Yuefang Zhou

Theoretical models of culture shock and adaptation in international students in higher education

Theoretical concepts of culture shock and adaptation are reviewed, as applied to the pedagogical adaptation of student sojourners in an unfamiliar culture. The historical development of ‘traditional’ theories of culture shock led to the emergence of contemporary theoretical approaches, such as ‘culture learning’, ‘stress and coping’ and ‘social identification’. These approaches can be accommodated within a broad theoretical framework based on the affective, behavioural and cognitive (ABC) aspects of shock and adaptation. This ‘cultural synergy’ framework offers a more comprehensive understanding of the processes involved. Implications for future research, policy and practice are explored.

Patterns of Adaptation of Chinese Postgraduate Students in the United Kingdom

International students coming to the United Kingdom have to adapt to academic cultural differences as well as general cultural differences. Questionnaires were administered to 257 Chinese postgraduate students on anticipated and actually experienced difficulties and on perceived differences between Chinese and U.K. academic cultures before departure, soon after arrival, and about 6 months after arrival. Some participants (n = 45) responded to questionnaires at three stages; others responded at just one or two stages. A sample of the 45 students (n = 28) were interviewed about their pre-departure expectations and post-arrival experiences. Patterns of adaptation over time differed in relation to general life, social life, and study life. A major finding was the different patterns of specifically academic adaptation of students who came in groups and those who came individually.

Chinese Postgraduate Students in the UK: A Two-Way Reciprocal Adaptation

Abstract Chinese students who come to study in the UK and their UK teachers have to adapt to cultural differences in their experience of and expectations about teaching and learning traditions and practices. Qualitative and quantitative data were obtained for Chinese postgraduate students and the staff teaching them in two Scottish universities to investigate the extent of their shared perceptions and their reciprocal adaptations. Students, especially those coming in groups, tended to deal with problems among themselves, which resulted in their teachers having limited awareness of their students’ difficulties. Several themes that emerged in relation to reciprocal adaptation are discussed.

Intercultural Adaptation of Chinese Postgraduate Students and their UK Tutors

Student sojourners are probably the best-researched group of cross-cultural travellers, as they tend to be located together and are more easily accessed as subjects of research (Zhou, 2006). More recent research has also started to investigate the dynamics of intercultural classrooms, for example considering factors influencing intercultural interaction, including individualism-collectivism (e.g. McCargar, 1993; Liberman, 1994) and teacher-student expectations (Cortazzi & Jin, 1997). Over the past 20 years, an increasing number of researchers have started longitudinal studies to find predictors of intercultural and educational adaptation (e.g. Ying & Liese, 1990, 1991; Kennedy, 1999) and to monitor adaptation over time (e.g. Lu, 1990; Ying & Liese, 1991; Ward & Kennedy, 1996, 1999).

Camera-related behaviours of female dental nurses and nursery school children during fluoride varnish application interactions in nursery school settings

OBJECTIVE To investigate camera awareness of female dental nurses and nursery school children as the frequency of camera-related behaviours observed during fluoride varnish applications in a community based health programme. METHODS Fifty-one nurse-child interactions (three nurse pairs and 51 children) were video recorded when Childsmile nurses were applying fluoride varnish onto the teeth of children in nursery school settings. Using a pre-developed coding scheme, nurse and child verbal and nonverbal behaviours were coded for camera-related behaviours. RESULTS On 15 of 51 interactions (29.4%), a total of 31 camera-related behaviours were observed for dental nurses (14 instances over nine interactions) and children (17 instances over six interactions). Camera-related behaviours occurred infrequently, occupied 0.3% of the total interaction time and displayed at all stages of the dental procedure, though tended to peak at initial stages. CONCLUSIONS Certain camera-related behaviours of female dental nurses and nursery school children were observed in their interactions when introducing a dental health preventive intervention. Since the frequency of camera-related behaviours are so few they are of little consequence when video-recording adults and children undertaking dental procedures.

How Do Medical Students Respond to Emotional Cues and Concerns Expressed by Simulated Patients during OSCE Consultations? – A Multilevel Study

Objectives How medical students handle negative emotions expressed by simulated patients during Objective Structured Clinical Examinations (OSCE) has not been fully investigated. We aim to explore (i) whether medical students respond differently to different types of patients’ emotional cues; and (2) possible effects of patients’ progressive disclosure of emotional cues on students’ responses. Methods Forty OSCE consultations were video recorded and coded for patients’ expressions of emotional distress and students’ responses using a validated behavioural coding scheme (the Verona Coding Definitions of Emotional Sequence). Logistic multilevel regression was adopted to model the probability of the occurrence of student reduce space response behaviour as a function of the number of patients’ expressions of emotional cues. Results We found that medical students offered responses that differed to emotional cue types expressed by simulated patients. Students appeared to provide space to emotional cues when expressed in vague and unspecific words and reduce space to cues emphasizing physiological or cognitive correlates. We also found that medical students were less likely to explore patients’ emotional distress nearer the end of the consultation and when the duration of a patient speech turn got larger. Cumulative frequency of patients’ emotional cues also predicted students’ reduce space behaviour. Practical Implications Understanding how medical students manage negative emotions has significant implications for training programme development focusing on emotion recognition skills and patient-centred communication approach. In addition, the statistical approaches adopted by this study will encourage researchers in healthcare communication to search for appropriate analytical techniques to test theoretical propositions.

