Theoretical Lens, Conceptual and Theoretical Frameworks in Qualitative Research

Looking From a Theoretical Lens Perspective

The language of qualitative research can be confusing. The words sound like regular English, but they have very particular meanings. To make the language even more complicated, the definitions can vary across different qualitative methodological scholars.

For the purpose of this course, distinctions between two important concepts should be considered:

  1. Theoretical framework: the use of constructs and propositions a recognized theory (or theories) to a research problem, purpose, and question.
    • Examples: Social Influence theory, transformational leadership theory, game theory
  2. Conceptual framework: the construction of ideas, assumptions, and beliefs sourced in both the literature and one’s own experience, which identify the main concepts that guide the formulation of the research problem, purpose, and question.
    • Examples: Concepts from positive psychology, mindfulness meditation, language development models

To prepare for this Discussion:

  • Review the Learning Resources related to the use of a theoretical or conceptual framework to guide the examination of a research problem in qualitative research.
By Day 3

Post an explanation of the role of a theoretical or conceptual framework in qualitative research and provide examples from the resources you read. Use proper APA format and citations to support your post.

RESOURCES

Ravitch, S. M., & Carl, N. M. (2021). Qualitative research: Bridging the conceptual, theoretical, and methodological (2nd ed.) Sage Publications.

  • Chapter 2, “Using Conceptual Frameworks in Research” (pp. 32–61)
  • Chapter 3, “Critical Qualitative Research Design” (pp. 62–103)
    • “Qualitative Research Design” (focus on pp. 62-63)

Rubin, H. J., & Rubin, I. S. (2012). Qualitative interviewing: The art of hearing data (3rd ed.). Thousand Oaks, CA: Sage Publications.

  • Chapter 1, “Listening, Hearing, and Sharing” (pp. 1–11)
  • Chapter 2, “Research Philosophy and Qualitative Interviews” (pp. 13–24)

http://academicguides.waldenu.edu/writingcenter/assignments/annotatedbibliographies

http://academicanswers.waldenu.edu/faq/72682

http://waldenwritingcenter.blogspot.com/2012/10/weathering-storm-of-problem-statements.html

http://waldenwritingcenter.blogspot.com/2012/10/weathering-storm-of-problem-statements.html

http://academicguides.waldenu.edu/rsch8310

https://class.content.laureate.net/cc041ecc15d15ed32d7d42335ec60b9c.docx

https://class.content.laureate.net/artifacts/USW1_RSCH_8310_majorAssignment1OverviewAndGuidelines.pdf

https://ezp.waldenulibrary.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=eue&AN=90147591&site=ehost-live&scope=site

https://doi-org.ezp.waldenulibrary.org/10.1177/0255761413508066

http://eric.ed.gov/?id=EJ1058505https://ezp.waldenulibrary.org/login?url=https://search.ebscohost.com/login.aspx?direct=true&db=mnh&AN=24293199&site=ehost-live&scope=site

Reflect on Socioeconomic Realities and Diverse Family Structures

 Instructions

You will add a new entry in the reflective journal that you began in Week 1 Assignment 2.

Continue your ongoing personal reflections by thinking about  socioeconomic factors and family structures, specifically.  Compare  yourself and your family background and schooling/community experiences  during your school-age years to those of students’ families today.   Consider the achievement gap in light of desegregation and ongoing  issues related to racial inequality.

Remember that you can submit your journal as a video using the video  tool available in NCUOne. Instructions for using this tool are available  in this week’s resources.

As before, you may want to post some of your thoughts from your  journal in the NCU Commons. While you are welcome to share your thoughts  wherever you would like, a special conversation has been started within  the Educational Leadership community of practice; the link is available  in this week’s resources.  Introduce yourself, if you have not already,  then include whichever parts of your journal you would like to share.  Maybe even ask a couple of questions to engage others in a conversation.  Remember that feedback and additional perspectives from the diverse  voices in the NCU Commons might support your ongoing reflections and  growth regarding cultural competence.

Be sure to consider your instructor’s comments on your previous journal entry and integrate that feedback as appropriate.

Length: an additional 1 to 3-minute video or 1-2 pages in the journal  you are building; title and reference pages not required for journal  entries.

References: References are not required for the journal.  However, if  you do choose to cite references, use APA style for in-text citations  and your reference list.

Your reflective journal should demonstrate thoughtful consideration  of the ideas and concepts presented in the course and provide new  thoughts and insights relating directly to this topic. Your response  should reflect scholarly writing and current APA standards. Be sure to  adhere to Northcentral University’s Academic Integrity Policy. 

Cyber Security Hypothesis

Cyber Security

I’ve attached all the work leading up to this point.  Build off of it.

Instructions:
HYPOTHESIS AND RESEARCH DESIGN:

Hypothesis:

Since your hypotheses may serve as your research questions (what you plan to measure/examine), list the questions and then convert them into hypotheses. Research questions must be individual questions that measure only one item (one question = one measurement). A couple of questions are expected in this section (typically 2 to 4). You MUST convert these questions into traditional hypotheses format. For example: If someone grows up in a poor neighborhood, they will be more likely to be involved with crime than someone in a middle or upper-class neighborhood. A hypothesis is a statement and not a question.

The Research Design (Methodology) Section:

This section should provide the reader with a summary of the research. You will address the research problem, the research questions (hypotheses) that need to be addressed to resolve this problem, the research method (qualitative or quantitative), how you will select your sample population, how you will collect your data, and how you will analyze your data.

In short, your research design should illustrate the “step by step” directions that would enable another researcher to execute your research if you are unable to conduct the study yourself. Think of this as directions from how to get to point A to point B. This detail is necessary as it demonstrates that you understand how to best conduct your research for your topic.

References:

Incorporate your references into this section and provide one comprehensive list. Remember to use APA 6th Edition format. If you have a citation in the body of your work, you must provide the appropriate reference in the reference section. Also, if you have a reference in your reference section, you must have a citation from that work somewhere in the body of your work. The citations and references must match up. You will be strictly held to the APA standards. Use proper citations and references!

CASE STUDY AND CARE PLAN

 

Apply what you have learned about Health Promotion and Disease Prevention, and demonstrate the ability to develop a holistic plan of care, incorporating Telehealth and defining assessment and intervention of specific population incorporating unique attributes of populations for health promotion, wellness preservation, and maintenance of function across the health-illness continuum.

Develop a case study and a plan of care, incorporating current mobile App technology:

  1. Select a population. Define your population by gender, age, ethnicity, socioeconomic status, spiritual need, and healthcare need.  Apply concepts learned in course to identify healthcare needs specific to the population and access to care (Utilize your textbook Chapters 1-25, and identified Websites).  Also use at least two references within the five years.
  2. Develop a case study for a patient in your chosen population.
  3. Define a provider level of care that includes telehealth, alternative therapies, and mobile App technology discussed in this class. Describe how telehealth could impact the care delivery of this patient. 

Hint: Concise, condensed information, with specifics and details about population and unique needs with a plan for meeting these needs should be considered. Incorporate the content you have learned in this course.

Expectations

  • Length: 3 pages not including the title page and references page
  • Format: APA, 7th edition format is to be observed (12 pt., 1” margins, Times New Roman)
  • Research: Two references within the last five years

Mythology essay

This essay should be about four to six pages long (without including title page and list of cited references).  This essay prompt asks that you engage in a reflection about the course’s contents (no library research is needed; engaging only with the textbook’s contents and other course materials is required).  You must:

a] Read the New York Times article, “In Narrow Decision, Supreme Court Sides With Baker Who Turned Away Gay Couple” (see the folder Recent Press Articles of Interest at the Student Resources link). Briefly summarize the case.

b] Read the New York Times article, “British Jury Delivers First Conviction for Female Genital Cutting” (see the folder Recent Press Articles of Interest at the Student Resources link). Briefly summarize the case.

c] Use as many specific concepts and contents (no vague reference accepted) from this course to develop a sophisticated discussion of the significance of these two cases when considered together.  Indeed, they contrast meaningfully: the first case is decided by the U.S. Supreme Court in favor of a religious perspective abd belief system at the detriment, perhaps, of “individual sexual rights,” while the second could be seen as promoting individual rights by limiting the reach of religious and cultural traditions–some of which are criminalized by law (female genital cutting).  In this section of your essay, you should engage in a discussion of all aspects of the contrast made by the two cases (two NYT articles) and the beliefs in the existence of supernatural forces/beings each are grounded on.  You should focus on what you find most relevant in the development of your sophisticated argument, FROM AN ANTHROPOLOGICAL PERSPECTIVE.  This means that I am not looking for you to attempt to simply write a summary of the legal arguments presented only.  YOUR DISCUSSION MUST ENGAGE WITH COURSE CONTENTS, and as you know, this is not a legal studies course, but a course that could be identified as belonging to the subfield called “the anthropology of religion.”  That argument should make as many relevant references to the course’s contents as possible.  This section of your essay may not focus on one of the articles only.  It must focus instead on the significance of the contrast between both cases.

Your accurate utilization of course contents in the development of a well-constructed argument will be the major criteria used to evaluate your essay. 

You must use the Author-Date Chicago Manual of Style (see the Student Resources link) to cite your written sources (including the textbook) and list your references cited at the end of your essay.

YOU MAY NOT QUOTE.  YOU SHOULD PARAPHRASE INSTEAD.  THE PROFESSOR WANTS TO HEAR YOUR OWN VOICE.

Your essay must have a brief introduction, and must end with a list of cited references.

You must submit your essay as a Word file.

This assignment is graded according to your ability to identify and articulate an argument about the central focus of the essay (the significance of the contrast between the two cases referred to in the two NYT articles, marshal evidence from the course’s materials to support the sophisticated argument you develop, as well as to show your ability to follow directions, present accurate information and cite examples from the texts that you paraphrase. Finally, this assignment will be graded on your demonstrated ability to adequately understand  anthropological explanations and adhere to the rules of English grammar.  For this assignment, I look for whether you have developed a sound argument and whether you have constructed logical paragraphs that explain how the examples you have chosen support your statement about the question’s focus/target.

You are advised to take a look at the grading rubric below.  It should further explain what the professor is looking for.

PICO

  

PICO INSTRUCTION

Purpose: PICO questions are used by practicing nurses and researchers to focus research questions and develop an efficient literature search strategy.  It is essential that future nurses learn how to do this to develop evidenced-based solutions to patient care problems in a healthcare organization. 

Instructions:

1. Write a PICO question based on a scenario you choose from the list of scenarios attached below.  Use the templates in the EBP Step by Step 3 article to help create your questions. You may need to do a pre-search to finding an intervention (the “I”) that has been studied and published to solve the problem.

2. Identify the PICO elements for each question. 

3. Develop a search strategy using at least 3 keywords from the P, I, and O parts of your PICO, 1 synonym for one of the keywords, and 1 MeSH term for one of your keywords. 

4. Locate 4 articles that help answer your PICO question.  The articles must meet the following requirements: 

o must be primary source quantitative research articles.  

o No article can be older than 2017. 

5. Obtain pdfs of the four articles you selected from the school database (medical or nursing school data based).  They must show the full text of the entire article. If not available for the School database, you may request access from the school Library, or you can email me the citation for the article, and I will attempt to locate a pdf of it. 

6. On a Word document, include your scenario; write your PICO question as a sentence; identify the P, I, C, and O for each question; and list the search terms (3 keywords, 1 synonym, 1 MeSH term) for each. You may use the template attached here. See also the link to the MeSH terms website below.

7. Provide a properly formatted APA reference page for your selected articles from Step 4 of these instructions. See the link to the APA and Writing LibGuide below.

