Reflection of Personal Art Therapy Experience as Facilitator

Reflection of Personal Art Therapy Experience as Facilitator Brett Cartwright Description I have chosen to do my reflection on the Art Therapy Focusing model in which I facilitated a process for my client, who for the purpose of confidentiality we will call ‘Jemima’. This session was conducted at the Phoenix Institute of Australia as a part of the learning model presented by my lecturer within the Art Therapy Module. During the â€Å"setting up† (Malchiodi 1998) the space process I went about finding an appropriate area and making sure there were sufficient items conducive of an Art Therapy session, such as pastels, paper, and markers, as well as a cabinet in the corner filled with Art Therapy supplies, should Jemima wish to use something different. Upon the completion of the setting up process, I quickly checked in with myself to ensure I was capable of holding space for my client before walking into the waiting area to greet Jemima, inviting her to join me in the room. Once in the room I enquired about how she felt regarding the comfort of the space and offered her the opportunity to rearrange it in any way she saw fit, also pointing out that there were many more art supplies in the corner cabinet. Jemima nodded and said â€Å"I’m actually quite happy with this† making a bodily gesture toward the previously setup space. Now sitting, we began to talk about how her day was going so far and if there was anything specific she would like to focus on. Upon creating an intention for the session I suggested that we try an Art Therapy Focusing process and proceeded to explain what would be involved. We began by drawing her attention into her body, in search of a ‘Felt Sense’ (Gendlin 1996) eventually finding an image that had an ‘emotional quality’ fitting to the intention we had set for the session. I then extended an invite to open her eyes and bring the image to concretised form on the paper, inviting her to open up a dialogue with me about the process if she saw fit at any time, which she ackn owledged but declined. The rest of the session was quite silent and required little more than my presence, â€Å"unconditional positive regard† (Rogers 1980) and holding of the space to facilitate. Jemima indicated when she had finished her image, at which time I asked her to close her eyes again, inviting her to bring her awareness back to the room and slowly drawing her out of the focusing process. At this point I asked her if she could share with me how the process was for her. I let Jemima know that the session was coming to a close, offering her the opportunity to express anything else that might have come up for her during the process, and we closed the session. I then invited Jemima to give reflection on my performance as a therapist, took some notes, and the entire process was complete. Feelings I felt quite comfortable entering into this process as I am reasonably familiar and confident with the focusing process from both the ‘Focuser’ and ‘Companion’ perspectives. Also, I have worked with Jemima on a number of occasions and have developed a good amount of rapport with her, which makes for a productive and healthy therapeutic relationship. Having said that there were, and always are, a certain amount of nerves for me when stepping into the role of therapist, as I have recently discovered via an empty chair process that I have a dominant inner critic that has created really strong insecurities around professionalism. This was, however, coupled with intense feelings of excitement about acting out the entire process of a therapy session and the learning that comes from the experience. At the end of the session, as always, I found myself left with mixed feelings. I became highly stressed and critical about how I performed as the therapist, and some of the feedback I received from Jemima, again coupled with an element of excitement about having made it through the process without any major hiccups on my end. Evaluation At the time I felt things went reasonably well for both the client, and myself. It seemed that the client had really managed to embody the Art Therapy Focusing process. The â€Å"Coming in† process (Purton 2004) was smooth and seemed to flow quite well as we slowly drew Jemima’s awareness toward her inner-world, searching for a Felt Sense that eventually matched that of a ‘Protector’ (as referenced in the Analysis section below). Throughout the creation of the artwork I made a few observations about certain things, such as the way Jemima smiled when the image of her protector came to her; the movements and motions of her strokes on the paper which were reflected as being â€Å"helpful for meaning making† by the client; and the pressure she seemed to apply to different areas of the page. The end of this session felt a bit rigid and clunky upon reflection, as I always seem to have some amount of trouble tying things off without interrupting the clientà ¢â‚¬â„¢s process. Analysis Upon analysis of the session and the feedback given by the client, it would seem that it was a productively therapeutic session that helped the client in â€Å"clearing space† (Gendlin 1996) and creating a â€Å"safe space† using an image of a â€Å"protector† as tools created by Judith Herman and described by Rappaport (1998), which the client can now refer to in consecutive sessions to help return to that feeling of safety, if the client resonates strongly with that image. There was the possibility for a couple of intersubjective responses, as I had a couple of images with protective qualities come up for me when I was witnessing the client’s process unfold, which I held back due to some nervousness around projection and interpretation as I did not want to influence the client’s process in any way. Conclusion In Conclusion, upon reflection of the content of the session from both my perspective and the feedback given, I realise that there is a level of incongruence, and slight lack of unconditional positive regard in not sharing my intersubjective responses with the client. Thus putting distance between myself and the client, and in turn creating a lack of attunement. As a final note, there is very little I would change about the process apart from exercising more congruence and working on developing better skills around closing the session. References Malchiodi, C.A. (1998). Setting up: Drawing on Environment and Materials. The Art Therapy Sourcebook: Art Making for Personal Growth, Insight, and Transformation. (p.79 – 102) Rappaport, L. (1998). Focusing And Art Therapy: Tools for Working Through Post-Traumatic Stress Disorder. Focusing Folio, Vol. 17 (1), (p.2-3) Gendlin, E.T. (1996). Focusing-Oriented Psychotherapy: A Manual of the Experiential Method. New York: Guildford Press. (p.57-58) Purton, C. (2004). Focusing as a Taught Procedure. Person-Centred Therapy: The Focusing-Oriented Approach. United Kingdom: Palgrave MacMillan. (p.90) Rogers. C. R. (1980). Characteristics of the Person-Centred Approach. A Way of Being. Boston: Houghton Mifflin. (p.115-116)

Cultural Competency of Nurses

Cultural Competency of Nurses 1.1 Cultural competency The commitment to equality in health care provision is ingrained within the core values of the health care profession and nurses are expected to fulfill these requirements. The Nursing and Midwifery Councils (NMC) Code of Professional Conduct clearly states that nurses must treat every patient as individual, respect their dignity and not to discriminate irrespective of age, ethnicity or cultural background (Husband and Torry 2004a). The NMC (2004) emphasises that culturally competent care is moral and legal requirement for nurses. Thus the requirement for the development of cultural competence is to be found within the NMC code of conduct. Josipovic (2000) points out that the delivery of individualised care, in consideration of religious and cultural requirements of Black and Ethnic Minorities (BME) patients can assist nurses to fulfill their obligations. However, there is no universal definition of cultural competence; Campinha-Bacote (2002) defines cultural competence as a process, which requires the health care professional to continuously attempt to gain the ability to work competently with the cultural context of the patient. Nevertheless Papadopoulas et. al. (1998) defines cultural competence as the ability to give effective care while taking into account patients specific cultural needs, behaviors and beliefs. Narayata definition Nonetheless, there has been significant discussion of different models of cultural competence in nursing literature (Gunaratnam, 2007). Campinha-Bacote (1998) model of cultural competence: the process of cultural competence in the delivery of health care service, identifies five essential constructor of cultural competence: Cultural awareness Cultural knowledge Cultural skill Culturally encounter Culturally desire Conversely the Papadopoulas et. al. (1998) model of developing cultural competence consists of four stages: