Download Intercultural issues Health Care

Intercultural Communication
Strategies
for Hospice Staff
Gail Henson, Ph. D.
Hospice Institute
December 14, 2004
Human beings draw close to one another
by their common nature, but habits and
customs keep them apart.
Confucius
Objectives



Identify 2 attitudes, behaviors that indicate
intercultural communication competence
Identify 2 barriers and challenges to
intercultural communication with Hospice
patients and families
Verbalize an understanding of reasons for
barriers and challenges to effective
intercultural communication
Objectives, continued


Describe 3 strategies for effective intercultural
communication to enhance intercultural work
in hospice role
Demonstrate behaviors that indicate
intercultural communication competence.
Intercultural contact occurs

Where?





Client base
Staffing in nursing homes, hospitals
Home setting
Where else?
What experiences can you share?
Objective 1
Why is there an increasing amount of
intercultural contact?



Immigration & refugee patterns
International interaction—e.g. through
business, media
Social contact—again through business,
internet, media
Objective 1
Who are Hospice’s culturally diverse clients?
Vietnamese
Bosnians
Indians
Cubans
Somali
Bantu
Objective 1
Iraquis
Mexicans
Definition of intercultural
communication
Circumstance in which people from diverse
cultural backgrounds interact with one another
Crucial element-culture and its impact on
cultural behavior
Objective 1
Definition of Intercultural
Communication Competence

Communication behavior that is
appropriate and effective in a
given context.
1
Objective 1
From Samovar & Porter
Communication between Cultures, 5th Ed
Indicators of intercultural
communication competence




Motivation
Knowledge—cultures, communication,
language
Attitudes—self-awareness, client’s
attitudes
Skills—listening, speaking, empathy
Objective 1
From Samovar & Porter
Communication between Cultures, 5th
Ed
What are some barriers & challenges to in
the Hospice setting?








Language
Gender roles, family structure
History of the culture, e.g. tribal warfare, ethnic
cleansing
Views of causes of illness
Experience with medical systems
Understanding, acceptance of treatment
Ethnocentrism, prejudice, stereotyping
Nonverbal communication patterns
Objective 2
Barriers & challenges may arise at any
point during interaction: reasons

Motivations, goals and
plans
Contradictory goals when
needs conflict
Cognitive skills inadequate
Goals change if there’s a
history of failure
Objective 3

Perception:




Low level of accuracy,
discrimination
Inaccurate stereotypes
Errors of attribution—
too much, too little
Halo effects—
perceiving people as
consistently good, bad
From Transcultural
Communication and Health
Care Practice: RCN.
Barriers arise because…..

Translation





Technical language
Idioms, slang
Dialect
Limited English
Proficiency
No linguistic equivalent
Objective 3

Feedback




Lack of skill
Withholding
Unrealistic or falsified
Perception errors
From Transcultural
Communication and Health
Care Practice: RCN.
Barriers may arise due to culture shock



Client/family may experience anxiety that
results from losing familiar signs and symbols
We all feel more comfortable with the familiar
Stages of culture shock: honeymoon phase,
culture shock, recovery, adjustment
Objective 3
The chief barrier to effective intercultural
communication is ethnocentrism



Notion that one’s culture is superior to any
other.
Ethnocentrism helps members of the culture
associate and identify with culture’s ideas,
ethics, pride, sense of personal worth
Consequences of ethnocentrism—negative or
derogatory evaluations of anything that’s
different. Political, moral, religious---
Objective 3
From Samovar & Porter
Communication between Cultures, 5th Ed
So what do we need to do to develop
intercultural communication skills?



Develop knowledge of other cultures and
their understandings of illness, life and death,
and their communication styles.
Develop attitudes open to others and to
understanding them.
Develop skills.
Objective 4
Develop knowledge of other cultures’
views of illness, life, death

Cultures differ in the
way they explain, treat,
and prevent illness,
suffering, death, dying,
life itself
Objective 4

Categories of systems:
biomedical
personalistic
naturalistic
Knowledge of causes of illness




Biomedical-terms
Spirits-personalistic
Naturalistic—
imbalance of humors,
yin and yang
Disharmony with
nature
Objective 4--handout
From Samovar & Porter Communication
between Cultures, 5th Ed
Knowledge of Treatments

Medicine

Alternative medicines
Cupping
Objective 4
Acupuncture
Shamans
Know the values that cause conflict
majority, minority culture

Future orientation


Informality
Direct, open, honest
Practical, efficiency
Materialism




Objective 4



Past, present
orientation
Formality
Indirect, “face,” ritual
Idealism
Spiritualism,
detachment
From Samovar & Porter
Communication between Cultures, 5th
Ed
Knowledge that culturally determined
family roles affect communication






Dominance patterns
Modesty
Female purity
Pregnancy
Childbirth
End of life
Objective 4
From Samovar & Porter Communication
between Cultures, 5th Ed
Knowledge of Prevention






