore obvious compared with others.As a whole, east people, especially Chinese have strong comprehensive thinking, image thinking and curved thinking, while analytical thinking, abstract thinking and direct thinking are possessed by the west people. 2. Impact of Cultural Differences on International Business Negotiations With the rapid development of economy, we need to do business with businessmen under different culture background, so in order to reach trade agreement, it is necessary for us to study the impact of culture differences on international negotiation in global business activities.The impact of culture differences on international negotiation is extensive and deeply. Different cultures divide the people into different group and they are also the obstacles of people’s communication. Accordingly, it is required that the negotiator should accept the culture of each other. Furthermore, through culture differences, it is important that the negotiator reveal and understa nd the other party’s goal and behavior and make him or herself be accepted by the opponent to reach agreement finally 2. 1Impact of Value Views Differences on International Business NegotiationsValue Views Differences on International Business Negotiations fall into three types: time view, negotiation style, thinking model. Each has big influences on business negotiation 2. 1. 1 Impact of Time View Difference on Negotiation. The time view which affects the negotiator’s behavior varies from east countries to west countries. The oriental or the Chinese negotiators are usually cautious and patient. They need to go through the phrases of coming up with proposes, bringing up objections and ending the trade which takes a longer time.And they hope to arrange rich time to go on a negotiation, thus knowing more about the opponent . They are good at long and continuous battle. While west people or we could say American people, consider time is precious. They tend to resolve prob lems swiftly. So, in business negotiation, American businessmen often complain about the delay and the lack of efficiency of negotiators from other countries, while these countries also make a complaint that the Americans lack patience. There is a popular saying among American negotiators and businessmen: It is prohibited to steal time.That shows the time view of Americans. To them, time means money. The time view of Chinese is cyclic. They use long-term and systematic viewpoints to value the importance of the topic. A famous people classify the time view into two kinds: straight-line time viewand cyclic time view. The former pay more attention to concentration and speed, and the later stress doing many things at one time. That they insist on different time view leads to different negotiating style and method. The American people represent the straight-line time view and they have a strong awareness of modern competition.They look for speed and efficiency. So they value time badly a nd consider time as a special commodity whose value could be assessed. They often use minute to calculate time . They hope to reduce negotiation time at every phrase and want to complete the negotiation quickly. But the Chinese time view is cyclic and they place emphasis on unity. Moreover, it is necessary to be punctual at negotiations. West people have a strong time view, if you don’t comply with the appointment time, they may give you a punishment and they will regard you as unreliable and irresponsible person.Being late for negotiation will give the west businessmen opportunities to exert pressure onyou, and then you will lose the status of being initiative. 2. 1. 2 Impact of Equality View Difference on Negotiation America went through the bourgeoisie revolution of striving for the equality and freedom, so they take equality into their heart. Americans stick to equality and fairness in business, and hope that both could gain benefit. When introducing the topic or situatio n, the west people would like to use concrete method, particularly data.Their negotiating method is that they will describe their viewpoint and propose at the beginning in order to get initiative. Under this principle, they would come up with a reasonable resolution which they think is very fair. In business relationship, the sellers from America regard the buyer as a counterpart. Americans are fairer than Japanese is sharing benefits. A lot of American managers think fair division of profits is more important than how much they could get. At this point, the east people are different. Because of the deeply influence of class view, they don’t pay much attention to equality.They usually adopt single-win strategy in business negotiations. When involving economic benefits they think much about their own benefits and profits and don’t give so much attention to the benefit of their partners. The market economic system of developed countries is quite mature, so west countries take win-win strategy more in negotiation; basically, they could take the benefits of both into consideration. 2. 1. 3 Impact of Objectivity Difference on Negotiation The objectivity in international business negotiation reflects the degree to which people treat any things.West people especially Americans have a strong objectivity on the understanding of issues. At negotiation table, Americans don’t care much about relationship between people. They don’t care if the status of the opponent is equal to theirs. They make decision based on facts and data, not people. The saying that public things use public ways is a reflection of American objectivity. Therefore,Americans emphasize that Businessmen should distinguish people and issues, what they are really interested in is the actual problems. But in the other parts of the world, it is impossible for them to distinguish people and issues. . 2 Impact of Negotiating Style Differences on International Business Negotiations T he impacts of negotiating style differences on international business negotiation mainly exist in negotiating method and negotiating structure. Take the negotiation between America and China as a example, since the oriental care more about unity in thinking, they method they adopt in negotiation is from unity to parts, from the big to little, from the abstract to the concrete, that is to say they should each agreement on general terms, then begin to talk about the concrete terms.And usually not until the end of the negotiation do they make compromise and promise based on all the items, and then to reach agreement. The west people are influenced by analytic thinking, so pay more attention to logical relations between things. They consider more about concrete things than integrity. And they tend discuss the concrete items at the beginning of negotiation, so they often resolve the price, delivery and issuance respectively at first. And they may make compromise at every detail, so the f inal contract is the combination of many little agreements.The negotiating structure is linked with cultures. Negotiating structure mostly refers to the number of the participants. In business negotiation, the foreign delegation is usually composed by 3-5 people, while the Chinese one could be more 15 people. The foreign negotiators not only need to negotiate with their counterparts but also need to discuss with related person in charge or the government. When making the final decisions, the Chinese negotiators often discuss the results repeatedly from the workers to the board to avoid being decided by a single person. That results from the influence of collectivism.So they often said to their partners: Let us think about it. Let us discuss it. But the west negotiators could make the final decision without going back for discussion. That because their admire individualism and hard working. They have strong independence. They would carry on according to the best ways after knowing th eir goals. What’s more, most west people think that they have the ability to deal with the negotiation situation on their own. And truly, they are brave enough to take responsibility. 2. 3 Impact of Thinking Model Differences on International Business NegotiationThe thinking model of Chinese tends to be comprehensive, concrete and curved, while the Americans are usually analytic, abstract and straight-line. We Chinese are accustomed to talking about general principles at first and then move onto details. To Chinese negotiators, the core is the general guideline, and the details are subject to the guideline. After figuring out the big picture, other problems are easier to resolve. It is the most obvious feature of Chinese negotiators. But west businessmen, especially Americans are likely to discuss the details first and try to avoid the principle.They value details very much and think noting about the unity. Accordingly, they want to discuss the details at the beginning of neg otiation. They are direct and simple in negotiation. As a matter of fact, many facts show that General principles first have impact of constriction on the parts and details. For instance, our government insists on the principle that Hong Kong and Macao are undivided parts of China’s territory. In the important diplomatic negotiations such as Entering into relationship with America, Hong Kong’s and Macao’s Coming back into their motherland.It is under such principle that we established the tone of the negotiation and controlled the skeleton of the negotiation, thus we get the advantage and prompt the success of negotiation. 3. Coping Strategy of Negotiating across Cultures The culture differences in cross-cultural communication have various impacts on operation of enterprises. These differences will influence negotiation and management of transnational operation; what’s more, it may have bad effects on the harmonious relationship between our country and fo reign countries.Maybe that will lead to the missing of market opportunities, the increase of trade cost and the low efficiency of company management. So, it is really necessary for us all to eliminate and avoid disadvantageous effects. 3. 