Intercultural Communication

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Intercultural Communication:

1 Intercultural Communication


Outline Objectives UAE Situation Introduction Cultural terminology Application of nursing process References 2


3 Objectives Define culture and describe related terminology Discuss the concept of intercultural communication Apply the nursing process to the care of the culturally-diverse client Discuss characteristics of selected cultures as they relate to the nurse-client relationship

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“ If human beings are to survive and live in a healthy, peaceful and meaningful world, then nurses and other health care providers need to understand the cultural beliefs, values and life ways of people in order to provide culturally- congruent and beneficial health care ”. Leininger , 1978 4

UAE Situation:

5 UAE Situation “From 1993 to 2002, its (UAE) total population increased by 79% to nearly 3 million, growing by a high average of six% a year per annum. Foreigners now make up some 85% of the population.” , 2003 “This imbalance continues to pose a grave problem which threatens the stability of our society and the prospects for future generations.” Late Sheikh Zayed bin Sultan al-Nahyan In an attempt to remedy this imbalance, the UAE Ministry of Labour and Social Affairs launched its “cultural diversity policy” to create more balance in the labour market.

UAE Situation (cont.):

6 UAE Situation (cont.) “A study by the UN Economic and Social Committee for Western Asia states that the demography is one of the major challenges facing the UAE.” , 2003


7 Introduction With a culturally diverse nation, culturally sensitive communication is essential when providing nursing care to clients. Sutton (2000) noted that people from diverse backgrounds suffer disproportionately from “..cardiovascular disease, diabetes, HIV/AIDS, and every form of cancer.” Minority populations have limited access to health care and compliance with treatment .

Healthy People 2010:

Healthy People 2010 Goals : Increase quality (Quality of Life) and years of healthy life (Life expectancy) Eliminate health disparities Thus, cultural competence in communication is an essential nursing skill, otherwise nurses may respond inappropriately to their clients. 8


9 Culture Culture is a multidimensional concept with community, psychosocial and ethical aspects. As a community concept: Culture describes the shared values, beliefs, customs, language, and behaviors held by designated group of people. Culture specifies boundaries and behaviors that distinguish those who belong from those who do not. Example: Culture of terrorism, culture of illiteracy


10 Culture As a psychosocial concept: Children learn psychosocial aspects of their culture from their parents, peers, teachers, religious symbols. For new immigrants, cultural dilemmas occur when values differ for new immigrants. Language of illness varies significantly from culture to culture Western culture favors a more individualistic approach than Eastern cultures


11 Culture As an ethical concept: Ethical dilemmas occur when moral and health practices are not congruent Significant ethical dilemma: disease and death as natural events vs. aggressive treatment. Respectful care requires the consideration of the client’s values, preferences, and needs compatible with client’s culture.

Cultural Competence:

12 Cultural Competence Cultural competence in health care requires the nurse to adapt individualized nursing skills to fit the cultural context of each client Cultural competence also requires culturally appropriate ways of speaking to clients Cultural competence starts with self-awareness by reflecting one one’s own values, attitudes, as well as knowledge of other’s culture

Cultural Terminology:

13 Cultural Terminology Multiculturalism Acculturation Subculture Cultural diversity Cultural relativism Ethnicity Ethnocentrism Intercultural communication


14 Multiculturalism “ Emic ” ideas and beliefs : “secrets” not willingly shared with cultural strangers, such as nurses, unless stranger is trusted Transcultural nurses are expected to tease out “ emic ” data when trust is established In contrast, “ etic ” (outsider’s) knowledge, such as the nurse’s professional ideas, may be very different from “ emic ” views and experiences. Both “ emic ” and “ etic ” knowledge are important to assess and guide nurse’s thinking and decisions with clients


Multiculturalism Describes heterogeneous society in which several diverse cultural world views can coexist with some general (“ etic ”) characteristics shared by all cultural groups, and some (“ emic ”) perspectives that are unique to a particular group Thru an understanding of the contrasts between the emic and etic views of the same health care situation, the nurse is able to tailor communication in ways that respect these differences and enhance collaboration to find a common communication meeting ground 15


16 Acculturation Process by which an individual or group from Culture A learns how to take on many (but not all) values, behaviors, norms, and lifeways of Culture B It is, however, interesting that an individual from Culture A may still retain and use some traditional values and practices from the old culture, but this does not interfere with taking on new culture norms With acculturation, one generally becomes attracted to another culture for various reasons


Acculturation Cultures are selective in what they choose to change and retain Socioeconomic status and education affect level of acculturation Nurses assess individuals or families to determine On other hand, important values of people from another culture can and should be accommodated, whenever possible 17


Assimilation Term used to describe a person’s adoption of customs, values, and language of the dominant culture, such that the political or ethnic identification with original culture virtually disappears Assimilation occurs over several generations Children of first generation of immigrants vs. subsequent generations 18


