RICERCA ITALIANA     

Research program

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

University Co-ordinator

Università degli Studi di ROMA "La Sapienza" - PSICOLOGIA DINAMICA E CLINICA - ()

Research Unit Leader

Giulio Cesare Zavattini

Description

Description if the programme and of the tasks of the research unit

Aim of the research:

As we showed in the previous paragraph, many foreign workers coming from different countries and belonging to heterogeneous cultures are employed in the field of health and assistance to people in our country.
This situation makes it necessary a reflection about the concepts of health and illness present in each individual. Since these representations are connected to the moral and social principles of the ethnic group to which the individuals belong, in the welfare institutions different ways of conceiving the professions of care coexist. Therefore we are facing a phenomenon that has not only trans-cultural implications, but that has also an influence upon the choices of the health policy and of public ethic.
We aim to take into account the representations and the operative practices connected to the different conceptions of health and illness as well as the different ways of conceiving the care in the individuals working in the health and welfare institutions.
From this point of view our purpose is to point out the peculiar features that characterize the ideas about health, illness and care relationship in different cultures and to investigate at the same time the way in which these aspects are conceived in our culture. We think that doing this is very important in order to build an “inter-culture” made up of shared operative practices concerning the different professional identities employed in the health and assistance working field.


Specific Aims:
This work aims at promoting the integration of the different cultural aspects connected to the way of conceiving health and illness in the different working contexts in the health and welfare field, through processes of evaluation and training.

In particular our goals are:

- to describe the perception of the moral and cultural values that characterize the care professions in the different cultures;
- to identify the best conditions in order to stimulate the creation of shared representations;
- to point out the critical areas or the areas at risk from an ethical point of view, where the personal cultural background of a worker could be in conflict with the needs of other subjects, such as colleagues or users , in the working context;
- to promote a relationship of trust among the workers that can make it easier to work together;
- to plan standards of interventions in the care relationships

The research will be divided in 4 steps, aimed at investigating the themes of the study (I step), at making an intervention with the health and assistance workers (II step), at evaluating the effectiveness of the intervention and finally at analysing the data collected.

Hypothesis
Concerning the step II of the research our purpose is to investigate the following hypothesis:

H1 There are cultural differences in the way of conceiving the health, the illness and the care relationship in individuals coming from different geographic areas (East Europe, South America, Italy)
H2 There are some common values among the different cultures quoted above concerning the themes of health, illness and care relationship
H3 Among the different cultures there are some conflicting values about what is right and desirable concerning the themes previously described
H4 The perception of the function and the organization of the working context is different among individuals with different cultural backgrounds
H5 The perception of the tasks connected to the care is different among individuals belonging to different cultures

Concerning the step III of the research we are interested in the exploration of the following hypothesis:

H6 In relation to the concepts of care, health and illness there are, in individuals belonging to different cultures, shared representations functional to the working context and to the attainment of the mission of the organization
H7 There is a decrease in conflicting areas among the different cultures
H8 The perceptions of the working contexts are more homogeneous
H9 We notice the shared construction of new operative practices functional to the context and more effective in the attainment of the mission of the organization

Methodology

This study is part of a wider research plan led by the Milan University that will last two years. The common goal of the different research units is the realization of a cognitive and formative intervention concerning the representations and the practices
connected to the themes of the care relationship, the health and illness present in people working in the health and welfare field (both autochthonous and immigrants). This in order to increase the professional knowledge through the exchange and the construction of a shared system of values about the definition and the practice of their profession.
In particular the present research unit aims at:

-coming in touch with people belonging to different ethnic groups and working in public and private health and welfare structures in order to create 3 groups of people for the research-intervention. Each group will be made up of 12 subjects of the same professional role (nurses, babysitters, professional nurses) with different nationalities.

