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TRANSCULTURAL COMMUNICATION Nursing 171 INTRODUCTION What happens when an Iranian doctor & a Filipino nurse treat a Mexican patient? When a Muckleshoot patient calls a Shaman to the hospital? When an Anglo nurse refuses to take orders from a Japanese doctor? Conflict & confusion, unless they all have some understanding of cultural differences OBJECTIVES To discuss the importance of communication with diverse populations To examine cultural differences in communication To describe cultural differences in verbal and nonverbal communication To examine individual cultural backgrounds and influence on health care beliefs, values, and behavior To discuss the use of interpreters to reduce the effects of language barriers CULTURE DEFINED Culture is a patterned behavioral response According to anthropology, it is “The complex whole which includes knowledge, belief, art, morals, law, custom and any other capabilities and habits acquired by a member of that society” CULTURE & RACE According to Webster’s: Culture is “the customary beliefs, social forms and material traits of a racial, religious or social group” Race is: “a family, tribe, people, or nation of the same stock” CULTURE Characteristics It is shared by all members of the same group It is an adaptation to environmental conditions It is a dynamic & ever changing process CULTURE & VALUES Values are perceptions of what is good or useful Each society has a dominant value orientation Cultural Norms are the rules by which human behavior is governed Values Influence our perception of others Reflect our identity Are the basis for self-evaluation Are the foundation for personal, professional, social, political & philosophical issues Motivate behaviors Give meaning to life & provide self esteem SUBCULTURES A group with shared characteristics not common to all members of the larger cultural group Subcultures can be categorized by: geographic region, age, sex, religion, social class, political party, ethnic identity, & occupational role MINORITY GROUP A group of people who because of physical or cultural characteristics receive different & unequal treatment from others Minority group members may see themselves as recipients of collective discrimination and often may have experienced prejudice by the majority group ETHNICITY Ethnic is derived from “Ethnos” (nation, people), relating to races or large groups of people classed according to common traits & customs (Webster) Includes the values, perceptions, feelings, assumptions & physical characteristics associated with an ethnic group Ethnicity influences our sense of space, time, & belonging It develops through daily contact with family, friends & associates CULTURAL GROUPS IN THE U.S. The pop. of the US is ^ in ethnic, racial & cultural diversity US census 2000: American Indian/Alaska Native Native Hawaiian 0.1% White 75.1% Latino 12.5% Black 12.3% Asian 3.6% Other Races 5.5% 0.9% PREDICTIONS By 2050: European descent Latino African descent Asian descent Shortly 52.8% 24.0% 13.6% 8.2% after 2050, white complexions will cease to be the majority population group in the U.S. 2005 Ethnic Groups for BSN’s* White 75.7% Black 11.7% Asian/Hawaiian/Pacific Islander 6.4% Hispanic 5.6% American Indian/Alaskan Native 0.7% *Minorities greatly underrepresented especially Latinos Source: AACN (American Association of Colleges of Nursing) CROSS CULTURAL COMMUNICATION Cross cultural and Intercultural are synonymous terms and defined as “communication between people with different language, national origin, race or ethnicity PRECONCEPTIONS Culture shapes perception We carry our cultural expectations (preconceptions) into all of our cross-cultural encounters Stereotypes and prejudices are preconceptions There are some reasons for perceived identities, common early experiences & values This does not mean all cultural members are the same as there is a wide range of individual characteristics ETHNOCENTRISM This is the assumption of cultural superiority (the belief that one’s ethnic group is better than all others) Oppression is the result of ethnocentrism Dominant culture: prevailing group within a society Cultural assimilation: the absorption of the minority into the dominant culture CULTURE & NURSING Nurses must learn culturally appropriate & competent care techniques When nurses consider race, ethnicity, culture & cultural heritage, they provide better care There is no “cookbook” approach There is much variation within different races, cultures & ethnic groups TRANSCULTURAL NURSING Transcultural nursing is “a humanistic and scientific area of formal study and practice which is focused upon differences and similarities among cultures with respect to human care, health (or wellbeing), and illness based upon the people’s cultural values, beliefs & practices” with the ultimate goal of culturally specific and culturally congruent nursing care Transcultural Assessment Model In this model, nursing is viewed as a culturally competent practice, which is client centered & research focused This model recognizes that culture influences how clients are viewed & care is given Each individual is culturally unique CULTURAL COMPETENCE This concept takes into account Communication Space Social organization Time Environmental control Biological variations CULTURAL ASSESSMENT Categories of information necessary for a thorough cultural assessment ethnic or racial background language & communication patterns cultural values & norms biocultural factors religious beliefs & practices health beliefs & practices SPATIAL BEHAVIOR The universal need for territoriality Meets needs for security, privacy, autonomy and self-identity Proximity to others (proxemics) is the study of human use of social & personal space Physical distancing from others varies with setting and is culturally learned PROXEMICS Western culture has 3 primary dimensions of space which are: Intimate zone 0 inches - 18 inches Personal zone 18 inches - 4 feet Casual zone 4 feet - 8 feet Public zone 8 feet - and beyond People in the US, Canada, & Britain require the most space whereas Latin Americans, Japanese, & Arabs need the least PROXEMICS Asians generally more sensitive to personal space Some West Indians maintain little space between friends, whereas outsiders are expected to maintain more distance Touching between members of the same sex is more common in Arabic cultures In Latin America, a handshake is seen as cold The embrace by hands around the shoulders is more normal Touching the shoulders of a Japanese man is seen as unpardonable HOSPTIALS Patients need some control of their space & rules to prevent invasion/misuse by others They need a place for belongings without fear of being bothered by others & freedom to do things, such as take a nap Gestures Know that certain hand gestures can be misinterpreted (pointing, waving, etc.) Head nodding is not always a sign of agreement (In Japan it means attentiveness) Laughing/Smiling: In U.S. it is a sign of happiness while in Asia it may indicate an embarrassing situation, or something unpleasant, and in Korea it means you are unintelligent COLORS In North American cultures, warm colors such as yellow, red & orange tend to stimulate creative & happy responses In some Asian countries, white is associated with a funeral In some African countries, red symbolizes witchcraft & death In western culture, cool colors such as blue, green & gray tend to encourage meditation & deliberation & discourage communication Traditional White American Middle-Class Values derived from the white, Anglo-Saxon protestant ethic (WASP) Independence Individuality Achievement Punctuality Assertiveness Future-oriented in Wealth Comfort Cleanliness Aggression Rationality Mastery of one’s own fate general, competition is valued over cooperation, and thus a person-to-object stance is favored over a person-to-person approach Utilizing Translators Professional Family Often children Sometimes same sex interpreters are preferred The nurse should always speak directly to the patient and family (not to interpreter) Avoid complicated Medical jargon Keep answers simple and concrete
