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Aim: This paper is part of a larger doctoral study that investigated the impact of nationality on the job satisfaction of nurses and their intentions to leave Saudi Arabian government hospitals. The paper aims to gain an understanding of the impact of expatriate status on nurses' perceptions, by comparing the factors that influence job satisfaction among Saudi nurses to those that affect nurses recruited from other countries. Background: Job satisfaction is a known predictor of nurse retention. Although there is a broad understanding of the factors that affect job satisfaction, little is known about how these vary between home and expatriate nurses working in countries which rely on a multicultural migrant workforce. Methods: A descriptive qualitative approach was taken, in which 26 semi‐structured interviews were conducted with nurses selected from different nationalities, all of whom were working in Saudi Arabian hospitals. Eight participants were Saudi Arabian, six Filipino, four Indian, four South African, two Jordanian and two Malaysian. Findings: Five themes were identified that differentiated the perceptions of expatriates regarding their job satisfaction from those of the home nurses: separation from family, language and communication, fairness of remuneration, moving into the future and professionalism. Conclusion: Focusing on the enhancement of job satisfaction experienced by expatriate nurses can result in a healthier work environment and greater retention of these nurses. Implications for nursing and nursing policy: To enhance nurse retention, policy makers in countries with migrant nurses should address their socio‐economic needs. This includes providing both greater access to their dependent family members, and language lessons and cultural orientation to reduce linguistic and cultural challenges. [ABSTRACT FROM AUTHOR]

Background: Psychological therapies especially Cognitive Behaviour Therapy (CBT) are used widely in the West to help patients with psychiatric problems. Cognitive Behaviour Therapy has an established evidence base for the treatment of different emotional disorders. In spite of these developments in the developed world, patients in most developing countries hardly benefit from non pharmacological interventions. Although a significant number of psychologists are trained in Pakistan each year, psychological interventions play only a minor role in treatment plans in Pakistan. We conducted interviews with psychologists in Pakistan, to explore their experiences and their views on "providing CBT in Pakistan". These interviews were conducted as part of a project whose focus was to try to develop culturally-sensitive CBT in Pakistan. Methods: In depth semi structured interviews were conducted with 5 psychologists working in psychiatry departments in Lahore, Pakistan. Results: All the psychologists reported that psychotherapies, including CBT, need adjustments for use in Pakistan, although they were not able to elicit on these in details. Four major themes were discovered, hurdles in therapy, therapy related issues, involvement of the family and modification in therapy. The biggest hurdles in therapy were described to be service and resource issues. Conclusions: For CBT to be acceptable, accessible and effective in Non Western cultures numerous adjustments need to be made, taking into consideration; factors related to service structure and delivery, patient's knowledge and beliefs about health and the therapy itself. Interviews with the psychologists in these countries can give us insights which can guide development of therapy and manuals to support its delivery. [ABSTRACT FROM AUTHOR]

Cognitive behaviour therapy (CBT) in its current form might not be applicable in non Western cultures. Differences between Western and non Western cultures have been reported widely. Psychotherapy was developed in the West and is underpinned by many beliefs which might be specific only to the Western culture. However, in order to modify CBT, we need to understand whether the concepts associated with the CBT might cause conflicts among people who receive therapy. This study explored the beliefs of the university students in Pakistan to find out if the concepts underpinning CBT are consistent with the personal, family, socio-cultural and religious values of the university students. Discussions were held with University students in Rahim Yar Khan, Pakistan. Students were given information on various aspects of the CBT and were asked to rate their agreement with these concepts on a visual analogue scale. There was little disagreement for the principles of CBT for personal values, while some disagreement existed for religious values. This study highlights the value of assessing peoples' beliefs about acceptability of CBT in non Western cultures. Students in Pakistan felt that the principles of CBT are consistent with their belief system in most areas. However, the value system of students might not be representative of the rest of the population. [ABSTRACT FROM AUTHOR]

