RICERCA ITALIANA     

Cultural differences and professional cooperation in Health Care settings. A clinical and social research.

Università Cattolica del Sacro Cuore

Abstract

The integration of foreign personnel in Social and Health Care Organizations as well as in family’s support activities is becoming by far an issue of social relevance. The present research aims to face this matter giving particular emphasis to the health-illness and care relationships’ representations.
Moreover the comparison on professional identity between operators having different cultural backgrounds seems to be crucial in organizational contexts when aiming to set up shared care practices.
In respect to this subject, the lack of national research projects has to be underlined. The three Units involved in this research (Milano, Catania and Roma) aim to narrow such a gap sharing themes, procedures and selecting specific research fields.
The aim is not only deepening the problems’ knowledge but also accomplishing best work practices involving foreign operators as well as Italian ones (professional nurses, paramedics, home health aides, babysitters), and enabling the participation of public and private social organizations’ managers, babysitters and home health aides’ employers. To this purpose, the research foresees the arrangement of focus groups followed by training groups led by experts in order to obtain professional integration and shared products to be spread at a national level. In this sense the research assumes a clinical-social nature.
The present research can be defined as a multimethod and multilevel one; it is in fact grounded on qualitative as well as quantitative data, it is divided in various steps in order to guarantee a strong cooperation and sharing among the research Units, involving more than 350 people. <<<

Principal Investigator

Vittorio Cigoli Università Cattolica del Sacro Cuore

Research Objectives

The project raises from the socially relevant problem of immigrant personnel integration in Social-Health Care Organizations and in the families. The presence of “caregivers” (professional nurses, paramedics, home health aides and babysitters) belonging to different cultural backgrounds implies noticeable difficulties due to the different ways of conceiving both health and illness and the care relationship itself. Such a problem is evident among multicultural professional groups as well as at an organizational level, where it is necessary to define procedures and operative duties according to the Service’s goals.
Given the increasing incidence of immigrants carrying out “care” jobs in different contexts, the absence, particularly at a national level, of specific studies on this matter is noteworthy.
The research project general aim is to:
· Study the representations, the attitudes and the values that lead the professional activity with regards to health and illness, health care relationships, particularly significative rites of passage (growth, illness and death);
· Evaluate the interventions and the operative practices the different professionals use to carry out their duties;
· Consider the functioning of work groups in their actual context in order to highlight the problems concerning the professional integration of operators having the same work roles but belonging to different cultural backgrounds;
· Develop integrated procedures and shared intervention criteria starting from the health care operators’ cultural difference and in respect of the organization’s needs. This is in fact the research clinical-social relevance.
The survey is articulated at three different levels:
1. individual level (in-depth analysis of the single person’s representations and actions regarding the topic under examination),
2. group level (research for the best practices in health care activities)
3. organizational level (involvement of managers and employers in order to understand their demands to the employees and to prompt their active role in the redefinition of integrated and effective operative procedures)
Milano, Roma and Catania research Units share the project general aim and most of the above mentioned goals. All the Units are in fact involved in the three different levels of analysis and pursue the same aims:
o to analyse the representations underlying professional identity,
o to highlight the relevance of health care practices and of organizational variables,
o to focus on professional integration procedures
o to implement training interventions
The strong uniformity among the aims set by the three Units permits comparisons of the data and allows the knowledge of the phenomenon to be extended to a national level.
Regarding the single Units’ specific aims, it can be stressed that:
· Catania Unit gives particular relevance to the topic of values and attitudes as crucial elements in professional identity representations;
· Milano and Roma Units focus their training on a) the integration of real work groups operating in Social-Health-Care Structures; b) the processing of operative protocols and more effective intervention procedures. <<<

