Cross Cultural Communication: Verbal and Non-Verbal Communication, Interpretation and Translation

Abstract

Effective cultural communication is a key to establishing trust, obtaining accurate health assessments, and implementing culturally congruent care with patients and their families. Cross-cultural communication includes verbal and nonverbal communication. Verbal communication involves preferred language and dialects, contextual use of the language, preferred greetings, voice volume and tone, health literacy, and the need for interpretation and translation. Nonverbal communication is just as important as verbal communication and encompasses temporality, acceptance of touch, degree of eye contact, facial expressions, and spatial distancing. Sign languages, of which there are numerous ones, are a combination of verbal and nonverbal communication. Recommendations for clinical practice, administration, education and training, and research are included.

Guideline: Nurses shall use culturally competent verbal and nonverbal communication skills to identify clients’ values, beliefs, practices, perceptions, and unique healthcare needs.

Douglas et al. (2014: 112)

Appendices

Appendix 1: Communication Exercise

Effective communication is essential in the delivery of culturally congruent health and nursing care. For cultural communication to be effective, the healthcare providers need to understand their own communication practices. The following exercise will assist providers to understand their own communication practices.

Instructions

• 1. Identify your own cultural identity and personal communication practices and how they differ with family, friends, and strangers, including patients.

• 2. Investigate the scholarly literature on your culture after you have completed the exercises.

• 3. Identify how your communication patterns differ from what was in the scholarly literature.

• 4. Posit why these personal practices differ.

Note: Variant characteristics within a culture can be used as a guide to addressing the statements below. These variant cultural characteristics include:

Nationality	Age	Skin color
Race	SES	Physical characteristics
Ethnicity	Occupation	Parental status
Gender	Marital status	Political beliefs
Sexual orientation	Educational status	Religious affiliation
Gender issues	Health literacy	Military experience
Enclave identity	Urban vs. rural residence
Length of time away from country of origin
Reason for migration: sojourner, immigrant, undocumented status

Once this exercise is completed, it should be shared with others for a discussion. This exercise can be used in academic classes, continuing education classes, and in-services.

• Identify your cultural ancestry. If you have more than one cultural ancestry, choose one for the sake of this exercise.

• Explore the willingness of individuals in your culture to share thoughts, feelings, and ideas. Can you identify any area of discussion that would be considered taboo?

• Explore the practice and meaning of touch in your culture. Include information regarding touch between family members, friends, members of the opposite sex, and healthcare providers.

• Identify personal spatial and distancing strategies used when communicating with others in your culture. Discuss differences between friends and families versus strangers.

• Discuss your culture’s use of eye contact. Include information regarding practices between family members, friends, strangers, and persons of different age groups.

• Explore the meaning of gestures and facial expressions in your culture. Do specific gestures or facial expressions have special meanings? How are emotions displayed?

• Are there acceptable ways of standing and greeting people in your culture?

• Discuss the prevailing temporal relation of your culture. Is the culture’s worldview past, present, or future oriented?

• Discuss the impact of your culture on your nursing and/or healthcare. Be specific, that is, not something that is very general.

Appendix 2: Reflective Exercises

The following reflective exercises can be used in formal courses at any level and discipline or interdisciplinary. They can also be used in staff development.

• 1. What changes in ethnic and cultural diversity have you seen in your community over the last 5 years? Over the last 10 years? Have you had the opportunity to interact with newer groups?

• 2. What health disparities have you observed in your community? To what do you attribute these disparities? What can you do as a professional to help decrease these disparities?

• 3. Who in your family had the most influence in teaching you cultural values and practices? Mother, father, or grandparent?

• 4. How do you want to be addressed? First name or last name with a title?

• 5. How do you address older people in your culture? First name or last name with a title?

• 6. What activities have you done to increase your cultural competence?

• 7. Given that everyone is ethnocentric to some degree, what do you do to become less ethnocentric?

• 8. How do you distinguish a stereotype from a generalization?

• 9. How have your variant characteristics of culture changed over time?

• 10. What ethnic and racial groups do you encounter on a regular basis? Do you see any racism or discrimination among these groups?

• 11. What does your organization do to increase diversity and cultural competence?

• 12. What barriers do you see to culturally competent care in your organization? School, work, etc.

• 13. How many languages are spoken in your community?

• 14. Do different languages pose barriers to healthcare, including health literacy? What affordability concerns for healthcare do you see in your community?

• 15. What complementary/alternative healthcare practices do you use?

• 16. What complementary/alternative healthcare practices are available in your community?

• 17. Is public transportation readily available to healthcare services in your community? What might be done to improve them?

• 18. What do you do when you cannot understand the language of your patient?

• 19. In what languages are healthcare instructions provided in your organization?

• 20. Does your organization offer both interpreter and translation services?

• 21. Given the heritage and diversity of the population in your community, what cultural, social, and material issues do you consider important?