GOBBI M. Nursing Inquiry 2005; 12: 117 –125 Nursing practice as bricoleur activity: a concept explored The debates concerning the nature of nursing practice are often rooted in tensions between artistic, scientific and magical/mythical practice. It is within this context that the case is argued for considering that nursing practice involves bricoleur activity. This stance, which is derived from the work of Levi-Strauss, conceives elements of nursing practice as an embodied, bricoleur practice where practitioners draw on the‘shards and fragments’ of the situation-at-hand to resolve the needs of the individual patient for whom they care. This conceptualisation of nursing practice will be analysed with a particular emphasis on its implication for nursing epistemology, pedagogy and praxis. The evidence to support this argument is drawn from empirical work that investigated nurses’ use of intuition, the work of Levi-Strauss, and issues in nursing epistemology and ontology. The paper itself is written from the perspective of a bricoleur who uses‘bits and pieces’ from the domains of nursing, philosophy, psychology, education, sociology and anthropology. [ABSTRACT FROM AUTHOR]

Cognitive behaviour therapy (CBT) as a treatment for schizophrenia and psychotic-related disorders has been shown to have significantly greater drop-out rates in clients of black and minority ethnic (BME) groups. This has resulted in poor outcomes in treatments. Our recent qualitative study thus aimed to develop culturally sensitive CBT for BME clients. The study consisted of individual in-depth 1:1 interviews with patients with a diagnosis of schizophrenia, schizo-affective, delusional disorders or psychosis (n = 15) and focus groups with lay members (n = 52), CBT therapists (n = 22) and mental health practitioners (n = 25) on a data set of 114 participants. Several themes emerged relating to therapist awareness on culturally derived behaviours, beliefs and attitudes that can influence client response and participation in therapy. The current paper aims to explore one of these themes in greater detail, i.e. client-initiated therapist self-disclosure (TSD). Using thematic analysis, the paper highlights key elements of TSD and how this could impact on therapist's reactions towards TSD, the therapeutic alliance and ultimately, the outcomes of therapy. The findings appear to show that TSD has significant relevance in psychological practice today. Some BME client groups appear to test therapists through initiating TSD. It is not the content of TSD they are testing per se, but how the therapist responds. Consequently, this requires therapists' cognisance and sensitive responses in a manner that will nurture trust and promote rapport. Further investigation in this area is suggested with a recommendation for guidelines to be created for clinicians and training. Key learning aims: (1) To develop a dialogue and practice with confidence when addressing issues of self-disclosure with diverse populations. (2) To appreciate the impact therapist self-disclosure has in early stages of engagement, in particular when working with patients from BME communities. (3) To understand the impact and role of self-disclosure as initiated by patients. (4) To increase therapist awareness on cultural differences in self-disclosure and develop ways to address this in therapy. (5) To challenge therapists to adapt psychological therapies to diverse cultures and be cognisant that 'one size does not fit all'. [ABSTRACT FROM AUTHOR]

Background Nursing involves caring for the ‘whole person’ and it is considered inappropriate for nurses to think or talk about patients in objectifying or dehumanising ways. Objectifying discourses can dominate within the arena of critical care, and critical care nurses can experience moral distress as they struggle to think about patients as persons. No previous study has examined the role played by ‘impersonal’ talk in the delivery of nursing care. This paper reports a study which examined the relationship between nursing practice and the way(s) in which critical care nurses think and talk about patients. Objectives The study objectives were to (1) identify and characterise the ways in which critical care nurses think and talk about patients; and (2) describe patterns of nursing practice associated with these different ways of thinking. Study design An ethnographic study was undertaken within one critical care unit in the United Kingdom. Data were collected over 8 months through 92 h of participant observation and 13 interviews. Seven critical care nurses participated in the study. Data analysis adopted the perspective of linguistic ethnography. Findings Analysis of these data led to the identification of seven Discourses, each of which was characterised by a particular way of talking about patients, a particular way of thinking about patients, and a particular pattern of practice . Four of these seven Discourses were of particular significance because participants characterised it as ‘impersonal’ to think and talk about patients as ‘routine work’, as a ‘body’, as ‘(un)stable’ or as a ‘medical case’. Although participants frequently offered apologies or excuses for doing so, these ‘impersonal’ ways of thinking and talking were associated with practice that was essential to delivering safe effective care. Conclusions Critical care practice requires nurses to think and talk about patients in many different ways, yet nurses are socialised to an ideal that they should always think and talk about patients as whole persons. This means that nurses can struggle to articulate and reflect upon aspects of their practice which require them to think and talk about patients in impersonal ways. This may be an important source of distress to critical care nurses and emotional exhaustion and burnout can arise from such dissonance between ideals and the reality of practice. Nursing leaders, scholars and policy makers need to recognise and legitimise the fact that nurses must think about patients in many ways, some of which may be considered impersonal . [ABSTRACT FROM AUTHOR]