Timescale

24 months

National and international background

According to the Italian Statistic Immigration Report (Caritas, Migrantes, 2005), 47.5% of immigrants work in the Social Services, this being the main source of employment, by far exceeding agriculture (13%) and industry (39.5%). As regards to the immigrants origin, people coming from South America, Eastern Europe and South-east Asia are mainly hired in the Services; moreover, this sector is becoming an increasing employment basin, outlining a continuously raising trend.
The actual change is the presence of foreign personnel in public and private Social Care Services: so that, in addition to the well-established domestic employments (house servants, babysitters and home health aides), a massive employment of foreign personnel in public and private Services such as Hospitals, Nursing Care Residency for the Elderly and Youth Centres has been registered.
It also appears interesting to point out that, besides the traditional offer of low profile unspecific jobs, a new high offer of qualified jobs (registered nurses and other social-health professionals), held by Italians in only 1/5 of the cases, is nowadays developing. In this regard it has been estimated that the 63,8% of the newly hired professional nurses and the 60% of the employed socio-sanitary assistants in 2005 were foreigners.
Hence in Italy a so called “care industry” (Hochschild, 2002) causing a strong demand of immigrant women is nowadays outlining. If in the past years immigrant women were mostly hired as baby sitters or house servants, now they are also employed in those institutional contexts that have progressively replaced the family taking care of its members. Immigrants, mainly women, can easily find a job in Nursing Care Residency for the Elderly, Community Centres, Hospitals and Communities that in various way deal with people needing assistance. The ISMU Report (2005) has stated that the hiring rate of foreign personnel in the Health Care field and in the Social Services during 2005 varied from 40 up to 70% .
The fact that people having such a different cultural background deal with health care relations raises a few concerns on the definitions and concepts of health and illness and on the different ways of “healing” and “caring”. To this purpose, two tendencies can be traced in the literature: a medical one (see W.H.O., 2001; Pan American Health Organisation, 1999, 2000, 2001, 2002) trying to find out universal standards concerning health and illness, and a psycho social one, stressing the need for an acknowledgement of the cultural differences and aiming to achieve an integration when possible. In this latter perspective the concepts of care and relationship are considered multifactorial constructs, whose nature and features have an emic and culture bound definition (Cigoli, 2002; Cigoli et al., 2003; Cigoli et al. 2006).
With regard to the present study concerning professional identity and cultural integration at work, we found no other research investigating the same topic in our country, and a few international studies analyse only some of the related constructs. Among those it is important to highlight the cultural dimension in building the professional identity, the cultural influences in defining health and illness across the life-span; the relationships between care practices and conflict dynamics within the equipe.
Ethnical differences in supportive relationships has been widely analysed particularly focusing on the client’s and the professional’s cultural difference (Nikelly, 1997; McFadden, 2003; Bouttè-Queen, 2004; Barrett e George, 2005). The implications of racist attitudes in help professions have also been evaluated (Jackson, 1999; Dicicco-Bloom, 2004; Motoike, 2004). Generally, however, attention has been devoted to highly qualified professions requiring skilled and experienced personnel dealing with mental disorders and psychological care. For example Shin et al. (2005) gave attention to the client’s and the counsellor’s racial difference, and the multicultural difference in school counselling has also been assessed (Frisz, 1999; Vasquez, 2006). In synthesis the so far quoted literature agrees that the variables related to the cultural and ethnical affiliation are critical aspects gaining a particular relevance in health care professions. In addition, professional identity has been defined as a multifactorial construct based upon cultural values that allows the acknowledgement and the explanation of supportive relationships’ accomplishment (Winckelmann-Gleed, Seeley, 2005; Gozzoli, Regalia, 2005; Marta, Regalia, in press).
Various research address the issues of health and illness representations and analyse health care and supportive relationships across life’s significant rites of passage. Results show that the culture of origin plays a major role in determining and explaining significative differences related to professional role and identity.
Thus Moitoke (2004) ascribes to the culture a considerable importance in defining problematic aspects related to professional roles, while De Olivera (2002) underlines the necessity to know the cultural representations underlying health and illness, as they may influence the care relationship and the ways professionals conceive their roles. Religious values and duties also play an important role in building the health and illness’ representation in many immigrant groups (Drenth et al., 1989).
Finally, as far as the professional integration is concerned, themes such as racisms, cultural incompatibilities and negative attributions towards the colleagues and the organization are thought to be capable of explaining misunderstandings, rivalries and even fractures between operators from different cultural backgrounds. This causes noticeable consequences on the care process as impacts on the coordination of employees sharing the same professional role (Lingard et al. 2002).
To this purpose it also appears important to underline how the Western care system is based on scientific postulates grounded on analytical thought, mind-body dualism, symptoms detection, and disease conceived in terms of an enemy to struggle with. Those aspects can hardly find a place in cultures basing the understanding and the explanation of health, illness and care on totally different beliefs (Nigenda et al., 2001). In the end, we need to point out that the meanings given to the work do influence the commitment and the personal dedication at in the working context (Gullickson, Ramser, 2004; Ellis, 1989).
In the cultural perspective grounding the present research, values, representations, expectations and motivations defining professional identity and integration, together with the work experience, are to be considered as crucial. <<<