Park University Negotiation Plan Paper

1. What is my goal in this negotiation? Why do I want to achieve this goal?2. What is my best alternative for achieving this goal if this negotiation is not successful?
3. Will I disclose my best alternative to the other side during this negotiation? (Usually “yes” if
your alternative is strong and “no” if your alternative is weak.)
4. How can I improve my best alternative? (By improving your alternative, you increase your
power.)
5. What is the other side’s goal in this negotiation? Why does the other side want to achieve
this goal?
6. What is the other side’s best alternative for achieving its goal if this negotiation is not
successful?
7. How can I weaken the other side’s best alternative? (By weakening the other side’s best
alternative, you increase your power.)
Issues That Are Likely to Arise
8. What issues are likely to arise during the negotiation? List them and after each issue note:
(In complex negotiations, you should consider using a spreadsheet to organize these
issues.)
9. Do I have a personal or long-term relationship with the other side? If so, how might this
relationship affect the analysis in #8? If not, do I want to build a relationship with the other
side?
10. Using the analysis at #8, what are the possible ways to create value for both sides—for
example, by trading issues or by building on interests? What questions do I want to ask the
other side when exploring these possibilities?
Authority When Agents Are Involved
11. Am I negotiating as an agent? If so, what are the limits of my authority?
12. If the other side is acting as an agent, what are the limits of the other side’s authority? (This
information should come from the principal, not the agent.)
This plan was adapted from this site: http://negotiationplanner.com/planner.html
WEEK FOUR‐ Negotiation
Exploring Culture and its role in healthcare conflicts
High-Context and Low-Context Cultures
High Context
Low Context
Group Orientation
Individual Orientation
Indirect, Nonconfrontational
Direct, Confrontational
Focus: Relationships
Focus: Actions & Solutions
Focus: Intuition & Feelings
Ambiguous and Indirect
Focus: Rationality & Facts
Open and Direct
Influence of Cultural Values:
1- A Hispanic woman had to sign an informed consent form for a hysterectomy. The patient spoke
no English and the hospital staff relied on her bilingual son to serve as the interpreter. When the son
explained the procedure to the mother, he appeared to be translating accurately and indicating the
proper body parts. His mother signed the consent form willingly. The next day, however, when she
learned that her uterus had been removed and she could no longer bear children, she became very
angry and threatened to sue the hospital.
Because it is inappropriate for Hispanic male to discuss her private parts with his mother the
embarrassed son had explained that a tumor would be removed from her abdomen and pointed to the
general area. The woman became quite angry and upset because a Hispanic woman’s status is derived
in large part from the number of children she produces.
Even speaking the same language is not always sufficient. Cultural rules often dictate who can
discuss what with whom. In general, it is best to use a same sex interpreter when translating matters
of a sexual or private nature.
2‐ A 36 year old Mexican man with second degree burns on his hands and arms. The skin grafts
had healed, and there was now a danger that the area would stiffen and the tissue shorten. The
only way to maintain maximum mobility was through regular stretching and exercise. The nurses
explained to the wife that feeding himself was an essential therapeutic exercise. She seemed to
understand the nurses’ explanation yet continued to cut her husband’s food and put it in his
mouth.
When one of the nurses, observed this, she took the fork out of the wife’s hand and told the patient
to feed himself because he needed to exercise his arms and hands. The wife appeared skeptical but
did not argue. When the nurse returned later, she saw the wife once again cutting her husband’s
food and putting it in his mouth. The nurses were irritated by the wife’s assistance with tasks the
patient could do himself. Fortunately a Cuban nurse on staff explained to the nurses that Hispanic
men expect to be waited on. Having the patient’s wife available to care for him most of the time
also eased their burden.
Failure to care for oneself is common in cultures that emphasize the family over the individual
(almost all cultures other than Anglo‐American). In many cases, Americans’ ethnocentrism blinds
them to the fact that life in a typical Hispanic household may be different than in the normal Anglo
home. Hispanic cultures emphasize family interdependence over independence. For them self care
is not an important concept, where someone is usually at home to care for the patient.
