Cultural Differences in Midwifery Care

Cultural Differences in Midwifery Care Introduction The provision of holistic midwifery care is a fundamental role of the midwife (NMC, 2004). However, holistic care must encompass a wide range of practices, including care for the psychosocial and spiritual needs of the women and families within their caseload. One concept which arises within the general healthcare debate and within professional midwifery practice is the notion of cultural competence. This essay focuses on a critique of one article from the midwifery literature which addresses of the needs of one distinct religio-cultural group. Leishman (2004) demonstrates the complex nature of the provision of healthcare in a multi-cultural society. Inequalities exist in the provision of care to diverse ethnic and cultural groups (Salt, 1997). The article being critiqued addresses two issues – the provision of care to parents who have been bereaved, and specifically, the preferences, beliefs, behaviours and needs of one group of clients, those of the Muslim faith. It is publi shed in a midwifery journal and specifically deals with aspects of care which would come under the remit of the midwife within the UK, as specified by the NMC (2004). Discussion The title of the article is clear and simple, and defines the client group as religiously distinct (which also implies cultural distinction) and in a particular state of need due to bereavement. That the client group is defined as Islamic, however, does not take into account the different cultural and racial associations of those who practise Islam. A broad spectrum of cultures and races are associated with the Islamic, faith, suggesting that Islamic people are not a homogenous group. Conversely, it has also been argued that it is important to distinguish between culture (which has racial and religious overtones) and religion as a separate form of difference or identification (Eade, 1997). The failure of research on ethnic and racial or cultural lines to distinguish between religion and culture is notable (Eade, 1997), and it may be the intention of the authors of the critique article to ensure that the distinction is both clear and unequivocal. It may also be another example of the prioritisation of Islam over other social identities which is found so often in the literature (Eade, 1997). The authors further identify the group under consideration as those originating from migrants from the Indian Sub-Continent in the 1950s (Arshad et al, 2004). This group is limited to Asians (2nd and 3rd generation) originating directly or indirectly from this area (Arshad et al, 2004). Such a distinction may be important. Marks and Worboys (1997) discuss the fact that multiple meanings can be attached to the terminology surrounding discussions of culture and ethnicity, terms such as ‘migrant’ and also ‘minority.’ In order to attain cultural competence in the provision of healthcare, it is important to understand the distinctions between those terms utilised within the debate (Srivastava, 2007). Race is usually associated with biological, genetic and physical distinguishing characteristics (Srivastava, 2007). Ethnicity is associated with commonalities of birth, descent, kinship and cultural traditions (Srivastava, 2007). However, culture is harder to define, and includes racial, social, linguistic and other common patterns or characteristics within groups (Srivastava, 2007). This level of ambiguity within the debate does not help illuminate the current situation. By so clearly defining the focus of the client group in this article, the authors are claiming association with religious meaning (Islam) and racial and ethnic groupings (Asian, Indian Sub-Continent). They also support their focus with figures from the locality in question, thus establishing this group further as being of one predominant ethnic group, that of people of Pakistani origin (Arshad et al, 2004). This author can only question whether this adds to the understanding of the reader or further confuses the issue. The group are clearly defined, but what distinguishes them from other Muslims, or even from other ethnic groups from Asia, is not defined at all. Given the continued lack of understanding or awareness of cultural difference in the NHS in the UK (Le Var, 1998), further elucidating details might have been useful here. However, Cortis (2004) found that deficits exist in Registered Nurses knowledge about Pakistani patients in the United Kingdom, which might suggest that a greater understanding of this particularly group is necessary for all healthcare professionals. The Healthcare Commission (2006) found in their investigation of 10 maternal deaths in one hospital trust that women from minority ethnic groups are at higher risk of a pregnancy-related death. In this report, 9 out of the 10 women who died in the time period 2002 to 2005 were from minority ethnic groups, and seven out of these were from Asia (Healthcare Commission, 2006). This would suggest that the maternity care provided to women from these ethnic groups needs to be explored, evaluated and improved. This perhaps relates to the continued drive towards cultural competence in the healthcare services (Srivastava, 2007). It also suggests that there is a need for more specific information and evidence regarding distinct sub-groups within the ethnic mix of clients of the NHS. This article provides information, but its status as a form of evidence could be somewhat questionable. This is a descriptive article containing practical details for the maternity care professional to be able to provide culturally or religiously competent care for Muslims who experience the loss or death of a baby or fetus. Callister (2005) describes descriptive literature in this field as literature which identifies cultural practices to increase understanding of how nurses can more effectively provide culturally competent care for specific racial/ethnic and/or cultural groups of women and children. Establishing the client group’s distinctions early on, however, does not achieve much more than also establishing the authority of the authors in the writing of such an article, as it contains some references, but not as many as would be expected in a research-based article. There is no critical review of the literature, and very little critique or discussion, but rather a presentation of the (assumedly) accepted facts that relate to care for the family and dead infant. As such, th is is useful and informative, but the critical reader cannot but be aware of the lack of reliable evidence. The authority of the authors must be trusted here. Cortis (2003) suggests that culture furnishes the beliefs and values that give individuals a sense of identity, self-worth and belonging, as well as providing rules and guidelines or standards for behaviour. If we believe that culture is something commonly understood by those who share it (Srivastava, 2007), then it could be that a common understanding of Pakistani emigrant Muslim culture exists between the authors of the article, to such an extent that they fail to illuminate certain perhaps important details that would inform the general reader. This is a significant issue in the light of the continued debate about the nature and importance of culture in how people engage with healthcare services