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)
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References
Abdel-Fattah MA (2004) Arabic sign language: a perspective. J Deaf Stud Deaf Educ 10(2):212–221
American Translators Association (ATA) (2015) www.atanet.org. Accessed 29 July 2017
Andrews MM, Boyle JS (eds) (2016) Transcultural concepts in nursing care, 7th edn. Wolters Kluwer, Philadelphia
Baron, M (2003) Beyond intractability. http://www.beyondintractability.org/essay/cross-cultural-communication. Accessed 29 July 2017
Black-Lattanzi J, Purnell L (eds) (2006) Exploring communication in a cultural context. In: Developing cultural competence in physical therapy practice. F.A. Davis Co., Philadelphia
Bui YN, Turnbull A (2003) East meets west: analysis of person-centered planning in the context of Asian American values. Educ Train Ment Retard Dev Disabil 38(1):18–31
Building an Organizational Response to Health Disparities (2016) A practical guide to a practical guide to implementing the national CLAS standards: for racial, ethnic and linguistic minorities, people with disabilities, and sexual and gender minorities. https://www.cms.gov/About-CMS/Agency-Information/OMH/Downloads/CLAS-Toolkit-12-7-16.pdf. Accessed 15 Oct 2017
Bureau of Labor Statistics: Department of Labor, Occupational Outlook Handbook (2006) Interpreters and translators. http://www.bls.gov/oco/ocos175.htm. Accessed 29 July 2017
Cotunga N, Vickery CE, Carpenter-Haefele KM (2005) Evaluation of literacy level of patient education pages in health-related journals. J Community Health 30(3):213–219
Douglas M, Rosenketter M, Pacquiao D, Callister C et al (2014) Guidelines for implementing culturally competent nursing care. J Transcult Nurs 25(2):109–221
Egbert N, Nanna K (2009). Health literacy: challenges and strategies. Online J Issues Nurs 14, 3, Manuscript 1. http://www.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol142009/No3Sept09/Health-Literacy-Challenges.html. Accessed 29 July 2017
Federation of Interpreters and Translators. (2015) www.ift-fit.org. Accessed 29 July 2017
Galanti G (ed) (1991) Communication and time orientation. In: Caring for patients from different cultures: case studies from American hospitals. University Pennsylvania Press, Philadelphia
Gardenswartz L, Rowe A (eds) (1998) Communication in diverse environments. In: Managing diversity in health care. Jossey-Bass, San Francisco
Gudykunst WB, Matsumoto Y (1996) Cross-cultural variability of communication in personal relationships. In: Gudykunst WB, Ting-Toomey S, Nishida T (eds) Communication in personal relationships across cultures. Sage Publishing, Thousand Oakes
Hall E (1990a) The silent language. Doubleday, New York
Hall E (1990b) The hidden dimension. Doubleday, New York
Hall E (1990c) Beyond culture. Doubleday, New York
Hall E (1990d) The dance of life. Doubleday, New York
Helman C (ed) (2000) Culture, health, and illness, 4th edn. Butterworth Heinemann, Oxford
How Many Languages do Indian People Speak?. http://www.answers.com/Q/How_many_languages_do_indian_people_speak. Accessed 14 Sept 2017
Huttlinger KW (2013) People of Appalachian heritage. In: Purnell L (ed) Transcultural health care: a culturally competent approach, 4th edn. F.A. Davis Co, Philadelphia
International Medical Interpreters Association (2017) www.imiaweb.org. Accessed 29 July 2017
Keeskes I (2016) Can intercultural pragmatics bring some new insight into pragmatic theories? In: Capone A, Mey JL (eds) Interdisciplinary studies in pragmatics, culture and society. Springer, New York
Kulwicki A, Ballout S (2014) People of Arab heritage. In: Purnell L (ed) Transcultural health care: a culturally competent approach, 4th edn. F.A. Davis Co., Philadelphia
Languages of Nigeria (n.d.) http://language.nigerianunion.org/. Accessed 14 Sept 2017
Lingua Translations (2016) http://www.lingua-translations.com/blog/asl-bsl/. Accessed 21 Sept 2017
Lionbridge: Professional Translation and Localization Services (2012) http://www.lionbridge.com/. Accessed 29 July 2017
Mattson S (2013) People of Vietnamese heritage. In: Purnell L (ed) Transcultural health care: a culturally competent approach, 4th edn. F.A. Davis Co., Philadelphia
Mexican Languages (2017) http://www.donquijote.org/culture/mexico/languages/index.asp. Accessed 14 Sept 2017
National Academy on an Aging Society (1999) Fact sheets. www.agingsociety.org/agingsociety/publications/fact/fact_low.html. Accessed 29 July 2017
National Association of the Deaf (n.d.) Interpreting American Sign Language. http://nad.org/issues/american-sign-language/interpreting-american-sign-language. Accessed 29 July 2017
National Council on Healthcare Interpreting (NCIHC) (n.d.) www.ncihc.org. Accessed 29 July 2017
Neilsen-Bohlman L, Panzer AM, Kindig DA (2004) Health literacy: a prescription to end confusion. National Academies Press, Washington, DC
Papadopoulos, I. (ed.). (2006). The Papadopoulos, Tilki, and Taylor model for developing cultural competence. Transcultural health and social care. London: Churchill Livingston.