Prediction of nursery school-aged children who refuse fluoride varnish administration in a community setting: a Childsmile investigation

BACKGROUND Young children of pre-school age may find a minimal intervention (fluoride varnish application) difficult to tolerate. AIM To determine the significant predictors for refusing a fluoride varnish application from child, parental and nurse behaviour factors. DESIGN Data included videos from 238 children (52% female, aged 3-5 years) receiving a fluoride varnish application in a Scottish nursery school setting. The St Andrews Behavioural Interaction Scheme (SABICS) was used for video coding and retrieved child refusal status, initial anxious behaviour, and nurse behaviour. A parental survey collected parents dental anxiety [Modified Dental Anxiety Scale (MDAS)] and the childs home behaviour [Strengths and Difficulties Questionnaire (SDQ)]. Child demographics, dental status, and previous varnish application experience were recorded. Multivariate binary logistic regression was applied to predict child refusal of the varnish application. RESULTS The response rate was 79%. Twelve children refused. The significant predictors of varnish refusal included initial anxious child behaviour (β = 5.14, P = 0.001), no previous varnish application (β = -3.89, P = 0.04), and no nurse praise (β = -1.06, P = 0.02). Information giving (P = 0.06) and reassurance (P = 0.08) were borderline significant. CONCLUSION Initial anxiety behaviour, previous varnish experience, and not using praise by the nursing staff predicted fluoride varnish application refusal.

Reassurance and Distress Behavior in Preschool Children Undergoing Dental Preventive Care Procedures in a Community Setting: a Multilevel Observational Study

BackgroundThe effect of reassurance in managing distress among children who receive procedures of a less aversive nature has not been fully investigated.PurposeThis study aimed to investigate the relationship between reassurance by dental staff and distress behavior of preschool children receiving preventive procedures in a community setting.MethodsNurse–child interactions (n = 270) during fluoride varnish application were video recorded and coded. Multilevel logistic regression modeled the probability of the occurrence of child distress behavior as a function of reassurance provision, controlling for child-level and nurse-level variables.ResultsChild distress behavior was positively related to nurse verbal reassurance but negatively linked to the time that this reassurance occurred. Both child initial anxiety and nurse nonprocedural training increased the probability of observable distress behavior.ConclusionsThe use of verbal reassurance to promote reception of mild invasive procedures was counterindicated, especially when offered early in the intervention (ClinicalTrials.gov number: NCT00881790).

Multimorbidity and Socioeconomic Deprivation in Primary Care Consultations

PURPOSE The influence of multimorbidity on the clinical encounter is poorly understood, especially in areas of high socioeconomic deprivation where burdensome multimorbidity is concentrated. The aim of the current study was to examine the effect of multimorbidity on general practice consultations, in areas of high and low deprivation. METHODS We conducted secondary analyses of 659 video-recorded routine consultations involving 25 general practitioners (GPs) in deprived areas and 22 in affluent areas of Scotland. Patients rated the GP’s empathy using the Consultation and Relational Empathy (CARE) measure immediately after the consultation. Videos were analyzed using the Measure of Patient-Centered Communication. Multilevel, multi-regression analysis identified differences between the groups. RESULTS In affluent areas, patients with multimorbidity received longer consultations than patients without multimorbidity (mean 12.8 minutes vs 9.3, respectively; P = .015), but this was not so in deprived areas (mean 9.9 minutes vs 10.0 respectively; P = .774). In affluent areas, patients with multimorbidity perceived their GP as more empathic (P = .009) than patients without multimorbidity; this difference was not found in deprived areas (P = .344). Video analysis showed that GPs in affluent areas were more attentive to the disease and illness experience in patients with multimorbidity (P < .031) compared with patients without multimorbidity. This was not the case in deprived areas (P = .727). CONCLUSIONS In deprived areas, the greater need of patients with multimorbidity is not reflected in the longer consultation length, higher GP patient centeredness, and higher perceived GP empathy found in affluent areas. Action is required to redress this mismatch of need and service provision for patients with multimorbidity if health inequalities are to be narrowed rather than widened by primary care.

High levels of socioeconomic deprivation do not inhibit patients’ communication of concerns in head and neck cancer review clinics

To examine associations between socioeconomic status and the extent to which patients with cancer of the head and neck expressed concerns to surgeons during routine follow-up clinics, we analysed audio recordings of 110 consultations with one consultant. We used the Verona Coding Definitions of Emotional Sequences (VRCoDES) to measure communication between the doctor and the patient, and grouped the English indices of multiple deprivation (IMD) 2015 scores into deciles to compare the VRCoDES with socioeconomic status. There were no significant correlations between IMD decile and the number and type of cues and concerns, or the type of response by the consultant, but there was a positive correlation between IMD decile and duration of appointment (r=0.288, p<0.01). When the duration of appointment was controlled for, there was a negative correlation between IMD decile and number of cues and concerns (r=-0.221, p<0.05). These findings question the assumption that socioeconomic status is associated with a patients willingness to express concerns. Shorter consultations suggest that less time is spent responding to their concerns or building a rapport. Clinicians might find it advantageous to adopt strategies that will improve their understanding of these patients and help them to communicate more effectively.