Trans culture

communication
 Objectives
After compilation this lecture the student should be able to :
1. Identify barriers to effective transcultural communication between
patients and client
2. Identify and describe the tree of racism that are found in our society
3. Define ethnocentrism and explain hoe this barrier blocks transcultural
communication
4. Describe the different types of language barriers that can impede
transcultural communication
5. develop awareness of the various dialects, regionalisms , and idioms that
distinguish the speech of people form different races, ethnic groups and
regions
6. Identify ways in which differing perceptions and expectations can
complicate communications between nurses and patients
Introduction
Communication between nurse and patients
from different cultures is often
complicated by different values, beliefs,
traditions, expectations, and languages.
When the nurse work with patients form
multicultural backgrounds, nurses will find
that differences raise barriers to trans-
cultural communication.
Language differences possibly play the
most important obstacle to providing
multicultural health care because
clients come from all over the world
and they affect all stages of the
patient caregiver relationship.
A. Basic Related Concepts:
❖ Communication occurs when a person (the sender (S)
or encoder) sends a message to another person (the
receiver (R) or decoder).
❖ Communication is most effective when the message
received is exactly the same as the message that was
sent and both sender and receiver agree on the
meaning of the message.
❖ Communication fails when (1) the sender’s message is
blocked for some reason and the receiver never gets
the message; or (2) the message is distorted.
Basic Related Concepts: ---- cont,
❖ Distortion of message occurs when the message has as different
meaning for the receiver than the sender intended. Distortion is
amplified when both receiver and sender fail to clarify message.
Factors that can distort message: anger, fatigue, fear, pain, and
anxiety.
❖ Communication may be blocked. Factors that foster blockage:
different cultural, ethnic, racial, socioeconomic, or educational
backgrounds.
❖ Example: Asians (Filipinos, Japanese, Chinese, etc) may silently
accept a physician’s recommendation even when they do not
understand the reasons for the medications or procedures that
are ordered.
 B. Types of Communication:
1. Verbal – includes spoken or
written word. Language is the
code senders use to carry
their message. Language
barriers can cause severe
communication problems
between S and R.
Causes:
❑May arise from use of the language (e.g. S is
speaking English and the R is speaking
Spanish.
❑Can arise when the S uses technical terms,
abbreviation, idioms or regionalisms that are
unfamiliar to the receiver (e.g., when a nurse
uses medical terms when explaining a
procedure to a layperson).
Causes:
Every culture has standards for verbal
communication – especially for
a) word choice,
b) the degree of emotion considered
appropriate,
c) volume and speed of speech,
d) inflection,
e) directness, and
f) the use of silence.
a) Word Choice:
✓American speech is filled with abbreviated
words, slang, and jargon. Americans tend to
communicate in an informal way with
superiors and subordinates alike.
✓ Japanese use of language is distinguished
by many levels of formality and directness
depending upon the status of the people who
are conversing. Distinctions are also made
between men’s and women’s speech. Choice of
word depends largely on the relationship
between the people who are communicating.
 Emotional Expressiveness, Tone, Pitch, Volume of Voice, and Speed of Speech

✓White American middle-class culture values a controlled tone and some

emotional restraint
✓Many black Americans are more verbal and value emotional
expressiveness in conversation
✓ Appalachians – speak very slowly and seem to dwell on each word, giving
their speech a hesitant, disjointed quality.
✓Many Asians and Native Americans display great emotional restraint in
their speech patterns, speaking slowly and quietly. These cultures value
the ability to endure pain and grief with silent stoicism.
✓Southern Europeans are typically warm, expressive; will loudly express
their discomfort
✓Hispanics use a lot of endearing words, are warm and expressive.
Voice Inflection
When emphasis is placed on certain words more
than the words themselves.
Example: “What do you need now?”
“What do you need now?”
Directness in Speech
Americans – quite direct, they go straight to the
point rather than wasting time on lengthy
preliminaries or long silences.
Japanese – strive to be polite, diplomatic, and
tactful
Mexicans –may take time for small talk and then
lead into a discussion.
 Use of Silence