and each other. Recent views on culture, although not discarding the importance of a persons cultural inheritance of ideas, values, behaviour and practices, also acknowledge that culture can be affected dynamically by social transformation, social conflicts, power relationships and migrati on (Cortis, 2003). Yet there is no notion of that here, perhaps because the authors are dealing with the strictures of faith rather than culture. There is some statistical evidence of the rates of pregnancy loss infant death in the locality in question, but again, this is poorly related to the rest of the article and seems perhaps a token gesture towards relevance and importance of the information. Also, these statistics refer to White British, Pakistani and Other (Ashard et al, 2004), without making any further distinctions. Without such distinctions, the reader can only understand part of the picture. The ‘Other’ group might also contain people of the Muslim faith, as might the White British group. Again, the authors could have included more critical discussion here of ethnic mix. Some readers might consider that, having identified the group in question, the authors have gone far enough in setting the context of the paper. However, this author also feels that there is a degree of ambiguity in the presentation of this article. By distinguishing the client group to such a degree, it could be assumed that the customs, rites and beliefs referred to in the article are peculiar to this particular ethnic group who subscribe to the Muslim faith. However, it could also be that readers would assume that because the terms used in the article are more general, referring to Muslims as a religious group rather than making ethnic distinctions, these are guidelines to be applied to all Muslims. This ambiguity does not assist the reader in understanding how best to apply this information. Similarly, there is no real acknowledgement of the issue and dangers of stereotyping. Stereotyping has been described as a limiting and intellectually crude way of seeming to understand individuals (Schott and Henley, 1996). There is a tendency for people to stereotype those in groups that they do not belong to or know little about (Schott and Henley, 1996). Again, a critical reader could infer from this article that the authors have stereotyped the client group in question as being similar to all other Muslims. However, the article does raise some other issues which may not be explicit, including the importance and behaviours of family and friends in Islam during such a challenging time (Arshad et al, 2004). There is a clear undertone here that all Muslims behave in this manner because of their common faith. The article is referenced correctly but not very well referenced. Conversely, Leishman (2004) carries out a literature review which highlights some of the more topical issues surrounding the notion of culture and the needs of distinct diverse groups within the healthcare system. One issue that Lieshman (2004) raises is the fact that there is a need not only for health professionals to be aware of other cultures and belief systems, but also to be aware of their own. Addressing this issue, of understanding one’s own reaction to the beliefs and practices of others, might be raised in this article when discussing the practices and behaviours that are associated with Muslim clients following the death of a baby. This would be a useful and relevant practice point for midwives and other healthcare professionals to consider. Another point raised by Lieshman’s (2004) literature review is the need to take into account the past and experiences of ethnic groups, particularly those who, for example, have entered this country as asylum seekers. Similar issues have been raised by other literature (Maternity Alliance, 2004). The group in the critique article are not asylum seekers, but their parents, grandparents, family and friends may be, and the experiences and shared realities may affect their relationship with healthcare services and professionals. Such a potential is highlighted by a report by the Maternity Alliance (Maternity Alliance, 2004). Discounting this issue leaves out the level of detail midwives may require to fully understand and respond to the needs of diverse ‘minority’ groups, perhaps even promoting stereotyping rather than combating it. Thus it can be seen that another author, utilising a more critical and academic approach to the topic, can provide more of a discursive u nderstanding of relevant issues. Similarly, Callister (2005) reviews the literature on cultural competence in the care of women and children, and draws conclusions about the nature of that literature. Through this detailed examination the author is able to define and suggest potential outcomes for clinical care, for education of the professionals who deliver that care and for nursing research to properly explore the most important issues (Callister, 2005). Again, this article misses important opportunities to link the issues of concern to the current literature and to opportunities to develop better practice through educational development and research. For example, Callister (2005) suggests that studies are needed exploring organisational and work environment issues to better promote cultural competence. Simply being conversant with the basics of Islamic beliefs and practices surrounding death is not enough to promote true sensitivity and individualised care. Cultural sensitivity has been described as the attitudes, values, beliefs and personal insight of healthcare providers (Doorenbos et al, 2005). Such sensitivity involves acknowledgement of personal heritage and beliefs, openness to otherness, and respect for the complex ways in which cultural issues influence every aspect of healthcare (Doorenbos et al, 2005). However, the Arshad et al, (2004) article does not deal with the challenges of promoting cultural sensitivity, not does it distinguish between the different kinds of knowledge, understanding and skills necessary to provide care for this client group in these circumstances. A thorough, critical literature review, especially perhaps of any research or case studies that might illuminate the issues, would have considerably enhanced the paper. Doorenbos et al (2005) highlight and discuss existing models of cultural competence within healthcare, and evaluate one of the models used to assess one cultural competence assessment instrument. Application of such models to the situations described by Arshad et al (2004) might also have enhanced the quality of their argument and elevated their paper into the realms of evidence for practice rather than information for practice. Doorenbos et al (2005) describe cultural competence of healthcare providers as being central to the healthcare system’s ability to provide access to and provision of high-quality healthcare services, and link it to the drive to reduce health disparities. Srivastava (2007) links cultural competence to respect, knowledge and skills, and the ability to use them effectively in cross-cultural care situations. Some discussion of cultural competence in the Arshad et al (2004) article might also have perhaps allowed a more critical awareness of the subject. The conclusions the authors draw are that individuals have unique responses to grief and loss, regardless