1 Making Preparations before Negotiation. The negotiators must make good preparations if they want control the development of negotiation successfully in the complex situation. Only do they make good preparations can they make changes freely according to the situation of negotiation and avoid the happening of conflicts. Because the international business negotiation involves extensive aspects, more preparations are needed.The preparations often include the analysis of the negotiators themselves and the opponents; the constitution of negotiation group, elaborating the negotiating goal and strategy and going on imitation negotiation when necessary. When making preparations, you should try to know the opponents while you analyze yourselves. Analyzing yourselves mainly refers to studying if the project is feasible. To knowing about the opponents means understanding their strength such as credit status, the policy? business customs and regulations of their countries and the conditions of their negotiating members and so on. . 2 Overcoming Cultural Prejudice Tolerating different cultures and overcoming cultural prejudice contribute to better communicating with each other and understanding each other. West people often think that they are powerful, capable and experienced, so sometimes, we need to recognize then and give then some good comments. We should learn about the foreign cultures before negotiation and accept and understand their cultures in negotiation, because every country regard their own cultures as a matter of course and hope that their culture could be recognized and accepted. 3. Conquering Communication Barriers Two trains running at different railways in the opposite direction will collide with each other; maybe thi s is the best arrangement for trains. But to communication between people, there won’t be communications if people go ahead according to their own ways. Trains will collide with each other if they run on the same railway at the opposite direction. But if we measure by the objective of people’s communication, only we meet each other, can we have communication and friendship. In negotiation, sometimes we can’t make much progress although we have talked for long time.And sometimes both parties are not satisfied. After thinking, that is caused by communication barriers which happen easily in cross-cultural negotiation. We should make sure if there appear communication barriers, if so, we must overcome them. Generally speaking, we should pay more attention to the following three communication barriers in cross-cultural negotiation: the communication barriers caused by culture background of both; the ones caused by misunderstanding of the contents and information from the partner; the ones caused by not being willing to accept the opponent’s contents and ideas.Conclusion â€Å"Social Customs varies in different countries†. In a word, cross- cultural communication will meet the problem of culture differences surely. In turn, culture differences also influence all aspects of international business communication. To avoid or to resolve the culture differences is a huge task in international business negotiation. In order to step into the international market successfully, we must have the awareness of culture differences, acknowledge culture differences and understand different cultures.Try to know yourself and know them. What’s more, we should respect different behavior of businessmen under different culture background, and then we could reduce unnecessary conflicts resulting from not respecting the opponents. It is beneficial for both to form an atmosphere of mutual trust and cooperation, reduce culture differences and turn d isadvantages into advantages and benefits. Thus, we could avoid conflicts and obstacles, then to promote communication and harmony in international business negotiation. Bibliography 1]George Yule. The study of Language[M]. Cambridge University Press,2000:202-209 [2]Harvey, Paul,,â€Å"The Oxford Companion to English Literature† [M]. London: Oxford University Press. 1978:23-25 [3]Philip R Harris, Managing Cultural Differences [M]. Gulf Publishing Company, 1987:234-260 [4]Wang Cheng fa. A Glimpse of Foreign Land [J]. Kaifeng: Henan Univesity Press, 2000:58-62 [5]. [M]. : ,2000:2-6 [6]  · —— [M]. : ,2004 [7].. [M] : ,2003:340-342 [8]. [M]. : ,2001 Acknowledgements As acknowledgements for my paper, only I — the writer is responsible for the shortcomings. I much acknowledges my thanks to all my teachers, especially to Miss Liu Mifan, my supervisor, who has provides me support, critical ideas and careful suggestions. I also want to thank my family who alwa ys give me time, encouragement and secretarial services, especially my parents. Finally, my classmate and friends, who provided thoughtful and thorough reviews of my paper, must be acknowledged.

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Business Ethics - Essay Example This means that, they should not base on the individual’s clinical decisions on matters concerning the care and prevention of each patient, policy decisions and management of the systems. In addition to that, personal decisions should not be allowed when organizing, managing and paying for a care. As a matter of fact, it is ideal for individuals involved in healthcare system to understand that getting the right clinical decisions needs a wider application of the â€Å"principles of evidence-based medicine.† The systematic utilization of evidence based management helps in improving the significant decisions affecting care in the health plan, hospital, community or nursing home and physician practice. In that case, for evidence -based medicine to be implemented successfully, it needs the evidence-based management support (Fraser, 2007). Evidence-based management widespread application might not be easy or rapid. This is because, its history is torturous and long and achie ving it is becoming extremely harder. Perhaps, most of the managers may conceive the clinical interventions conceptual foundation of evaluation irrelevant. Biology as it is does not possess local variation unlike the way health plan or hospital administrations and physician practices do. ... tioner literature and academic literature on the management of human resource is a perfect cause and indicator of the existing separation between practice and research in management of human resource (Boudreau, 2007). Whatever is passed as† best Practice† in human resource management in most cases is not. In some instances, there exists no evidence validating what are conceived to be practices that are perfect. On the other hand, there are some circumstances there are evidences available to suggest whatever practices are thought to be best are indeed inferior. In summary, human resource management that is evidence-based is not practiced in most of the organizations. As a result, there is underperformance in the organization with respect to principal stakeholders including investors, employees and the community (Lawler, 2007). Situation There exist a conflict between the Chief Executive Officer Mr Mark Willey and the Medical officer Miss Sally Randolph. Both of them work i n American Medical Centre (AMC). Mark Willey has emailed Sally Randolph a message that has completely blurred her vision. She claims that the email that had been sent to her was labelled urgent with an exclamation in red whose subject line was† Evidence-based- Management seminar has been cancelled.† This is because the focus of Mark the CEO had shifted from taking care of patients to profits. The message not only disturbed sally but also other employees such as Richard who had been among the thirty six participants in the evidence-based management workshop that had been performed by sally. His remarks were as follows† I just read the e-mail from Mark and I am really frustrated. Making us middle managers on these task forces won’t change how anyone works.† According to Richard, the medical

Finance for E-Business (Report) Essay Example | Topics and Well Written Essays - 2750 words

Finance for E-Business (Report) - Essay Example BT Group plc is listed on stock exchanges in London and New York.† (btplc.com). The group has four (4) principal lines of business: BT Global Services; Openreach, BT Retail and BT Wholesale. The principal activities of the group include: â€Å"networked IT services, local, national and international telecommunications services, and higher value broadband and internet products and services† (btplc.com).) The ratios below and an explanation as to their use will indicate to you why this particular company’s share may or may not be recommended. However, as you will find out, there are limitations to these ratios. Profitability ratios are usually calculated in order to perform vertical analysis or to compare one year with another. These ratios include net profit margin and gross profit margin. Figures are also taken from the balance sheet and used for the calculation of specific ratios to determine how well the fixed assets were utilised. These ratios are known as asset management ratios. These include asset turnover ratios and return on capital employed. Shareholder or investment ratios such as return on equity, earnings per share and price earnings ratio are some of the other ratios that are useful here. A number of these ratios will be used to assess the financial performance of BT group over the past three (3) years. â€Å"It is impossible to assess profits or profit growth properly without relating them to the amount of funds (capital) that were employed in making the profits. The most important profitability ratio is therefore return on capital employed (ROCE), which states the profit as a percentage of the amount of capital employed† (BPP 2009) The figures above show the return on capital employed for the past three (3) years.. ROCE fell sharply from 11.86% in 2008 to 1.5% in 2009. However it increased in 2010 to 11.63%. These

Lamb to the Slaughter Essay Example for Free