19 Subculture Subgroups who deviate in certain ways from a dominant culture in values, beliefs, norms, and ways of living with some distinctive features that characterize their unique way of life Examples: homeless, substance abused, people living with AIDS, mentally ill, teenagers, etc. Nurses are supposed to familiarize themselves with subcultures as they have different care and health needs than larger groups

Cultural Diversity :

20 Cultural Diversity Refers to variations and differences among and between cultural groups resulting from differences in skin color, language, dress, gestures, values, norms, and other cultural aspects Cultural diversity helps nurses to value differences among their clients and provide culture-specific care practices But even among members of particular racial, ethnic or religious group, differences occur Also certain emotions are universal experiences “tears have no color”, sadness over loss of loved ones

Cultural Relativism:

21 Cultural Relativism A concept that proposes that each culture or ethnic group should be evaluated on basis of its own values and norms of behavior and not against another. It refers to the belief that cultures are neither inferior or superior to one another, and that all cultures are equally worthy of respect This concept allows nurses to care for clients w/o judging them; allows nurses to transcend their own beliefs; and enables nurses to identify with people throughout the world


22 Ethnicity Ethnicity is not the same as culture Ethnicity refers to racial and often skin-color identity of particular groups related to specific and obvious features based on national origins An ethnic group is a social grouping of people who share a common racial, geographic, religious or historical culture Common ethnic groups include Hispanics, Indians, African-American, etc. Not always a positive experience (enslavement of Africa-Americans, ethnic cleansing); this at times spills into health care


23 Ethnocentrism Belief that one’s own culture is superior to others, leading to stereotypes Age, race, and disability discrimination are examples of ethnocentrism, (example p. 237) Ethnocentrism carried to extreme can foster the belief that one culture has the right to impose the opinions of its culture onto another, leading to discrimination, property confiscation, violence and terror Nurse providing care to clients from different cultures must make every effort to see each client individualistically

Intercultural Communication:

24 Intercultural Communication Communication in which sender and receiver of message belong to different cultures Intercultural communication takes account of not only differences in words and dialects, but also voice volume, vocal tone, and nonverbal differences (eye contact, gestures, touch, etc.) Nurse communicating with clients with limited language skills, should use precise language, avoid slang and clichés, and allow more time Goal of intercultural communication in nurse-client relationship is to find common ground thru which people from different cultures can connect in meaningful way Nurses can sometimes transcend cultural differences with caring behaviors that are universally understood (Example p. 241)

Application of Nursing Process:

25 Application of Nursing Process To address communication needs of a culturally diverse client: Develop self-awareness of own cultural values and biases Develop good understanding of client’s cultural values, health beliefs and practices


26 Assessment Introduce yourself and ask how client prefers to be addressed Nurse to use topic questions in Table 11-1 to better understand the cultural implications of client’s illness Remember that illness is not a single concept but rather a complex personal experience, colored by cultural norms, values, social roles and religious beliefs

Cultural Assessment Sequence:

27 Cultural Assessment Sequence To understand needs of client from a different culture, nurse performs cultural assessment consisting of: General assessment of cultural care issues that could affect tx process (response to pain, need for privacy/body exposure, number of people involved in decision making, hygiene practices, touch, eye contact, etc.) Problem-specific assessment allows the nurse to fully understand each client’s unique health care situation from cultural perspective Integration of general & specific understandings into comprehensive care plan that has meaning to client (diet free of pork to Muslim client in US)

Nursing Diagnoses:

28 Nursing Diagnoses NANDA identifies 3 nursing diagnoses: Impaired verbal communication related to cultural differences Impaired social interaction related to sociocultural dissonance Noncompliance related to patient’s value system: beliefs about health and cultural influences

Factors in Planning:

29 Factors in Planning Language barriers Defining role relations Level of family involvement Time orientation


30 Intervention Empowering clients Using culturally based teaching ( LEARN ) L isten to client’s perspective E xplain understanding of health pbm, using simple terminology, ask for validation A cknowledge differences and similarities R ecommend interventions and N egotiate mutually acceptable tx approaches Use of interpreters

Application to Special Populations:

31 Application to Special Populations Muslim-Arab Clients Ethical Considerations


Evaluation Were the learning activities culturally specific and sufficient to produce the desired outcomes? Is client satisfied with outcomes? What cultural modifications need to be made to provide client with the content and process to achieve objectives? Did the nurse display any biases that might have gotten in the way of providing culturally sensitive care? 32


References Arnold, E.C., & Boggs, K.U. (2007). Interpersonal relationships. Professional communication skills for nurses (5 th ed.). St. Louis, MI: Saunders Elsevier. Leininger , M., & McFarland, M.R. (2002). Transcultural nursing (3 rd ed.). McGraw Hill. 33

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