MeSH term website: https://www.ncbi.nlm.nih.gov/mesh/

8.  Name each document (one Word doc and 4 articles pdfs) as follows and upload to this submission folder:  

  • Lastname PICO, 
  • Lastname article 1,
  • Lastname article 2,
  • Lastname article 3,
  • Lastname article 4

work has to be unique and plagiarism-free. School used turninit

Ethnic studies 4.1.1

1.   Assignment Information

  1. Due DateThursday, June 21, 201811:59 PMPoints Possible15
  2. Conflict In Culture Research Sources & Notes

    Assignment Instructions:
    Step I: Your assignment is to find at least 3 sites to help you better understand conflict in values, norms, mores among and between cultural groups. Be sure to note down the annotated bibliography information you will need to submit with your final essay assignment.
    POSSIBLE RESEARCH SITES:

    1. Define: ethnicity, race, globalization, values, norms, mores, status, and social roles.
    2. How does ethnicity, race, globalization, values norms, mores, status, social roles shape our perceptions and behaviors? What are the major values of American society?
    3. How do the major values of American society differ from values of other people or places?
    4. What is globalization and what does it have to do with you?
    5. Why is globalization an issue today? Who is resisting globalization and what are they protesting?
    6. What values do these protesters believe are at stake with globalization?
    7. Why do cultural activist resent globalization re: internationalization of trade, services, investments, internet information sharing and new technologies?
    8. Is globalization and protestors of globalization a new phenomena?
    9. Step III: Write an expository essay (click on link).  Essay should contain a minimum 5 paragraphs-1 intro, 3 body (supporting evidence), 1 conclusion answering the following question: 
      How does the issue of globalization (one nation’s interaction among the people, businesses and governments of other nations) create a “conflict in values and mores” within that society? Use the notes and examples from your research (part I & II) to support you answer to this question.
      PART IV:  Turn in your Part II (notes from your research with bibliography) and your Part III

MLA format

nursing research critique

Nurse Education Today 87 (2020) 104348

page1image54969856 page1image60909104 page1image60908896

Contents lists available at ScienceDirect

Nurse Education Today

journal homepage: www.elsevier.com/locate/nedt

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Clinical mentors’ experiences of their intercultural communication T competence in mentoring culturally and linguistically diverse nursing students: A qualitative study

Pia Hagqvista,b, Ashlee Oikarainena, Anna-Maria Tuomikoskia, Jonna Juntunena, Kristina Mikkonena,⁎

a Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland b Healthcare Unit, Centria University of Applied Sciences, Finland

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ARTICLE INFO

Keywords:

Clinical practice
Intercultural communication Competence
Cultural and linguistic diversity Nurse
Mentor
Student

ABSTRACT

Background: Intercultural communication has become increasingly important in nursing due to the cross-border mobility of patients, health professionals and students. Development of cultural competence continues to be a challenge, particularly among professionals such as educators or healthcare providers who work in professions requiring communication across cultural boundaries. Despite challenges in nursing education related to cultural diversity, competence in intercultural communication has been proven to empower students and to help them grow professionally.

Objectives: The aim of this study was to describe clinical mentors’ experiences of their intercultural commu- nication competence in mentoring culturally and linguistically diverse nursing students during completion of their clinical practice.
Design: Qualitative study design.

Participants: The participants were 12 nurses who had previously mentored at least two culturally and lin- guistically diverse nursing students.
Methods: Data were collected during spring 2016 using semi-structured interviews of 12 mentors working in specialized nursing care at one hospital located in central Finland. Data were analyzed using deductive-inductive content analysis. The main concepts of the Integrated Model of Intercultural Communication Competence were used during the semi-structured theme interviews and during analysis. These concepts include empathy, moti- vation, global attitude, intercultural experience and interaction involvement.

Results: Mentors stated that empathy motivates them in the development of intercultural communication. Mentors experienced a lack of resources and support from their superiors, which caused psychological and ethical strain and reduced mentors’ motivation. Mentors openly admitted that they had experienced fear towards unknown cultures, but that this fear was reduced through positive mentoring experiences and cultural en- counters.

Conclusions: Continuous education on intercultural communication competence could succeed to further de- velop clinical mentors’ mentoring expertise, which could have the potential to greatly benefit students, patients and staff. Such education could be designed, implemented and measured for its effect in collaboration between health care organizations and higher educational institutions.

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1. Introduction

There is an increased demand for cultural competence in nursing care due to current trends in globalization. Internationally, the expan- sion of nursing education to international students has become a common trend (Mikkonen et al., 2016). The strategic framework for

European cooperation in education and training (2009) states that education should promote cultural competencies, democratic values, respect for fundamental rights, as well as work against all forms of discrimination and to teach young people to interact positively with their peers from diverse backgrounds. In the United States, the National Standards for Culturally and Linguistically Appropriate Services call for

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⁎ Corresponding author at: Research Unit of Nursing Science and Health Management, Faculty of Medicine, University of Oulu, P.O. Box 5000, FI-90014, Finland. E-mail address: [email protected] (K. Mikkonen).

https://doi.org/10.1016/j.nedt.2020.104348

Received 14 April 2019; Received in revised form 3 December 2019; Accepted 20 January 2020

0260-6917/ © 2020 Elsevier Ltd. All rights reserved.

P. Hagqvist, et al.

Nurse Education Today 87 (2020) 104348

healthcare professionals to provide quality care and services that are responsive to diverse cultural health beliefs and practices (U.S. Department of Health and Human Services, 2013). Accreditation stan- dards for programs including nursing and pharmacy require the in- tegration of cultural competency training in their educational programs (Accreditation Council for Pharmacy Education, 2015; Commission on Collegiate Nursing Education, 2018). The common need of promoting safe and quality patient care for diverse patients by enhancing inter- cultural communication serves as a foundation for interprofessional education development (Liu et al., 2015).

Due to high levels of immigration (Bhopal, 2014), cultural compe- tence is seen in many countries to be a major future competence area of society. Cultural diversity offers rich opportunities for creativity and innovation, but also requires new leadership practices, development of new skills in the professional context, and continuous education on cultural knowledge (Mikkonen et al., 2017; Oikarainen et al., 2019). Culturally competent nurses are a necessity in today’s healthcare, they play a critical role in improving health outcomes and decreasing health disparities. Nurses and nursing students need to have a deeper under- standing of how to apply cultural competence while conducting patient assessments and delivering treatment options (Alpers and Hanssen, 2014). The development of cultural competence continues to be a challenge, particularly among professionals such as educators or healthcare providers who work in professions requiring communication across cultural boundaries (Oikarainen et al., 2019). A key assumption of education is that cultural competence contains cognitive, affective and behavioral dimensions, which can be developed through partici- pation in well-designed educational programs (Spitzberg and Changnon, 2009).

In today’s cross-cultural world, cross-cultural values are needed to break down international barriers to practice (Collins and Hewer, 2014). Culturally and linguistically diverse (CALD) nursing students have been shown to experience greater challenges in clinical learning environments than in academic settings (Mikkonen et al., 2016). Clin- ical practice is an important part of nursing education through which nursing students are provided with the opportunity to familiarize themselves with common nursing tasks and to apply skills and knowl- edge from theoretical studies into practice (Mikkonen et al., 2017). Successful communication between the mentor and the student has been shown to play an important role in satisfaction, achievement of learning outcomes (Mikkonen et al., 2016), and maintenance of patient safety (Sairanen et al., 2012). Effective communication in nursing re- quires knowledge, a positive attitude, and motivation to develop mu- tual understanding with others. Competence in intercultural commu- nication has been proven to empower students and to help them grow professionally (Pitkäjärvi et al., 2012a). It has been previously re- cognized that mentors have negative attitudes towards CALD students (Pitkäjärvi et al., 2012a; Pitkäjärvi et al., 2012b) and that students experience difficulties in communication with their mentors during clinical practice (Mikkonen et al., 2016; Mikkonen et al., 2017; Oikarainen et al., 2018).

Oikarainen et al. (2018) observed that although mentors were po- sitive in their evaluations of their competence in cultural diversity in mentoring, they had a tendency to stereotype CALD nursing students. Mentors reported that language barriers hindered interaction with CALD students (Oikarainen et al., 2018). When examining nursing students’ outcomes in clinical learning environments, language and communication were found to affect students’ experiences of cultural discrimination and limitation of learning opportunities in clinical practices (Mikkonen et al., 2017). Based on previous studies, we found it important to address the current gap in knowledge on intercultural communication by searching to understand mentors’ experiences with CALD nursing students. The aim of this study was to describe clinical mentors’ experience of their intercultural communication competence in mentoring culturally and linguistically diverse nursing students during their clinical practice.

2. Background

Nursing degree programs are commonly provided at the university or university of applied sciences degree level and contain a curriculum that requires a total of three to three and a half years of full-time stu- dies. Following completion of degree programs, students are awarded a bachelor’s degree and are given the right to practice the nursing pro- fession. According to the European Union Council Directive (Directive 2013/55/EU), up to 50% of the duration of nursing education should be conducted as clinical practice. In European Union countries on average, clinical practice is conducted during a period of 4–5 weeks (Pitkänen et al., 2018; Warne et al., 2010). While completing clinical practice in clinical learning environments and being provided with mentoring, nursing students are able to fulfill their learning outcomes and pro- gressively deepen their learning experiences (Pitkänen et al., 2018; Tuomikoski et al., 2019).

Nursing students from European Union countries are offered the opportunity to go on exchange for a period of three to six months to a European Union country and/or outside of the European Union. In European countries where the native language is not English, nursing students from diverse backgrounds are provided with the opportunity to complete their nursing degree in English-language-taught degree nursing programs. Finland is one of the few European countries that offers these kinds of programs, which are offered so that both inter- national and national students study together. Although the nursing programs are offered in English, students need to conduct up to half of their education in clinical practice with patients who speak only Finnish and/or Swedish (Mikkonen et al., 2017; Pitkäjärvi et al., 2012a).

Nurse educators are on the frontline in educating the next genera- tion of nurses and have an important role in developing nursing cur- ricula to withstand international comparison and in preparing cultu- rally competent nurses of the future (Parcells and Baernholdt, 2014; Tella et al., 2015). Since clinical practice takes up to half of nursing education, mentors have great impact on the experiences of nursing students (Pitkänen et al., 2018). It was shown in a previous study that mentors are registered nurses who commonly have no previous edu- cation in mentoring (Tuomikoski et al., 2019). Good mentorship during clinical practice has a positive effect on promoting students’ learning and on assisting students in building their own professional identity (Jokelainen et al., 2011; McSharry and Lathlean, 2017). Mentors of CALD nursing students need to create positive, culturally appropriate learning environments, a process that requires resources and support also from other nurses who work as mentors on the ward (Mikkonen et al., 2017).

Hawala-Druy and Hill (2012) argue that it is imperative for all nurse educators to link and bridge cultural competence and to teach cultu- rally congruent care to future nurses. According to Garneau and Pepin (2015), cultural competence “involves knowledge, skills, and know- how that, when combined properly, lead to a culturally safe, congruent, and effective action” (pg. 12). Cultural competence is a dynamic and developmental process, where the nurse is committed to develop his or her own competence to function better with clients who come from culturally diverse contexts (Giger and Davidhizar, 2008). Within the Cultural Competence and Confidence model by Jeffreys (2010), cultural competence is defined as a multidimensional learning process where cognitive, practical, and affective dimensions of transcultural self-effi- cacy are emphasized, that can change over time as a result of for- malized education and other learning experiences. Cultural competence can also be described as the ability to work and communicate effec- tively and appropriately with people coming from culturally diverse backgrounds (Alizadeh and Chavan, 2016).