Lamb to the Slaughter Essay Sir Arthur Conan Doyles style of making the reader want to read on is a world apart from Dahls efforts, although the actual plot hooks you immediately in any Sherlock Holmes story. Doyle focuses on the man himself to ensure the readers full attention to the story. He uses Holmes superb character, a man sharper than a knife, more cunning than a fox and an untouchable track record to reel in the readers. The way he talks, he acts and follows out investigations and eventually solving them gives the reader an air of unpredictability around Holmes. Questions roll through your mind as you advance through a story featuring the famous detective, of how he ever unveiled something so sealed from view, its beyond belief, how he cheated death in the most frightening circumstances. Sherlock Holmes intelligence as a detective is matched by none and its this that Doyle uses to keep the reader entertained and on the edge of his/her seat throughout all of his Sherlock Holmes novels. Which proves that characters in a book, not always its plot make a story memorable. The endings of the two stories were an underlining big factor in what set them apart. Lamb to the Slaughter saw Mary Maloney murdering her husband spontaneously with a bizarre object, which proved much to her advantage as the story ended with the local police, who were investigating the murder, eating the only evidence to actually put Mary Maloney away for the ultimate crime. And in the other room, Mary Maloney began to giggle. As I read this, my feelings towards Mrs Maloney suddenly doubled back and began moving in the opposite direction. From the point when Mr Maloney sternly gave his loving wife the cold shoulder early on in the story, I had been resentful to him and a supporter of Mrs Maloney. Even when she had murdered her cold husband and proceeded to pull the wool over everyones eyes with her guilty conscience, I remained faithful, but as I read that last sentence, Marys crime came into perspective and it repulsed me to see her get away with such a terrible crime and be smug about it. This however, in my opinion was intended by Dahl. In a clever twist he had been playing with our emotions throughout and had left it until the last moment to cease his spell over the reader. This ending was certainly unexpected and made the story twice as enjoyable and successful as it already was. The Speckled Bands ending, as mentioned earlier is immensely diverse from that of Lamb to the Slaughters. From the outset, the result of Holmes investigation was clearly obvious. No case goes unsolved when Sherlock Holmes takes it by the horns. The point of reading Holmes stories is in order to experience Sherlock himself, as explained earlier this is Sir Arthur Conan Doyles way of making the reader want to read on. Once again, Holmes didnt disappoint us by solving the case. He picked up on the detail much forgotten by myself, the fact that Dr Roylott, Miss Stoners father had a collection of animals inspired by his work in India. Once Sherlock had studied the room in which the death of Helen Stoners sister had taken place, he had it in mind that a venomous snake was the culprit. This was in fact the reality of the matter and Sherlock had saved the day again. The way in which Holmes solved the case, as always provided the superb story we have come to expect from Doyle. Some of the blows of my cane came home, and roused its snakish temper, so that it flew upon the first person it saw. In this way I am no doubt indirectly responsible for Dr Grimesby Roylotts death, and I cannot say that it is likely to weigh very heavily upon my conscience. These final sentences of the story, not only demonstrate Holmes renowned intelligence, but wit as he printed a smile on my face with the final quip about the doctors death weighing on his conscience. The ending had me imagining a film adaptation of the story, Sherlock stepping from view, leaving a bemused Watson to follow, trusty notepad in hand, as credits rolled across the screen. To say what my favourite ending was would be unfair as I am evidently a Sherlock Holmes fanatic, but both stories were fantastic and worth the hour or so I spent on each. Show preview only The above preview is unformatted text This student written piece of work is one of many that can be found in our GCSE Arthur Conan Doyle section.

Sports Essays Eating Disorders Athletes

Sports Essays Eating Disorders Athletes Eating disorders can be common among athletes. This may be due to the pressure of the sporting background that commonly precipitates the beginning of these problems. In this day and age certain obsessive behaviour such as extreme exercise and also erratic eating habits have become a normal part of society. Williamson et al suggests that (â€Å"Concern about an athletes body size and shape has become greater than ever before due to the pressure for thinness from coaches and also from athletic performance, and negative self appraisal of athletic achievement†) It has been suggested that the majority of successful athletes are strong minded, and set almost impossible targets for themselves and work long hard hours to achieve these targets. However these factors can bring on eating disorders that can often be found in anorexia and bulimic patients. Disordered eating is possibly found in most sporting activities. The athletes most at risk from developing or indeed having an eating disorder are those who engage in sports that require certain characteristics. For instance gymnasts and also figure skaters are under extreme and constant pressure to preserve a chid like body. Chaotic eating disorders are prevalent in girl athletes but not so much in boy athletes. In 1992 the NCCA conducted a survey of athletes. The NCCA stated (â€Å"93% of the programs reporting eating disorders were in womens sports) (Dying to win 1994 suggests that † Some male athletes do use extreme methods for losing weight, but an important difference exists between these and the self-starvation strategies of anorexics)† For instance, a weight lifters view of his body is not warped. When the weight lifter is not in competition he can regain the weight easily. This suggests that it is possible for the body to return to normal when the athletes sport ing career comes to an end. But unfortunately this is not the case in females. Eating disorders often happen to young girls who become obsessed with avoiding the progression of becoming a woman. These girls will go to extreme measures to keep a child like physique. This is what gymnastics are told they must do in order to stay in gymnasts competition. Because of this it is a gymnastics biggest fear of developing a womanly shape that might obstruct their performance. Sundgot-Borgen 1994 states that † This could provoke a conflict in which an athlete struggles to prevent or counter the natural physical changes precipitated by growth and maturity† many gymnasts have been training since early childhood. In taking part in such specific training before the body reaches maturity these girls risk losing out in a which another sport that they could do in adult hood when their gymnastic career ends. The leading UK charity for people with eating disorders is called B-eat. This stands for beating eating disorders. Beat surveyed 600 young people who suffer from an eating disorders-eat results were: Only 1 percent of children felt they could talk to their parents about their eating related concerns. 9 percent of children felt they might be able to talk to someone at school. 17 percent of children felt they might be able to talk to a doctor or nurse 92 percent of children felt they couldnt tell anyone. B-eat states that† currently the number of people receiving treatment for anorexia or bulimia to be near 90, 000, while many more people have eating disorders undiagnosed†. So of these 92%, the 17% who felt they might be able to talk to a doctor or nurse. So might benefit from the programme. If 92 percent of children feel that they could not tell anyone that they had an eating disorder then it is obvious that there is a need for young people to be educated about the dangers of eating disorders. There is also a need for counsellors or something similar to the Samaritans. So that children have the opportunity to talk about eating disorders to people who will not judge them. The will just listen and give advice if it is asked for. Gymnasts are only too aware about how their slender body shape can mean winning or losing a competition. This one of the main reasons why gymnasts are more at risk from developing an eating disorder. The qualities that make a good gymnast such as high expectations, being compulsive and also striving to be the best are all key characteristics connected to eating disorders. These statistics suggest that there is a need for a well being programme targeting female gymnasts of secondary school age. In beats survey 92% of children felt that they could not tell anyone that they have an eating disorder.17% said they might be able to talk to a doctor or nurse about it. In order to combat this discussion groups could take place on a monthly basis, as part of the gymnastic curriculum in local clubs such as the YMCA (The YMCA is part of the voluntary sector that rely mainly on good will donations and also club membership. It is a non-profit organisation). However conducting a programme surrounding eating disorders should be done with caution and awareness that the people most vulnerable will take any comment or criticism to heart. For example taking a persons weight and vital statistics is not a good way to try and combat eating disorders. This will only make the person mare aware abut body issues even more so if others in the group are thinner or have a smaller body mass index. For this reason, YMCA volunteers should receive training on how to approach and discuss the subject. In 1992 Claire Vickery founded the Butterfly Foundation. In Australia. The Foundation offers support to those people who suffer from an eating disorder and also poor or negative self body image. Claire was said to have discovered â€Å"gaps† in the† public health system† for the people