In this situation, it is of greater importance that when a family member is ill, love and concern are
demonstrated through care and attention. The nurses might have instructed the wife to help her
husband in ways not to hinder his rehabilitation. For example, show her how to massage lotion on
his hands.
3‐ A home health nurse, received an angry call from a Mexican American woman after visiting
her house the day before. Her infant had been crying and feverish the next morning and the woman
recalled the nurse had remarked the child was adorable. The nurse’s compliment and the fact that
she had not touched the child, led her to concluded that the nurse had given him the evil eye.
In Mexican culture, babies are considered weak and very susceptible to the power of an envious
glance. A simple compliment without touching the child, can bring on the evil eye. Touching the
person while complimenting him or her, neutralizes the power of the evil eye.
Not all Mexicans adhere to this belief, so it is important to pay close attention to non‐verbal clues
from the mother.
References :
Fernandez V.M.: Personal interviews and experiences with patients in Venezuela,
Colombia, Mexico and Cuba. 1995‐1999
Galanti G.A.: Caring for Patients from Different Cultures. University of Pennsylvania
Press, Philadelphia, 1991
Spector R.E.: Cultural Diversity in Health and Illness. Appleton‐Century‐Crofts, New
York, 1979
1- A 27 year old Arab man refused to allow a male lab technician to enter his wife’s room to
draw blood. She had just given birth. The staff finally convinced the husband of the need, he
reluctantly allowed the technician in the room. However, he took the precaution, of making sure his
wife was completely covered. Only her arm stuck out from beneath the covers. For Arab families,
honor is one of the highest values. Since family honor is dependent on female purity, extreme
modesty and sexual segregation must be maintained at all times. Male nurses should not be assigned
to female Muslim patients. In many parts of the world, female purity and modesty are major values.
In this instance his sense of responsibility and need to protect her modesty from very much an
“intrusive” health care experience for the most part could be curbed by a simple sign placed on the
door that says “Please Knock before entering, this pt. observes modest dress and requires the
announcement of your presence.” This would help communicate to the pt. and her husband that
we understand and wish to honor your modesty. This is empowering for the family. The rudeness or
sense of oppression of the pt. the nurses might have felt would be understandable. However, when
ever patients. or their families are rude or pushy we only need ask ourselves …. What is the
underlying motive behind rudeness …. The answer is fear.
2- When the nurse entered the room of her Iranian patient, she found the patient huddled on the
floor, mumbling. At first she thought the patient had fallen out of bed, but when she tried to help her
up the patient became visibly upset. She spoke no English and the nurse had no idea what the
problem was. The patient had been praying.
She was practicing her religion in the traditional manner. Since she was scheduled for surgery the
next day, she thought it was especially important to pray.
Devout Muslims believe they must pray to Mecca, the Holy Land, five times a day. Traditionally,
they pray on a prayer rug placed on the floor. If the nursing staff had some understanding of Muslim
customs, they could have arranged to provide the patient some privacy during certain times of the
day so she could pray.
3- A nineteen-year-old Saudi Arabian woman had just given birth. Her husband moved into the
hospital room with his wife immediately after she gave birth. He kept the door to the room shut, and
questioned everyone who entered, including the nurses. The nurses were not happy but felt they had
no choice but to comply.
Although the patient could speak some English, the only time she would speak directly to the nurses
was when her husband was out of the room. Otherwise, he answered all questions addressed to her.
He also decided when she would eat and bathe. As leader of the family, he felt it was his role to act
as intermediary between his wife and the world.
The truth is Labor hurts like hell, and technology is scary as hell, the idea of an epidural is often
misunderstood, and many women fear it therefore don’t opt for it. In the faith of Islam, heaven rests
beneath the feet of mothers …..Strange isn’t it for a male dominated society. The truth is women are
sacred and revered, often protected, not because she can’t handle herself or has no voice, but because
the solidarity of the family unit depends on her well being. 1
4- TRANSCULTURAL NURSING CARE OF AN ARABIAN PATIENT
Nurses need to be culturally competent in the prenatal care of women from Saudi Arabia. A basic
understanding of the Arab culture, attitudes, values, beliefs and practices is addressed.