Cultural awareness, Cultural knowledge, Cultural sensitivity and Cultural competent. Rosenjack Burchum (2002) identified the attributes of cultural competence as same as those of Papadopolos et al (1998) but adds cultural understanding, and cultural skill as essential attributes. Cultural competence is, according to Rosenjack Burchum (2002), the development of knowledge and skill manifested by the synthesis of the above attributes and their respective dimensions in human interaction. Although there is distinction in the models of cultural competence they all express common concern of three main components: cultural sensitivity, cultural knowledge and cultural skills (Gogwin et al. 2001). According to Garity (2000) cultural competence involves having understanding and sensitivity toward different cultural groups and factors that affect their lives such as immigration, discrimination and the possibility for these factors to improve or inhibit professional practice. Hence, for a nurse to become cultural competent s/he needs to develop an understanding of ones own cultural needs, views, beliefs, behavior and those of the patient while avoiding stereotyping and generalisation (http://www.culturediversity.org/cultcomp.htm). The aim is to ensure that the health care services and professionals are respectful and responsive to the health beliefs, practices, cultural and linguistic needs of diverse patients, which can help bring about positive health outcome (http://minori tyhealth.hhs.gov/templates/browse.aspx?lvl=2lvl). Cultural competency is a process that needs to be continuously developed in order to enhance ones ability to give affective health care (Papadopoulos 2006). All registered nurses have the responsibility to competently maintain professional knowledge and practice by ensuring up to date knowledge, skill and ability as well as safe and effective practice (NMC2008). Although the NMC clearly places the individual with the responsibility of developing cultural competence, it should be acknowledged that individuals alone cannot be held responsible for the delivery of culturally safe and competent health care service if insufficient resources are not made available (Husband and Torry, 2004a). Nonetheless, Dreher and MacNaughton (2002) described cultural competence as the same as nursing competence; the ability to deliver care individualised and therapeutic to each patient despite social context or cultural background, this being the signature of contemporary nursing. However, the basic principle of providing nursing care to culturally diverse populations is not an entirely new idea, as the need for such was recognised in the United States in the late 1800s (Davis, 1996) and was also recognized by Florence Nightingale when advising British nurses working in India (Wilkins, 1993). In the last century, most western countries saw significant changes in the make up of their populations due to increased trends in global migration that resulted in multiethnic and multi-religious societies. In the UK BME groups make up 7.9 % of the total population (Office for National Statistics, 2001). As the population becomes more diverse so does the complexity of the patients needs that the nurse must address (Black, 2008). Thus far, the need for the nurses to become culturally competent has become import (Black, 2008, Gunaratnam, 2007).The pertinent literature highlights that, in the last few decades, scholars and researchers have debated the issue relating to the delivery of appropriate nursing care to meet the needs of BME groups (refs). There is a growing body of evidence that show there are inadequacies in the nursing care provided to these groups (Vydelingum, 2006, Cortis, 2004) and concerns about ethnic disparities in health in the UK (Aspinall and Jacboson, 2004). Studi es on utilisation of hospital services by BME patients, in particular the elderly have consistently demonstrated level of dissatisfaction with the care provided from cultural and/or religious viewpoints (DoH, 2009; Clegg, 2003; Patel, 2001; Cortis, 2000, Vydelingum 2000) 1.2 BME Elders Nevertheless, the concept of the ageing population is one that has generated much discussion in the UK (Caldwell et al, 2008) as this age group is the main users of both health and social care services (Department of Health, 2001). While all older people have common needs and experiences of hospitals, the needs and experiences of the BME older people are shaped by their race and ethnicity (Ahmad, 1993; Blakemore and Boneham, 1994). Majority of todays BME elders are yesterdays young migrants from the commonwealth countries (Patel, 2001), who came to the UK during the 20th century as a result of government policy to fill labour shortage (Houston and Cowley, 2002). According to Evandrou, (2006) in 2001 4% of the BME population were over 65 and this number is rapidly rising, from approximately 60 000 in 1981 to about 360 000 in 2001-2002 (Butt and ONeil, 2004, Beaven, 2006) and is expected to increase in the next 15 years (Evandrou, 2000). These elderly groups have particularly been disadvantaged by the cumulative effect of age, race and inaccessibility to services (Norman, 1985). However, newly arrived migrants are likely to share similar concerns and experience in hospital care (Patel, 2001). The 2001 and earlier censuses show that health disparities exist in the UK and that levels of long term illness are higher in older BME groups than in the general population (From A Szczepura 2005).Older people from BME are report more chronic illnesses such as cardio-vascular disease, diabetes, hypertension and stroke when compared to the majority (Tilke, 1998; Ebrahim, 1999; Evandrou, 2000b). An appreciation of the health care needs of this group is vital in understanding the difficulties they face in accessing health care services (Toofany, 2007). One occurring theme connected with old age and ethnicity that has been repeatedly identified from the1980s until today is the lack of urgency over government action for the group (Norman, 1985, Patel, 1990, Lindesay, 1997, Patel, 2001). The Policy Research Institution on Aging and Ethnicity (PRIAE) highlights that these groups are not normally considered in old age research (Patel, 2003). Hoong Sin, (2003) points out that BME older people in the UK are disadvantaged by the lack of a reliable sampling frame. Although there are few national studies, most research projects are small and involve localised samples (Hoong Sin 2003). Therefore the infrastructure for doing research with such population groups is inadequately set up (Hoon Sin, 2003). In PRIAEs view we have had too much discussion, action is overdue (Patel, 2001). This information suggests that BME elderly groups have never been a priority on the agenda for research or policy makers in the health care services. Saleh (2009) su ggests that the introduction of the Race Relations (Amendment) Act 2000 increased pressure on health care organisations to adapt services to ensure equitable access for local all BME groups. On the other hand, Department of Health (DoH) ensures that reducing health disadvantage and social exclusion for BME elders is central to UK health and social policy (DoH, 2001b). The DoH made specific commitments, in the National Standards, Local Action, to improve quality of service for BME where they are disadvantaged in terms of health (refs). This approach according to Papadopoulos et al. (2006) is a sign that the NHS is undergoing modernization. Unfortunately, the last two National Patient Survey Programme reports (2008 2009) show the experiences of all BME groups (with the exception of those from the Irish community) are significantly less likely to be positive than those of the indigenous populations. From a nursing aspect this outcome questions the nurses competence in delivering culturally appropriate care. The literature available identifies cultural competency as one of the main factor that can help cease the inequalities in health care system (refs). According to Papadopoulos et al. (1999) although mention of the term cultural competence in DoH and National Health Services (NHS) documents has increased, there is no attention to what this actually means for patients or nurses and how it could be measured. Having and implementing clear, strong policies on race and equality is essential for health and social care organisations but this has to be supported with training and education (PRIAE, 2005). Consequently, Dreher and MacNaughton (2002) doubted whether cultural knowledge translated into culturally specific care would necessarily result in improved clinical outcomes or the reduction of health disparities. 