who are and continue to suffer from eating disorders. The Butterfly Foundation suggests that† there is more pressure than ever before on young people who are exposed to highly stylized unrealistic images in the media at an alarming rate every day† This in turn can lead to thoughts of failure unsafe expectations, resulting in little confidence negative thoughts about body image. The Butterfly Foundation can offer support to educational establishments and also local community groups in the structure of workshops presentations to aid youngsters to develop their body image, self-esteem media understanding. The Eating Difficulties Education Network is another organisation that deals with eating disorders. EDEN is community service, which is based in Auckland New Zealand. The organisation is run by a group of women who can provide information and also assistance for those individuals who suffer from eating disorders, and also support their family and close ones. Eden can provide counselling and also workshops for Health professional, the community and also educational establishments. Edens main focus is for the promotion of â€Å"body satisfaction† and takes the approach that you can be happy whatever your size may be. It may be that girls will respond better to women speakers and counsellors. EDEN works in two main areas. These being, working with the people who have eating problems and also working towards the prevention of eating disorders among young people. . EDEN states that† dieting is ineffective and potentially leads to weight and body image difficulties in all their forms. Aiming to work with individuals to develop body satisfaction and seek to create environments that are accepting of size diversity and which support body trust†. At present in the United Kingdom there is little support for vulnerable children including athletes in relation to eating disorders. Only B-eat tries to help combat eating disorders-eat is relatively unheard of and is not well publicized. If the Butterfly Foundation in Australia has been in operation since 1992 then this would suggest that the foundation is working well in helping combat eating disorders. The United Kingdom would profit to follow a similar programme. The programme could include areas such as: Workshops, which are interactive, group discussions activities on Self Esteem Body Image: group discussions are a good way to get people to open up and discuss their ideas/feeling on the relevant subject. Open-ended questions tend to get the best response from people. Open-ended questions ask specific questions which cannot be answered with a simple yes/no or a specific piece of information. In extreme cases, referal to a mental health practitioner. Using a series of cards with different statements is a good way to help children open up and discuss their feeling. It is also a good way of getting children involved in self-esteem group activities. Media literacy uses an â€Å"inquiry based instruction model† This model helps motivate people into asking questions in relation to what they see in the media whether they watch it or read it. Media literacy provides different means of assessment tools to help people look at the media and to help people become aware of one sided views in the media. Media Literacy can help provide people with greater perceptive of understanding the role of mass media and bias media in blocking views of reality. Presentations are a good way of getting important information across to the audience 15mins or 20mins presentations could be used, as the audience will be young teenagers and/or children and may not have a long attention span that an adult would have. These presentations would include questions to/from the audience, but do not involve activities. For this reason they can be delivered to large numbers of students for example up to 50 at a time. The following topics could be used in presentations: Self Esteem Body perception and Image: Body image and perception is how a person feels and views their physical appearance. A lot of young people, mainly in their early teens, suffer from low self -esteem this is because as children develop into adolescents, they become aware about how others see and perceive them. Media Influences: recently, in the past few years it has become† politically correct† for the media to make some attempt to fight eating disorders. Magazines and TV shows and adverts featuring the misfortune of anorexia and bulimia, but this hard work is proving to be unsuccessful when they are presented in the usual perspective. For instance, how can one think that a teenage magazine is actually motivated to beat eating disorders when the stories relating to that area are covered by advertisements featuring childlike looking role models. People often feel that the do not â€Å"measure up† this is attributable to the anxiety of trying to live up to unhealthy† cultural expectations† of physical body perfection. BUPA suggests â€Å"Children and young people need to do 60 minutes of moderate intensity physical activity every day. This needs to include at least two weekly activities that produce high physical stress on bones, such as dancing, jumping or aerobics to aid development†. (Muscat, 2002). Suggests† Another method that coaches, parents (family) and athletes may use to help prevent disordered eating in sport is to avoid making derogatory comments about the female body.† Research shows that female athletes who report critical comments, compared with those who do not, also report greater disordered eating. Such athletes clearly suffer from body-image anxiety. Findings indicate that critical comments related to disordered eating behaviours are from multiple sources (Rieves Cash, 1996) rather than limited to coaches and peers (Beals, Manore, 1994; Berry Howe, 2000; Sundgot-Boren, 1994; Williamson et al., 1995). In addition to comments from coaches and peers, female athletes reported critical comments from parents, grandparents, medical professionals, siblings, and teachers (Muscat, 2002) Therefore this makes the task of altering their self-image extremely complex. Evaluation of the programme could be in the form of anonymous post cards that would be posted in a box. The cards would allow for comments and feedback both positive and negative, which will be essential to the success of the programme and will allow for changes to be made if needed. So the foregoing is the proposed programme. The media is partly to blame for placing a huge importance on what a person looks like and also what size they are. The television and also glossy magazines continually flood our brains with images of body perfection and images of attractive perfect looking people. These messages, which are specifically targeted at females, motivate people into believing that in order to be successful you have to be good looking and slim. This media stereotyping is thought to be the causes why of only ten percent of men have eating disorders, while 90 percent are women. Eating disorders are said to stem from addictive and compulsive behaviours.Other people who have the same or similar traits may turn to alchol,be drug users,self abuse or gamble.People who suffer from eating disorders also suffer from low self esteem,and also a lack of direction in life.This may be a reason why gymnasts are prone to eating disorders.They realise their careers will be over when they reach their mid 20s and do not know what their life will hold from them beyond then. McPherson et al. (1989) states, â€Å"Deviant Behaviour is a product of numerous interacting social and cultural forces. These include an inadequate socialisation process; lack of, or failure of social controls; perceived inequities in a situation; the individuals definition of the situation; and the labelling of individuals who engage in deviance. More specifically, one learns deviant behaviour by directly and indirectly acquiring opportunities†. Over conformity is a behavioral characteristic commonly found in sport. Overcomformity goes way beyond normally accepted rules or regulations that it interferes with the persons health and well-being. Over conformity is behavior grounded in a naive acceptance of rules and regulations. According to Coakley p.166† deviance grounded in overconformilty is often identified as an indication of commitment and dedication, even though it may be dangerous and have serious consequences for the health and well being of self and others†. According to Dying to win 1994 â€Å" a large percentage of gymnastic coaches are constantly instructing the girls on how to count calories, how to act, what to wear, and what to say in public† Because of this these girls feel that the only part of their lives that they are able to control is the food and drink that they consume. Because these coaches are authority figures to these gymnasts any remark made will have deep impact and be taken to heart. One of the main reasons that these girls embark on such drastic diets is because their coach suggests that they need to lose some weight in order from them to look their best. These girls are young and vulnerable to such comments and remarks that they be seen as a basis for enhanced routines. Athletes can be under the illusion that to be a real athlete they must make sacrifices whether it is to your own body or to others and pay the price to increase skills in order to stay in the industry as long as they can. Judging gymnasts ability is not objective. Each of the Judges makes a score according to what they believe makes a good routine. The look of the gymnast may control their perceptions and in doing so affect their final verdict. This reinforces the idea that in order to be at the top of their game a gymnast has to maintain a childlike body. This encourages deviant behaviour, as these girls will do anything to be a winner including going way beyond the norms of society. A terrible example of when a judges decision helped destroy a girls life is an event with gymnast Christy Henrich who was a top contestant in gymnastics in the latter part of the 1980s. She died of a multiple organ failure due to her fight with anorexia and associated eating disorders. At a meeting in Budapest, an American. Judge stated that† Henrich would have to lose weight if she wanted to make the Olympic team.