References :
Galanti G.A.: Caring for Patients from Different Cultures. University of Pennsylvania Press,
Philadelphia, 1991
Laffrey, S.C., A.I. Meleis, J.G. Lipson, M. Solomon and P.A. Omidian. “Arab-American Health Care
Needs.” Social Science and Medicine 29(7): 877-83 (1989).
Lipson, J.G., A.E. Reizian and A.I. Meleis. “Arab-American Patients: A Medical Record Review.”
Social Science and Medicine 24(2): 101-07 (1987).
Meleis, A.I. “The Arab American in the Health Care System.” American Journal of Nursing 81(6):
1180-83 (June 1981).
1 Najah Bazzy R.N.
1‐ A middle‐aged Chinese patient refused pain medication following cataract surgery. When
asked, he replied his discomfort was bearable and he could survive without any medication. Later
the nurse found him restless and uncomfortable. Again the nurse offered pain medication. Again he
refused, explaining that her responsibilities at the hospital were far more important than his
comfort and he did not want to impose. Only after she firmly insisted that the patients comfort was
one of her most important responsibilities did the patient finally agree to take the medication.
Chinese are taught self‐restraint. The needs of the group are more important than those of the
individual. Another factor that may be involved in Asian’s refusal of pain medication is courtesy.
They generally consider it impolite to accept something the first time it is offered. The safest
approach for the nurse is to anticipate the needs of an Asian patient for pain medication without
waiting for requests. Nurses should be aware of Asian rules of etiquette when offering pain
medication, food or other services. But if the patients continue to refuse medication, their wishes
should be respected.
2‐ A Vietnamese woman was rushed to the hospital by her adult children. The emergency room
personnel discovered dark red welts running up her arms, shoulders and chest, yet the only
presenting complaint was dizziness. When questioned, her son explained that he had rubbed her
body with a quarter.
A nurse becomes concerned when she finds an elderly Chinese patient rubbing him self with a
quarter( she thought he was trying to hurt himself). When she took the coin away from the patient,
he became very upset, grabbed it back from her and continued to rub his arms and legs, leaving
dark red scratches.
A Vietnamese girl in her first year at an American elementary school, was not feeling well one
morning, so her mother rubbed the back of her neck with a coin. When the school staff discovered
the welts on the girls neck, they immediately assumed they were seeing a case of child abuse and
reported the family to the authorities.
In each case the patient was practicing a traditional form of healing known as coin rubbing. There
are several variations, including heating the coin, but they all involve vigorously rubbing the body
with a coin. This produces red welts, which can distract medical staff from the real problem or be
mistaken for child abuse. It is important to recognize and become familiar with this practice, and
not to be distracted from the real problem or mistakenly make accusations of child abuse.
Asians rubbing their children with coins is not any more abuse than Americans having thin pieces of
metal wrapped around their children’s teeth and tightened until their teeth move out of place.
Braces are usually applied for merely aesthetic reasons. Coin rubbing, at least, is an attempt to heal.
Apparently, it often works, only the failures show up in the medical system.
3‐ A 24 year old Korean man, visiting family in the United States, became ill and was
hospitalized. With a diagnosis of renal and respiratory failure, was put on strict bed rest because
exertion would be dangerous. Conflict arose when the family would get him out of bed to squat
over the bedpan on the floor. The nurse tried to explain that the bedpan was to be used in bed, but
they spoke little English and became very upset.
In most Asian countries, traditional toilets are holes in the ground. To eliminate from the bowels,
one squats over the hole. There is no other way to do it. Elimination is considered unclean and
certainly should not be done in bed. The patient was trying to maintain standards of cleanliness and
decency. He was using the bedpan in the only way he knew how. After a co‐worker explained the
patients behavior, the nurse called the doctor and had him rewrite the orders from strict bed rest to
bathroom privileges as needed with assistance. The patient and family were much happier and
more cooperative as a result.