2. The review Aim and Research Strategies 2.1 Aim Nurses are at the front line of care for BME older people in hospital therefore it is important that the care delivered is in line with what is viewed as appropriate by the patients to their needs. The Department of Health openly acknowledges that much remains to be done in terms of measuring older patients experiences of the process of care, respect, dignity, information and education (Shaw and Wilson, 2008). This review, therefore, intends to bring together the literature concerning nurses views of what is essential in delivering culturally appropriate care to BME older patients as well as this groups expectations and experiences of nursing care. The aim is to explore the cultural competency of nurses in caring for BME elderly patients in Hospital setting. 2.2 Search Strategy (Include: inclusion/exclusion criteria, databases searched, keywords, languages and inclusive dates of the literature searched.) Search Term Search was carried out using combination of keywords such as Nurses, Cultural Competence/Awareness/Sensitivity, Geriatric, Elderly/Older, Black and Minority Ethnic and Experiences/Views. Furthermore, concepts relevant to hospital care such as Dignity, Respect and Appropriate Care were searched in combination with the above key terms. Databases The electronic databases British Nursing Index, PsycINFO, MEDLINE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Assia and Cochrane Library were searched to identify peer-reviewed literature published in the English language between 1990 and 2010 that are UK based. The databases yielded XXX potential studies relevant to the topic under review. Further search was conducted in the World Wide Web using the same key words and it produced xxx studies. The websites of the Department of Health, Transcultural Nursing Society, Royal Collage of Nursing and relevant Third Sector Organisations such as Age Concern, and PRIAE were also accessed which yielded XXX literature. Further literature was gained from the reference and the bibliography of the gathered data as well as the library of the University. The titles and abstracts of the obtained literature were examined and studies focusing on care provided by nurses to BME elderly patients as well as studies examining the views/experiences of hospital care by this particular geriatric group were selected. For the purpose of the literature review an older person is defined as person older than 50 years. NSF considers an older person as a person who is over the age of 50 years. Yet, a limited numbers of studies (how many) about BME elders in hospital setting were identified. For this reason studies focusing on the topic that had a wide range of age sample group i.e. 30-80 were included as it would assist in identifying additional pertinent literature. In total, XX studies were identified to meet the inclusion criteria for the literature review. The literature selected were mainly primary empirical studies using qualitative approach. A qualitative research aims to understand the feelings, values, and perceptions that under lie and influence behavior (xxxx). Therefore the use of a qualitative methodology is seen to be appropriate as all the studies examine the experiences of the BME patients through their own eyes and those of the nurses (from internet). 2.3 Critical Appraisal of Three Qualitative Studies on the Experiences of Nurses in Caring for BME Patients and BME patients Experiences of Nursing Care Cortis (2004) Meeting the Needs of Minority Ethnic Patients Clegg (2003) Older South Asian patients and Care Perceptions of Culturally Sensitive Care In a Community Hospital Setting Hamilton and Essat (2008) Minority Ethnic Users Experiences and Expectations of Nursing Using Caldwells frameworks for critiquing health research, the three above stated studies will be analyzed systematically and supporting/contradicting evidence from other studies will be offered. WHY USE THIS FRAME WORK? Following the discussion of the review themes will be identified. Title Although the title of the study of Cortis is brief and conveys the nature of the study (Polit and Beck, 2010), it could be viewed as misleading as it gave the impression that the sample group was representative of different communities of BME groups. However, the study specifically focuses on the Pakistani ethnic community. Conversely, the titles of the researches by Clegg (2003) and Hamilton and Essat (2008) are short, accurate and clearly specifies what and who is being studied while reflecting the study content (Burns, 2000). The Researchers Academic and Professional Qualification The authors of the three researches have particular interest about the topic in question, which gives the assumption that they are familiar or have professional insights. The qualification (PhD, MsC) of the researchers is relevant as it indicates that they are competent and have creditability to carry out researches. Further evidence to support researchers knowledge and interest of the topic was demonstrated as they are all nurses with extensive experience; Cortis is a senior lecturer at the University of Leeds with Qualitative Research interest in ethnicity and BME issues. Clegg is a consultant in older peoples services and intermediate care at Leeds Teaching Hospital NHS Trust. Hamilton was a principal lecturer at De Montfort University with research interests in multi-ethnic care and Essat was research assistant at the same university working on a project exploring the educational preparation of student nurses to work in a culturally diverse way. Abstract and Rationale A qualitative study must offer an abstract containing summary of study aim/objectives, research approach, methods adapted and the result of the study including the clinical applications (Cormack, 1996). Bellow the abstract there should be key words related to the study offering the reader an overview of the research question. All studies have offered a comprehensive abstract with key words relevant to their topics. Clear rationale for undertaking the study was given by all researchers; Cortis rationale was the fact that there is little exploration of nurses experiences of caring for specific BME community while Cleggs rationale was that there is a lack of research defining the concept of cultural sensitive care from patient/care perspective. Lastly, the rationale provided by Hamilton and Asset is that, nationally, there is an evidence to suggest that care provided doesnt always meet the needs of BME patients. LR All three researchers did review pertinent literature (classics up to date), which was evident in the studies as well as the reference list. According to Doordan (1999) the literature offered should have discussed and critically reviewed related literature to find out what questions remains to be answered. Nevertheless, only Clegg (2003) provided a separate section for LR, which she must be praised for (Morse, 1994). In grounded theory studies, researchers start with data collection first and as the data is analysed and as the theory takes shape researchers then begin to search the literature in order to link it to the emerging theory (Polit and Beck, 2010), which was evident in Cleggs study. Aim The three studies clearly identify and justify their aims. Cortiss (2004) argues that in a number of studies BME are seen as homogeneous therefore the aim of his study is to investigate a specific communitys uniqueness: the experiences of nurses caring for Pakistani patients in north England. However, this aim is inconsistence with the title of study, which clearly treats BME as a homogeneously. WHAT DOES THIS MEAN? While the aim of the Clegg (2003), was to identify older south Asian patients and carers perception of culturally sensitive care. Lastly, the aim of the research by Hamilton and Asset (2008) was to give the minority ethnic groups the opportunity to voice their opinions on nursing care and to inform future nursing education. Ethical Issues Both Cortis and Clegg clearly highlight that permission to do the study was sought from the Local Research Ethics Committee (LREC), which is an imperative step before conducting any research. However, Hamilton and Essat (2008) omit to mention whether appropriate approval was gained from LRECs; who exist to examine proposed research projects in order to guard peoples rights and interests (Cormack, 2000). All the researchers have to be praised for specifying the process and purpose of the study was explained to the participants before the study in order to obtain informed consent. Cortis (2004) clearly specifies that assurance was given to maintain confidentiality and anonymity of the sample group, which is something Hamilton and Essat (2008) fail to address in their study. Both Cortis and Hamilton Asset dont comment on the associated ethical issues of autonomy, non-maleficience and beneficence, (Cormack, 20000). Nevertheless, Clegg considered the vulnerability of the participants (Gerrish and Lacey 2006, Speziale and Carpenter 2007) and therefore committed to the ethical principles of autonomy, non-maleficience and beneficence (RCN, 2004), but fails to mention how confidentiality and anonymity was maintained. Clegg showed sensitivity towards the participants by informing them the voluntary nature of the research with the option of being able to withdraw at any time. This implies a non-coerciveness