† When Henrich returned to America her mum remembers the first words out of her daughters mouth:† she was fat and she would have to lose weightthat was the only way she would reach her dreams†. Because of these judges tough rules coakley p174 suggests that the roots of deviance go deeper than the individual desire to win or make money. These roots are grounded in the very values promoted through the sport ethic itself. Therefore, much of the deviance in sports is most accurately identified as a social issue rather than just a personal problem of indi vidual athletes. Eitzen, 1988, States that† Within sport, deviance involves violating the rules of a game or organisation, going beyond commonly accepted definitions of fair- play and sportsmanship, and intentionally using illegal means to intimidate or injure an opponent† This means athletes are willing to do anything to get to the top of their game e.g. drug use for weight control and/or stimulants for endurance. No matter how bad the end consequence is. Christy Enrich died as a result of her deviant behaviour spiralling out- with her control. The increase of commercialism in sports has lead to more rules and more pressure to win and be at the top of the game. This in turn has lead to deviance becoming widespread due to the fact that the top judges are reluctant or powerless to punish all acts of deviance. Due to government intervention and equal rights in athletes participation in sports female participation has increased. The first law in America to disallow sex discrimination in any shape or form among people of educational establishment was named† title X†This law was enforced to allow greater gender equality. This means that no one can be discriminated against in relation to gender. Under the â€Å"Title X law both men and women must be treated the same and fairly without judgment. †Title X† covers all areas of government policy including recruitment, housing, insurance and athletics. In the United Kingdom similar law to â€Å"Title X† this law is called â€Å"The Brighton Decleration.†The main aim of the declaration is to â€Å"develop a sporting culture which enables and values the full involvement of women in every aspect of life†. When sport is practiced equally and also fairly it can help make society a better place and also encourage equality. A good example of this is the Olympic games. Sport is a cultural activity, which, practiced fairly and equitably, enriches society and encourages friendship between nations. â€Å"Sport is an activity which offers the individual the opportunity of self-knowledge, self-expression and fulfillment; personal achievement, skill acquisition and demonstration of ability; social interaction, enjoyment, good health and well-being†. (The Brighton declaration) In society, sport plays a part in the culture of every nation. Sport participation in women varies vastly between nations. Females make up more than half of the worlds population. However in sport participation is still predominately male. In recent years despite growing participation of women in sporting activities and also improved opportunities due to laws being past on equal opportunities such as â€Å"Title X† and â€Å"The Brighton Declaration† women in high positions within sport has not followed. Females continue to be undermined and miss- represented in relation to management roles within sport especially at the top ranks. Equal opportunities will continue not to exist and be achieved within sport because of the lack of these role models. For example, women aducation and their ensuring comments might persuade young female athletes away from deviant behavior in relation to body weight and image. In conclusion, eating disorders can happen to anybody. It seems to be most prevalent in young teenage girls. Gymnasts, more than any other athletes are more at risk from eating disorders like anorexia and bulimia. This may be due to the fact that gymnasts, especially the females, are put under regular stress to keep to a very low body weight for visual presentation to the judges. Many judges award points for small body size alone. Because of this there is a need to educate young teenage girls to the dangers of having an eating disorder. As Coakley states â€Å"deviance grounded in overconformilty is often identified as an indication of commitment and dedication, even though it may be dangerous and have serious consequences for the health and well being of self and others†. These gymnasts believe that the have to be the thinnest to be at the top of their game. Their coaches reinforce this idea. According to (Dying to win 1994) a large percentage of gymnastic coaches are constantly instructing the girls on how to count calories, how to act, what to wear. Because of this these girls feel that the only part of their lives that they are able to control is the food and drink that they consume. Because these coaches are role models to these gymnasts any remark made will have deep impact and be taken to heart. One of the main reasons that these girls embark on such drastic diets is because their coach suggests that they need to lose some weight in order from them to look their best. These girls are young and vulnerable to such comments and remarks that may be seen as a basis for enhanced routines. And so if there were more females in positions of authority, e.g. judges, they could counteract this perspective. According to Health magazine, April 2002,†32% of female TV network characters are underweight, while only 5% of females in the U.S. audience are underweight†. In contrast, actors who are older, frumpier, scruffy, perhaps physically challenged, represent evil and also stupid people. The majority seem to be heavy. Once more according to Health magazine,† only 3% of female TV network characters are obese, while 25% of U.S. women fall into that category† This shows that the media is partly to blame for eating disorders in young people. No one wants to be known as heavy, overweight or scruffy. We need more realism for example the normal size for a woman is more like Opra Winfery. According to B—eats survey of 600 young people with eating disorders 92% of children felt that they could not tell anybody that the had an eating disorder. This suggests that there are a large number of children that need help and also someone to talk to and discuss their feelings in relation to eating disorders. However, of these 92%, 17% would seem amenable to help. The Butterfly Foundation in Australia and also EDEN in Auckland, New Zealand are both for non-profit which help young girls combat eating disorders. Both organisations offer support and counselling. Though different means of evaluation such as presentations to schools on the dangers of eating disorders. By following a programme similar to both the Butterfly Foundation and also Eden Britain can begin to tackle the growing problem of eating disorders. In which takes a multidisciplinary approach in schools, the voluntary sector, sports establishments and also G.P, mental health referrals. Government funding could be ring-fenced money for programme funding. More women of authority and also approachable councillors and training may require women instead of men. References About eating disorders/what is an eating disorder. Beat [internet]. Available from: [Accessed on 07 April 2008]. Berger, John. (1972) Ways of Seeing. London: BBC/Harmondsworth: Penguin. Body image. Hms Harvard. [Internet]. Available from:www.hms.harvard.edu [Accessed 18April 2008] Coakley, J (2007) Sports in Society: Issues Controversies. International edition. 9th edition. McGraw Hill, New York. Coakley, J. and Dunning, E. (2002) Handbook of Sports Studies, London, Sage. Eating disorder statistics. [Internet]. Available from: [Accessed 03 May 2008]. Eitzen, D.S. (1988). Ethical problems in American sportJournal of Sport and Social Issues. Garner DM, Garfinkel PE. (1980) Socio-cultural factors in the development of anorexia nervosa. Psychol Med. Hargreaves, J. (1994) Sporting Females, London: Routledge. Hargreaves, J. (1986) Sport, Power Culture, Cambridge: Polity. Holt, R. (1989) Sport the British: A Modern History, Oxford, University Press. Horne, J, et al., (1999) Understanding Sport: An Introduction to the Sociological and Cultural Analysis of Sport, London, EFN Spon. McPherson, B.D.; Curtis, J.E.; and Loy, J.W.; (1989), The Social Significance Of Sport, Human Kinetics Books Illinois. The Butterfly Foundation. [Internet]. Available from,http://www.thebutterflyfoundation.org/ [Accessed 12 May 2008] Ideal weight varies across cultures, but body image dissatisfaction pervades [Internet] Available from, http://www.physorg.com/news [Accessed 12 May 2008]

Cultural Competency of Nurses