Objective 4
Immunizations
Healthy living
Avoid violating cultural taboos
Astrology
Fatalism
Charms and amulets
From Samovar & Porter Communication
between Cultures, 5th Ed
Knowledge of interplay of religion,
spirituality + healthcare




Very strong
Biomedical model—limited
Has profound effect on outcomes
How does the client answer the question,
“Which is more important, the body or the
soul?”
Objective 4
From Samovar & Porter
Communication between Cultures, 5th
Ed
Healthcare practices must
accommodate cultural diversity
Attitudes from culture, religion
 Attitudes to pain
 Belief systems

Objective 4: handout
Develop strategies for effective
intercultural communication with Hospice
clients and families. Step 1




Recognize one’s reactions to differences
Consider the origins of these reactions
Consider how might the specific
communication barriers, challenges affect the
ability to provide services
Consider how the clients/families might
perceive one’s behavior.
Objective 4
From Samovar & Porter Communication
between Cultures, 5th Ed
We can all change



The brain is an open system
We have free choice to respond
Our communication behavior influences other
people.
Objective 4
Ward off potential problems




Reasons for
communication
problems vary
Seek similarities
Reduce uncertainty
Address withdrawal –
interpersonal,
intercultural,
international




Check
stereotyping
Confront
prejudice
Confront racism
Power
Objective 4
Recognize diversity



medical systems
treatment
ethnocentrism
Objective 4
Effective strategies

Develop strategies that are






Culture specific—knowing client base
Context specific—to Hospice
Culture general-common across all cultures
Learn the culture-specific norms for
nonverbal communication
Understand the communication style
Ask questions
Objective 4
From Samovar & Porter
Communication between
Cultures, 5th Ed
Improving intercultural effectiveness






Know yourself
Know your culture
Know your personal attitudes
Know your communication style
Monitor yourself
Consider the physical and human settings—

Timing, physical setting, customs
Objective 4
From Samovar & Porter
Communication between Cultures, 5th
Ed
Know your communication style in
intercultural settings




Do I seem tense or at
ease?
Do I smile often?
Do I repeatedly
interrupt?
Do I show sympathy
when there’s a crisis or
problem?




What does my tone of
voice suggest?
How do I react to being
touched by a client?
How do I handle
silence?
In this setting, do you
appear rushed?
Communication style involves vocal, verbal, non verbal
Objective 4
From Samovar & Porter
Communication between Cultures, 5th Ed
Effective strategies

Understand the communication style




Direct or indirect
Collectivist—group members weigh in on
decisions or Individualistic
Appropriateness of language for expressing pain,
emotion, dealing with ambiguity
Amount of conversation—high context, low
context
Objective 4
Improving intercultural effectiveness

Seek to understand diverse message systems



Learn different languages
Understand cultural variations in language use
Remember words are culture bound





Objective 4
Idioms
Ambiguity
Expressions
Subcodes
Nonverbal codes
Improving intercultural effectiveness










Achieving clarity
State your information clearly and precisely
Adjust to listener’s level of understanding without being
demeaning
Explain jargon
Use idioms carefully
Slow down speaking
Speak in smaller units
Repeat key points
Encourage listener to ask questions
Check for understanding
Objective 4
Develop empathy

Empathy is the bedrock of effective
intercultural communication
(Calloway-Thomas, Cooper, Blake)
Objective 4
Effective strategies

Learn the culture-specific norms for
nonverbal communication




Body behavior—attire, gestures, posture, facial
expressions, eye contact, touch, smell,
vocalizations (qualifiers), volume, noises,
laughing, accents, dialects
Space & distance
Timing
Silence
Objective 4
From Samovar & Porter
Communication between Cultures, 5th E
Strategies for effective intercultural
communication: Ask questions
—







What do you call the problem?
What do you think has caused the problem?
Why do you think it started when it did?
What does the illness do? How does it work?
What kind of treatment should the patient receive? What
are the most important results you hope the patient
receives from the treatment?
What are the chief problems the sickness has caused?
What do you fear most about the sickness?
Objective 4
Arthur Kleinman, Patients and Healers in the Context
of Culture. Berkeley, Univ of California Press, 1980.
Practice strategies


Which is more important to your client, the
body or the soul?
Case studies
Objective 5
Values of majority, minority cultures







Master over nature
Personal control over
environment
Doing/ activity
Time dominates
Human equality
Youth valued
Competition







Harmony with nature
Fate determines one’s
destiny
Being orientation
Personal relationships
Group welfare
Elders valued
Cooperation
Values of majority, minority culture

Future orientation


Informality
Direct, open, honest
Practical, efficiency
Materialism




Objective 4



Past, present
orientation
Formality
Indirect, “face,” ritual
Idealism
Spiritualism,
detachment
Intercultural Communication
Strategies
for Hospice Staff
Gail Henson, Ph. D.
Hospice Institute
December `4, 2004