approach which was important in this study as this was vulnerable group. Conversely, The three studies inform that permission was sought from the participant to audio-tape the interviews but omit to identify where data was stored and the disposal procedure used (Polit and Beck, 2008). This supports the premise that data used for a particular project should not be used for another without consent (Gerrish and Lacey, 2006). Methodological Both Cortis and Hamilton Essat (2008) fail to specify that the method used was phenomenological-exploratory, which is useful when studying individuals lived experiences (Crookes and Davies, 1998). The main methodological strength of using phenomenological in these studies is that it is an inductive and holistic approach that looks at what occurs within (Crookes and Davies, 1998). Both of the studies focus was on the unique experiences of providing care by nurses to BME patients and perception of BME older patient views/expectations of nursing care. The biggest methodological limitation for using phenomenological in these studies is that it is labour intensive and time consuming for the researchers in terms of data collection and analysis (Crookes and Davies, 1998). Clegg, on the other hand, identifies the methodology utilized as grounded theory, which is useful when studying individuals XXXX (GG). Methodological strength associated with the use of this approach in this study is xxxx x. Methodological weakness associated with the use of this approach in this study is The three studies clearly identify the major concepts of the design used and their concepts, which are what? Sampling Technique and method According to Polit and Beck, (2010) in qualitative research there is no rule for sample size as long as data saturation achieved. The sample number (n=30) used by Cortis was considered to be suitable for qualitative research (Cormack 1999) why? However, the sample number by Clegg was four patients and three relatives. Clegg states in her study that she is not sure if data saturation has been achieved. Morse (2000 in polit and beck book) suggests that number of participants required to reach saturation is a firmed by number of factors, such as the wider the research question the more participants necessary. This gives the impression that the sample size could have been too small for the scope of the research question hence why saturation was not reached (Morse 2000) possibly due to time or budget constraints (ref). Sampling number for Hamilton and Essat: six focus groups, member of which range from 8 to 15 (? large sample number for qualitative). All three researches state how many participants were recruited and from where; areas with high population of BME. Cortis participants were recruited from a large acute hospital in north England and Clegg recruited this sample from a two community Hospital inner city and Hamilton and Essat recruited their sample of 6 diverse BME communities groups. The researchers must be praised for providing a clear indication of inclusive/exclusive criteria, in the process of recruiting participants. In contrast the three studies fail to identify the sampling methods and techniques used but inferred from the research studies is that non-probability method of purposive sampling was employed (Cormack, 1996). The method of purposive/judgmental sampling relies on the belief that researcher have enough knowledge about the population to be able to pick sample members (Polit and Bechk, 2010). The main strength associated with the use of purposive sampling in these studies is that the researchers purposively choose the participants knowing they would give relevant information about the topic in question (Polit and Beck, 2008). However, one main limitation is that this technique relies upon the researchers knowledge of cultural competence of nurses (Polit and Beck, 2008). Method of Data Collection All researchers collected data by audio taping interview and transcription. Cortis, Clegg and Hamilton Assset adapted different types qualitative self-reporting technique, which is flexible in gathering self-reported information as it allows the participants to express their views in a naturalistic way (Polit and Beck, 2008). Data collection is described by Cortis as semi-structured interviews and supplementary questions to follow-up for clarification. Cortis informs that most interviews were done in the clinical area; implying that participant had choice of venue, which he must be commend for. However, he omits to state where the rest of the interviews were done. WHY IS VITAL TO GIVE PARTICIPANTS CHOICE OF VENUE? Nevertheless, Cleggs choice of data collection was unstructured interview that were done in the first language of the interviewee. Cross validation of the taped interviews was under taken by a second linguist. Both Cortis and Clegg fail to point out who/how many people performed the interview. Interview performed by one person provides uniformity and consistency (Denscombe, 2003). On the contrary, method of data collection used by Hamilton and Essat was focus group, which was sub-divided into 6 groups where each group had facilitator. The advantage with use of this method in this study is it can generate a lot of dialogue but the disadvantage is that not everyone is comfortable experiences their experiences/view in front of others (Polit and Beck, 2010). Overall, an advantage associated with the use of all interview technique utilized is that the interviewer can observe the participants non-verbal responses, which can provide valuable information (Burns 2000). Some of the main methodological limitation with the use of this method in these studies is that it was done in face to face, which could jeopardize the participants anonymity since they were identifiable for the interviewer (Cormack, 1996). Method of Data Analysis All the researches used thematic content analysis, which is creditable method of data collection (xxxx). Only Hamilton and Asset clearly stated the method used and who analysed the data: two members of the team. What does this mean for the research? Cortis transcribed the interviews himself to became personally immersed in the information. What does this mean for the research? Clegg points out that Micro-analysis of the data were used to identify categories but fail to say who analysed data. Having different people conducting the interview and the analysis of the texts can have an impact on the richness of the analysis performed (Strauss and Corbin, 1998). Nonetheless, steps were taken by all researchers to uphold the rigour of the interpretation by checking the transcript with the participants to ensure correctness, which gave the data conformability and credibility (Forchuk and Roberts, 1993). They also must be praised for indicating that the data was analysed systematically in several steps. However, they all fail to state the type of qualitative software used to categorise the information i.e. Ethnograph and if it was positive or negative to the analysis (Barnard, 1991). (Clegg: Triangulation was introduced into the process of data analysis, which was carried out by a colleague from India). The methodological strength linked to the utilisation of this thematic content analysis in these studies is that it is commonly used in qualitative research and is suitable the three study aims. Limitation would be this analysis includes gathering statements on the bases of similarity and frequency with the aim of making them to themes (Barnard, 1991). It could be argued that by doing so the researchers are using a quantities method of analysis for qualitative data as each data is not being treated uniquely (Barnard, 1991). Study Results The three studies identified themes based on the participants experience which implies themes were not based on presumption authors (Cormack, 1996). Each studies result relate to its aim, which they must be praised for. The finding of each study uses the participants precise statement from the interview, which demonstrates analytical points and allows the reader to hear the voices of the participants. This demonstrates conformability and credibility (Burns, 2000) and lets the reader to get in-depth understanding of topics in discussion (Morse1196). Hamilton and Essats results highlight the view held by BME groups regarding nursing communitys lack of knowledge of cultural and religious beliefs. Cortiss findings agree with this as majority of the nurse participants did not deem that the provision of care was affected by culture and spirituality/religion was viewed narrowly by identifying the need for patients to perform prayers with no lack of recognition of other religious requirements. Participants in Cleggs study described the fundamental importance of religion and its effect on health and hospitalization. Other references re culture and religion to be added. All three studies highlighted communicational problem between patients and nurses, which as an issue hinders the development of relationship. However, problems in this