Cultural Competency of Nurses 1.1 Cultural competency The commitment to equality in health care provision is ingrained within the core values of the health care profession and nurses are expected to fulfill these requirements. The Nursing and Midwifery Councils (NMC) Code of Professional Conduct clearly states that nurses must treat every patient as individual, respect their dignity and not to discriminate irrespective of age, ethnicity or cultural background (Husband and Torry 2004a). The NMC (2004) emphasises that culturally competent care is moral and legal requirement for nurses. Thus the requirement for the development of cultural competence is to be found within the NMC code of conduct. Josipovic (2000) points out that the delivery of individualised care, in consideration of religious and cultural requirements of Black and Ethnic Minorities (BME) patients can assist nurses to fulfill their obligations. However, there is no universal definition of cultural competence; Campinha-Bacote (2002) defines cultural competence as a process, which requires the health care professional to continuously attempt to gain the ability to work competently with the cultural context of the patient. Nevertheless Papadopoulas et. al. (1998) defines cultural competence as the ability to give effective care while taking into account patients specific cultural needs, behaviors and beliefs. Narayata definition Nonetheless, there has been significant discussion of different models of cultural competence in nursing literature (Gunaratnam, 2007). Campinha-Bacote (1998) model of cultural competence: the process of cultural competence in the delivery of health care service, identifies five essential constructor of cultural competence: Cultural awareness Cultural knowledge Cultural skill Culturally encounter Culturally desire Conversely the Papadopoulas et. al. (1998) model of developing cultural competence consists of four stages: Cultural awareness, Cultural knowledge, Cultural sensitivity and Cultural competent. Rosenjack Burchum (2002) identified the attributes of cultural competence as same as those of Papadopolos et al (1998) but adds cultural understanding, and cultural skill as essential attributes. Cultural competence is, according to Rosenjack Burchum (2002), the development of knowledge and skill manifested by the synthesis of the above attributes and their respective dimensions in human interaction. Although there is distinction in the models of cultural competence they all express common concern of three main components: cultural sensitivity, cultural knowledge and cultural skills (Gogwin et al. 2001). According to Garity (2000) cultural competence involves having understanding and sensitivity toward different cultural groups and factors that affect their lives such as immigration, discrimination and the possibility for these factors to improve or inhibit professional practice. Hence, for a nurse to become cultural competent s/he needs to develop an understanding of ones own cultural needs, views, beliefs, behavior and those of the patient while avoiding stereotyping and generalisation (http://www.culturediversity.org/cultcomp.htm). The aim is to ensure that the health care services and professionals are respectful and responsive to the health beliefs, practices, cultural and linguistic needs of diverse patients, which can help bring about positive health outcome (http://minori tyhealth.hhs.gov/templates/browse.aspx?lvl=2lvl). Cultural competency is a process that needs to be continuously developed in order to enhance ones ability to give affective health care (Papadopoulos 2006). All registered nurses have the responsibility to competently maintain professional knowledge and practice by ensuring up to date knowledge, skill and ability as well as safe and effective practice (NMC2008). Although the NMC clearly places the individual with the responsibility of developing cultural competence, it should be acknowledged that individuals alone cannot be held responsible for the delivery of culturally safe and competent health care service if insufficient resources are not made available (Husband and Torry, 2004a). Nonetheless, Dreher and MacNaughton (2002) described cultural competence as the same as nursing competence; the ability to deliver care individualised and therapeutic to each patient despite social context or cultural background, this being the signature of contemporary nursing. However, the basic principle of providing nursing care to culturally diverse populations is not an entirely new idea, as the need for such was recognised in the United States in the late 1800s (Davis, 1996) and was also recognized by Florence Nightingale when advising British nurses working in India (Wilkins, 1993). In the last century, most western countries saw significant changes in the make up of their populations due to increased trends in global migration that resulted in multiethnic and multi-religious societies. In the UK BME groups make up 7.9 % of the total population (Office for National Statistics, 2001). As the population becomes more diverse so does the complexity of the patients needs that the nurse must address (Black, 2008). Thus far, the need for the nurses to become culturally competent has become import (Black, 2008, Gunaratnam, 2007).The pertinent literature highlights that, in the last few decades, scholars and researchers have debated the issue relating to the delivery of appropriate nursing care to meet the needs of BME groups (refs). There is a growing body of evidence that show there are inadequacies in the nursing care provided to these groups (Vydelingum, 2006, Cortis, 2004) and concerns about ethnic disparities in health in the UK (Aspinall and Jacboson, 2004). Studi es on utilisation of hospital services by BME patients, in particular the elderly have consistently demonstrated level of dissatisfaction with the care provided from cultural and/or religious viewpoints (DoH, 2009; Clegg, 2003; Patel, 2001; Cortis, 2000, Vydelingum 2000) 1.2 BME Elders Nevertheless, the concept of the ageing population is one that has generated much discussion in the UK (Caldwell et al, 2008) as this age group is the main users of both health and social care services (Department of Health, 2001). While all older people have common needs and experiences of hospitals, the needs and experiences of the BME older people are shaped by their race and ethnicity (Ahmad, 1993; Blakemore and Boneham, 1994). Majority of todays BME elders are yesterdays young migrants from the commonwealth countries (Patel, 2001), who came to the UK during the 20th century as a result of government policy to fill labour shortage (Houston and Cowley, 2002). According to Evandrou, (2006) in 2001 4% of the BME population were over 65 and this number is rapidly rising, from approximately 60 000 in 1981 to about 360 000 in 2001-2002 (Butt and ONeil, 2004, Beaven, 2006) and is expected to increase in the next 15 years (Evandrou, 2000). These elderly groups have particularly been disadvantaged by the cumulative effect of age, race and inaccessibility to services (Norman, 1985). However, newly arrived migrants are likely to share similar concerns and experience in hospital care (Patel, 2001). The 2001 and earlier censuses show that health disparities exist in the UK and that levels of long term illness are higher in older BME groups than in the general population (From A Szczepura 2005).Older people from BME are report more chronic illnesses such as cardio-vascular disease, diabetes, hypertension and stroke when compared to the majority (Tilke, 1998; Ebrahim, 1999; Evandrou, 2000b). An appreciation of the health care needs of this group is vital in understanding the difficulties they face in accessing health care services (Toofany, 2007). One occurring theme connected with old age and ethnicity that has been repeatedly identified from the1980s until today is the lack of urgency over government action for the group (Norman, 1985, Patel, 1990, Lindesay, 1997, Patel, 2001). The Policy Research Institution on Aging and Ethnicity (PRIAE) highlights that these groups are not normally considered in old age research (Patel, 2003). Hoong Sin, (2003) points out that BME older people in the UK are disadvantaged by the lack of a reliable sampling frame. Although there are few national studies, most research projects are small and involve localised samples (Hoong Sin 2003). Therefore the infrastructure for doing research with such population groups is inadequately set up (Hoon Sin, 2003). In PRIAEs view we have had too much discussion, action is overdue (Patel, 2001). This information suggests that BME elderly groups have never been a priority on the agenda for research or policy makers in the health care services. Saleh (2009) su ggests that the introduction of the Race Relations (Amendment) Act 2000 increased pressure on health care organisations to adapt services to ensure equitable access for local all BME groups. On the other hand, Department of Health (DoH) ensures that reducing health disadvantage and social exclusion for BME elders is central to UK health and social policy (DoH, 2001b). The DoH made specific commitments, in the National Standards, Local Action, to improve quality of service for BME where they are disadvantaged in terms of health (refs). This approach according to Papadopoulos et al. (2006) is a sign that the NHS is undergoing modernization. Unfortunately, the last two National Patient Survey Programme reports (2008 2009) show the experiences of all BME groups (with the exception of those from the Irish community) are significantly less likely to be positive than those of the indigenous populations. From a nursing aspect this outcome questions the nurses competence in delivering culturally appropriate care. The literature available identifies cultural competency as one of the main factor that can help cease the inequalities in health care system (refs). According to Papadopoulos et al. (1999) although mention of the term cultural competence in DoH and National Health Services (NHS) documents has increased, there is no attention to what this actually means for patients or nurses and how it could be measured. Having and implementing clear, strong policies on race and equality is essential for health and social care organisations but this has to be supported with training and education (PRIAE, 2005). Consequently, Dreher and MacNaughton (2002) doubted whether cultural knowledge translated into culturally specific care would necessarily result in improved clinical outcomes or the reduction of health disparities. 2. The review Aim and Research Strategies 2.1 Aim Nurses are at the front line of care for BME older people in hospital therefore it is important that the care delivered is in line with what is viewed as appropriate by the patients to their needs. The Department of Health openly acknowledges that much remains to be done in terms of measuring older patients experiences of the process of care, respect, dignity, information and education (Shaw and Wilson, 2008). This review, therefore, intends to bring together the literature concerning nurses views of what is essential in delivering culturally appropriate care to BME older patients as well as this groups expectations and experiences of nursing care. The aim is to explore the cultural competency of nurses in caring for BME elderly patients in Hospital setting. 