of religious background or belief systems (Arshad et al, 2004). This is no innovative or surprising finding, but the fact that they make no other conclusions is surprising. They also conclude that the resulting distress is often overwhelming (Arshad et al, 2004), another generalisation which is not new and does not really add anything to the debate. These conclusions do not really relate to the rest of the article, which is chiefly concerned with describing the beliefs and practices of Muslim people around the death of a child (Arshad et al, 2004). They also highlight that health professionals may not feel properly equipped or be well enough informed to support families of different faiths at such a time (Arshad et al, 2004). This is a fact well established by a range of other literature within healthcare and within midwifery (Srivastava, 2007; Marks and Worboys, 1997; Schott and Henley, 1996). The recommendations which are given are similarly brief and somewhat vague. Arshad et al (2004) suggest that an insight into religious beliefs and practices can only be beneficial when delivering care in the field of loss and bereavement. This is a rather sweeping statement, because while they do take into account the need to avoid generalisation, they have in fact generalised throughout the article and failed to provide any critical evaluation or insight into, for example, the differences in culture, race, background and practices that may exist between people who nevertheless subscribe to Islam. However, this may be this author’s own ethnocentrism surfacing – it could be that the expression of Islamic faith is universal and changes little between ethnic, racial or cultural groups. This article might be simply stemming from such a simple fact. The Maternity Alliance (2004) found that serious inequalities still exist in the provision of maternity care to women from minority ethnic groups, especially women who were asylum seekers. There is a need for more investigation of the reasons why staff are still improperly equipped to provide the highest standard of individualised care free of bias, prejudice or stereotyping. There is also a need to investigate the reasons for continued inequalities in access to and experience of healthcare, and any possible links between the two. There are a number of implications for midwifery practice, though these are not as explicitly stated within the article as they could be. The main and most useful implication is the need to provide correct and sensitive care for Muslim clients when they experience pregnancy loss or the death of an infant. This article is ideal to use to inform midwives of this. Other implications for midwifery practice are inherent in the article, and include, for example, implications for the practicalities of care provision in often busy maternity units within the NHS. The placing of the body so that it is facing Mecca, for example, is an important consideration for midwives who are usually the professionals who prepare the body of an infant or fetus following death. Another consideration is the fact that the whole of the body including the placenta and umbilical cord, should be buried (Arshad et al, 2004). It would be easy for a midwife to cause significant distress to a family by following usual hospital protocol for disposal of placenta, membranes and cord. There may also be issues of health and safety to be considered in the storage and transport of these tissues. If a midwife was aware of these particular religious practices, she might be able to discuss them with the client at an appropriate time and ensure that all their needs are met. Cortis (2003) suggests that nurses should appreciate how the domains of culture need to be used for data collection to identify specific cultural needs. It is through this process that important domains health beliefs, communication, spirituality, death and dying distinguish the needs of patients (Cortis, 2003). Cultural assessment also offers midwives and other healthcare professionals the opportunity for identifying potential differences between theirs and their patients’ value systems (Cortis, 2003). Chenowethm et al (2006) describes the common clash between healthcare professional’s perceptions of the professional responsibility to deliver care in a particular way, and the patient’s view of how they wish to be cared for. Such clashes are somewhat inevitable, but if anything can help t o overcome them or minimise them, it can only be of benefit to the midwifery profession. Chenowethm et al (2006) suggest one way to ensure cultural sensitivity is to access community resources appropriate to the cultural or ethnic group under consideration. This issue, however is not explicitly addressed in the Arshad et al (2004) article. More general issues for midwifery are those which apply to the broader, clinical governance spectrum of the maternity services as part of the healthcare services. The Department of Health (2007) in its operating framework for 2007-08 lay out core principles for the provision of care in the NHS. These include individualised care, partnership working, respecting dignity, reducing inequality and providing access to all based on need (DOH, 2007). Such a vision is nothing new, but does once again remind midwives of the need to provide both culturally sensitive and appropriate services. The information in this article may contribute to the development of such services, but it is the opinion of this author that it is still inadequate in addressing the complexity of the issues. However, Arshad et al (2007) do not address a range of other issues which can be found in the literature. For example, Park et al (2007) state that recruitment and retention efforts for non-white midwives, regular edu cation for cultural competence of midwives, and provision of culturally and linguistically appropriate care for women from ethnic minorities should be considered in future provision of maternity services. Neile (1995) also pinpoints education as important in supporting midwives gain a realistic insight into how the needs of the multiracial community may be met. There appears to be a need for a comprehensive programme of multicultural education for all midwifery professionals (Neile, 1996), a view which is echoed by Campinha-Bacote (2006) and Brathwaite and Majumdar (2006). If the Arshad et al (2004) article more directly targeted itself at professional education, it might have greater impact on the improvement of services. The Arshad et al (2004) article was published in the British Journal of Midwifery, which claims to be the leading clinical journal for midwives (BJM, 2007). This is well known as the pre-eminent peer-reviewed Journal for midwives in the United Kingdom, and the editorial board contains a range of the most senior and well respected midwives and midwifery academics in the country (BJM, 2007). The article is available by subscription online and in print, and is available in most Universities and Trust libraries. Contents, discussions and abstracts can also be found online, making this very accessible. This would give the article a degree of weight and authority, and as the BJM has such a large distribution – national and international – this adds further authority to the article. The writers themselves appear well qualified to write an article on this