Intercultural communication is key to cultural understanding and in the ability to value cultural differences (Saint-Jacques, 2011). It in- volves knowledge about other cultures and the application of appro- priate and effective communication behaviors (Neuliep, 2015). As a discipline, intercultural communication seeks to understand how

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Nurse Education Today 87 (2020) 104348

people from different cultures and social groups interact with equal terms and respect to their cultural identities and how they perceive the world around them. Competence in intercultural communication can support nurses and mentors to understand communication better with CALD patients and students (Hawala-Druy and Hill, 2012).

According to Arasaratnam (2012), intercultural communication unfolds in symbolical intercultural spaces. Communication between individuals is affected by cultural differences in a way that would not have been noteworthy in the absence of these differences. Members who belong to the same thought community and share the same kind of values and beliefs communicate relatively seamlessly on the premise of shared understanding. However, when members of different thought communities communicate, the differences in their thinking is a sig- nificant factor that affects communication (Arasaratnam, 2012.)

In this study, we have applied the Integrated Model of Intercultural Communication Competence (IMICC) (Arasaratnam et al., 2010). In- tercultural communication competence is defined using the concepts of empathy, motivation, global attitude, intercultural experience and in- teraction involvement within communication. Empathy is defined as the extent to which one can infer the cognitions and motivation of another person. Empathy also includes the ability to accurately sense, perceive and respond to one’s personal, interpersonal and social en- vironment. The concept of motivation includes interest and anticipation of actual engagement in intercultural communication. The global atti- tude dimension describes individuals who are open, positive and have a non-ethnocentric attitude. These individuals show interest in differ- ences with awareness towards diversity. Intercultural experience in- volves the actual study of intercultural communication and studying, working and traveling abroad. Interaction involvement includes an individual’s interest and effort to talk and understand. It involves en- gaging in active listening through paying close attention to the other person’s communication (Arasaratnam et al., 2010).

3. Methods

3.1. Study design

A descriptive qualitative study design using a content analysis ap- proach. The content analysis approach was applied in order to under- stand the deeper meaning of nurses’ experiences and the phenomena of intercultural communication competence in the mentoring of students during clinical practice (Elo and Kyngäs, 2008). The content analysis approach is commonly used in critical realist research designs, where the reality of participants is explained through their own experiences (Tong et al., 2012). Data were collected through interviews of in- dividual participants. During the interviews, participants were provided the opportunity to actively share their own experiences related to the research aim.

3.2. Data collection

Data were collected in spring 2016 from 12 clinical mentors em- ployed at one hospital located in central Finland. Among the 12 par- ticipants, nine were female and three were male. Clinical mentors who met the inclusion criteria for participation in the study worked in acute nursing care and had previously mentored a minimum of two CALD nursing students (including international students from English-lan- guage-taught degree programs, immigrant students studying in Finnish language degree programs or exchange students). Purposive and snowball sampling were used to enroll the participants in the study (Polit and Beck, 2011). Charge nurses provided information on the study to potential participants. Nurses who agreed to participate in the study were contacted via email by one researcher (P.H.). Participants who were recruited into the study suggested additional potential par- ticipants. Two interviews were pretested before the main data collec- tion. The understandability and clarity of the questions were improved

following feedback received during these interviews. The two inter- views were included in the data because the feedback received was minor.

Semi-structured theme interviews were conducted. The main con- cepts of the Integrated Model of Intercultural Communication Competence were used including the themes of empathy, motivation, global attitude, intercultural experience and interaction involvement (Arasaratnam et al., 2010). The themes were used as main topics with open questions provided by the interviewer without controlling parti- cipants in the sharing of their experiences. Interviews were conducted in locations most convenient to the participants. Eight interviews were held at the hospital where the participants were employed and the re- maining four interviews were held at a local café and a public library. The interviews varied from 40 min to 75 min in length. Eleven inter- views were held in Finnish and one in Swedish. Data saturation was reached after twelve interviews were completed. The data were tran- scribed word for word into a document in Microsoft Word.

3.3. Data analysis

Data were analyzed using qualitative content analysis (Elo and Kyngäs, 2008). Three main stages were followed during qualitative content analysis: preparation of the data, organization of the data and reporting of the results. A deductive approach guided the analysis during the preparation stage, and data was transformed into a classi- fication matrix according to the five chosen concepts (empathy, moti- vation, global attitude, intercultural experience and interaction in- volvement) from the IMICC theoretical framework (Arasaratnam et al., 2010). Following this, the analysis continued using an inductive ap- proach within the matrix containing the five main themes from Arasaratnam et al. (2010) theoretical model. The data was then orga- nized into meaning-units, which represented one sentence or one phrase. The meaning-units were combined into 951 codes, 259 sub- categories, 44 generic categories and 14 main categories. The cate- gories were named based on the content of the collected data. The analysis process was conducted by one researcher (PH) and con- tinuously verified with another researcher (KM) to maintain double coding and accuracy, and to increase the trustworthiness of the results.

3.4. Ethical considerations

This study was conducted according to the standards of good and ethical practices in scientific research. Research permission was ob- tained from the participating hospital prior to conducting the inter- views. All participants gave written informed consent to participate in the study at the beginning of the interview. The participants were in- formed about the benefits of the study, guaranteed confidentiality and autonomy to remove themselves from the study at any point in time (Stang, 2015). Data from the interviews were stored as secured com- puter files which were accessible only to one researcher (PH). The re- cords and notes will be permanently deleted after the research project has been completed.

4. Results

The main themes defining clinical mentors’ intercultural commu- nication competence in mentoring CALD nursing students are described through the main categories presented in Table 1.

4.1. Empathy

Clinical mentors had a caring and empathic approach towards CALD nursing students during mentoring. Empathy was seen as part of men- tors’ personality, but also as a skill gained through nursing education and work experience. Mentors felt that CALD nursing students need more empathy from mentors than national students. One interviewee

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P. Hagqvist, et al. Nurse Education Today 87 (2020) 104348

Table 1

Main categories of data analysis according to the themes of the Integrated Model of Intercultural Communication Competence (IMICC).

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Main themes of IMICC model

Empathy

Motivation

Main categories

Mentors’ caring and empathic approach towards CALD students strengthens mentors’ mentoring competence

Cultural and linguistic diversity influences mentors’ empathy towards CALD students

Motivation in cultural diversity and students’ active approach in learning

Mentors’ competence relating to motivation to mentor CALD students

Lack of resources and support influences motivation to mentor Mentors’ experiences of prejudice and racism that CALD students face

Mentoring CALD students as a way to enhance cultural knowledge in nursing

Mentoring CALD students contributes to enhanced competence in intercultural communication

Mentors’ intercultural communication competence is supported by continuous education and free time activities

Mentors’ international experiences enhances their mentoring of CALD students

Mentors’ cumulative intercultural communication competence is developed in clinical practice and through the mentoring of CALD students
Mentors work as cultural interpreters for students, patients and for the working community

Cultural, linguistic and ethical challenges of communication in the mentoring of CALD students

Categories

Characteristics of personal empathy (Nr 1,2,3,4,5,7,8,9,10,12)
Caring and empathic mentoring (Nr 2,3,5,7,8,9,10,12)
Gaining skills in empathy during professional growth (Nr 1,2,3,5,7,8,9,10,12) Empathy as a motivating aspect to develop one’s own mentoring (Nr 3,4,5,7,8,10,12)

The linguistic challenges of realization of empathy in mentoring (Nr 1,2,3,4,5,6,7,11,12)
Cultural diversity causes unempathetic behavior by other colleagues (Nr 1,4,8,10,11,12)

Students’ culture and linguistic skills motivates mentors (Nr 1,2,4,5,7,8,9,10,12) Students’ own role in learning motivates mentors (Nr 1,2,4,5,6,7,8,9,10,11) Students’ passiveness and lack of motivation in learning reduces mentors’ motivation (Nr 1,2,3,4,5,6,7,8,9)

Positive feedback and success in mentoring (Nr 2,5,7,8,10,11,12)
Mentor’s competence (Nr 1,3,7,8,9,12)
Mentors’ attitudes towards international degree programs (Nr 1,3,4,6,10,11)

Psychological and ethical dilemmas in mentoring due to the lack of support and knowledge (Nr 2,3,4,5,8,9,10,11,12)
Uneven distribution of resources for mentoring (Nr 1,2,3,5,6,8,10,11)

Fears and attitudes towards unknown cultures (Nr 2,3,4,6,7,8,10,12) Racist attitudes of colleagues towards CALD students (Nr 2,4,6,8,10,12) Social media and press affect attitudes towards CALD students (Nr 1,3,4,5,6,8,9,10,12)

Effect of increasing migration on general attitudes towards CALD students (Nr 1,2,3,4,6,7,8,10,11)

Mentors’ positive attitude of learning about the students’ culture (Nr 1,3,5,7,8,9,10,11,12)
Mentors experience mentoring students from different cultures as enriching (Nr 1,2,3,4,6,7,9,10,12)
Mentors’ learning experiences of the nursing cultures of different countries (Nr 1,2,3,4,5,6,7,9)

Mentors gain learning experiences in cultural interaction and communication in mentoring (Nr 1,2,3,4,5,6,7,8,9,10,11,12)
Mentors recognize the students’ individual cultural communication (Nr 1,3,4,5,6,7,8,10,12)

Mentors’ experience of recognizing their own bias towards different cultures (Nr 1,2,3,6,7,8,9,10,12)
General nursing education provided mentors’ with only limited knowledge on cultural competence (Nr 2,3,4,5,6,7,8,9,10,11)

Cultural competence gained from continuous education (Nr 1,3,4,5,6,7,8,10,12) Cultural experiences gained through traveling and free time activities
(Nr 2,3,5,6,9,10,11,12)

Mentors’ working and studying experience from abroad (Nr 1,7,8,12)
Mentors’ international experience enhances cultural diversity in communication (Nr 1,7,8,12)

Increase of cultural diversity in nursing practice (Nr 2,3,5,6,7,10) Increase of cultural diversity in mentoring (Nr 2,3,4,5,6,9,10,11,12)

Mentors’ experiences cultural interaction in working life of nursing (Nr 1,2,3,4,5,6,7,12)
Mentors’ experiences of intercultural communication issues with students and patients (Nr 1,2,3,4,5,6,7,8,9,10,11,12)

Mentors experience linguistic challenges in mentoring and in the evaluation of CALD students learning outcomes (Nr 1,2,3,4,5,6,7,8,9,10,11,12)
Mentors experience ethical and cultural challenges in the evaluation process of CALD students (Nr 2,3,4,5,6,8,9,10,11,12)

Mentors’ foreign language skills facilitates communication with student (Nr 1,2,3,4,7,8,12)
Mentors experience students’ language skills and desire to learn Finnish as a promoting aspect for the good mentorship (Nr 1,2,3,4,5,6,7,8,9,10,11,12)

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Global attitude

Intercultural experience

Interaction involvement

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P. Hagqvist, et al. Table 1 (continued)

Main themes of IMICC model

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page5image54710400

Main categories

Mentors’ receive rich learning experiences that enhance their intercultural communication in mentoring

Categories

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(Nr 8) expressed: “Students are that age where they are like my own children or even younger. Mentoring should include motherly empathy. With international students, you should think that their mother is far away. If I think of myself as a self-taught mentor, it was in the early stages of my nursing career that I thought that these students here are now the ones I should pass the knowledge and skills that I had learned to, but now my mentoring may have become motherly.” Mentors stated that empathy is a motivating factor for them to develop their mentoring competence and improve their intercultural communication. They were aware of their lack in theoretical knowledge of cultural competence in mentoring. The impact of communication and cultural diversity on empathy in men- toring was stated by mentors as a challenge. Mentors also faced chal- lenges related to difficulties in communication, with how time-con- suming and burdening mentoring was, and at times were faced with students who had weak commitment to the clinical practice. Mentors reported that they lacked empathetic support from their colleagues and that they had experienced receiving negative feedback from them about students.