4‐ A Vietnamese woman, after giving birth to a son, refuses to cuddle him but she willingly
provided minimal care such as feeding and changing his diaper. The nurse feeling sorry for the baby,
picked him up, cuddled him and stroked the top of his head. Both the mother and the husband
became visibly upset.
This apparent neglectful behavior does not reflect poor bonding, but instead indicates a cultural
belief and tradition. Many people in rural areas of Vietnam believe in spirits. They believe these
spirits are attracted to infants and are likely to steal them (by inducing death). The parents do
everything possible not to attract attention to their new born, for this reasons infants are not
cuddled or fussed over. This apparent lack of interest reflects an intense love and concern for the
child, not neglect.
Not only did the nurse attract attention to the infant but she touched him in a taboo area.
Southeast Asians view the head as private and personal, it is seen as the seat of the soul and is not
to be touched.
Another Vietnamese tradition that is seen as a sign of poor bonding is the delay in naming the infant.
The name is often decided on by the family in a naming ceremony that takes place at the parent’s
house with all relatives present. This custom emphasizes the infant’s importance as a member of
the family.
5‐ A 27 year old Vietnamese woman in the delivery room with very strong and closely spaced
contractions. The baby was positioned a little high and there was some discussion of a possible c‐
section. Despite her difficulties, she cooperates with the doctor’s instructions and labors in silence.
The only signs of pain or discomfort were her look of concentration and her white knuckles.
Vietnamese women, as most Asians, believe that a woman must experience pain and discomfort as
part of childbirth. To express these feelings, however, brings shame upon her. It might be very
disconcerting for an Asian woman accustomed to controlling her emotions to labor next to a highly
expressive Middle Eastern or Hispanic woman.
6‐ A Chinese woman in her mid‐twenties, had just given birth. The nurses became concerned
when she would not eat the hospital food and did not bathe. She would only eat foods her family
brought to her. The patient later explained her custom prevented her from bathing for seven days
after childbirth and permitted her only to eat certain foods.
This patient was practicing the traditional lying‐in period observed in much of Asia and Latin
America. It is believed that for a period of time after childbirth, the women’s body is weak and
susceptible to outside forces. New mothers are encouraged to avoid exercise and bathing (bathing
could introduce organisms into the body and cause illness.)
Pregnancy is thought to be a hot condition. Giving birth causes a loss of yang, or heat, which must
be restored. This is accomplished by eating yang foods such as chicken and avoiding cold liquids.
The woman is to rest, stay very warm, and avoid bathing and exercise. The price for not observing
these customs is aches, pains, arthritis and other ailments in later life.
Compromises can be made. The use of boiled water (removes impurities) may make a sponge bath
more acceptable. Do not assume the patient will follow orders that would violate the traditions and
wisdom’s of her own culture.
7‐ In China there is a strong cultural aversion to donating blood. By tradition, giving ones blood
is considered disrespectful to parents and ancestors. Blood is thought to contain qi, or life energy.
The Chinese believe the more blood in the body, the better. Health care workers there acknowledge
the wasteful distribution of what is known as sympathy blood in hospitals. This practice occurs
sometimes when a patient is about to die, a nurse will give him blood, just to make him feel better.
While some wealthy Chinese request blood transfusions in hopes to improve the qi.
This year, Beijing’s state owned Giyou Department Store held a lottery to
determine which of its employees would “voluntarily” give blood. Those selected
were handed $120 bonus‐twice the average monthly salary‐ and 15 days of
vacation. But they were still unhappy. “Thank God I wasn’t chosen,” said Mao Mao,
a 28‐year‐old telephone operator at the store. “I would never give my blood if I
could help it.” (U.S. News & World Report, 1998. (p.44))
References
Galanti G.A.: Caring for Patients from Different Cultures. University of Pennsylvania
Press, Philadelphia, 1991
Spector R.E.: Cultural Diversity in Health and Illness. Appleton‐Century‐Crofts, New
York, 1979
U.S. News & World Report, Why it’s really hard to draw blood in China Bay Fang
November 9, 1998. (p.44)

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