-promoting the debate and the discussion about the following areas: representation of the health and the illness, definition of the care relationship, meanings of the transitions of the life cycle of the users;

-making an investigation concerning different levels: the individual one (about the conceptions of the individuals in respect to the themes of the study), the group one (about the sharing of the values and of the practices of each profession), the organization one (the analysis of the function and of the structure of the institution in which the workers are employed);

The sample of the research is made up of 36 subjects divided in three groups: the first group is made up of 12 professional nurses (4 coming from Italy, 4 coming from East Europe, 4 coming from South America), the second group is made up of 12 elderly people helpers (4 coming from Italy, 4 coming from East Europe, 4 coming from South America), the third group is made up of 12 full-time babysitters (4 coming from Italy, 4 coming from East Europe, 4 coming from South America).
The choice of considering these different ethnic groups is in line with the data of the Report about immigration Caritas/Migrantes (2005) that show that in the health and welfare field the ethnic groups more represented are the ones coming from East Europe and South America.
The study, as said before, will be divided in 4 steps:

a) The first step will have an exploratory goal: through a clinical interview administered to three pilot groups, made up of professional nurses, elderly people helpers and babysitter, it will be possible to find the most important themes to be discussed in the scheduled meetings and to choose the materials (clips, stories, photos…) to be used in order to stimulate the group discussion.
Among the themes we want to investigate there are:

- in relation to the concepts of health and illness:

-the meaning of the illness and of the care
-the meaning of the prevention
-the perception of the risk
-the conception of the life cycle
-the ideas about the wellbeing and the malaise

- in relation to the care relationship:
-the way of handle the physical and affective dependence of the user
-the relationship with the power both towards the user and the employer
-the relationship with the body
-the perception of the care practices
-the perception of the critical event in relation with the experiences of the user (separation, psychosocial evolutions of the users, death..)

The clinical interview will be aimed at evaluating the level of comprehension, the interest arisen , the level of activation caused by the questions as well as at finding new areas important for the subject of the study. The themes will be then discussed in a pilot focus group.
The research team will spend about 4 months to elaborate the themes and to find the subjects that will take part into the pilot phase of the study.
During the first phase it will be done an analysis of the different working contexts, in order to point out their structure and the organization, through the administration of semi-structured interviews to the managers of the health institutions and to the employers of elderly people helpers and babysitters.

b) During the second step there will be the selection of the research sample (see above). To the 36 subjects there will be administered interview in order to get information about them and their motivation; their personal data will be collected. These data will be then analysed and elaborated. The three groups will be formed and the themes of the discussion will be presented to the participants of the study. The subjects will take part to 4 focus group meetings aimed at investigating the different cultural representations of care, illness and health and at stimulating a discussion about the construction of a shared professional identity. A following meeting will be spent for the administration of the Family Life Space (Gozzoli, Tamanza, 1998) with the goal of investigating the perception of the working context.
The time expected is about 10 moths.

c) The third step will be aimed at the evaluation of the intervention realized with the participants at the study and is made up of 2 focus group meetings, during which the attention will be focused on the construction of conscious shared representations about the concepts of care, health and illness, functional to the working context.
Furthermore a meeting will be spent for a new administration of the Family Life Space (Gozzoli, Tamanza, 1998) in order to evacuate the changes in the way of perceiving the working context.
This phase will need about 10 moths.

d) The fourth step concerns the data analysis. This will be realised using qualitative techniques and will be aimed at elaborating the results of the focus groups discussions: our goal is to focus the cultural differences about the representations of health, illness and care relationship and to evacuate how much the different conceptions are integrated in a more complex and shared system of values after the individuals’ participation to the focus group.
Our data will be compared to the ones collected by the other research units.
Then an evaluation of the work will be done, from the point of view of the people taking part in the research and of the members of the research teams, through the use of an evaluation questionnaire specifically realised for the goals of the research.
There will be a final report.
The time expected for this step is about 3 months.

Research Applications
The general aim is the shared construction and the diffusion of new operative practices functional to the working context, through the knowledge acquired during the group discussion.
The diffusion will be realised through publication both in paper and in the Web, in the field of the health psychology or of the clinical psychology, as well as about the themes of the integration, of the inter-cultural meeting, of the management of the care systems.