4.2. Motivation

Students’ cultural and linguistic background and active approach to learning affected the motivation of mentors. Mentors also stated that their experiences of challenges related to intercultural communication and students’ poor Finnish language skills reduced their motivation to mentor. Mentors’ motivation to mentor CALD students was enhanced when they received feedback and felt that they had good mentoring competence. Additionally, successful mentoring experiences with stu- dents motivated mentors to improve their mentoring competence. According to the results, students’ willingness to learn strongly im- pacted mentors’ motivation. One interviewee (Nr 6) shared: “It motivates me if the student gives me the impression that she wants to learn. That she is genuine, asks questions, and comes with me. But then if the student is passive and just comes along but shows no interest, you really get the feeling that how is this going to work. You just want that practice to be over with.” Mentors felt that incentives for mentoring in the English language would succeed to motivate other nurses to agree to mentor CALD stu- dents. They had experiences of compensation for mentoring being un- evenly distributed which affected their motivation to mentor. Although mentors were motivated to mentor and guide students as they learned about health care, clinical nursing and developed skills in the Finnish language, they felt burdened with issues arising from their leaders. During mentoring, mentors experienced a lack of resources, knowledge and support from superiors, colleagues and nurse educators, which caused a psychological and ethical dilemma for mentors and reduced their motivation. Ethical dilemmas arose from mentors’ experiences that CALD students were not given equal learning opportunities due to language barriers with patients and lack of time and resources for mentoring. Mentors felt that they are not able to resolve this issue, which negatively impacted their motivation.

Mentors’ experience that CALD students are active listeners who observe the mentors’ interaction (Nr 1,3,5,7,8,9,10,11,12)
Mentors apply their own communication competence to facilitate the understanding of CALD students (Nr 1,2,3,4,5,6,7,8,9,10,11,12)

Mentors’ experiences of non-verbal communication as a dominant form of communication in student mentoring (Nr 4,5,6,10,11)
Mentors experience that they lack the intercultural communication competence needed to interpret CALD students (Nr 2,4,5,6,9,10,11)

4.3. Global attitude

Mentors reported that CALD students experience prejudice and ra- cism during clinical practice. Mentors openly admitted that they themselves had experienced fear towards unknown cultures, but this fear was reduced through positive mentoring experiences, cultural en- counters and cultural knowledge. Mentors were concerned for CALD students when they had to face people on the working units with racist attitudes, especially when they faced nurses who refused to mentor these students. Mentors recognized the impact of the economic situa- tion and the rise in immigration on the attitudes of staff towards mentoring. They also discussed the effects of certain debates in the press and on social media. Mentors expressed a positive attitude to- wards learning and felt that the mentoring of CALD students was a resource through which they could learn more about cultures. The opportunity to experience different nursing cultures during mentoring was seen as an enriching factor. Interviewee (Nr 6.) replied: “When we had these exchange students on the ward, it was such a rich learning ex- perience to be able to compare their way of doing things, how things are done in their countries and how we do them here in Finland. I remember when we were reflecting together on how different our worlds are.” According to the results, the mentoring of CALD students shaped mentors’ attitudes and contributed to their skill development in intercultural communication. Mentors were able to receive various learning experiences related to intercultural communication during mentoring.

4.4. Intercultural experience

Mentors stated that their intercultural communication skills devel- oped through continuous education and their personal free time ac- tivities. Mentors felt that nursing education had limited contribution on their development of cultural competence. Interviewee (Nr 10) replied: “There was nothing about different cultures in my education. I graduated in the beginning of the 1980s. There was not a single foreigner, not a nurse, a student, or a patient from another culture. Then later on there were refugees or immigrants as patients. There was one nurse visiting us from the Arab Emirates and he had some experience from working there. These things were nice to listen to, but that was the only time.” Mentors with international and intercultural experience stated that this experience had a positive impact on their intercultural communication skills with CALD students. Mentors with experience working and studying abroad replied that this intercultural experience had given them the courage to communicate effectively in mentoring and the ability to understand cultural diversity in communication. Due to an increase in cultural diversity in nursing, mentors stated that they had cumulatively gained intercultural com- munication skills through mentoring CALD students during clinical practice. Mentors’ working experience increased their intercultural skills and motivated them to develop their cultural competence.

4.5. Interaction involvement

According to the results, mentors acted as cultural interpreters for CALD nursing students, patients and for the working community.

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Mentors reported that they teach students about issues related to nur- sing culture and cultural interaction in working life. Mentors reported experiencing issues between students and patients related to inter- cultural communication, for example, the need to provide details on the students’ cultural and linguistic backgrounds to elderly patients who were not accustomed to cultural diversity at the hospital. The results indicated that the mentoring of CALD students increased mentors’ in- tercultural communication skills because mentors received enriching learning experiences in intercultural communication during mentoring and they learned to recognize students’ cultural backgrounds and in- dividuality in cultural interactions. Mentors described that during mentoring they processed their own personal stereotypic attitudes and fears, and also those of other people on the working unit. Mentors ac- knowledged cultural, linguistic and ethical challenges of communica- tion during the mentoring and evaluation of CALD students. Mentors experienced linguistic challenges when communicating in a foreign language and trying to ensure common understanding during men- toring and the evaluation process. Mentors also experienced ethical and cultural challenges during the evaluation process because they lacked clear instructions on how to apply evaluation criteria to the evaluation of students’ learning. Interviewee (Nr 6) replied: “If I have an interna- tional student, or at least I feel so, that there is this assumption, that I need to handle these students more tenderly and not be so strict with them like with Finnish students. But I try to mentor all of my students with the same criteria and with the same demands for basic things, same rules for everyone.”

Mentors’ good foreign language skills facilitated communication between CALD students and mentors. Students’ language skills and their desire to learn Finnish was seen to promote a successful student-mentor relationship in mentorship. Mentors had experiences of CALD students being active listeners and observers of the mentors’ interaction during the clinical practice. Mentors stated that they adapt their own com- munication style during mentoring in order to facilitate common un- derstanding between the student and the mentor by avoiding the use of dialects and by speaking slowly and clearly. They learned that non- verbal communication becomes the dominant form of communication in the mentoring of students in situations where the common language is missing. However, mentors experienced a lack in their intercultural communication skills to interpret CALD students’ nonverbal commu- nication in mentoring.

5. Discussion

This study applied the integrated model of intercultural commu- nication competence by Arasaratnam et al. (2010) to the context of the mentoring of CALD nursing students during their clinical practice. This study aimed to describe clinical mentors’ experiences of their inter- cultural communication competence in mentoring. It has been pre- viously shown that there is a need for more research regarding the mentoring of CALD nursing students in nursing education (Mikkonen et al., 2017; Pitkäjärvi et al., 2012a) to create culturally safe learning environments for students by avoiding misunderstandings caused by poor intercultural communication (Sairanen et al., 2012) and to im- prove the quality of mentoring (Jokelainen et al., 2011).

Mentors with international experience were more empathetic to- wards the CALD students and had a wider understanding of the cultural effects of communication. These findings are consistent with Arasaratnam et al. (2010) regarding a positive significant correlation between empathy and intercultural communication competence. Ability to empathize is shown to be important in mentoring because it promotes motivation to communicate and engage in active listening, which in turn results in perception of intercultural communication competence (Arasaratnam et al., 2010). Clinical mentors are seen as role models for CALD students and known to be supportive, having the ability to be empathetic and hold nursing in high regard (Montenery et al., 2013).

Mentors experienced higher motivation when students took an

active approach to learning and showed courage in communicating with staff and patients despite the existence of a certain level of lan- guage barriers. In previous studies, it was observed that there is con- tradiction between mentors’ evaluation of their competence in men- toring nursing students (Tuomikoski et al., 2019) and students’ experiences of clinical learning environment and mentoring (Pitkänen et al., 2018). Mentors evaluated their competence highly, whereas students evaluated their clinical learning environment and mentoring at the satisfactory but not at the excellent level. (Izadinia, 2016; Moked and Drach-Zahavy, 2016). The role of students is highly emphasized in clinical learning, especially their language competence and ability to speak the language of the country they study in Mikkonen et al. (2016a). However, students are in a vulnerable position when they come to learn in clinical learning environments and highly depend on their mentors, and are significantly impacted by how mentors approach them. Pitkäjärvi et al. (2012a, 2012b) recognized that nurses’ attitudes had positive influence upon students’ motivation to overcome barriers in language and in their learning.

In this study, lack of resources and support influenced mentors’ motivation to mentor. In a previous study by Jeong et al. (2011), it was shown that mentors were not provided with resources to take care of mentoring duties in clinical learning environments by the hospital and/ or leadership, but rather had a full workload having to take care for their patients and mentor students at the same time. Carlson (2013) stated that it is difficult to reduce the workload of mentors meaning that they often have to balance patient care with the demands of mentor- ship, leading to feelings of stress and inadequacy. Such pressures create ethical dilemma for mentors. In our study, mentors experienced psy- chological and emotional pressure from colleagues and organizations such as the hospital and higher education institution. Cassidy et al. (2017) emphasize that leaders and educators take team responsibility for the clinical practice of nursing students. According to the results of our study, mentors also experienced pressure related to their mentoring competence and experienced ethical challenges to pass a student with less-demanding evaluation criteria and would have liked to receive more support of their team. Cultural diversity encompasses ethical ac- ceptance and respect, which means understanding and recognizing each individual’s uniqueness with individual differences. The Code of Ethics for Nurses set by the International Council of Nursing (ICN, 2012, 2013) states that inherent in all nursing is a respect for human rights, in- cluding cultural rights, to dignity and to be treated with respect. This can be applied to the mentoring of CALD students. According to our findings, mentors had the competence to identify the need to promote a more culture sensitive evaluation process during clinical practices, but they lacked sufficient resources.

In this study, mentors shared their fears related to CALD students experiencing discrimination on the ward and of them not feeling ac- cepted by staff in the learning environment. Pitkäjärvi et al. (2012a, 2012b) and Mikkonen et al. (2017) had similar findings indicating that language barriers and staff attitudes towards students played a major role in whether the clinical practice experience would be positive or negative. However, mentors in this study recognized the changing so- ciety and international mobility, especially visible among patients and the global demand for nurses. The global demand for nurses is fueled by an aging population and nursing workforce, a shrinking applicant pool, unfavorable work environments, the increasing complexity of health care delivery, and international nurse migration (Ford and Stephenson, 2014; Nichols et al., 2010). The increasing number of immigrants in the European Union has the potential to become a future asset that can be used to address the shortage of social- and health professionals (Bhopal, 2014). The World Health Organization recommends preparing for the growing number of aging population by ensuring that the future nurses have the competencies needed to provide high-quality and effective care to older patients (Buchan et al., 2017). Nursing curriculums need to include competencies related to healthy aging in the curriculum of all health professions students. This includes also competencies around

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communication and empowerment, interprofessional practice and cul- tural competence (Buchan et al., 2017).

In our study, mentors with intercultural experience had an in- creased level of cultural competence and cultural knowledge. They also acknowledged the need to update their cultural competence through continuous education. Alpers and Hanssen (2014) emphasize that nurses are not able to develop sufficient cultural competence solely through working experience, but that there is a need to provide nurses with continuous cultural competence education. However, mentors with intercultural experience had linguistic boldness to communicate and to clarify unclear issues with CALD nursing students. Moulder (2011) stated that development of cultural competence is linked to the amount of cultural encounters a person has experienced and the length of their clinical experience. Shen (2014) reported similar findings based on their study, and they recognized that cultural encounters are an important domain of cultural competence along with cultural sensi- tivity, awareness, skill, communication and knowledge.