The study aimed to investigate the process of reflection in professional nurse education and the part it played in a teaching and learning context. The research focused on the social construction of reflection within a post-registration, palliative care programme, accessed by nurses, in the United Kingdom (UK). Through an interpretive ethnographic approach, the organisational, contextual and cultural issues impacting upon teaching and learning interactions, and the use of reflection therein were explored with student and nurse educator participants. Data were collected from observations of teaching and learning, interviews, and extracts from programme documentation and reflective learning contracts (RLCs). Findings contribute new empirical knowledge regarding the process of teaching and learning about reflection, including educator and clinical supervisor facilitation, the emotional work involved in reflection and methods of ‘mapping’ and ‘modelling’ to support reflection. The influence of both higher education and practice partner organisations on the use of reflection is also evident and indicates that professional reflective education requires institutional support from both education and practice. Specific findings in this paper are pertinent and transferable to other disciplines, where reflective education is used to develop being critical in order to learn through experience. This research offers valuable insights into the realities of reflective education and has currency for educators committed to developing skills for reflection and learning through experience for students, through the generation of a reflective culture. [ABSTRACT FROM PUBLISHER]

Background: There is sufficient research evidence in favour of cognitive therapy in western world. However, only limited research has been carried out on its effectiveness in other countries. It is suggested that adaptations in content, format and delivery are needed before CBT can be employed in non-western cultures. We describe a preliminary evaluation of culturally adapted CBT for depression in Pakistan. Aims: We aimed to evaluate the efficacy of this culturally adapted CBT using a therapist manual. Method: In a randomized controlled trial we compared combination of CBT and antidepressants with antidepressants alone (treatment as usual) in primary care. Referred patients with ICD-10 diagnosis of depression were invited to participate and randomized to the intervention and control groups. Hospital Anxiety and Depression Scale (HADS) and Bradford Somatic Inventory (BSI) were used to measure changes in depression, anxiety and somatic symptoms. Results: Seventeen patients each were randomized to each arms of the trial. Except for financial status there were no differences between the two groups on various demographic variables. Patients receiving CBT showed statistically significant improvement on measures of depression (p < .001), anxiety (p < .001) and somatic symptoms (p < .000) as compared to antidepressant alone group. 82% patients attended six or more sessions of therapy. Conclusions: A culturally sensitive manualized CBT was effective in reducing symptoms of depression and anxiety in Pakistan. [ABSTRACT FROM AUTHOR]

Over the years, healthcare has been an important domain for CSCW research. One significant theme carried through this body of work concerns how hospital workers coordinate their work both spatially and temporally. Much has been made of the coordinative roles played by the natural rhythms present in hospital life, and by webs of mundane artefacts such as whiteboards, post-it notes and medical records. This paper draws upon the coordinating role of rhythms and artefacts to explore the nested rhythms of the Cardio-Pulmonary Resuscitation (CPR) protocol conducted to restore the proper heart rhythm in a patient who has suffered a cardiac arrest. We are interested in how the teams delivering CPR use various 'smart' assistive devices. The devices contain encoded versions of the CPR protocol and are able to sense (in a limited way) the situation in order to give instructions or feedback to the team. Using an approach informed by ethnomethodology and conversation analysis (EM/CA) we analysed video of trainee nurses using these devices as they delivered CPR in dramatized training scenarios. This analysis helped us to understand concepts such as autonomy and authority as interactional accomplishments, thus filling a gap in CSCW literature, which often glosses over how authority is formed and how it is exercised in medical teams. It also helps us consider how to respond to devices that are becoming more active in that they are being increasingly imbued with the ability to sense, discriminate and direct activity in medical settings. [ABSTRACT FROM AUTHOR]