area have been covered in many other studies such as (add referennces)à ¢Ã¢â€š ¬Ã‚ ¦Ãƒ ¢Ã¢â€š ¬Ã‚ ¦. And proposals and provisions to address them have been made by the DoH in order to reduce health inequalities (reference). Study Discussion All researchers offer a comprehensive discussion of their topics while comparing and contrasting their results relating to themes with other similar literature, which puts their finding in context making it more objective (Meltzoff, 1998). However, only Clegg specifies the study limitation which was the sample size- a larger sample size would have enhanced the probability of reaching saturation and increase the importance of the finding. Conclusion The three studies offer comprehensive conclusions which summarises the main results while suggesting area of further research or implementation. Cortis suggests that holism needs further conceptualization as his study highlighted nurses understanding of culture as part of holistic care was superficial, which presents a challenge for educators, nursing management, researchers and nursing practice in general. Clegg suggested further research needs to be carried out in order to define the nature of culturally sensitive services. She also points out that nurses understanding of culture and cultural sensitivity needs clarification. Hamilton and Asset suggests that nursing education must ensure that nurses initial training and post training education prepares them to become culturally understanding and sensitive. It could be argued that these three studies make useful recommendation for practice for nurses working with BME patients, which are based on education and research on cultural sensitivity. The three studies suggests that nurses are not culturally competent as required by professional bodies and the Government (English National Board for Nursing and Midwifery and Health Visiting 1997, DoH, 1997, United Kingdom Central Council for Nursing, Midwifery and Health Visiting 1999, Quality Assurence Agency 2001). Cortis (2004) conducted a phenomenological study investigating the experiences of 30 registered nurses who had nursed Pakistani patients in a large acute hospital in north England within the last three months. Semi-structure interviews and supplementary questions to follow up were the main method of da

Reservation Blues by Sherman Alexie Essay -- Reservation Blues, Sherma

In the novel Reservation Blues, most of the characters struggle with their identity at some point. Victor has an especially strong urge to rebel against his Native American heritage, which is apparent in his violent, arrogant demeanor and his obvious problem with alcohol. Victor is tied to his past and has trouble coping with his life as it is, and is in a constant battle with himself, his surroundings, and other people.   Ã‚  Ã‚  Ã‚  Ã‚     Ã‚  Ã‚  Ã‚  Ã‚  Early in the book, Victor is portrayed as somewhat of a bully, and he and Junior are even referred to as, "two of the most accomplished bullies of recent Native American history." (page 13) Victor's closest and most meaningful relationship in the book is his friendship with Junior. It's unclear why Junior is best friends with Victor, but both of the men seem to need each other and depend on each other more than they might be willing to admit. Victor never had a real relationship with his father, who moved to Arizona and then died of a heart attack. His mother had met another man and fallen in love with him very soon after Victor?s real father left.   Ã‚  Ã‚  Ã‚  Ã‚  Victor doesn?t seem to be very attached to his Native American culture. When his father left, his mother married a white man, so Victor grew up with a significant figure in his life being white. He seems to follow his mother?s example to some extent, and is frequently attracted to white women. Although Victor doesn?t seem to care about being Native American, in some way, his tendency to t...

internment camp :: essays research papers

well. I have realize that the people and government that maintain, cleanse, and protect the social fabric of America is a great one. But the social fabric of America is not as clean as we like to think it is. As a matter of fact the fabric has been stain quite a few times actually, and not with the type of stains that can be simply remove. But the kind of stains that take years of steam cleaning and chemical treatment to restore to its original condition. In this case, the stains I am referring to is regarding the internment of Japanese Americans and the long restoration period it took for Japanese Americans to restore their lives physically and mentally. John Locke was an advocator of three natural rights: life, liberty, and property. The Japanese who were detain lost all of these, including life. When I mean life I don’t mean being executed, but when you lose your liberty and property based on your ancestry; your whole life has been basically stripped away from you, so what is life then? A long history of Anti-Japanese sentiments fueled by economic competition and racial stereotypes propel the frontrunner(in my opinion) of this unconstitutional act, General DeWitt, to make it a personal quest of sort to assure a forced exodus of Japanese American into internment camps, ran by the WRA. The decision of internment was implemented towards Japanese Americans living on the west coast in 1942 after the bombing of Pearl Harbor. Claims of Japanese soldier being aid by Japanese American to help plan the attack on pearl harbor caused concern for the general public. The fingers of dead Japanese's soldiers were allege to have worn class rings from Hawaii university. But what made matter was when many influential news and media sources failed to investigate these claims of Japanese American sabotages against the united states. the media didn’t take time to check questionable evidence of regarding these claims. The majority of the media were being bias by leading public opinion polls against Japanese's Americans instead of presenting evidence. Few journalists have claim there was no differences between u.s citizens of Japanese ancestry and the Japanese citizens who attack pearl harbor. A popular slogan for the journalist who felt this way was â€Å" A viper is nonetheless a viper wherever the egg is hatched. So a Japanese -American grows up to be a Japanese not an American.

Economic Markets and State Governments: Adversaries or Symbiotic in the

Do economic markets and state governments share an adversarial or symbiotic relationship? Scholars of International Political Economics have been at odds over what role, if any, the state should have in the International Economy. Despite such disagreements, most scholars can concur that IPE is ultimately concerned with the ways in which states shape the systems through which economic interactions are expressed, and conversely the results that economic interactions (including the power of collective markets and individuals acting both within and outside them) have upon political structures and outcomes. The relation between states and markets in the international scene, and whether, the relationship at home affects relationships abroad, is of great importance. One contemporary in particular Ian Bremmer has attempted to explain this relationship in light of the latest economic recession, and what impact the state should have in the future. In his book titled The End of the Free Marke t Bremmer believes that the Free Market Capitalism which has been a staple of American Economic prosperity is still the system that will provide for innovation and the free flow of ideas, information, people, money, goods, and services (Bremmer,183-184). Countries like China, Russia, Brazil, Mexico, and regions like Southeast Asia and Africa have all converted from command economies to a degree into state capitalist countries. These countries have all experienced the positives of the free market system, but are just now seeing the results of unregulated US domestic bubbles. Globalization, therefore, has created a system that requires government regulation of domestic products and services to ensure that a symbiotic relationship between governments cont... ...elationships between states roar back the world will continue down the current recessionary path which quite possibly could lead to war on a truly global scale. The best way to ensure soverignty for all is with the free-market system which Adam Smith made so famous. As long as nation-states continue to exist (and it appears that they always will) their will be a temptation to revert back into protectionist ways. This I feel is only normal as it bolsters the national scene at home. If America and the rest of the world wants to continue to thrive and expand the pie much needed investment is necessary but maybe we should seek foreign investment help/advice when it is offered. One thing is for certain regulation domestically would go far in instilling the confidence foreign governments had in the United States to not only police the world but also police itself.