Mentors who participated in this study experienced challenges re- lated to intercultural communication in mentoring and in under- standing CALD students’ nonverbal communication. However, mentors also received rich learning experiences that enhanced their intercultural communication in mentoring. Mentors observed and recognized dif- ferences in the communication of CALD students compared to native nursing students. Mentors were able to develop their intercultural communication skills during the mentoring of students. Mentors de- scribed their own personal biases and stereotypes related to different ethnic groups or cultural backgrounds during mentoring. This kind of stereotyping was also reported in Oikarainen et al. (2018) where mentors reported having a tendency to stereotype CALD students during their clinical practice. ICN (2013) strongly emphasizes the de- velopment of nurses’ cultural and linguistic competence by under- standing and responding effectively to linguistic needs faced in health care encounters. When interacting with clients and students from cul- turally or linguistically diverse groups, mentors need to be able to re- cognize the extra steps that may need to be taken to ensure interven- tions are sensitive to the client’s cultural and linguistic needs. Employers should provide all mentors with an appropriate orientation to ensure they have the competence to address the cultural and lin- guistic needs of their client and student groups (ICN, 2013).

6. Conclusion

It is evident that there is a need to educate clinical mentors in order to increase their competence in intercultural communication in men- toring. Continuous education could succeed to further develop clinical mentors’ mentoring expertise, which could greatly benefit students, patients and staff from cultural and linguistic diversity backgrounds. Such education could be designed, implemented and measured for its effect in collaboration between health care organizations and higher educational institutions. Providing intercultural experiences for nurses could be beneficial in the process of building their intercultural com- munication competence, a process that requires face-to-face encounters with other cultures. Providing mentors with further education on the evaluation and reflection of CALD and national nursing students can provide structure and tools for mentors to use in daily mentoring practice. Finally, we suggest that health care leadership and higher education institutions together develop clear collaborative strategies on how to enhance the quality of mentoring CALD students by building positive attitudes in staff members towards cultural and linguistic di- versity.

Funding

Declaration of competing interest

None.

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Pitkänen, S., Kääriäinen, M., Oikarainen, A., Tuomikoski, A.M., Elo, S., Ruotsalainen, H., Saarikoski, M., Kärsämänoja, T., Mikkonen, K., 2018. Healthcare students’ evaluation of the clinical learning environment and supervision – a cross-sectional study. Nurse Educ. Today 62, 143–149. https://doi.org/10.1016/j.nedt.2018.01.005.

Polit, D.F., Beck, C.T., 2011. Nursing Research: Generating and Assessing Evidence for Nursing Practice. Wolters Kluwer Health/Lippincott Williams & Wilkins, Philadelphia.

Saint-Jacques, B., 2011. Intercultural communication in a globalized world. In: Samovar,

L.A., Porter, R.E., McDaniel, E.R. (Eds.), Intercultural Communication: A Reader,

13th edition. Cengage Learning, Boston Mass, pp. 45–53.
Sairanen, R., Richardson, E., Kelly, H., Bergknut, E., Koskinen, L., Lundberg, P., Muir, R.,

Olt, H., De Vlieger, L., 2012. Putting culture in the curriculum: a European project.

Nurse Educ. Pract. 13 (2), 118–124. https://doi.org/10.1016/j.nepr.2012.08.002. Shen, Z., 2014. Cultural competence models and cultural competence assessment in-

struments in nursing: a literature review. J. Transcult. Nurs. 26 (3), 308–321. https://

doi.org/10.1177/1043659614524790.
Spitzberg, B.H., Changnon, G., 2009. Conceptualizing intercultural competence. In:

Deardorff, D.K. (Ed.), The Sage Handbook of Intercultural Competence. Sage,

Thousand Oaks, CA, pp. 1–52.
Stang, J., 2015. Ethics in action: conducting ethical research involving human subjects: a

primer. J. Acad. Nutr. Diet. 115 (12), 2019–2022. https://doi.org/10.1016/j.jand.

2015.10.006.
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European Union council conclusions of 12 May 2009. Retrieved from. https://eur-

lex.europa.eu/legal-content/EN/ALL/?uri=celex%3A52009XG0528%2801%29. Tella, S., Smith, N.J., Partanen, P., Turunen, H., 2015. Learning patient safety in academic

settings: a comparative study of Finnish and British nursing students’ perceptions. Worldviews Evid.-Based Nurs. 12 (3), 154–164. https://doi.org/10.1111/wvn. 12088.

Tong, A., Flemming, K., McInnes, E., Oliver, S., Craig, J., 2012. Enhancing transparency in reporting the synthesis of qualitative research: ENTREQ. BMC Med. Res. Methodol. 12, 181. https://doi.org/10.1186/1471-2288-12-181.

Tuomikoski, A.-M., Ruotsalainen, H., Mikkonen, K., Miettunen, J., Juvonen, S., Sivonen, P., Kääriäinen, M., 2019. How mentoring education affects nurse mentors’ compe- tence in mentoring students during clinical practice – a quasi-experimental study. Scand. J. Caring Sci. https://doi.org/10.1111/scs.12728.

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8

Project: Pt. 1: Identification of a social problem and Identification of a policy

As an astute social worker and professional policy advocate, you must be adept at identifying social problems that exist in your community or in an agency or organization with which you are acquainted. Once you have selected a social problem, you begin the process of creating and implementing a policy that addresses that social problem.
 

In this assignment, you identify and describe a current social problem. You also identify a policy created and implemented to address the problem. This is the first part of your Social Change Project final assignment.

Complete Part 1 of your Social Change Project.
 

Address the following items in a 3-4 page paper:

  • Describe a current social problem. How might this problem be incongruent with social work values/ethics?
  • How/when has this problem been identified historically, and what were the actions taken to address this concern?
  • How have the groups affected by this concern changed over time?
  • Describe the policy area related to this social problem.
  • Is the policy identified by your group dictated by local, state, or federal statute—or a combination thereof?
  • What are the different aspects of the policy?
  • How long has the current policy been in place?
  • Who supports and who opposes the policy?
  • What changes/amendments have been made to the policy?
  • Explain how this policy affects clients you might see in a clinical setting and why, as a clinical social worker, it would be important to advocate for change.

Class discussion 6

BOOK 1

 THE ARGUMENT

 This first Book proposes, first in brief, the whole Subject, Mans disobedience, and the loss thereupon of Paradise wherein he was plac’t: Then touches the prime cause of his fall of him, the Serpent, or rather Satan in the Serpent;  who revolting from God, and drawing to his side of him many Legions of Angels, was by the command of God driven out of Heaven with all his Crew of him into the great Deep.  Which action past over, the Poem hasts into the midst of things, presenting Satan with his Angels now fallen into Hell, describ’d here, not in the Center (for Heaven and Earth may be suppos’d as yet not made, certainly not  yet accurst) but in a place of utter darkness, fitliest call’d Chaos: Here Satan with his Angels lying on the burning Lake, thunder-struck and astonisht, after a certain space recovers, as from confusion, calls up him who next in  Order and Dignity lay by him;  they confer of thir miserable fall.  Satan awakens all his Legions from him, who lay till then in the same manner confounded;  They rise, thir Numbers, array of Battel, thir chief Leaders nam’d, according to the Idols known afterwards in Canaan and the Countries adjoyning.  To these Satan directs his Speech from him, comforts them with hope yet of regaining Heaven, but tells them lastly of a new World and new kind of Creature to be created, according to an ancient Prophesie or report in Heaven;  for that Angels were long before this visible Creation, was the opinion of many ancient Fathers.  To find out the truth of this Prophesie, and what to determine thereon he refers to a full Councel.  What his Associates of him thence attempt.  Pandemonium the Palace of Satan rises, suddenly built out of the Deep: The infernal Peers there sit in Councel.

 OF Mans First Disobedience, and the Fruit

 Of that Forbidden Tree, whose mortal tast

 Brought Death into the World, and all our woe,

 With loss of Eden, till one greater Man

 Restore us, and regain the blissful Seat, [5]

 Sing Heav’nly Muse, that on the secret top

 Of Oreb, or of Sinai, didst inspire

 That Shepherd, who first taught the chosen Seed,

 In the Beginning how the Heav’ns and Earth

 Rose out of Chaos: Or if Sion Hill [10]

 Delight thee more, and Siloa’s Brook that flow’d

 Fast by the Oracle of God;  I thence

 Invoke thy aid to my adventrous Song,

 That with no middle flight intends to soar

 Above th ‘Aonian Mount, while it pursues [15]

 Things unattempted yet in Prose or Rhime.

 And chiefly Thou O Spirit, that dost prefer

 Before all Temples th ‘upright heart and pure,

 Instruct me, for Thou know’st;  Thou from the first

 Wast present, and with mighty wings outspread [20]

 Dove-like satst brooding on the vast Abyss

 And mad’st it pregnant: What in me is dark

 Illumin, what is low raise and support;

 That to the highth of this great Argument

 I may assert Eternal Providence, [25]

 And justifie the ways of God to men.

 Say first, for Heav’n hides nothing from thy view

 Nor the deep Tract of Hell, say first what cause

 Mov’d our Grand Parents in that happy State,

 Favor’d of Heav’n so highly, to fall off [30]

 From thir Creator, and transgress his Will

 For one restraint, Lords of the World besides?

 Who first seduc’d them to that foul revolt?

 Th ‘infernal Serpent;  he it was, whose guile

 Stird up with Envy and Revenge, deceiv’d [35]

 The Mother of Mankind, what time his Pride

 Had cast him out from Heav’n, with all his Host

 Of Rebel Angels, by whose aid aspiring

 To set himself in Glory above his Peers de el,

 I have trusted to have equal’d the most High, [40]

 If I have oppos’d;  and with ambitious aim

 Against the Throne and Monarchy of God

 Rais’d impious War in Heav’n and Battel proud

 With vain attempt.  Him the Almighty Power

 Hurld headlong flaming from th ‘Ethereal Skie [45]

 With hideous ruine and combustion down

 To bottomless perdition, there to dwell

 In Adamantine Chains and penal Fire,

 Who durst defie th ‘Omnipotent to Arms.

 Nine times the Space that measures Day and Night [50]

 To mortal men, he with his horrid crew

 Lay vanquisht, rowling in the fiery Gulfe

 Confounded though immortal: But his doom

 Reserv’d him to more wrath;  for now the thought

 Both of lost happiness and lasting pain [55]

 Torments him;  round he throws his baleful eyes

 That witness’d huge affliction and dismay

 Mixt with obdurate pride and stedfast hate:

 At once as far as Angels kenn he views

 The dismal Situation waste and wilde, [60]

 A horrible dungeon, on all sides round

 As one great Furnace flam’d, yet from those flames

 No light, but rather darkness visible

 Serv’d onely to discover sights of woe,

 Regions of sorrow, doleful shades, where peace [65]

 And rest can never dwell, hope never comes

 That comes to all;  but torture without end

 Still urges, and a fiery Deluge, fed

 With ever-burning Sulfur unconsum’d:

 Such place Eternal Justice had prepar’d [70]

 For those rebellious, here thir Prison ordain’d

 In utter darkness, and thir portion set

 As far remov’d from God and light of Heav’n

 As from the Center thrice to th ‘utmost Pole.

 O how unlike the place from whence they fell!  [75]

 There the companions of his fall of him, o’rewhelm’d

 With Floods and Whirlwinds of tempestuous fire,

 He soon discerns, and weltring by his side

 One next himself in power, and next in crime,

 Long after known in Palestine, and nam’d [80]

 Beelzebub.  To whom th ‘Arch-Enemy,

 And thence in Heav’n call’d Satan, with bold words

 Breaking the horrid silence thus began.