topic, in that it is written by two Muslim chaplains (one of whom is an Imam) and one bereavement support midwife. Thus the reader would be more inclined to accept and use their assertions in practice. This may explain why such a respected, peer-reviewed journal has accepted an article which is not related to research or a literature review. The authors do not appear to have published in other peer-reviewed journals but have contributed to the development of Trust policies and publications locally (Bradford NHS Trust, 2007). The rationale for the article seems sound. Arshad et al (2004) suggest that supporting parents who are bereaved following pregnancy loss can be complicated by a lack of knowledge and understanding of specific spiritual needs, leaving professionals feeling helpless and families feeling dissatisfied. The purpose, therefore, of their article is to provide information to address this issue (Arshad et al, 2004). This proposal seems reasonable and even necessary, given the need for improved understanding, knowledge, awareness and attitudes highlighted by the literature (Srivastava, 2007; Marks and Worboys, 1997; Schott and Henley, 1996). Cortis (2004) highlights the fact that there is a continued need for research into multi-cultural aspects of care. Through one research study, Cortis (2004) also identifies the danger of ethnocentrism in the health services, suggesting that it may contribute to racism, as ethnocentric practice fails to recognize significant cultural differences and their importance for the people concerned. If this is true, then such an article, informative and descriptive in nature, may contribute to the quality of care by informing those with ethnocentric tendencies of important details relating to this client group. However, in the provision of individualised care, this article may not supply the level of critical detail that the truly client-centred midwife would need to fully enhance their practice in this area. They also claim that the rituals and beliefs of Islam in these circumstances are complex and may appear strange to the uninitiated (Arshad et al, 2004). Conclusion As has been demonstrated, this article provides a descriptive, factual picture of the beliefs, practices and behaviours that Muslims experiencing pregnancy loss or infant death might display. It is of some use to midwives in an informative manner, but also does not seem to address the complex and challenging nature of the provision of care to a range of clients whose only common factor may be their Islamic faith. It does not address the issue of evidence-based care, and fails to engage in any real critique of the evidence base, literature or debate which does exist around this topic. It also fails to highlight some key terms of the current debate, including notions of cultural competence and cultural sensitivity, to any great degree. There are a range of issues which could have been highlighted such as education, communication and immigration. However, any truly client-centred midwife can only conclude that the information itself is vital to the provision of midwifery care to such cl ients and it also serves to highlight the notion of the great differences that exist in responses to and behaviours around pregnancy bereavement within different racial, ethnic and religious groups in society. Any such article has a place in the drive to improve care standards and quality, and should be incorporated into client-centred care. References Arshad, M., Horsfall, A., Yasin, R. () ‘Pregnancy loss- the Islamic perspective.’ British Journal of Midwifery 12 (8) 481-484. Bradford NHS Trust (2007) www.meded.bradfordhospitals.nhs.uk/DesktopModules/ViewDocument.aspx? Brathwaite, A.C. Majumdar, B. (2006) ‘Evaluation of a cultural competence educational programme.’ Journal of Advanced Nursing 53 (4) 470–479. British Journal of Midwifery (2007) http://www.britishjournalofmidwifery.com/ Accessed 6-5-07 Callister, L.C. () ‘What has the literature taught us about culturally competent care of women and children?’. Maternal Child Nursing 30 (6) 380-388. Campinha-Bacote, J. (2006) ‘Cultural competence in nursing curricula: how are we doing 20 years later?’ Journal of Nursing Education. 45(7) 243-4. Chenowethm, L., Jeony, H., Goff, M. Burke, C. (2006) ‘Cultural competency and nursing care: an Australian perspective. International Nursing Review 53 24-40. Cortis, J.D. (2004) ‘Meeting the needs of minority ethnic patients.’ Journal of Advanced Nursing . 48(1) 51-58. Cortis, J.D. (2003) ‘Managing societys difference and diversity’ Nursing Standard 18(14-15-16) 33-39. Dennis, S. (2004) ‘Transcultural nursing resources’ Nursing Standard 19(6) 25 Department of Health (2007) The NHS in England: the operating framework for 2007-08’ http://www.dh.gov.uk/en/Consultations/Liveconsultations/DH_064732 Dimond, B. (2002) ‘Race relations and the law.’ British Journal of Midwifery 10 (9) 580-583. Doorenbos, A.Z., Schim, S.M., Benkert, R. and Borse, N.N. (2005) ‘Psychometric Evaluation of the Cultural Competence Assessment Instrument Among Healthcare Providers.’ Nursing Research 54 (5) 324-331 Eade, J. (1997) ‘The power of the experts: the plurality of beliefs and practices concerning health and illness among Bangladeshis in contemporary Tower Hamlets, London.’ In: Marks, L. Worboys, M. (1997) Migrants, Minorities and Health: historical and contemporary studies London: Routledge. Healthcare Commission (2006) Investigation into 10 maternal deaths at, or following delivery at, Northwick Park Hospital, North West London Hospitals NHS Trust, between April 2002 and April 2005. www.healthcarecommission.org.uk/_db/_documents/Northwick_tagged.pdf -. Accessed 6-5-07. Le Var, R.M. (1998) ‘Improving educational preparation for transcultural health care.’ Nurse Education Today. 18(7) 519-33 Lieshman, J. (2004) ‘Perspectives of cultural competence in health care. Nurisng Stanard. 19 (11) 33-38. Marks, L. Worboys, M. (1997) Migrants, Minorities and Health: historical and contemporary studies London: Routledge. Neale, E. (1996) ‘Investigating midwifery education in a multiracial and multicultural society.’ In: The art and science of midwifery gives birth to a better future. Proceedings of the International Confederation of Midwives 24th Triennial Congress, 26-31 May 1996, Oslo. London: International Confederation of Midwives. 1996, pp 171-175. Neale, E. (1995) ‘The maternity needs of the Chinese community.’ Nursing Times 1 (4) 34-35. Papadopoulos, I., Tilki, M. and Lees, S. (2004) Promoting cultural competence in healthcare through a research-based intervention in the UK. Diversity in Health Social Care. 1(2). Park, J-H., Vincent, D. and Hastings-Tolsma, M. (2007) ‘Disparity in prenatal care among women of colour in the USA.’ Midwifery 23 (1) 28-37. Salt, K. (1996) ‘African-American midwifery: past, present and future.’ Midwifery Today 38 25-27. Schott, J. Henley, A. (1996) Culture, Religion and Childbearing in a Multiracial Society: A handbook for health professionals Oxford: Butterworth-Heinemann. Srivastava, R.H. (2007) The Healthcare Professional’s Guide to Clinical Cultural competence Toronto: Mosby Elsevier. Weller, P., Feldman, A. and Purdam, K. (2001) Religious Discrimination in England and Wales: Home office Research Study 220. London: Home Office Research, Development and Statistics Directorate.