Critically discuss the extent to which the duty to make reasonable adjustments has eliminated discrimination and inequality of opportunity faced by disabled individuals

Introduction The Government described the duty to make reasonable adjustments as â€Å"a cornerstone of the [Equality] Act and requires employers to take positive steps to ensure that disabled people can access and progress in employment.† On the face of it, this should have resulted in a decrease of disability discrimination in the UK, unfortunately has not been the case. This essay will critically discuss the extent to which the introduction of reasonable adjustments has been successful in the UK, and whether or not the duty to make reasonable adjustments has eliminated discrimination and inequality of opportunity faced by disabled individuals. This essay will focus upon disability and employment as its main point of reference to highlight any discrepancies between non-disabled and disabled people in the workplace. Background to the Equality Act 2010 Disability is defined in the Equality Act 2010 in Section 6(1) as meaning a physical or mental impairment, which adversely affects normal day-to-day activities, with the adverse effect needing to be substantial. Instead of a list of disabilities that are capable of this definition, the Act has given a broad definition, which the disability would have to adhere to if a Claimant is to be successful in their claim. Whether or not a person is disabled is often the first hurdle for an Applicant and can be the most contentious in employment litigation. Discrimination is defined in the Act as when, â€Å"A person (A) discriminates against another (B) if, because of a protected characteristic, A treats B less favourably than A treats or would treat others.† Prior to 2010, the Disability Discrimination Act 1995 was the leading statute in this area, ensuring employers were under a duty to make reasonable adjustments for their disabled employees. The House of Lords in Archibald v Fife Council stated that, â€Å"The DDA does not regard the differences between disabled people and others as irrelevant. It does not expect each to be treated in the same way. The duty to make adjustments may require the employer to treat a disabled person more favourably to remove the disadvantage, which is attributable to the disability. This necessarily entails a measure of positive discrimination.† This case was the first substantial case to be litigated on the basis of making reasonable adjustments. The employee had been dismissed on the bas is that they could no longer fulfil their job duties following an operation. This was a discrimination claim and the House of Lords held that there had been a failure by the employer to make reasonable adjustments. Current Law As the law currently stands, the duty to make reasonable adjustments is found in Section 20 of the Equality Act 2010, which states that this duty is comprised of three requirements found at section 20(3), (4) and (5). Firstly, where an employer’s â€Å"provision, criterion or practice of A’s puts a disabled person at a substantial disadvantage in relation to a relevant matter in comparison with persons who are not disabled,† then the duty arises. Secondly, it also arises if the disabled person has a physical feature which puts him at a substantial disadvantage and thirdly, without an auxiliary aid, the disabled person would suffer from an inequality of opportunity. Overall, the duty arises when, without such adjustments, the disabled person would be put in a severely disadvantaged position when compared to their non-disabled colleagues. The law imposes upon employees a duty to take reasonable steps to ensuring that the adjustments made would avoid this disadvanta ge. It is interesting to note that the duty on employers to make reasonable adjustments to disabled individuals extends to contract workers and other temporary members of staff such as trainees. This should provide adequate protection from disability discrimination as it extends to all staff but this does not necessarily suffice. Section 20(7) of the Act states that employers are not permitted to charge disabled employees for the costs in making any reasonable adjustments. This is arguably a very important section of the Equality Act as it ensures that disabled individuals are not penalised and bearing the costs themselves for any adjustments to make. It is fair to say that without such protection, the opportunity for discrimination in this way would have been rife in the workplace. Therefore, the duty on employers to make reasonable adjustments is a positive step forward to eliminating disability discrimination in employment. The requirement for equal opportunities for all employee s extends to the recruitment policies of an organisation as well. This will include ensuring that the job advertisement and description is adequately detailed about what is required of the job, yet at the same time making no discriminatory claims. If applicants have to complete an application form then it should be available in different forms to accommodate all disabled people, such as an option in braille. When individuals are invited for interview, all reasonable adjustments should be made to welcome them and assist them on the day, such as having the interview on the ground floor if the applicant is a wheelchair user. The recruitment committee should, ideally, have an equality and diversity officer within the human resources team to ensure compliance with their legal duty of no discrimination against disabled people. When selection tests form part of the recruitment process, applicants with dyslexia or other conditions, should be given longer to read and answer the questions to ensure a fair process. If an applicant is offered the job, then discussions should take place as to what steps and measures should be given to enable the individual to work in a comfortable environment. On the other hand, if an individual is not suitable for the position, then reasons why they were deemed not suitable should be recorded. There should be no evidence of discrimination in these reasons as this could potentially form the basis for a discrimination claim. Reasonable Adjustments The importance of making reasonable adjustments was emphasised by a previous Parliamentary Under-Secretary of State for Education and Employment, who advised that local authorities, â€Å"will be able to do virtually anything to encourage and enable disabled people to work for them, as long as they appoint the person who is most suitable for the job after they have made reasonable adjustment †¦ there is no maximum for such adjustments. If a local authority is prepared to invest vast sums of money in making provision so that a disabled person is suitable for a job, that is up to the authority, and it has that privilege†. The Tribunal in Wynn v Multipulse Electronics Ltd also considered this, where the job applicant was not interviewed on â€Å"health and safety† grounds because of his disability. The Tribunal found that the applicant had the requisite skills and experience for the job, but had been initially rejected as the small company decided that they did not ha ve the resources/finance to make the necessary reasonable adjustments. The Tribunal rejected this reasoning and decided that the company had not made a sensible consideration for the reasonable adjustments, including the fact that the Government provided support for work initiatives and, on this basis, they were successfully sued for disability discrimination. The duty to provide reasonable adjustments to disabled workers has provided the individuals with the statutory vehicle to pursue litigation to alleviating disability discrimination. It is an important outcome from the legislation. Reasonable adjustments can be temporary and can include improvements to the workplace to enable disabled employees to access their workspace and to be able to do their job correctly. This is often seen by the providing of ramps to work premises to assist wheelchair users. There is also the option of delegating certain parts of the job to temporary staff. By allowing disabled people the option of flex ible working hours and by granting them leave of absence for medical appointments etc, employers would be satisfying their legal duty of reasonable adjustments. This ties nicely with the opportunity of job-share. Before starting their role, employers should ensure that disabled people have had the requisite training for their role and correctly understand what is required of them. Employees should have the right equipment in order to complete their duties and this can include specially formatted computers for those with hearing and speaking difficulties. The statute has ensured that employers should take into consideration and take action into the above, and this on the face of it should be sufficient to combat discrimination to provide all employees with equal opportunities at work. Section 21 of the Equality Act 2010 states that it is against the law for an employer to fail to comply with this duty and they can face a discrimination claim if a breach has occurred. Notwithstanding this, Part 3 of Schedule 8 of the Act allows employers the defence that if they lacked knowledge of the disability then they cannot be sued for any lack of action on their part. This is arguably a fair section in the Act as the legal duty on employees has to be reasonable and employers cannot be expected to act if they were unaware of the disability. This is especially so when there is no legal duty on employees to report