 If thou beest he;  But O how fall’n!  how chang’d

 From him, who in the happy Realms of Light [85]

 Cloth’d with transcendent brightness didst out-shine

 Myriads though bright: If he Whom mutual league,

 United thoughts and counsels, equal hope

 And hazard in the Glorious Enterprize,

 Joynd with me once, now misery hath joynd [90]

 In equal ruin: into what Pit thou seest

 From what highth fall’n, so much the stronger prov’d

 He with his Thunder from him: and till then who knew

 The force of those dire Arms?  yet not for those,

 Nor what the Potent Victor in his rage de él [95]

 Can else inflict, do I repent or change,

 Though chang’d in outward luster;  that fixt mind

 And high disdain, from sence of injur’d merit,

 That with the mightiest rais’d me to contend,

 And to the fierce contention brought along [100]

 Countless force of Spirits arm’d

 That durst dislike his reign of him, and me preferring,

 His utmost power of him with adverse power oppos’d

 In dubious Battel on the Plains of Heav’n,

 And he shook his throne from him.  What though the field be lost?  [105]

 All is not lost;  the unconquerable Will,

 And study of revenge, immortal hate,

 And courage never to submit or yield:

 And what is else not to be overcome?

 That Glory never shall his wrath or might of him [110]

 Extort from me.  To bow and sue for grace

 With suppliant knee, and deifie his power of him,

 Who from the terror of this Arm so late

 Doubted his Empire of him, that were low indeed,

 That were an ignominy and shame beneath [115]

 This downfall;  since by Fate the strength of Gods

 And this Empyreal substance cannot fail,

 Since through experience of this great event

 In Arms not worse, in foresight much advanc’t,

 We may with more successful hope resolve [120]

 To wage by force or guile eternal Warr

 Irreconcileable, to our grand Foe,

 Who now triumphs, and in th ‘excess of joy

 Sole reigning holds the Tyranny of Heav’n.

 So spake th ‘Apostate Angel, though in pain, [125]

 Vaunting aloud, but rackt with deep despare:

 And him thus answer’d soon his bold Compeer de el.

 O Prince, O Chief of many Throned Powers,

 That led th ‘imbattelld Seraphim to Warr

 Under thy conduct, and in dreadful deeds [130]

 Fearless, endanger’d Heav’ns perpetual King;

 And put to proof his high Supremacy of him,

 Whether upheld by strength, or Chance, or Fate,

 Too well I see and rue the dire event,

 That with sad overthrow and foul defeat [135]

 Hath lost us Heav’n, and all this mighty Host

 In horrible destruction laid thus low,

 As far as Gods and Heav’nly Essences

 Can perish: for the mind and spirit remains

 Invincible, and vigor soon returns, [140]

 Though all our Glory extinct, and happy state

 Here swallow’d up in endless misery.

 But what if he our Conquerour, (whom I now

 Of force believe Almighty, since no less

 Then such could hav orepow’rd such force as ours) [145]

 Have left us this our spirit and strength intire

 Strongly to suffer and support our pains,

 That we may so suffice his vengeful ire de el,

 Or do him mightier service as his thralls

 By right of Warr, what are his business be [150]

 Here in the heart of Hell to work in Fire,

 Or do his Errands de él in the gloomy Deep;

 What can it then avail though yet we feel

 Strength undiminisht, or eternal being

 To undergo eternal punishment?  [155]

 Whereto with speedy words th ‘Arch-fiend reply’d.

 Fall’n Cherube, to be weak is miserable

 Doing or Suffering: but of this be sure,

 To do ought good never will be our task,

 But ever to do ill our sole delight, [160]

 As being the contrary to his high will

 Whom we resist.  If then his Providence

 Out of our evil seek to bring forth good,

 Our labor must be to pervert that end,

 And out of good still to find means of evil;  [165]

 Which oft times may succeed, so as perhaps

 Shall grieve him, if I fail not, and disturb

 His inmost counsels from thir destind aim.

 But see the angry Victor hath recall’d

 His Ministers of vengeance and pursuit [170]

 Back to the Gates of Heav’n: The Sulphurous Hail

 Shot after us in storm, oreblown hath laid

 The fiery Surge, that from the Precipice

 Of Heav’n receiv’d us falling, and the Thunder,

 Wing’d with red Lightning and impetuous rage, [175]

 Perhaps he has spent his shafts, and ceases now

 To bellow through the vast and boundless Deep.

 Let us not slip th ‘occasion, whether scorn,

 Or satiate fury yield it from our Foe.

 Seest thou yon dreary Plain, forlorn and wilde, [180]

 The seat of desolation, voyd of light,

 Save what the glimmering of these livid flames

 Casts pale and dreadful?  Thither let us tend

 From off the tossing of these fiery waves,

 There rest, if any rest can harbor there, [185]

 And reassembling our afflicted Powers,

 Consult how we may henceforth most offend

 Our Enemy, our own loss how repair,

 How overcome this dire Calamity,

 What reinforcement we may gain from Hope, [190]

 If not what resolution from despare.

 Thus Satan talking to his neerest Mate

 With Head up-lift above the wave, and Eyes

 That sparkling blaz’d, his other Parts of him besides

 Prone on the Flood, extended long and large [195]

 Lay floating many a rood, in bulk as huge

 As whom the Fables name of monstrous size,

 Titanian, or Earth-born, that warr’d on Jove,

 Briareos or Typhon, whom the Den

 By ancient Tarsus held, or that Sea-beast [200]

 Leviathan, which God of all his works

 Created hugest that swim th ‘Ocean stream:

 Him haply slumbring on the Norway foam

 The Pilot of some small night-founder’d Skiff,

 Deeming some Island, oft, as Sea-men tell, [205]

 With fixed Anchor in his skaly rind

 Moors by his side of him under the Lee, while Night

 Invests the Sea, and wished Morn delayes:

 So stretcht out huge in length the Arch-fiend lay

 Chain’d on the burning Lake, nor ever thence [210]

 He had ris’n or heav’d his head de el, but that the will

 And high permission of all-ruling Heaven

 Left him at large to his own dark designs of him,

 That with reiterated crimes he might

 Heap on himself damnation, while he sought [215]

 Evil to others, and enrag’d might see

 How all his malice de él serv’d but to bring forth

 Infinite goodness, grace and mercy shewn

 On Man by him seduc’t, but on himself

 Treble confusion, wrath and vengeance pour’d.  [220]

 Forthwith upright he rears from off the Pool

 His mighty Stature of him;  on each hand the flames

 Drivn backward slope thir pointing spires, and rowld

 In billows, leave i’th ‘midst a horrid Vale.

 Then with expanded wings he stears his flight from him [225]

 Aloft, incumbent on the dusky Air

 That felt unusual weight, till on dry Land

 He lights, if it were Land that ever burn’d

 With solid, as the Lake with liquid fire;

 And such appear’d in hue, as when the force [230]

 Of subterranean wind transports a Hill

 Torn from Pelorus, or the shatter’d side

 Of thundring Ætna, whose fuel

 And fewel’d entrals thence conceiving Fire,

 Sublim’d with Mineral fury, aid the Winds, [235]

 And leave a singed bottom all involv’d

 With stench and smoak: Such resting found the sole

 Of unblest feet.  Him followed his next Mate de el,

 Both glorying to have scap’t the Stygian flood

 As Gods, and by thir own recover’d strength, [240]

 Not by the sufferance of supernal Power.

 Is this the Region, this the Soil, the Clime,

 Said then the lost Arch-Angel, this the seat

 That we must change for Heav’n, this mournful gloom

 For that celestial light?  Be it so, since he [245]

 Who now is Sovran can dispose and bid

 What shall be right: fardest from him is best

 Whom reason hath equald, force hath made supream

 Above his equals of him.  Farewel happy Fields

 Where Joy for ever dwells: Hail horrours, hail [250]

 Infernal world, and thou profoundest Hell

 Receive thy new Possessor: One who brings

 A mind not to be chang’d by Place or Time.

 The mind is its own place, and in it self

 Can make a Heav’n of Hell, a Hell of Heav’n.  [255]

 What matter where, if I be still the same,

 And what I should be, all but less then he

 Whom Thunder hath made greater?  Here at least

 We shall be free;  th ‘Almighty hath not built

 Here for his envy of him, he will not drive us hence: [260]

 Here we may reign secure, and in my choyce

 To reign is worth ambition though in Hell:

 Better to reign in Hell, then serve in Heav’n.

 But wherefore let us then our faithful friends,

 Th ‘associates and copartners of our loss [265]

 Lye thus astonisht on th ‘oblivious Pool,

 And call them not to share with us their part

 In this unhappy Mansion, or once more

 With rallied Arms to try what may be yet

 Regaind in Heav’n, or what more lost in Hell?  [270]

 So Satan spake, and him Beelzebub

 Thus answer’d.  Leader of those Armies bright,

 Which but th ‘Onmipotent none could have foyld,

 If once they hear that voyce, thir liveliest pledge

 Of hope in fears and dangers, heard so oft [275]

 In worst extreams, and on the perilous edge

 Of battel when it rag’d, in all assaults

 Thir surest signal, they will soon resume

 New courage and revive, though now they lye

 Groveling and prostrate on yon Lake of Fire, [280]

 As we erewhile, astounded and amaz’d,

 No wonder, fall’n such a pernicious highth.

 He scarce had ceas’t when the superiour Fiend

 He was moving toward the shoar;  his ponderous shield

 Ethereal temper, massy, ​​large and round, [285]

 Behind him cast;  the broad circumference

 Hung on his shoulders like the Moon, whose Orb

 Through Optic Glass the Tuscan Artist views

 At Ev’ning from the top of Fesole,

 Or in Valdarno, to descry new Lands, [290]

 Rivers or Mountains in her spotty Globe.

 His Spear de ella, to equal which the tallest Pine

 Hewn on Norwegian hills, to be the Mast

 Of some great Ammiral, were but a wand,

 He walkt with to support uneasie steps [295]

 Over the burning Marle, not like those steps

 On Heavens Azure, and the torrid Clime

 Smote on him sore besides, vaulted with Fire;

 Nathless he so endur’d, till on the Beach

 Of that inflamed Sea, he stood and call’d [300]

 His Legions of him, Angel Forms, who lay intrans’t

 Thick as Autumnal Leaves that strow the Brooks

 In Vallombrosa, where th ‘Etrurian shades

 High overarch’t imbowr;  or scatterd sedge

 Afloat, when with fierce Winds Orion arm’d [305]

 Hath vext the Red-Sea Coast, whose waves orethrew

 Busiris and his Memphian Chivalry,

 While with perfidious hatred they pursu’d

 The Sojourners of Goshen, who beheld

 From the safe shore thir floating Carkases [310]

 And broken Chariot Wheels, so thick bestrown

 Abject and lost lay these, covering the Flood,

 Under amazement of thir hideous change.

 He call’d so loud, that all the hollow Deep

 Of Hell resounded.  Princes, Potentates, [315]

 Warriers, the Flowr of Heav’n, once yours, now lost,

 If such astonishment as this can sieze

 Eternal spirits;  or have ye chos’n this place

 After the toyl of Battel to repose

 Your wearied vertue, for the ease you find [320]

 To slumber here, as in the Vales of Heav’n?

 Or in this abject posture have ye sworn

 To adore the Conquerour?  who now beholds

 Cherube and Seraph rowling in the Flood

 With scatter’d Arms and Ensigns, till anon [325]

 His swift pursuers from Heav’n Gates discern

 Th ‘advantage, and descending tread us down

 Thus drooping, or with linked Thunderbolts

 Transfix us to the bottom of this Gulfe.