Background: Cognitive Behaviour Therapy (CBT) has an established evidence base and is recommended by the national organizations in United Kingdom and the United States. CBT remains under utilized in low and middle income countries. CBT was developed in the west and it has been suggested that it is underpinned by western values. It therefore follows that to make CBT accessible for non western clients, it needs adapting into a given culture. Aims: Our aim was to develop guidelines for adapting CBT for psychosis in Pakistan by incorporating the views of the patients, their carers and mental health professionals. Method: We conducted a series of qualitative studies in Pakistan to adapt CBT for psychosis (a total of 92 interviews). The data were analyzed by systematic content and question analysis. Analysis started by identifying emerging themes and categories. Themes emerging from the analyses of interviews by each interviewer were compared and contrasted with others interviewers constantly. Triangulation of themes and concepts was undertaken to further compare and contrast the data from the different participating groups. Results: The results of these studies highlighted the barriers in therapy as well as strengths while working with this patient group. Patients and their carers in Pakistan use a bio-psycho-spiritual-social model of illness. They seek help from various sources. Therapists make minor adjustments in therapy. Conclusions: The findings from this study will help therapists working with this client group using CBT for psychosis in Pakistan. These results need to be tested through controlled trials. [ABSTRACT FROM AUTHOR]

It has been suggested that cognitive behaviour therapy (CBT) needs adaptation for it to be effective for patients from collectivistic cultures, as currently CBT is underpinned by individualistic values. In prior studies we have demonstrated that CBT could be adapted for Pakistani patients in Southampton, UK, and for local populations in Pakistan. Findings from these studies suggest that CBT can be adapted for patients from collectivistic cultures using a series of steps. In this paper we focus on these steps, and the process of adapting CBT for specific groups. The adaptation process should focus on three major areas of therapy, rather than simple translation of therapy manuals. These include (1) awareness of relevant cultural issues and preparation for therapy, (2) assessment and engagement, and (3) adjustments in therapy. We also discuss the best practice guidelines that evolved from this work to help therapists working with this population. We reiterate that CBT can be adapted effectively for patients from traditional cultures. This is, however, an emerging area in psychotherapy, and further work is required to refine the methodology and to test adapted CBT. [ABSTRACT FROM AUTHOR]

Background: Studies of cognitive behaviour therapy (CBT) for schizophrenia demonstrate that African-Caribbean and Black African patients have higher dropout rates and poor outcomes from treatment. Aim: The main aim of the study was to produce a culturally sensitive adaption of an existing CBT manual for therapists working with patients with psychosis from specified ethinic minority communities (African-Caribbean, Black-African/Black British, and South Asian Muslims). This will be based on gaining meaningful understanding of the way members (lay and service users) of these minority communities typically view psychosis, its origin and management including their cultural influences, values and attitudes. Method: This two-centre (Hampshire and West London) qualitative study consisted of individual semi-structured interviews with patients with schizophrenia (n = 15); focus groups with lay members from selected ethnic communities (n = 52); focus groups or semi-structured interviews with CBT therapists (n = 22); and mental health practitioners who work with patients from the ethnic communities (n = 25). Data were analyzed thematically using evolving themes and content analysis. NVivo 8 was used to manage and explore data. Results: There was consensus from the respondent groups that CBT would be an acceptable treatment if culturally adapted. This would incorporate culturally-based patient health beliefs, attributions concerning psychosis, attention to help seeking pathways, and technical adjustments. Conclusion: While individualization of therapy is generally accepted as a principle, in practice therapists require an understanding of patient-related factors that are culturally bound and influence the way the patient perceives or responds to therapy. The findings of this study have practical implications for therapists and mental health practitioners using CBT with people with psychosis from BME communities. [ABSTRACT FROM AUTHOR]