2.2 Search Strategy (Include: inclusion/exclusion criteria, databases searched, keywords, languages and inclusive dates of the literature searched.) Search Term Search was carried out using combination of keywords such as Nurses, Cultural Competence/Awareness/Sensitivity, Geriatric, Elderly/Older, Black and Minority Ethnic and Experiences/Views. Furthermore, concepts relevant to hospital care such as Dignity, Respect and Appropriate Care were searched in combination with the above key terms. Databases The electronic databases British Nursing Index, PsycINFO, MEDLINE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Assia and Cochrane Library were searched to identify peer-reviewed literature published in the English language between 1990 and 2010 that are UK based. The databases yielded XXX potential studies relevant to the topic under review. Further search was conducted in the World Wide Web using the same key words and it produced xxx studies. The websites of the Department of Health, Transcultural Nursing Society, Royal Collage of Nursing and relevant Third Sector Organisations such as Age Concern, and PRIAE were also accessed which yielded XXX literature. Further literature was gained from the reference and the bibliography of the gathered data as well as the library of the University. The titles and abstracts of the obtained literature were examined and studies focusing on care provided by nurses to BME elderly patients as well as studies examining the views/experiences of hospital care by this particular geriatric group were selected. For the purpose of the literature review an older person is defined as person older than 50 years. NSF considers an older person as a person who is over the age of 50 years. Yet, a limited numbers of studies (how many) about BME elders in hospital setting were identified. For this reason studies focusing on the topic that had a wide range of age sample group i.e. 30-80 were included as it would assist in identifying additional pertinent literature. In total, XX studies were identified to meet the inclusion criteria for the literature review. The literature selected were mainly primary empirical studies using qualitative approach. A qualitative research aims to understand the feelings, values, and perceptions that under lie and influence behavior (xxxx). Therefore the use of a qualitative methodology is seen to be appropriate as all the studies examine the experiences of the BME patients through their own eyes and those of the nurses (from internet). 2.3 Critical Appraisal of Three Qualitative Studies on the Experiences of Nurses in Caring for BME Patients and BME patients Experiences of Nursing Care Cortis (2004) Meeting the Needs of Minority Ethnic Patients Clegg (2003) Older South Asian patients and Care Perceptions of Culturally Sensitive Care In a Community Hospital Setting Hamilton and Essat (2008) Minority Ethnic Users Experiences and Expectations of Nursing Using Caldwells frameworks for critiquing health research, the three above stated studies will be analyzed systematically and supporting/contradicting evidence from other studies will be offered. WHY USE THIS FRAME WORK? Following the discussion of the review themes will be identified. Title Although the title of the study of Cortis is brief and conveys the nature of the study (Polit and Beck, 2010), it could be viewed as misleading as it gave the impression that the sample group was representative of different communities of BME groups. However, the study specifically focuses on the Pakistani ethnic community. Conversely, the titles of the researches by Clegg (2003) and Hamilton and Essat (2008) are short, accurate and clearly specifies what and who is being studied while reflecting the study content (Burns, 2000). The Researchers Academic and Professional Qualification The authors of the three researches have particular interest about the topic in question, which gives the assumption that they are familiar or have professional insights. The qualification (PhD, MsC) of the researchers is relevant as it indicates that they are competent and have creditability to carry out researches. Further evidence to support researchers knowledge and interest of the topic was demonstrated as they are all nurses with extensive experience; Cortis is a senior lecturer at the University of Leeds with Qualitative Research interest in ethnicity and BME issues. Clegg is a consultant in older peoples services and intermediate care at Leeds Teaching Hospital NHS Trust. Hamilton was a principal lecturer at De Montfort University with research interests in multi-ethnic care and Essat was research assistant at the same university working on a project exploring the educational preparation of student nurses to work in a culturally diverse way. Abstract and Rationale A qualitative study must offer an abstract containing summary of study aim/objectives, research approach, methods adapted and the result of the study including the clinical applications (Cormack, 1996). Bellow the abstract there should be key words related to the study offering the reader an overview of the research question. All studies have offered a comprehensive abstract with key words relevant to their topics. Clear rationale for undertaking the study was given by all researchers; Cortis rationale was the fact that there is little exploration of nurses experiences of caring for specific BME community while Cleggs rationale was that there is a lack of research defining the concept of cultural sensitive care from patient/care perspective. Lastly, the rationale provided by Hamilton and Asset is that, nationally, there is an evidence to suggest that care provided doesnt always meet the needs of BME patients. LR All three researchers did review pertinent literature (classics up to date), which was evident in the studies as well as the reference list. According to Doordan (1999) the literature offered should have discussed and critically reviewed related literature to find out what questions remains to be answered. Nevertheless, only Clegg (2003) provided a separate section for LR, which she must be praised for (Morse, 1994). In grounded theory studies, researchers start with data collection first and as the data is analysed and as the theory takes shape researchers then begin to search the literature in order to link it to the emerging theory (Polit and Beck, 2010), which was evident in Cleggs study. Aim The three studies clearly identify and justify their aims. Cortiss (2004) argues that in a number of studies BME are seen as homogeneous therefore the aim of his study is to investigate a specific communitys uniqueness: the experiences of nurses caring for Pakistani patients in north England. However, this aim is inconsistence with the title of study, which clearly treats BME as a homogeneously. WHAT DOES THIS MEAN? While the aim of the Clegg (2003), was to identify older south Asian patients and carers perception of culturally sensitive care. Lastly, the aim of the research by Hamilton and Asset (2008) was to give the minority ethnic groups the opportunity to voice their opinions on nursing care and to inform future nursing education. Ethical Issues Both Cortis and Clegg clearly highlight that permission to do the study was sought from the Local Research Ethics Committee (LREC), which is an imperative step before conducting any research. However, Hamilton and Essat (2008) omit to mention whether appropriate approval was gained from LRECs; who exist to examine proposed research projects in order to guard peoples rights and interests (Cormack, 2000). All the researchers have to be praised for specifying the process and purpose of the study was explained to the participants before the study in order to obtain informed consent. Cortis (2004) clearly specifies that assurance was given to maintain confidentiality and anonymity of the sample group, which is something Hamilton and Essat (2008) fail to address in their study. Both Cortis and Hamilton Asset dont comment on the associated ethical issues of autonomy, non-maleficience and beneficence, (Cormack, 20000). Nevertheless, Clegg considered the vulnerability of the participants (Gerrish and Lacey 2006, Speziale and Carpenter 2007) and therefore committed to the ethical principles of autonomy, non-maleficience and beneficence (RCN, 2004), but fails to mention how confidentiality and anonymity was maintained. Clegg showed sensitivity towards the participants by informing them the voluntary nature of the research with the option of being able to withdraw at any time. This implies a non-coerciveness approach which was important in this study as this was vulnerable group. Conversely, The three studies inform that permission was sought from the participant to audio-tape the interviews but omit to identify where data was stored and the disposal procedure used (Polit and Beck, 2008). This supports the premise that data used for a particular project should not be used for another without consent (Gerrish and Lacey, 2006). Methodological Both Cortis and Hamilton Essat (2008) fail to specify that the method used was phenomenological-exploratory, which is useful when studying individuals lived experiences (Crookes and Davies, 1998). The main methodological strength of using phenomenological in these studies is that it is an inductive and holistic approach that looks at what occurs within (Crookes and Davies, 1998). Both of the studies focus was on the unique experiences of providing care by nurses to BME patients and perception of BME older patient views/expectations of nursing care. The biggest methodological limitation for using phenomenological in these studies is that it is labour intensive and time consuming for the researchers in terms of data collection and analysis (Crookes and Davies, 1998). Clegg, on the other hand, identifies the methodology utilized as grounded theory, which