 Awake, arise, or be for ever fall’n.  [330]

 They heard, and were abasht, and up they sprung

 Upon the wing, as when men wont to watch

 On duty, sleeping found by whom they dread,

 Rouse and bestir themselves ere well awake.

 Nor did they not perceive the evil plight [335]

 In which they were, or the fierce pains not feel;

 Yet to thir Generals Voyce they soon obeyd

 Innumerable.  As when the potent Rod

 Of Amrams Son in Egypts evill day

 Wav’d round the Coast, up call’d a pitchy cloud [340]

 Of Locusts, warping on the Eastern Wind,

 That ore the Realm of impious Pharaoh hung

 Like Night, and darken’d all the Land of Nile:

 So numberless were those bad Angels seen

 Hovering on wing under the Cope of Hell [345]

 ‘Twixt upper, nether, and surrounding Fires;

 Till, as a signal giv’n, th ‘uplifted Spear

 Of thir great Sultan waving to direct

 Thir course, in even ballance down they light

 On the firm brimstone, and fill all the Plain;  [350]

 A multitude, like which the populous North

 Pour’d never from her frozen loyns, to pass

 Rhene or the Danaw, when her de ella barbarous Sons

 Came like a Deluge on the South, and spread

 Beneath Gibralter to the Lybian sands.  [355]

 Forthwith from every Squadron and each Band

 The Heads and Leaders thither hast where stood

 Thir great Commander;  Godlike shapes and forms

 Excelling human, Princely Dignities,

 And Powers that earst in Heaven sat on Thrones;  [360]

 Though of thir Names in heav’nly Records now

 Be no memorial blotted out and ras’d

 By thir Rebellion, from the Books of Life.

 Nor had they yet among the Sons of Eve

 Got them new Names, till wandring ore the Earth, [365]

 Through Gods high sufferance for the tryal of man,

 By falsities and lyes the greatest part

 Of Mankind they corrupted to forsake

 God thir Creator, and th ‘invisible

 Glory of him that made them, to transform [370]

 Off to the Image of a Brute, adorn’d

 With gay Religions full of Pomp and Gold,

 And Devils to adore for Deities:

 Then were they known to men by various Names,

 And various Idols through the Heathen World.  [375]

 Say, Muse, thir Names then known, who first, who last,

 Rous’d from the slumber, on that fiery Couch,

 At thir great Emperors call, as next in worth

 He came singly where he stood on the bare strand,

 While the promiscuous croud stood yet aloof?  [380]

 The chief were those who from the Pit of Hell

 Roaming to seek thir prey on earth, durst fix

 Thir Seats long after next the Seat of God,

 Thir Altars by his Altar de el, Gods ador’d

 Among the Nations round, and durst abide [385]

 Jehovah thundring out of Zion, thron’d

 Between the Cherubim;  yea, often plac’d

 Within his Sanctuary of he it self thir Shrines,

 Abominations;  and with cursed things

 His holy Rites de el, and solemn Feasts profan’d, [390]

 And with thir darkness durst affront his light from him.

 First Moloch, horrid King besmear’d with blood

 Of human sacrifice, and parents tears,

 Though for the noyse of Drums and Timbrels loud

 Thir childrens cries unheard, that past through fire [395]

 To his grim Idol of him.  Him the Ammonite

 Worship in Rabba and her de ella watry Plain de ella,

 In Argob and in Basan, to the stream

 Of utmost Arnon.  Nor content with such

 Audacious neighborhood, the wisest heart [400]

 Of Solomon he led by fraud to build

 His Temple de el right against the Temple of God

 On that opprobrious Hill, and made his Grove

 The pleasant Vally of Hinnom, Tophet thence

 And black Gehenna call’d, the Type of Hell.  [405]

 Next Chemos, th ‘obscene dread of Moabs Sons,

 From Aroar to Nebo, and the wild

 Of Southmost Abarim;  in Hesebon

 And Horonaim, Seons Realm, beyond

 The flowry Dale of Sibma clad with Vines, [410]

 And Eleale to th ‘Asphaltick Pool.

 Worse his other Name of him, when he entic’d

 Israel in Sittim on thir march from Nile

 To do him wanton rites, which cost them woe.

 Yet thence his lustful Orgies of him I have enlarg’d [415]

 Even to that Hill of scandal, by the Grove

 Of Moloch homicide, lust hard by hate;

 Till good Josiah drove them thence to Hell.

 With these came they, who from the bordring flood

 Of old Euphrates to the Brook that parts [420]

 Egypt from Syrian ground, had general Names

 Of Baalim and Ashtaroth, those male,

 These Feminine.  For Spirits when they please

 Can either Sex assume, or both;  so soft

 And uncompounded is thir Essence pure, [425]

 Not ti’d or manacl’d with joynt or limb,

 Nor founded on the brittle strength of bones,

 Like cumbrous flesh;  but in what shape they choose

 Dilated or condens’t, bright or obscure,

 Can execute thir aerie purposes, [430]

 And works of love or enmity fulfill.

 For those the Race of Israel oft forsook

 Thir living strength, and unfrequented left

 His righteous Altar of him, bowing lowly down

 To bestial Gods;  for which thir heads as low [435]

 Bow’d down in Battel, sunk before the Spear

 Of despicable foes.  With these in troop

 Came Astoreth, whom the Phoenicians call’d

 Astarte, Queen of Heav’n, with crescent Horns;

 To whose bright Image nightly by the Moon [440]

 Sidonian Virgins paid thir Vows and Songs,

 In Sion also not unsung, where stood

 Her Temple of her on th ‘offensive Mountain, built

 By that uxorious King, whose heart though large,

 Beguil’d by fair Idolatresses, fell [445]

 To Idols foul.  Thammuz came next behind,

 Whose annual wound in Lebanon allur’d

 The Syrian Damsels to lament his fate

 In amorous dittyes all a Summers day,

 While smooth Adonis from his native Rock by him [450]

 Ran purple to the Sea, suppos’d with blood

 Of Thammuz yearly wounded: the Love-tale

 Infected Sions daughters with like heat,

 Whose wanton passions in the sacred Porch

 Ezekiel saw, when by the Vision led [455]

 His eye of him survay’d the dark Idolatries

 Of alienated Judah.  Next came one

 Who mourn’d in earnest, when the Captive Ark

 Maim’d his brute Image of him, head and hands lopt off

 In his own Temple of him, on the grunsel edge, [460]

 Where he fell flat, and sham’d his Worshipers de el:

 Dagon his Name de el, Sea Monster, upward Man

 And downward Fish: yet had his Temple de él high

 He rear’d in Azotus, dreaded through the Coast

 Of Palestine, in Gath and Ascalon [465]

 And Accaron and Gaza’s frontier bounds.

 Him follow’d Rimmon, whose delightful Seat

 He was fair Damascus, on the fertile Banks

 Of Abbana and Pharphar, lucid streams.

 He also against the house of God was bold: [470]

 A Leper once I have lost and gain’d a King,

 Ahaz his sottish Conquerour de él, whom he drew

 Gods Altar to disparage and displace

 For one of Syrian mode, whereon to burn

 His odious off’rings, and adore the Gods [475]

 Whom he had vanquisht.  After these appear’d

 A crew who under Names of old Renown,

 Osiris, Isis, Orus and their Train

 With monstrous shapes and sorceries abus’d

 Fanatic Egypt and her de ella Priests de ella, to seek [480]

 Thir wandring Gods disguis’d in brutish forms

 Rather then human.  Nor did Israel scape

 Th ‘infection when thir borrow’d Gold compos’d

 The Calf in Oreb: and the Rebel King

 Doubl’d that sin in Bethel and in Dan, [485]

 Lik’ning his Maker to the Grazed Ox,

 Jehovah, who in one Night when he pass’d

 From Egypt marching, equal’d with one stroke

 Both her de ella first born de ella and all her de ella bleating Gods.

 Belial came last, then whom a Spirit more lewd [490]

 She fell not from Heaven, or more gross to love

 Vice for it self: To him no Temple stood

 Or Altar smoak’d;  yet who more oft then hee

 In Temples and at Altars, when the Priest

 Turns Atheist, as did Ely’s Sons, who fill’d [495]

 With lust and violence the house of God.

 In Courts and Palaces he also Reigns

 And in luxurious Cities, where the noyse

 Of riot ascends above thir loftiest Towrs,

 And injury and outrage: And when Night [500]

 Darkens the Streets, then wander forth the Sons

 Of Belial, flown with insolence and wine.

 Witness the Streets of Sodom, and that night

 In Gibeah, when the hospitable door

 Expos’d a Matron to avoid worse monkfish.  [505]

 These were the prime in order and in might;

 The rest were long to tell, though far renown’d,

 Th ‘Ionian Gods, of Javans Issue held

 Gods, yet confest later then Heav’n and Earth

 Thir boasted Parents;  Titan Heav’ns first born [510]

 With his enormous brood of him, and birthright six’d

 By younger Saturn, he from mightier Jove

 His own of him and Rhea’s Son like measure found;

 So Jove usurping reign’d: these first in Creet

 And Ida known, thence on the Snowy top [515]

 Of cold Olympus rul’d the middle Air

 Thir highest Heav’n;  or on the Delphian Cliff,

 Or in Dodona, and through all the bounds

 Of Doric Land;  or who with Saturn old

 Fled over Adria to th ‘Hesperian Fields, [520]

 And pray the Celtic roam’d the utmost Isles.

 All these and more came flocking;  but with looks

 Down cast and damp, yet such wherein appear’d

 Obscure some glimps of joy, to have found thir chief

 Not in despair, to have found themselves not lost [525]

 In loss it self;  which on his count’nance cast

 Like doubtful hue: but he his wonted pride

 Soon recollecting, with high words, that he bore

 Semblance of worth, not substance, gently rais’d

 Thir fainting courage, and dispel’d thir fears.  [530]

 Then strait commands that at the warlike sound

 Of Trumpets loud and Clarions be upreard

 His mighty Standard of him;  that proud honor claim’d

 Azazel as his right of him, a Cherube tall:

 Who forthwith from the glittering Staff unfurld [535]

 Th ‘Imperial Ensign, which full high advanc’t

 Shon like a Meteor streaming to the Wind

 With Gemms and Golden luster rich imblaz’d,

 Seraphic arms and Trophies: all the while

 Sonorous mettal blowing Martial sounds: [540]

 At which the universal Host upsent

 A shout that tore Hells Concave, and beyond

 He frighted the Reign of Chaos and old Night.