➢Some cultures value silence, whereas others

feel that silence is a vacuum that must
immediately be filled with word.
➢Among Native Americans – silence is an
essential element of showing respect and
understanding.
➢ In some Arab cultures, silence may indicate
concern for personal privacy.
➢In French, Spanish, and Eastern European
cultures silence may be a sign of agreement.
➢ Silence during a conversation gives each person
an opportunity to speak without having to
interrupt.
 B. Nonverbal Communication
It has been estimated that as much as 2/3
of all communication is non-verbal consisting
of messages that are conveyed via body
language and facial expressions.
 B. Nonverbal Communication

Gestures and Facial Expressions

Common types of nonverbal communication may
differ from culture to culture. A smile may imply
acceptance and compliance, or may mean respect
and social grace, or flirting.
In nearly all cultures, people used their mouths and
eyebrows to convey anger, surprise, pleasure, fear
and hand gestures to convey openness or
intimidation.
 Eye Movement and Eye Contact

“The eyes are the windows of the soul.”

➢When a person avoids eye contact, many Americans assume that
it is a negative sign. It is not unusual for an American to say, “Look
at me when I talk to you.” or “She must be lying. Did you notice that
she avoided looking at us?”
➢American physician and nurses usually note if a patient avoids eye
contact when they perform a psychosocial assessment.
➢Some Asians and Native Americans believe that prolonged eye
contact is rude and an invasion of privacy.
➢ Native Americans may direct their eyes to the floor when they
are paying attention or thinking.
➢Muslim women may avoid eye contact as a show of modesty.
 Touch

Touch patients only when you know touching is

acceptable.
Conveys many meanings: gentle, sensual, harsh or brutal
We use touch to connect with others and to establish a
feeling of warmth, approval, emotional support, and
intimacy.
Touch can also indicate anger, aggression, frustration,
and a desire to control others by invading their personal
space.
Cultures have specific guidelines for times and
situations when it is acceptable to touch others.
Handshake – a form of greeting, esp. when introduced;
consummate a business deal
 Touch ----cont

Native Americans – view a firm handshake as aggressive

and even offensive.
Many Westerners think nothing of kissing or hugging a
friend as a form of greeting when meeting in public
places; in traditional Asian cultures, such behavior is
reserved for intimate relationship in private settings.
In many Asian cultures (Indians, Vietnamese, Japanese,
Thai) avoid touching the head because the head has
been traditionally considered to be the “the abode of
the spirit.”
 Posture

➢Helps to communicate how one

person feels towards another
➢Middle-class Americans may lean in
the direction of individuals they like
or respect
➢Posture can also communicate a
tense or relaxed state
➢Rigid muscles and a flexed body may
indicate physical pain.
 C. Barriers to Transcultural Communication
➢There are eight barriers to transcultural communication in
nursing :
(1)Lack of knowledge
(2)Fear and distrust
(3)Racism
(4)Bias and ethnocentrism
(5)Stereotyping
(6)Ritualistic behavior
(7)Language barriers
(8)Differences in perceptions and expectation
 Barriers to Transcultural Communication
(1) Lack of knowledge
The failure to understand cultural differences in
values, behaviors, and communication styles is a
common stumbling block for nurses who work in
transcultural settings. Nurses who are not
knowledgeable about cultural differences risk
misinterpreting patients’ attempts to
communicate. As a result, patients may not
receive the proper care.
 C. Barriers to Transcultural Communication
➢ Lack of knowledge – remember that each culture
dictates what is “normal” when sick.
✓Japanese patients might react with silent
obedience to your request
✓Italian patients might dramatically express their
discomfort
 (2) Fear and distrust
Fear, dislike, and distrust are emotions that all too
often erupt when people from diverse cultures
first meet. Rothenburger (1990) has identified
seven stages of adjustment that individuals pass
through during their initial encounters with people
of different cultures that they do not know or
understand.
These stages are:
✓ Fear Respect
✓Dislike Trust
✓ Distrust Like
✓ Acceptance
 (3) Racism
Racism in American nursing is a formidable
barrier that strangles transcultural
communication between nurses and patients, and
between nurses and other health care providers.
(3) Racism
Barbee’s article points out that there are three types of racism:
1. Individual racism: Individuals are discriminated against
because of their visible biological characteristics; for
example, black skin or the epicanthic fold of the eyelid in
Asians.

2. Cultural racism: An individual or institution claims that its

cultural heritage is superior to that of other individuals or
institutions.