Physics, Roller Coasters

Part 1 Roller coasters Additional notes: GPE = m x g x h KE = m x v? The main energy transfers that happen as a car travels along the track from the start of the ride to the end: [1]The rollercoaster car gains gravitational potential energy (GPE) as it travels to the top. Once over the top, the car gains speed as GPE is transferred to kinetic energy (KE). As it travels to the top of another loop, KE is transferred to GPE. Not all the energy is transferred to or from GPE – some is transferred to the surroundings as heat and sound.All moving objects have kinetic energy, KE. The kinetic energy an object has depends on the mass and speed. If the mass doubles, the KE doubles and if the speed doubles, the KE quadruples. Normally energy is lost through sound and heat (friction, air resistance). How the heights of the hills are designed to allow an empty car to reach the end of the ride: [2]The hills are designed so that it is low enough that the momentum of the car from the previous drop carries it up and over the hill.This is why the hills are usually lower towards the end of the ride, because the car has lost momentum due to friction and air resistance. Mainly the consecutive hill must be lower as it will not have enough energy because some of it is lost and sound and heat. Therefore, if the car was to reach the end of the ride, the height of the hills must be lower each consecutive time. How the energy transfers determine the heights of the hills: [4] After the roller coaster is drops from the first hill it does two things with its energy.First, it begins to transform that energy from one form to another–from gravitational potential energy to kinetic energy and from kinetic energy to gravitational potential energy, back and forth. Second, it begins to transfer some of its energy to its environment, mostly in the form of heat and sound. Each time the roller coaster goes downhill, its gravitational potential energy decreases and its kinetic energy incre ases. Each time the roller coaster goes uphill, its kinetic energy decreases and its gravitational potential energy increases.But each transfer of energy isn't complete because some of the energy is lost to heat and sound. Because of this lost energy, the roller coaster can't return to its original height after coasting downhill. That's why each successive hill must be lower than the previous hill. Eventually the roller coaster has lost so much of its original total energy that the ride must end. With so little total energy left, the roller coaster can't have much gravitational potential energy and must be much lower than the top of the first hill.This is why the hills must be a certain height, in order to transfer enough GPE into KE. Bibliography: [1] http://www. bbc. co. uk/schools/gcsebitesize/science/add_ocr_gateway/forces/themeridesrev2. shtml [2] http://science. howstuffworks. com/engineering/structural/roller-coaster3. htm [3] http://www. coasterforce. com/coasters/technical- info/physics-of-a-coaster [4] http://library. thinkquest. org/26455/amuse/roller/roller01. shtml [5] – Collins Additional Sciences B ISBN-13 978-0-00-741531-1 Colin Bell, 2011

Buyer Behaviour Literature Quotes - 888 Words

Consumer behaviour, Peter M. Chisnall (1995) Published London: McGraw-Hill 1995 3rd ed. â€Å"Buying behaviour is complex and influenced by many factors, some of which may conflict with so-called rational decision-making. The interactions of groups and personal behaviour, the interrelationships between attitudes and behaviour, the challenge of authority and status, and the profound, and sometimes subtle, effects of culture on consumption make up, in part, the intricate web of influences which surrounds patterns of consumption.† â€Å"People’s behaviour as consumers of diverse products and services cannot realistically be isolated from their societal roles as parents, workers, students and so on. Personal consumption takes place in a social and†¦show more content†¦144) differentiated between â€Å"consumer behaviour† and â€Å"consumer buying,† a distinction even modern consumer behaviorists do not always recognize. In other words, he differentiated purchasing from consuming. Engel et al. (1968, p. 6), the first full-length textbook on consumer buying, acknowledged Alderson’s contribution: The difference between consuming and buying is further clarified by Wroe Alderson who correctly recognized that much of what is called the study of consumer behavior is in reality not the study of consumption but of consumer buying. The term â€Å"consumer behaviour† can be an ambiguous expression. What are the differences between choice behavior, search behavior, purchase beha vior, consumption behavior, use behavior, and routinized behavior? More importantly, where does one positionAlderson in thismyriad of possible behaviors? Such position does not become any easier when we realize Alderson’s own thinking about marketing and the consumer evolved over time. The study of consumption is a multidisciplinary field and has a long history in the social sciences, including economics. 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The Us Presidency - 1765 Words

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The Power Struggles in Jury of Her Peers and Mama Come...