their disability to their employers. Although, if at interview the person’s disability is obvious at first sight, for example a wheelchair user, then the defence will not be permitted. Similarly, employers are permitted to ask such questions at interview and/or through an application form as to whether reasonable adjustments would be necessary for interview etc. It is argued that organisations that subscribe through these methods are adequately protecting themselves against potential disability discrimination claims. This may be more difficult for current em ployees whose conditions develop during their employment. The most common example is when an employee is suffering from depression and does not exhibit any outward symptoms. The question for the Tribunal is whether or not the employer ought reasonably to have known about the disability. These questions are arguably fair restrictions on the duty to make reasonable adjustments that should not prevent a clear case of disability discrimination. Approach by the Employment Tribunal If successful, Claimants can be awarded substantial fines by the Employment Tribunal, which should, in principle, lead to adequate deterrence to prevent further discrimination by organisations. Despite this, it is not necessarily the case as numerous claims have occurred every year since the introduction of the Equality Act 2010, thereby highlighting the large numbers of discrimination occurring in the workplace. Although, this figure is not truly representative as a number of employees do not take their case to the Tribunal, and it is worrying that the current figure may hide more discrimination in the UK. The lack of cases being taken to the Tribunal may be accounted for the rise in costs to take such action that is largely preventing claimants from pursing their claims. Those in the legal profession have voiced their concerns over the Government’s cuts in legal aid to this area and rising costs. Whilst the statue has in place the duty to make reasonable adjustments, if peop le cannot take their cases to Tribunal, this will severely reduce the deterrence and enforcement impact of the duty. The question of whether or not the adjustments made were ‘reasonable’ is assessed objectively by the Employment Tribunal: â€Å"The question of whether any reasonable adjustments were required †¦ depends on an objective assessment of what could be done to ameliorate the disadvantage in fact created.† The objective nature of the test was reinforced by the case of Tarbuck v Sainsbury Supermarkets Ltd and this remains under the Equality Act 2010. When deciding whether or not the employer has taken ‘reasonable’ measures, the Tribunal will consider factors, such as effectiveness and questioning whether it was a practical move. For example, by providing a blind employee with a computer formatted with braille, is both an effective and practical move to assisting the employee. Costs are a very important consideration and this will depend on a number of factors, such as the resources available to the organisation. It is common sense that a bigger company with more disposable income will be expected to have contributed more to the reasonable adjustments than a smaller company. Notwithstanding this, it is no justification for the employer to say that they could not afford the adjustments required to enable the disabled person to work. It is their legal duty to comply and the Government have providing numerous ways of funding these adjustments. Therefore the legal duty should be complied with and it should have initiated a sharp decrease in the instances of disability discrimination. In Tribunals today, the most popular test is that of The Secretary of State for Work and Pensions v Wilson, where the EAT held that firstly employers have to ask themselves whether the adjustment would overcome the disadvantage the disabled person is currently facing. If this is answered affirmatively, then the Tribunal considers whether or not it was practicable to take these steps. By assessing practicality, the Tribunal will consider the company’s resources and finances to ensure a fair decision is reached. Therefore a smaller company cannot have the defence of saying that they cannot afford to employ a disabled person. On this basis, the legal duty should be alleviating disability discrimination as it applies to all businesses. Academic Commentary Academics such as Anna Lawson point to the fact that disability is the only protected characteristic whereby an employer is under a reasonable adjustment duty. The UK is not unique in this respect, as the same situation is found in the EU and international law. â€Å"There have been calls for a more expansive approach which would extend such duties to religion or to other characteristics more generally. There was, however, surprisingly little discussion of such a possibility in the lead up to the Equality Act. Such a discussion might have been helpful in identifying whether disadvantages often associated with other protected characteristics require the flexibility of response of a reasonable adjustment duty or can be more effectively tackled through specific schemes (such as those applying to flexible working and parental leave).† From this academic perspective, it is fair to say that the legal duty on employers is a positive development in removing discrimination from disable d people. In this article, Lawson is such a supporter of the concept that she campaigns for its existence in other protected characteristics such as religion. This is because failing to comply with the duty to make reasonable adjustments is a form of discrimination in Employment law and the same cannot be said for other protected characteristics. On this viewpoint, it is strongly suggested that disabled people face higher protection than others in this regard. One of the many positives of the legal duty is that it, â€Å"If an employer has failed to make a reasonable adjustment which would have prevented or minimised the unfavourable treatment, it will be very difficult for them to show that the treatment was objectively justified.† However, one of the major problems with discrimination affecting disabled people is that, even if an employer complies with his duty to make reasonable adjustments, they can still treat the disabled employee unfairly on the basis of their disabili ty. For example, an employer may change an employee’s working hours to ensure they attend medical appointments, but that does not prevent them from dismissing the employee on the ground of absence from work. From an objective perspective, the legal duty on employees to make reasonable adjustments for disabled workers has resulted in an increase in the number of disabled people in employment. This can be viewed as a positive step forward in support of disabled people in the workplace. Yet this has occurred with at the same time as an increase in the number of disability discrimination claims. Given the high number of claims, it is at least arguable that reform of the law is required to provide stronger deterrence against disability discrimination. Case Law The case law in this area is interesting and provides valuable assistance in examining whether or not adjustments have eliminated discrimination and inequality of opportunity faced by disabled individuals. The case of Wilson v DWP provides a useful insight into the attitudes of the Tribunal and the way that disability discrimination law has developed, as the Tribunal was seen to be making a substantial award as a mark of deterrence. The case of O’Hanlon v Commissioner for HM Customs said that, â€Å"It will be a very rare case indeed where the adjustment said to be applicable here, that is merely giving higher sick pay than would be payable to a non-disabled person who in general does not suffer the same disability related absences, would be considered necessary as a reasonable adjustment†¦although we do not rule out the possibility that it could be in exceptional circumstances.† Therefore, in exceptional circumstances this could form part of the employer’s legal duty to make reasonable adjustments for disabled people to alleviate any disadvantages or inequality of opportunity. The Tribunal in Nottinghamshire County Council v Miekle echoed this, where the employee was awarded full sick pay for her leave of absence from work. But, this was namely because the failure to make reasonable adjustments was the reason for the employee’s absence, there was a causal connection that assisted her claim. Therefore, this should provide sufficient protection for disabled people from discrimination in the work place. Although, successful cases against employers have been found in cases, such as Burke v Clinton Cards. In this case, a female employee was diagnosed with cancer and despite her employer being aware of her condition, she received an increased workload and the work was not suitable for her. The Tribunal found that her employer had not complied with their legal duty to provide reasonable adjustments, such as a lighter workload or job d uties more suitable to her condition. Both of these measures could have been easily implemented and it only highlights the lack of action by the employer. Therefore, the Tribunal awarded the employee ?10,000 in compensation for her discriminatory treatment. This shows that the Tribunals are willing to find actions of disability discrimination and are doing their part to significantly reduce disability discrimination at work. In the case of Chief Constable of South Yorkshire police v Jelic, the Employment Appeals Tribunal upheld the