RICERCA ITALIANA     

Research program

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

University Co-ordinator

Università Cattolica del Sacro Cuore - PSICOLOGIA - ()

Research Unit Leader

Vittorio Cigoli

Description

Refering to the above mentioned theoretical baisis, the MIlan task group aims to examine the helth care relationship in social-health organizations employing foreign personnel.
BaSing on the three main concepts of professional integration, professional integration-comparison, organizational setting, the research aims to:
1. study the representations that convey the professional activity of foreign social health-workers operating in public utilities in Lumbardy. Partcularly the research will focus on the health and illness relation representations, on the health care relationship and on the rites of passage. Tasks and duties differences, such as NURSING or HEALTH-CARE JOBS, will also be cosidered;
2. evaluate the functioning of TASK UNITS involving professionals from different ethnic groups. Groups, each composed of 10-12 operators all having the same professional role, will be constituted for this purpose involving both italians and foreigners (South-Americans, Philippinians and East-Europeans). Each organization will foresee the involvement of two different groups: one constituted by paramedics and assistants and the other constituted by professional nurses, both will be “real” groups (not ad hoc), actually working in the oganizations. Each group will partecipate to EIGHT MEETINGS, spread over the course of a year, focusing on different topics such as: health and illness cultural representations, definition and health-care practices, tites of passage;
3. involve the services’ MANAGERS in order to pinpoint the mission of every single structure and to define and the operative procedures required to nurses and paramedics.

In brief the research project seems to be original and innovative for the following reasons:
- it focuses on FEMALE MIGRATION AND ON WOMEN PROFESSIONAL EMPLOYMENT instead of just analyzing male inclusion at work. Most of the health care professions this projects aims to study involve a female target (the ratio to males and females working in social-health services is in fact one in six, according to the 2005 Ismu report);
- it provides an in depth survey of the culture-oriented REPRESENTATIONS building professional identity; this obviously requires a better knowledge on how different cultures deal with health and illness, with health care relationships and with the meaning of crucial events such as birth, illness and death.
- it tries to integrate health care practices and to define SHARED INTERVENTION MODELS so that they could be put in practice in real task groups, composed of people from different cultures, improving the services’ efficiency and the health-care interventions’ quality.


METHODS
The research foresees the involvement of two social-health organization for both: the organizational functioning analysis and the individuation of the groups.
As far as the organizational functioning analysis is concerned, two focus groups with services’ managers (8 to 12 people in total) are foreseen in order to specify the sevice caracteristics and the operative procedures required to professional and general nurses working in the structure and also to involve managers themselves in defining the goals and the possible operative changes the project aims to achieve.
In each organization, two homogeneous groups will be established, with each group having the same professional roles but different nationalities. One group will be composed of both native and non-native professional nurses (10-12 people), and the other will be composed of equally represented native and foreign paramedicals.
In each of the two designed structure there will be two groups, members having different professional qualification, for a total of 4 groups, involving 40-48 people in the research project. According to the action research theoretical basis, 8 meetings, lasting 2,5 hours each, will be scheduled (them being 32 in total) for each group. Sessions will be led by clinical psychologists with expertise in cross-cultural issues.
Hence, 80 hours of tape recordings, constituting the research empirical basis, will be carried out.
The data analysis for the two groups will be carried out both in terms of OUTCOMES and PROCESSES. Evaluating the OUTCOMES will require:
- The administration, both at the beginning and in the end of the action research process, of SELF ASSESSMENT TOOLS; them being: the Semantic Differential and the the test (developed ad hoc by the research task group) with images related to health, illness and health-care relationship concepts.
- The administration of GROUP ASSESSMENT TOOLS, involving Todd’s Map and drawing of the working life space, will be carried out both at the beginning and in the end of the action research process(Gozzoli, Tamanza, 1998).
All the tools take account of the linguistic comprehension ability of foreign workers. In total: 48 people X 2tools X 2administrations (192 individual outputs) plus 2 tools X 4groups X 2administrations (16 group outputs)
The PROCESS study foresees two levels of analysis
- CONTENT ANALYSIS of the recorded tape verbatim is written on a grid and analyzed using text analysis statistical packages such as T-Lab and Atlas-ti.
- A GROUP DYNAMICS and development ANALYSIS during the formative intervention. Intended osbservative grids will be created to this purpose on the basis of national and international literature. Variables related to power relationships, leadership, cohoperation, conflict, inclusion, exclusion, emotional climate and partecipants’ role will also be considered (Cfr. Carli , Kaneklin, Levy).
Besides an in-group, an INTER-GROUP (between) analysis will also be caried out in order to compare data on the basis of the sampling variables.
For such purpose, two levels of investigation have been specified, them being based upon:
1. ethos
- Intra-work-group comparison (native versus non-native) to be carried out for every work group in order to find out significative differences within them;
- intra-organizational comparison, notwithstanding professional roles, (all the immigrants working in the straucture versus all the natives working in the same structure); this comparison will involve both the organizations, looking for characteristics and elements influenced by the work context;
- comparison between cultures (all the immigrants involved in the projects versus all the natives) in quest of values and cultural general norms, notwithstanding professional roles;
2. professional roles
- intra-organizational comparison between the paramedics group and the professional nurses, searching differed or homegenous aspects when analyzing their professional roles;
- inter-departmental comparison between the two groups of nurses and the two medical support personnel groups, aiming to compare and contrast methods of group organization, collaboration and dynamics
- Professional roles comparison on the whole sample in order to detect significant macroscopic/general aspects influencing the professional role’s rapresentations.
Data analysis will be carried out through parametric and non-parametric, univaried and multivaried techniques depending on the data under consideration.
Finally a booklet composed of professional interventons PROTOCOLS will be printed out and given to health care organizations, in order to implement the “good work practices” related to professional identity and to different cultures’ integration.

The project time table is scheduled as follows:
STEP 1 (4-6 months)
- definition of contents, tools and ways of carrying out the Milan Unit research project;
- coordination and planning integration with Rome and Catania research units;
- involvement of the two designated social health structures and recruitment of the sample-groups.

STEP 2 (12-14 months):
- connection and comparison with other research teams regarding operative aspects
- setting up of interviews to the social-health-care services’ managers
- action research set up in all the four designed work groups.

STEP 3 (4-6 months):
- Milan Unit data analysis
- comparison with data from other research units
- final research report drafting
- sharing of outcomes and achieved results with the involved health care structures.