is useful when studying individuals XXXX (GG). Methodological strength associated with the use of this approach in this study is xxxx x. Methodological weakness associated with the use of this approach in this study is The three studies clearly identify the major concepts of the design used and their concepts, which are what? Sampling Technique and method According to Polit and Beck, (2010) in qualitative research there is no rule for sample size as long as data saturation achieved. The sample number (n=30) used by Cortis was considered to be suitable for qualitative research (Cormack 1999) why? However, the sample number by Clegg was four patients and three relatives. Clegg states in her study that she is not sure if data saturation has been achieved. Morse (2000 in polit and beck book) suggests that number of participants required to reach saturation is a firmed by number of factors, such as the wider the research question the more participants necessary. This gives the impression that the sample size could have been too small for the scope of the research question hence why saturation was not reached (Morse 2000) possibly due to time or budget constraints (ref). Sampling number for Hamilton and Essat: six focus groups, member of which range from 8 to 15 (? large sample number for qualitative). All three researches state how many participants were recruited and from where; areas with high population of BME. Cortis participants were recruited from a large acute hospital in north England and Clegg recruited this sample from a two community Hospital inner city and Hamilton and Essat recruited their sample of 6 diverse BME communities groups. The researchers must be praised for providing a clear indication of inclusive/exclusive criteria, in the process of recruiting participants. In contrast the three studies fail to identify the sampling methods and techniques used but inferred from the research studies is that non-probability method of purposive sampling was employed (Cormack, 1996). The method of purposive/judgmental sampling relies on the belief that researcher have enough knowledge about the population to be able to pick sample members (Polit and Bechk, 2010). The main strength associated with the use of purposive sampling in these studies is that the researchers purposively choose the participants knowing they would give relevant information about the topic in question (Polit and Beck, 2008). However, one main limitation is that this technique relies upon the researchers knowledge of cultural competence of nurses (Polit and Beck, 2008). Method of Data Collection All researchers collected data by audio taping interview and transcription. Cortis, Clegg and Hamilton Assset adapted different types qualitative self-reporting technique, which is flexible in gathering self-reported information as it allows the participants to express their views in a naturalistic way (Polit and Beck, 2008). Data collection is described by Cortis as semi-structured interviews and supplementary questions to follow-up for clarification. Cortis informs that most interviews were done in the clinical area; implying that participant had choice of venue, which he must be commend for. However, he omits to state where the rest of the interviews were done. WHY IS VITAL TO GIVE PARTICIPANTS CHOICE OF VENUE? Nevertheless, Cleggs choice of data collection was unstructured interview that were done in the first language of the interviewee. Cross validation of the taped interviews was under taken by a second linguist. Both Cortis and Clegg fail to point out who/how many people performed the interview. Interview performed by one person provides uniformity and consistency (Denscombe, 2003). On the contrary, method of data collection used by Hamilton and Essat was focus group, which was sub-divided into 6 groups where each group had facilitator. The advantage with use of this method in this study is it can generate a lot of dialogue but the disadvantage is that not everyone is comfortable experiences their experiences/view in front of others (Polit and Beck, 2010). Overall, an advantage associated with the use of all interview technique utilized is that the interviewer can observe the participants non-verbal responses, which can provide valuable information (Burns 2000). Some of the main methodological limitation with the use of this method in these studies is that it was done in face to face, which could jeopardize the participants anonymity since they were identifiable for the interviewer (Cormack, 1996). Method of Data Analysis All the researches used thematic content analysis, which is creditable method of data collection (xxxx). Only Hamilton and Asset clearly stated the method used and who analysed the data: two members of the team. What does this mean for the research? Cortis transcribed the interviews himself to became personally immersed in the information. What does this mean for the research? Clegg points out that Micro-analysis of the data were used to identify categories but fail to say who analysed data. Having different people conducting the interview and the analysis of the texts can have an impact on the richness of the analysis performed (Strauss and Corbin, 1998). Nonetheless, steps were taken by all researchers to uphold the rigour of the interpretation by checking the transcript with the participants to ensure correctness, which gave the data conformability and credibility (Forchuk and Roberts, 1993). They also must be praised for indicating that the data was analysed systematically in several steps. However, they all fail to state the type of qualitative software used to categorise the information i.e. Ethnograph and if it was positive or negative to the analysis (Barnard, 1991). (Clegg: Triangulation was introduced into the process of data analysis, which was carried out by a colleague from India). The methodological strength linked to the utilisation of this thematic content analysis in these studies is that it is commonly used in qualitative research and is suitable the three study aims. Limitation would be this analysis includes gathering statements on the bases of similarity and frequency with the aim of making them to themes (Barnard, 1991). It could be argued that by doing so the researchers are using a quantities method of analysis for qualitative data as each data is not being treated uniquely (Barnard, 1991). Study Results The three studies identified themes based on the participants experience which implies themes were not based on presumption authors (Cormack, 1996). Each studies result relate to its aim, which they must be praised for. The finding of each study uses the participants precise statement from the interview, which demonstrates analytical points and allows the reader to hear the voices of the participants. This demonstrates conformability and credibility (Burns, 2000) and lets the reader to get in-depth understanding of topics in discussion (Morse1196). Hamilton and Essats results highlight the view held by BME groups regarding nursing communitys lack of knowledge of cultural and religious beliefs. Cortiss findings agree with this as majority of the nurse participants did not deem that the provision of care was affected by culture and spirituality/religion was viewed narrowly by identifying the need for patients to perform prayers with no lack of recognition of other religious requirements. Participants in Cleggs study described the fundamental importance of religion and its effect on health and hospitalization. Other references re culture and religion to be added. All three studies highlighted communicational problem between patients and nurses, which as an issue hinders the development of relationship. However, problems in this area have been covered in many other studies such as (add referennces)à ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦. And proposals and provisions to address them have been made by the DoH in order to reduce health inequalities (reference). Study Discussion All researchers offer a comprehensive discussion of their topics while comparing and contrasting their results relating to themes with other similar literature, which puts their finding in context making it more objective (Meltzoff, 1998). However, only Clegg specifies the study limitation which was the sample size- a larger sample size would have enhanced the probability of reaching saturation and increase the importance of the finding. Conclusion The three studies offer comprehensive conclusions which summarises the main results while suggesting area of further research or implementation. Cortis suggests that holism needs further conceptualization as his study highlighted nurses understanding of culture as part of holistic care was superficial, which presents a challenge for educators, nursing management, researchers and nursing practice in general. Clegg suggested further research needs to be carried out in order to define the nature of culturally sensitive services. She also points out that nurses understanding of culture and cultural sensitivity needs clarification. Hamilton and Asset suggests that nursing education must ensure that nurses initial training and post training education prepares them to become culturally understanding and sensitive. It could be argued that these three studies make useful recommendation for practice for nurses working with BME patients, which are based on education and research on cultural sensitivity. The three studies suggests that nurses are not culturally competent as required by professional bodies and the Government (English National Board for Nursing and Midwifery and Health Visiting 1997, DoH, 1997, United Kingdom Central Council for Nursing, Midwifery and Health Visiting 1999, Quality Assurence Agency 2001). Cortis (2004) conducted a phenomenological study investigating the experiences of 30 registered nurses who had nursed Pakistani patients in a large acute hospital in north England within the last three months. Semi-structure interviews and supplementary questions to follow up were the main method of da