3. Institutional racism: Institutions (universities, businesses,

hospitals , schools of nursing) manipulate or tolerate policies
that unfairly restrict the opportunities of certain races,
cultures, or groups.
(4) Bias and Ethnocentrism
Whatever their cultural background, people have
a tendency to be biased toward their own
cultural values, and to feel that their values are
right and the values of others are wrong or not
as good.
Many people are surprised to discover that the
values and actions they so admire in their own
culture may be looked upon with suspicion by
people from other cultures, who are equally
biased.
(5) Stereotyping
A cultural stereotype is the unsubstantiated
assumption that all people of a certain racial and
ethnic group are alike.
For example: All Eskimos are reserved, deliberate,
and noncommittal. Certainly, some or even the
majority
of Eskimos may be reserved, deliberate, and
noncommittal, but it is cultural stereotyping to state
that all Eskimos have these traits. Stereotyping is
particularly destructive when negative traits or
characteristics are imposed on all members of a
cultural group
(6) Ritualistic Behavior
A ritual is a set procedure for performing a
task. In the past, students in nurse’s training
were taught to perform their duties in a
ritualistic manner.
Even today, nursing rituals persist. Many
nursing rituals are beneficial, such as
always performing certain safety checks
when preparing and administering
medications.
(7) Language Barriers
Language provides the tools (words) that
allow people to express their thoughts and
feelings. Thus, language barriers present a
grave threat to transcultural communication
between nurses and patients. There are
several types of language barriers that
impede communication in the United States.
These barriers include:
a. foreign languages,
b. different dialects and regionalisms, and
c. idioms and “street talk.”
(8) Conflicting Perceptions and Expectations
When people from different cultures try to
communicate, their best efforts may be thwarted by
misunderstandings and even serious conflicts. In
health care situations, misunderstandings often arise
when the nurse and patient have different
perceptions and expectations, and consequently
misinterpret each others’ messages.
Misunderstandings due to cultural differences
commonly arise in situations involving food and drink.
(8) Conflicting Perceptions and Expectations
Imagine that you are taking care of a
postoperative Vietnamese female patient who,
as her culture dictates, is almost constantly
attended by her family. You want to clearly
instruct family members that they are not to
give the patient anything to drink. As the
family speaks only Vietnamese, you motion
that the patient is not to drink, and you
explain via an interpreter that the patient
must not drink.
D. The Use of an Interpreter: A way to
resolve language barrier.
When obtaining the precise meaning of
words in a language that is difficult, it is
best for health care providers to obtain
someone who can interpret the meaning
and message, not just translate the
individual words.
 TRANSCULTURAL ASSESSMENT: BASIC PRINCIPLES OF CULTURAL
ASSESSMENT

➢All cultures must be viewed in the context in which

they have developed. Cultural practices develop as a
“logical” or understandable response to a particular
human problem, and the setting as well as the problem
must be considered.
➢ Understanding the premises of the behavior must be
examined. Example: The Hispanic clients refusal to
take a “hot” medication with a “cold” liquid is
understandable if the client is aware that many
Hispanic patients adhere to hot/cold theories of illness
causation.
TRANSCULTURAL ASSESSMENT: BASIC PRINCIPLES OF CULTURAL
ASSESSMENT

➢The meaning and purpose of the behavior must be

interpreted within the context of the specific culture.
Example: Close relationship often seen in Asian and
Hispanic cultures may be viewed as abnormal in
European American families.
➢There is such a phenomenon as intracultural variation.
Not every member of a cultural group displays all the
behaviors that we might associate with that group.
Example: Not every Filipino will adhere to the same
methods of folk healing
 H. BARRIERS TO HEALTH CARE

In order for people to receive adequate health

care, a number of considerations need to be
addressed.

Availability: Is the service available and at a

time when needed? For ex.: No services after
6:00 p.m.

Accessibility: Transportation services may not

be available, or rivers and mountains may make
it difficult for people to obtain needed health-
care services when no health provider is
available in their immediate region?
 H. BARRIERS TO HEALTH CARE

Affordability: The service is available, but the client does

not have financial resources.

Appropriateness: Maternal and child services are available,

but what might be needed are geriatric and psychiatric
services.

Accountability: Are health-care providers accountable for

their own education and do they learn about the cultures of
the people they serve?
 H. BARRIERS TO HEALTH CARE

Adaptability: A mother brings her child to

the clinic for an immunization. Can she get
a mammogram at the same time or must she
make an appointment?

Acceptability: Are services and client

education offered in a language preferred
by the client?