ruling by the trial Tribunal that the employer had failed to make reasonable adjustments for the disabled employee. The EAT ruled that it would have been a reasonable measure to have allocate the employee’s duties to another police officer in order to assist them. Job sharing and allocating of responsibilities is an important delegation decision for the employer and the Tribunal views it as a reasonable action to take in the circumstances views it. The relatively simple nature of such an action is arguably strong evidence of the continual presence of discrimination against disabled people by employers. The fact that it is against the law to do so does not appear to be an adequate deterrent against discriminatory behaviour. In the media, there have been a couple of high profile cases involving disabled people and the lack of reasonable adjustments. One of the most controversial cases, which showed an apparent discrimination case that shocked the nation, was the female employee at Abercrombie & Fitch. The woman had had her arm amputated and as a result, the employer said it was not a sight that customers should have to see whilst they were shopping. Instead, of making reasonable adjustments to accommodate this, the female employee was sent to the stockroom. The Tribunal and most reading the case were appalled with the behaviour and attitude of the employer. This was reflected in the award the Tribunal provided to the employee. The high profile nature of such claims should act as sufficient deterrence but this case shows that it has been successful at this. Therefore, more is required in order to reduce discriminatory actions against disabled work to allow everyone to be treated equally at work. Conclusion The statute provides that the employer has an important duty to take reasonable practicable steps to ensure that their employees are protected from any risk of harm. This is extended when the situation concerns disabled people as employers must go one step further to make sure that the work and their work premises do not prohibit their ability to do their job. On the face of it, it is clear that the duty to make reasonable adjustments has, to some extent, eliminated discrimination and inequality of opportunity faced by disabled individuals. The same problem applies across the law of discrimination as protection is only granted to the individual if their condition meets the definition of ‘disability.’ It is arguably a complex definition that should be given wider scope to ensure adequate protection for all disabled people in the UK against discrimination. The high number of hurdles a claimant has to jump over to be successful in this litigation is a worrying concern for s ome academics, as they propose that even more has to be done in this area to alleviate disability discrimination in the workplace. As one academic, who campaigns for a reform in the law, says: â€Å"The requirement of knowledge reinforces the reactive nature of the reasonable adjustment duty and likewise places no obligation on employers to consider adjustments until they are confronted either by an applicant, or employee whom they know, or ought to know, to be disabled and to be exposed to a substantial disadvantage as a result of their provisions, criteria, practices or physical features.† Also, the vast number of cases being heard by Employment Tribunals nationally shows that the law is not acting as deterrence to employers. Instead, it may be advisable that reforms do occur in the law to ensure that disabled people have the same opportunities that are open to all. Bibliography Articles Employment Law Bulletin, ‘Disability Discrimination Act 1995’ (1996) 2 Anna Lawson, ‘Disability and employment in the Equality Act 2010: opportunities seized, lost and generated† Industrial Law Journal (2011) 359 Stephen Bunbury, ‘The Employer’s Duty to make Reasonable Adjustments. When is a reasonable adjustment not reasonable?’ International Journal of Discrimination and the Law 2009, Vol.10, pp. 111-131 Books Ian Smith & Aaron Baker, ‘Smith & Wood’s Employment Law’ (11th ed, OUP, 2013) Cases Archibald v Fife Council [2004] IRLR 651 Burke v Clinton Cards October 2010, ET/2900622/09 Chief Constable of South Yorkshire police v Jelic [2010] UKEAT 0491/09/2904 Nottinghamshire County Council v Miekle [2004] EWCA Civ 859 O’Hanlon v Commission for HM Customs [2006] IRLR 840 Tarbuck v Sainsbury Supermarkets Ltd [2006] IRLR 664 The Secretary of State for Work and Pensions v Wilson UKEAT/0289/09 Wilson v DWP [2010] EAT/0289/09 Wynn v Multipulse Electronics Ltd 22 October 2007, Case Number: 2301416/07 Government Report Equality of Human Rights Commission, ‘Equality Act 2010 Code of Practice’ Legislation Disability Discrimination Act 1995 Equality Act 2010 Website Rebecca English (The Daily Mail) â€Å"I was banished to the stockroom, says disabled shop girl now suing Abercrombie & Fitch for discrimination† available at http://www.dailymail.co.uk/news/article-1192674/I-banished-stockroom-says-disabled-shop-girl-suing-Abercrombie–Fitch-discrimination.html accessed 9 May 2014 Equality & Human Rights Commission ‘Reasonable adjustments’ http://www.equalityhumanrights.com/advice-and-guidance/education-providers-schools-guidance/key-concepts/reasonable-adjustments/ accessed 13 May 2014 Gov.uk, ‘Reasonable adjustments for disabled workers’ https://www.gov.uk/reasonable-adjustments-for-disabled-workers accessed 13 May 2014 HSE ‘The law’ http://www.hse.gov.uk/disability/law.htm accessed 13 May 2014 Samira Shackle (NewStatesman) ‘How legal aid cuts are harming the voiceless and most vulnerable’ (13 January 2014) http://www.newstatesman.com/politics/2014/01/how-legal-aid-cuts-are-h arming-voiceless-and-most-vulnerable accessed 13 May 2014 Xpert HR, ‘Disability discrimination awards 2011/12’ http://www.xperthr.co.uk/quick-reference/disability-discrimination-awards-201112/114296/ accessed 9 May 2014

Geography Influenced Civilization

Sakija Wilkinson HST 140 WA/4 WA2 Geography Influenced Civilization Geography influenced civilization that arose in china, in so many ways. One way was the yellow river in which ancient china basically grew out of. All of the earliest civilizations arose on flood plains of major rivers because these lands provided the fertile land required to support their civilization. The yellow river was used to contribute to china’s civilization by also being as a highway to unify and control.There was also the warring states period which came about when the steppe cavalries became a serious threat to china in northern region, which ended when Qin Kingdom conquered the rest. During this period though, there were fights among seven major kingdoms that were independent and they were fighting to gain power and to become superior to all other in authority.Geography comes in with the help of the mountains and hills that contributed toward the sturdy walls that were built by the three northern s tates to keep raids from happening with the nomads and also to defend their villages. Lui, pp. 22-23, Unit 4 Module; Politics in State Power in Great River Valley Societies). The Land, soil and river provide resources for the farming and contributed toward the ranking and freedom of certain people. â€Å"Those who devoted themselves to the fundamental enterprise and through their farming and weaving contributed much grain and cloth would be freed from tax and corvee. † (Rielly, 2010, p. 129). Also farmers served as soldiers, and because of this the portion of agriculture provided the lifeblood of the state.Food was also produced and any of the farmer-soldiers that did not produce such food for everyone in the state this would lead to them playing less of a role inside the society. It is also bee allegedly stated that with the help of agricultural land, the Qin removed the grid paths, footpaths were opened up and boundaries were set. This also led to the thought of historians which thought that these changes that were made contributed to the sale of land and made it able to be done. Rielly 4/1). There are some differences among China and Mesopotamia and there were also some similarities when it came to the civilization and geography. As it is true that the early societies and states including Mesopotamia and China all arouse along large rivers, and they were also the earliest states to become established on the earth. Many people in both civilizations, China and Mesopotamia were farmers providing crops and food for others.Since they both were river civilizations they each had its own advantages of trade routes, transportation, food, and plenty of water for drinking and also for crops at one point. China was located in eastern Asia where mountains helps a lot of their civilization and was common. These mountains cause china to be protected due to the walls that were built, and also helped out with trade which provide an upper hand for china. As for Mesopo tamia its locations was in western Asia where the lands were flat and them not being able to have much protection.Mesopotamia was big in armies and military because of their flat open land which caused them to be more advanced in military defense than china. They also had similarities in problems which seem to be something like a global pattern when it came to war, rituals and oracles being gamblers means of power. Geography played much part in civilization of the passed also when it came to similarities and differences of certain regions, and it will continue to play a part in the future as well. (Armesto pp. 89-90. Unit 4 module; The Influence of Geography on the Development of Societies and States)