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Water Supply Project Brief Free Essays

string(90) " baffles help the formation and in turn settle finer particles such as silt and colloids\." Contents Table of Contents†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 1 Task†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 2 List of Abbreviations†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢ € ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. We will write a custom essay sample on Water Supply Project Brief or any similar topic only for you Order Now 3 TASK2 1. 1Project Title4 1. 2Introduction4 1. 3Project Location Map5 1. Terms of Reference6 1. 4. 1Project Details6 1. 4. 2Reporting Structure6 1. 4. 3Personnel Duties7 1. 5Schematic Layout7 2. 1DELIVERABLES8 2. 1. 1Dam8 2. 1. 2Water Treatment Works9 2. 1. 3Elevated Steel Tank10 2. 1. 4Water Transmission10 2. 1. 5Metering11 3. 1Project Management Process12 3. 1. 1Initiating12 3. 1. 2Planning12 3. 1. 3Executing13 3. 1. 4Controlling14 3. 1. 5Closing14 List of references†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 16 List of Annexure Annexure 1 – Project Budget Annexure 2 – Work Breakdown Structure Annexure 3 – Project Network Diagram Annexure 4 – Project Gantt Chart Annexure 5 – Project Summary TASK You are a consultant of a firm that has won a tender to develop a turnkey water project in Kajiado County. Using necessary tools including Ms Project prepare a WBS, and do a schedule of project tasks, their resources and assume a tracking of the project progress. Hence do a status report in a PDF file. The completed work should not exceed 20. LIST OF ABBREVIATIONS WBS- Work Breakdown Structure WARMA – Water Resource Management Authority NEMA – National Environmental Management Authority ToR – Terms of Reference GI – Galvanized Iron RCC – Reinforced Cement Concrete 1. 1Project Title Proposed Water Supply Project in Kajiado Town 1. 2Introduction A project is one-time, multitask job with a definite starting point, definite ending point, clearly defined scope of work, a budget and usually a temporary team. A project is therefore a series of activities which are meant to achieve particular goals or objectives using specified resources and in a specified period of time. A turnkey project refers to a project that is built and handed over ready for use. The proposed water project in Kajiado County being a turnkey project will entail the consultant to take up construction from the initial stages of the project and hand it over when water has been connected to individual residents and/or users. Kajiado town lies at the intersection of the Nairobi – Kajiado road along the A 104 highway, and the railway line that serves Magadi Soda Company in Magadi. The town is situated 80 KM South of Nairobi. It is the administration centre for Kajiado County. Kajiado Town has a mean annual rainfall ranging from 450mm to 900mm. The major rivers found in Kajiado are among others Athi River, Ewaso Ngiro South River, Olekejuado River, Nool-Turesh River, Esokota River. The project involves construction of a dam along Olekejuado River, a water treatment plant, an elevated tank, a generator room, water transmission and distribution lines and water meter chambers. The presenter intends to use tools of Project Management Information Systems including MS Project 2010 software in achieving the implementation framework. The paper will be guided by Project Management processes of Initiating, Planning, Executing, Controlling and Closing to achieve set deliverables of the proposed project. 1. 3Project Location Map Figure1 – Map of Kajiado County 1. 4Terms of Reference This contractual document outlines the terms and conditions for the contracted project team. The process of initiating a project starts when the Client contacts the Contractor either with an already drawn ‘Terms of Reference’ or with intent for a joint process in drawing the Terms of Reference. 1. 4. 1Project Details EmployerMinistry of Water and Irrigation Funding agencyGovernment of Kenya (Development Vote) EngineerGeneral Manager (Design Construction) ConsultantsKiama Consortium Limited Contract No. MOWI/001/2011-2012 Contract Area20 Square Kilometres Water Meters2000 Residents Contract Value (USD)USD 2,000,000 Capacity Required2,000,000 Litres/day ContractorPentacon Limited Award Date2 December 2012 Commencement Date1 January 2013 Completion Date4 October 2015 Project Duration2 Years 1. 4. 2Reporting Structure 1. 4. 3Personnel Duties The following will be the Key personnel for the project: Project Manager – Overall supervision of the project ?Financial Controller – Financial supervision ?Human Resource Officer – staff recruitment ?Procurement Officer – acquisition of resources (material) Monthly and Quarterly reports will be submitted to the client. The monthly report shall be submitted by the 5th of every month while quarterly report shall be submitted after ever y three months of the project duration. 1. 5Schematic Layout 2. 1DELIVERABLES Deliverables are the end results or outputs of undertaking a project. They may include reports, manuals, actual working systems or actual products. In this project deliverables include a dam, a water treatment plant, an elevated water tank, water distribution mains and water meters. 2. 1. 1 Dam ?Diversion of River The dam is designed to hold 10,000, 000 liters of water at its full capacity. The dimensions shall be 100m x 100m x 2m. During the construction of the dam, River Olkejuado will be temporarily blocked up stream and water diverted until the dam construction is completed. ?Intake Chamber The intake will be constructed and an allowance velocity of 0. 45m/s will be provided that will direct water to the pumping station. ?Spill Way The spill way will allow water to overflow in case the dam fills up excessively. ?Embankment An embankment will also be constructed to safeguard the walls of the dam from failing. Reinforced Cement Concrete retaining wall works will be done as an embankment to safeguard and strengthen the dam walls. ?Pump House A pump house shall be constructed to provide for a stand by generator to cater for 50% of the maximum pumping capacity and incase of power failure. It should also be noted that a generator can work for a maximum of 16 hours a day, therefore that should be considered in case of a total power failure in case of electrical faults. . 1. 2Water Treatment Works The assumption is, the water being harvested contains 50 – 50, 000 coli form count, a figure that requires water to undergo full treatment before consumption. ?Coagulation Tank This is the first tank, where water is chemically coagulated by adding alum and soda ash. The tank contains flocculation chambers. The water pa sses through baffles so that it can mix up well with the chemicals. ?Sedimentation Tank The sedimentation process will be aided by addition of alum in the coagulation tank. The baffles help the formation and in turn settle finer particles such as silt and colloids. You read "Water Supply Project Brief" in category "Papers" The sedimentation tanks designed as upward hydraulic velocity and downward settling velocity enable sludge concentration. The design flow rate is proposed at 222m3/hr and the surface loading rate velocity is proposed at 1. 