 All in a moment through the gloom were seen

 Ten thousand Banners rise into the Air [545]

 With Orient Colors waving: with them rose

 A Forest huge of Spears: and thronging Helms

 Appear’d, and serried shields in thick array

 Of depth immeasurable: Anon they move

 In perfect Phalanx to the Dorian mood [550]

 Of Flutes and soft Recorders;  such as rais’d

 To hight of noblest temper Hero’s old

 Arming to Battel, and in stead of rage

 Deliberate courage breath’d, firm and unmov’d

 With dread of death to flight or foul retreat, [555]

 Nor wanting power to mitigate and swage

 With solemn touches, troubl’d thoughts, and chase

 Anguish and doubt and fear and sorrow and pain

 From mortal or immortal minds.  Thus they

 Breathing united force with fixed thought [560]

 Mov’d on in silence to soft Pipes that charm’d

 Thir painful steps o’re the burnt soyle;  and now

 Advanc’t in view, they stand, a horrid Front

 Of dreadful length and dazling Arms, in guise

 Of Warriers old with order’d Spear and Shield, [565]

 Awaiting what command thir mighty Chief

 Had to impose: He through the armed Files

 Darts his experienc’t eye, and soon traverse

 The whole Battalion views, thir order due,

 Thir visages and stature as of Gods, [570]

 Thir number last he summs.  And now his heart

 From him Distends with pride, and hardning in his strength

 Glories: For never since created man,

 Met such imbodied force, as he nam’d with these

 He could merit more then that small infantry [575]

 Warr’d on by Cranes: though all the Giant brood

 Of Phlegra with th ‘Heroic Race were joyn’d

 That fought at Theb’s and Ilium, on each side

 Mixt with auxiliary Gods;  and what resounds

 In Fable or Romance of Uthers Son [580]

 Begirt with British and Armoric Knights;

 And all who since, Baptiz’d or Infidel

 Jousted in Aspramont or Montalban,

 Damascus, or Marocco, or Trebisond,

 Or whom Biserta sent from Afric shore [585]

 When Charlemain with all his Peerage de he fell

 By Fontarabbia.  Thus far these beyond

 Compare of mortal prowess, yet observed’d

 Thir dread commander: he above the rest

 In shape and gesture proudly eminent [590]

 He stood like a Towr;  his form of he had yet not lost

 All her Original brightness of him, nor appear’d

 Less then Arch Angel ruind, and th ‘excess

 Of Glory obscur’d: As when the Sun new ris’n

 Looks through the Horizontal misty Air [595]

 Shorn of his Beams from him, or from behind the Moon

 In dim Eclips disastrous twilight sheds

 On half the Nations, and with fear of change

 Perplexes Monarchs.  Dark’n’d so, yet shon

 Above them all th ‘Arch Angel: but his face de él [600]

 Deep scars of Thunder had intrencht, and care

 Sat on his faded cheek of him, but under Browes

 Of dauntless courage, and considerate Pride

 Waiting revenge: cruel his eye of him, but cast

 Signs of remorse and passion to behold [605]

 The fellows of his crime by him, the followers rather

 (Far other once beheld in bliss) condemn’d

 For ever now to have thir lot in pain,

 Millions of Spirits for his fault by him amerc’t

 Of Heav’n, and from Eternal Splendors flung [610]

 For his revolt de él, yet faithfull how they stood,

 Thir Glory witherd.  As when Heavens Fire

 Hath scath’d the Forrest Oaks, or Mountain Pines,

 With singed top thir stately growth though bare

 Stands on the blasted Heath.  He now prepar’d [615]

 To speak;  whereat thir doubl’d Ranks they bend

 From wing to wing, and half enclose him round

 With all his Peers de el: attention held them mute.

 Thrice he assayd, and thrice in spight of scorn,

 Tears such as Angels weep, burst forth: at last [620]

 Words interwove with sighs found out thir way.

 O Myriads of immortal Spirits, O Powers

 Matchless, but with th ‘Almighty, and that strife

 Was not inglorious, though th ‘event was dire,

 As this place testifies, and this dire change [625]

 Hateful to utter: but what power of mind

 Foreseeing or presaging, from the Depth

 Of knowledge past or present, could have fear’d,

 How such united force of Gods, how such

 As stood like these, could ever know repulse?  [630]

 For who can yet beleeve, though after loss,

 That all these puissant Legions, whose exile

 Hath emptied Heav’n, shall fail to re-ascend

 Self-rais’d, and repossess thir native seat?

 For mee be witness all the Host of Heav’n, [635]

 If counsels different, or danger shun’d

 By me, we have lost our hopes.  But he who reigns

 Monarch in Heav’n, till then as one secure

 Sat on his Throne of him, upheld by old repute,

 Consent or custome, and his Regal State de él [640]

 Put forth at full, but still his strength of he conceal’d,

 Which tempted our attempt, and wrought our fall.

 Henceforth his might of him we know, and know our own

 So as not either to provoke, or dread

 New warr, provok’t;  our better part remains [645]

 To work in close design, by fraud or guile

 What force effected not: that he no less

 At length from us may find he, who overcomes

 By force, he has overcome but half his foe of him.

 Space may produces new Worlds;  whereof so rife [650]

 There went a fame in Heav’n that he ere long

 Intended to create, and therein plant

 A generation, whom his choice regard

 Should favor equal to the Sons of Heaven:

 Thither, if but to pry, shall be perhaps [655]

 Our first eruption, thither or elsewhere:

 For this Infernal Pit shall never hold

 Cælestial Spirits in Bondage, nor th ‘Abyss

 Long under darkness cover.  But these thoughts

 Full Counsel must mature: Peace is despaird, [ 660 ]

 For who can think Submission? Warr then, Warr

 Open or understood must be resolv’d.

 He spake: and to confirm his words, out-flew

 Millions of flaming swords, drawn from the thighs

 Of mighty Cherubim; the sudden blaze [ 665 ]

 Far round illumin’d hell: highly they rag’d

 Against the Highest, and fierce with grasped arms

 Clash’d on thir sounding Shields the din of war,

 Hurling defiance toward the vault of Heav’n.

 There stood a Hill not far whose griesly top [ 670 ]

 Belch’d fire and rowling smoak; the rest entire

 Shon with a glossie scurff, undoubted sign

 That in his womb was hid metallic Ore,

 The work of Sulphur. Thither wing’d with speed

 A numerous Brigad hasten’d. As when Bands [ 675 ]

 Of Pioners with Spade and Pickax arm’d

 Forerun the Royal Camp, to trench a Field,

 Or cast a Rampart. Mammon led them on,

 Mammon, the least erected Spirit that fell

 From heav’n, for ev’n in heav’n his looks and thoughts [ 680 ]

 Were always downward bent, admiring more

 The riches of Heav’ns pavement, trod’n Gold,

 Then aught divine or holy else enjoy’d

 In vision beatific: by him first

 Men also, and by his suggestion taught, [ 685 ]

 Ransack’d the Center, and with impious hands

 Rifl’d the bowels of thir mother Earth

 For Treasures better hid. Soon had his crew

 Op’nd into the Hill a spacious wound

 And dig’d out ribs of Gold. Let none admire [ 690 ]

 That riches grow in Hell; that soyle may best

 Deserve the precious bane. And here let those

 Who boast in mortal things, and wond’ring tell

 Of Babel, and the works of Memphian Kings

 Learn how thir greatest Monuments of Fame, [ 695 ]

 And Strength and Art are easily out-done

 By Spirits reprobate, and in an hour

 What in an age they with incessant toyle

 And hands innumerable scarce perform.

 Nigh on the Plain in many cells prepar’d, [ 700 ]

 That underneath had veins of liquid fire

 Sluc’d from the Lake, a second multitude

 With wondrous Art found out the massie Ore,

 Severing each kind, and scum’d the Bullion dross:

 A third as soon had form’d within the ground [ 705 ]

 A various mould, and from the boyling cells

 By strange conveyance fill’d each hollow nook,

 As in an Organ from one blast of wind

 To many a row of Pipes the sound-board breaths.

 Anon out of the earth a Fabrick huge [ 710 ]

 Rose like an Exhalation, with the sound

 Of Dulcet Symphonies and voices sweet,

 Built like a Temple, where Pilasters round

 Were set, and Doric pillars overlaid

 With Golden Architrave; nor did there want [ 715 ]

 Cornice or Freeze, with bossy Sculptures grav’n,

 The Roof was fretted Gold. Not Babilon,

 Nor great Alcairo such magnificence

 Equal’d in all thir glories, to inshrine

 Belus or Serapis thir Gods, or seat [ 720 ]

 Thir Kings, when Ægypt with Assyria strove

 In wealth and luxurie. Th’ ascending pile

 Stood fixt her stately highth, and strait the dores

 Op’ning thir brazen foulds discover wide

 Within, her ample spaces, o’re the smooth [ 725 ]

 And level pavement: from the arched roof

 Pendant by suttle Magic many a row

 Of Starry Lamps and blazing Cressets fed

 With Naphtha and Asphaltus yeilded light

 As from a sky. The hasty multitude [ 730 ]

 Admiring enter’d, and the work some praise

 And some the Architect: his hand was known

 In Heav’n by many a Towred structure high,

 Where Scepter’d Angels held thir residence,

 And sat as Princes, whom the supreme King [ 735 ]

 Exalted to such power, and gave to rule,

 Each in his Hierarchie, the Orders bright.

 Nor was his name unheard or unador’d

 In ancient Greece; and in Ausonian land

 Men call’d him Mulciber; and how he fell [ 740 ]

 From Heav’n, they fabl’d, thrown by angry Jove

 Sheer o’re the Chrystal Battlements: from Morn

 To Noon he fell, from Noon to dewy Eve,

 A Summers day; and with the setting Sun

 Dropt from the Zenith like a falling Star, [ 745 ]

 On Lemnos th’ Ægean Ile: thus they relate,

 Erring; for he with this rebellious rout

 Fell long before; nor aught avail’d him now

 To have built in Heav’n high Towrs; nor did he scape

 By all his Engins, but was headlong sent [ 750 ]

 With his industrious crew to build in hell.

 Mean while the winged Haralds by command

 Of Sovran power, with awful Ceremony

 And Trumpets sound throughout the Host proclaim

 A solemn Councel forthwith to be held [ 755 ]

 At Pandæmonium, the high Capital

 Of Satan and his Peers: thir summons call’d

 From every Band and squared Regiment

 By place or choice the worthiest; they anon

 With hunderds and with thousands trooping came [ 760 ]

 Attended: all access was throng’d, the Gates

 And Porches wide, but chief the spacious Hall

 (Though like a cover’d field, where Champions bold

 Wont ride in arm’d, and at the Soldans chair

 Defi’d the best of Paynim chivalry [ 765 ]

 To mortal combat or carreer with Lance)

 Thick swarm’d, both on the ground and in the air,

 Brusht with the hiss of russling wings. As Bees

 In spring time, when the Sun with Taurus rides,

 Pour forth thir populous youth about the Hive [ 770 ]

 In clusters; they among fresh dews and flowers

 Flie to and fro, or on the smoothed Plank,

 The suburb of thir Straw-built Cittadel,

 New rub’d with Baum, expatiate and confer

 Thir State affairs. So thick the aerie crowd [ 775 ]

 Swarm’d and were straitn’d; till the Signal giv’n.

 Behold a wonder! they but now who seemd

 In bigness to surpass Earths Giant Sons

 Now less then smallest Dwarfs, in narrow room

 Throng numberless, like that Pigmean Race [ 780 ]

 Beyond the Indian Mount, or Faerie Elves,

 Whose midnight Revels, by a Forrest side

 Or Fountain some belated Peasant sees,

 Or dreams he sees, while over-head the Moon

 Sits Arbitress, and neerer to the Earth [ 785 ]

 Wheels her pale course, they on thir mirth and dance

 Intent, with jocond Music charm his ear;

 At once with joy and fear his heart rebounds.

 Thus incorporeal Spirits to smallest forms

 Reduc’d thir shapes immense, and were at large, [ 790 ]

 Though without number still amidst the Hall

 Of that infernal Court. But far within

 And in thir own dimensions like themselves

 The great Seraphic Lords and Cherubim

 In close recess and secret conclave sat [ 795 ]

 A thousand Demy-Gods on golden seats,

 Frequent and full. After short silence then

 And summons read, the great consult began.

 The End of the First Book.

Question:

If you were raised a Christian, it is very hard to separate one’s knowledge of Adam and Eve with Milton’s ParadiseLost because Milton has had such a profound influence on how we see this prototypical couple. Still, Milton’s depiction of Satan as tarnished but potent, Adam and Eve as lovely and perfectly paired, and Eden as a paradise but not without care, form the backbone of this great literary epic. Milton poured his life and learning into the composing of Paradise Lost, and a brief study only scratches its surface. What do you find most compelling in the excerpts we read from it?

You must  post your response of at least 300 words.