Cross-Cultural Communication
Tamika R. Sanchez-Jones PhD, MBA, APRN, BC
OBJECTIVES
To discuss the importance of communication with diverse populations
To examine cultural differences in communication
To describe barriers to cross-cultural 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 bilingual interpreters to reduce the effects of language barriers
The ability to effectively send and receive messages is essential to communication and allows individuals to interact with each other. This interaction may be especially difficult when the sender and receiver do not share the same cultural background or language. Culture influences how each individual perceives and responds to the world, solves life’s problems, and interacts with others. Although there is no single definition of culture, it may be defined as the sum total of behavioral norms, methods of communication, patterns of thinking, and beliefs and values of a designated group of people that can be passed down to the next generation. This may be evident in day-to-day interactions. When shopping or engaging in social activities, you may encounter people who shop in the same stores or wear the same clothes but who look and talk differently than you. During these interactions, regardless of how brief, there may be awareness of the influence of culture on communication. Differences in communication across cultures are evident in language, verbal and nonverbal behaviors, and silence.1
Why is this significant to nursing? When trying to understand the health belief system of a client it is necessary to explore culture. Recent demographic trends indicate increasing cultural and ethnic diversity in the United States leading to a more diverse client population. Within the health care setting, nurses and other providers understand the importance of communication when working with clients. However, there is less understanding of the impact of culture on the communication process. Nurses spend a great deal of their time with clients and therefore must realize the importance of culture as it relates to communication. Transcultural nursing skills and knowledge will be necessary to provide competent care to the rapidly changing, heterogeneous population.
Learning to value cultural and ethnic diversity involves the appreciation of variations in culture as well as negotiating skills for effective communication. Communication with individuals from diverse backgrounds is especially complex because of the influence of culture on language and communication. When communicating with individuals, the nurse should be aware of cultural beliefs and behaviors and communicate (both verbally and nonverbally) in a way that meets the clients’ cultural needs. Meeting the needs of clients requires the ability to provide and understand clear and accurate communication.
Intercultural or cross-cultural communication refers to the presence of at least two individuals who are culturally different from each other on important attributes such as value orientations, preferred communication codes, role expectations, and perceived rules of social relationships.2 Often, speaking the same language does not guarantee understanding between client and nurse.3 In intercultural communication, differences in communication styles are often met with confusion, impatience, and misunderstanding. Imagine how difficult it would be to communicate when the listener does not share the same language, context, or symbolism. How could you teach a newly diagnosed insulin-dependent diabetic about dietary management and medication regimens when there is not a shared language or culture? How could you assist in developing menu plans when you are unaware of culturally specific foods? How could you explain the use of insulin and the procedure for administration if you do not speak the language? These issues represent the difficulties in intercultural communication. Table 5-1 offers guidelines for cross-cultural communication.
Although knowledge of cultural rules and norms can help to avoid mistakes in communication, it is not possible for individuals to be familiar or competent with the differences in communication patterns for all cultures. Even when you are aware of cultural differences, it is difficult to consider the subtle differences among individuals within the same culture. Nurses must be open to subgroup variability within cultures. Differences may be seen within the culture based on factors such as gender, educational level, income, and status. Additionally, recognize and apologize for mistakes in communication to maintain trust and respect for communication.4
Table 5-1 Guidelines for Cross-Cultural Communication | ||||||
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▪ OVERCOMING BARRIERS TO PROVIDING CROSS-CULTURAL CARE
When caring for clients from diverse populations, nurses should be aware of their own cultural behaviors and habits. Each individual is socialized into a cultural environment. Assuming cultures are similar to your own will lead to confusion and misinterpretation of messages. It is better to expect differences and explore ways in which these differences will affect communication. Nurses may have little awareness of how their own cultural beliefs define the type of care they give or messages they send to clients. Both nonverbal and verbal communication skills are important in the nursing process. How would a client from a different culture respond to personal questions regarding health practices or personal history? How do others perceive personal uses of distance, gestures, and dialect? Cultural differences in both verbal and nonverbal communication will be discussed later in this chapter.
Cultural barriers may also be present in the way in which members of an ethnic group perceive health, illness, and discharge following treatment.5 Effective communication is the ability to understand the other person’s perspective. For example, clients who view illness as a punishment or curse may delay medical treatment or seek medical treatment only as a last resort.
Respect for cultural traditions will take into account alternative health care practices and beliefs such as the use of lay practitioners and complementary therapies while incorporating medical interventions.
Respect for cultural traditions will take into account alternative health care practices and beliefs such as the use of lay practitioners and complementary therapies while incorporating medical interventions.
Ethnocentric values may make it difficult for the nurse to be objective in providing care, especially to diverse populations. Ethnocentrism is the belief that one’s own culture is superior to that of another.6 Being proud of one’s own culture is appropriate, but the difficulty begins when there is less respect for the values or beliefs of the other person. Listen to the client’s view with an open mind. The nurse should refrain from defending or imparting their own cultural beliefs.4 For example, instead of trying to understand a newly admitted client from the client’s cultural context, the ethnocentric nurse would try to understand the client within the nurse’s own cultural context. Nurses should respect the differences in behavior and knowledge that may influence health care practices and recognize that their own ideas or behavior may not be best for every client.7 Ethnocentrism may make it difficult for the nurse to accept client decisions not based on the nurse’s culturally derived value system or beliefs.
Case example
Mr. Rodriquez, a 65-year-old Hispanic male, was admitted at 8:00 p.m. to the hospital following a stroke. Visiting hours were just ending, and Mr. Rodriquez was accompanied by his wife and four grown children and their spouses. The nurse felt overwhelmed with so many relatives present, but they were insistent that they needed to stay with the client through the night. What would be the nurse’s most appropriate course of action?
▪ HIGH- AND LOW-CONTEXT CULTURES
Hall8 conceptualized high- and low-context cultures. When individuals attempt to communicate, it is important to understand the amount of information transmitted through words versus the context of the situation. Context refers to the situation and/or environment where the communication occurs and helps to define the communication. Culture is also considered to be context and may set the stage for communication. However, cultures may differ in the amount and type of information conveyed through verbal and nonverbal cues.
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