5m3/m2/hr. The allowed detention time is 3 – 4 hours. ?Rapid Sand Filter The proposed rapid gravity filters are back washed with air and water. The design flow rate is recommended at 222m3/hr and a filtration rate of 5m3/m2/hr. The storage time is about 10 – 20 minutes. ?Disinfection Tank pH correction will be done by adding soda ash. It could be due to dissolved carbon dioxide (CO2) or excess amount of alum was added into the water during the coagulation process. Disinfection of the water will be necessary to lower health risk and infection with water borne diseases. In that case, Calcium Hypochlorite will be added to the water as per the calculated quantity depending on the volume. ? Reinforced concrete storage tank After water has been successfully disinfected, it will be pumped to the storage tank and allowed for chemical reaction for about 30 minutes before it is pumped to the elevated water tank ready for distribution. . 1. 3Elevated Steel Tank The elevated water tank is dependent on the highest level in the region. This also allows for water flow by gravity therefore, there will savings of electricity and fuel cost that might have been used for pumping water. 2. 1. 4 Water Transmission ?Transmission Main Galvanized iron (GI) pipes of 250mm diameter are preferred since they withstand high water pressures. Th e pipe velocity is set at 2. 0 m/s and set at a depth n. e. 1000mm deep below the ground level. Reflux valves are allowed at a distance of 3-4 km spacing to ease repair and maintenance. ?Distribution Main The minimum diameter of pipes recommended is 100mm diameter. uPVC pipes shall be used and the maximum 60m and minimum pressure of 10m. The pipe velocity is set at 06 – 1. 0 m/s, and service valves are set every 1km for ease of inspection, repair and maintenance. 2. 1. 5Metering Meters are installed in all 2000 houses or users to monitor water consumption. This will also helps in billing as per the actual amount of water consumed. The Meters will assist in curbing vandalism of water. 3. 1Project Management Process Project management is the process of initiating, planning, executing, controlling and closing a project. The project goal is the desired outcome it should be short and simple yet clearly communicate scope, time frame and budget. To achieve the goal of supplying water to 2000 users in Kajiado county, the management process outlined above will be adhered to. 3. 1. 1 Initiating It involves recognizing that a project should begin and committing to do it. Feasibility concerning technical, financial, operational, legal, environmental and social aspects of the project shall be carried out. Using MS Project 2010 the project start and finish date were identified. Legal issues such as NEMA and WARMA licensing were identified and dealt with accordingly. Approval of the project by the County council was also sought. The start date was 1st January 2013 while the expected completion date is 4th October 2013. The budget for the project was also drawn; it is envisaged that the project will cost Ksh. 179,445,100 (USD 2,000,000) This is shown in annexure 1 of this paper. 3. 1. 2Planning Initially, the project scope was defined and the appropriate methods for completing the project were determined. Following this step, the durations for the various tasks necessary to complete the work were listed and grouped into a work breakdown structure; this is attached in annexure 2. The logical dependencies between tasks were defined using an activity network diagram as shown in annexture 3 that enables identification of the critical path. Float or slack time in the schedule can be calculated. Then the necessary resources were estimated and costs for each activity allocated to each resource, giving the total project cost. At this stage, the project schedule was optimized to achieve the appropriate balance between resource usage and project duration to comply with the project objectives. Once established and agreed, the project schedule became the baseline schedule. Progress will be measured against the baseline schedule throughout the life of the project. Planning Involves devising a workable scheme of a schedule of tasks and resources. In the planning process, the project activities were identified and entered in the Gantt Chart. Timelines for the activities were drawn and subdivisions identified, milestones were also noted. Restrictions and relationships of predecessor and successor activities were also considered. Resources were then assigned to the tasks identified. The Gantt chart is shown in annexure 4 of this paper. ?Assumptions When planning for this project, a few assumptions were made. They include the following: i. Land for the development of the dam and excavation of trenches for pipes’ distribution is already procured by the Olkejuado County Council. ii. River Olkejuado is a temporary river and the dam is being excavated during the dry season. The river does not, therefor, need diversion but, only blocking. iii. The electrical work cater for all the structures iv. Each tank will have a booster pump. v. All hired machines and equipment comes fully with operators vi. The shilling is exchanging at the dollar rate of 90 Ksh. ii. The dollar sign in the budget represents Kenya Shillings. 3. 1. 3Executing This phase will involve carrying out the scheduled plan while coordinating the people and resources to achieve the project goal. It will also involve reporting on a monthly and quarterly basis as stated in the ToR. Reporting will involve progress, resource usage, achieved milestones and challenges enc ountered if any. Milestones and Critical Path are shown in annexure 5. Creating project records and presentations will also be done at this stage. Adherence to the drawn out plan will be key to achieve the desired results. henever necessary, changes will be requested and improvements recommended. 3. 1. 4Controlling It ensures that the project remains within the objectives, tracking performance and taking necessary corrective measures. During this phase, achieved progress is compared to the scheduled progress and any slippage is noted. Tracking for activities especially at the preliminary stage of the project has been assumed. The tracking Gantt Chart has been observed to give progress in percentage. Corrective measure suggested in case of slippage is crashing of the project activities. Crashing will involve identifying activities with float and slack times and interrogating the resource allocation and dependencies therein. (24 hour days in shifts) Though it may imply increase in project cost, it may be the only way to ensure timely finishing of the project. Ensuring timely procurement of materials and hiring of equipment whenever required is also key in controlling the project. Effects of weather changes will also need to be taken into consideration. 3. 1. 5Closing It involves formalizing the acceptance of the project and bringing it to an orderly end. Users are trained and handover of the project is conducted together with necessary documentation which aid in support and maintenance in future. The project audit and commissioning has been scheduled for the last month of the project duration as indicated on the Gantt chart shown in annexure 4. This being a turnkey project, cut-off handover is proposed. List of References www. imestopedia. com/terms/r/risk. asp en. wikipedia. org/wiki/Risk breakdown – freecover. blogpost. com www. mastery-project-management. com/project closure,html Uher, T. (2003) Programming and Scheduling Techniques, UNSW Press, Sydney How to cite Water Supply Project Brief, Papers

Cross-Cultural Differences in Childrearing Essay Sample free essay sample

Throughout my clip spent here in Spain. I have found the cross-cultural similarities and differences of child-rearing patterns to be an highly interesting country of survey. Relatively the households of the American and Spanish societies have rather different methods of raising a kid and presenting him or her to this universe. What is and what is non socially acceptable is the lone differing country when looking at any two civilizations side-by-side. Certain things that are considered normal for the Spanish civilization are looked at as odd from an American position ; along with the opposite bing when the Spanish people examine American civilization. The things that are taught to kids populating in Africa compared to those that live in America differ much more widely but still serve the same intent. The different civilizations contribute the exact same thing to each several society in the long-run. a new productive member of each society. How a kid is raised and taught to populate is a alone facet of every civilization that exists throughout the universe. Rogoff states that members of each society are â€Å"prepared by both our cultural and biological heritage to utilize linguistic communication and other cultural tools and to larn from each other. † ( Orienting Concepts. P. 3 ) Through this definition it is easy to see why child-rearing techniques are alone to each and every society. The people of any society use their ain tools and their ain linguistic communication to learn the young person of their society what exactly it means to be portion of their civilization. For illustration. one does non see many adult females in the United States who are breast-feeding on the tube. This is something that is a much more private event in the United States because the people of America are less unfastened about this day-to-day activity. The households of Spain see it as something more unfastened and natural and therefo re freely do it throughout public when their babe is hungry. This is a more obvious illustration of a cross-cultural difference between the two societies. Child-rearing patterns contribute to and reflect overall societal values which can be observed when analyzing the daily life of Spain compared to America. While I have been in Spain I have found many differences that exist between the ways I was raised compared to how kids are raised here in Sevilla. One difference I found interesting was the times at which younger kids are still wake up with their parents at dark. In the United States it is about impossible to happen a babe in a saunterer out past 10 at dark. allow entirely be at a saloon with their ma and pa. I have found out through my experiences here and the inquiries that I have asked my host household that this difference exists because that is a really traditional facet of Spanish civilization. It is normal to hold kids out past that clip in Spain because of the social values that are tied to eating in the Spanish civilization. The American people normally eat dinner at around half past seven at dark in their places with thei r households. The Spanish people usually eat dinner at about ten at dark and are eating outside of their places more frequently with other friends of the household. I found the times that kids become accustomed to eating to be one of the most interesting differences of Spanish and American child-rearing because nutrient is one of the most culturally alone facets to every society in the universe. The differences in child-rearing methods are seen much more clearly when looking at other different civilizations and comparing them. In the movie â€Å"Babies† that we watched in category the kids of the African small town are allowed to play with tools that American parents would neer let. The small babies are seen sitting in the soil playing with stones and socking them following to their female parent. An American ma would see this as unsafe and perchance harmful to their kid. while the African female parent merely sees their kid acquiring used to the normal tools that will subsequently be used in life. This is yet another illustration of how social values of each civilization are ingrained into a child’s caput throughout the beginning of their life. Another more utmost illustration is how the Efe of the democratic democracy of Congo allow their kids to utilize matchets safely. This is a tool that is entirely associated with violent death and that the American peopl e find as holding no good component if they taught their kids how to utilize it. On the other manus the Efe usage this tool on a daily-basis for a assortment of different grounds and happen plentifulness of usage in learning a kid how to utilize a machete early on in life. Despite the really differing ways of raising a kid that are used by the American. African. and Spanish people the households of each civilization are bring forthing the same productive member of each society. The ways of achieving this member of society vary widely. but what difference should that do. I consider myself no better than anyone who belongs to any of the other civilizations I have discussed. I am merely different in what I find socially acceptable. merely like how my ways are looked at as different by person who belongs to another civilization. The ways of child-rearing are some of the most culturally bound facets of a group of people that can be examined. People all over the universe have different methods of raising and bring forthing a good member of society. but despite the differences they all produce the same thing. In order to acquire an accurate apprehension of why the methods differ. one must understand the significance for the difference and how it fits into con text. No manner of raising a kid is â€Å"better† or â€Å"worse† than another ; they all serve the same intent and exist to bring forth the same productive member of each society.