Public Health Assessment Guidance Manual (2005 Update) (2011) Involving and communicating with the community. https://www.atsdr.cdc.gov/hac/phamanual/ch4.html#4.8. Accessed 29 July 2017
Purnell L (2008) The Purnell model for cultural competence. In: Purnell L, Paulanka B (eds) Transcultural health care. A culturally competent approach. F.A. Davis Co., Philadelphia
Purnell L (2010) Cultural rituals in health and nursing care. In Esterhuizen P, Kuckert A (eds) Diversiteit in de verpleeg-kunde [Diversity in Nursing]. Bohn Stafleu van Loghum, Amsterdam
Purnell L (2011) Application of transcultural theory to mental health-substance use in an international context. In: Cooper D (ed) Intervention in mental health-substance use. Radcliffe Publishing, London
Purnell L (ed) (2013) The Purnell model for cultural competence. In: Transcultural health care. A culturally competent approach. F.A. Davis Co., Philadelphia
Purnell L, Finkl E (2018) Guide to culturally competent health care. F.A. Davis Co., Philadelphia
Purnell L, Pontious S (2014) Cultural competence. In: Gurung RAR (ed) Multicultural approaches to health and wellness in America: Volume 1. Praeger, Santa Barbara
Ritter LA, Hoffman NA (2010) Cross cultural concepts of health and illness. Multicultural health. Jones & Bartlett Publishing, Boston
Rothstein-Fisch C, Greenfield PM, Quiroz B (2001) Continuum of “individualistic” and “collectivistic” values. National Center on Secondary Education. http://www.ncset.org/publications/essentialtools/diversity/partIII.asp. Accessed 29 July 2017
Sagar P (2014) Transcultural concepts in adult health courses. In: Sagar P (ed) Transcultural nursing education strategies. Springer, Philadelphia
Translation Central (n.d.) Translation versus interpretation. http://www.translationcentral.com/. Accessed 29 July 2017
U.S. Department of Health and Human Services (2015) National Institute of Deafness and other Communication Disorders. http://www.nidcd.nih.gov/health/hearing/pages/asl.aspx. Accessed: 29 July 2017
Van Ness F, Abma T, Jonsson J (2010) Language differences in qualitative research: is meaning lost in translation. Eur J Aging 7:313–316
World Federation of the Deaf (2016) https://wfdeaf.org /. Accessed 29 July 2017
World Heritage Encyclopedia (2017) Distinguishing “blue” from “green” in different languages. http://self.gutenberg.org/articles/Distinguishing_%22blue%22_from_%22green%22_in_language. Accessed 29 July 2017
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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
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1.
Identify your own cultural identity and personal communication practices and how they differ with family, friends, and strangers, including patients.
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2.
Investigate the scholarly literature on your culture after you have completed the exercises.
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3.
Identify how your communication patterns differ from what was in the scholarly literature.
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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.
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Identify your cultural ancestry. If you have more than one cultural ancestry, choose one for the sake of this exercise.
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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?
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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.
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Identify personal spatial and distancing strategies used when communicating with others in your culture. Discuss differences between friends and families versus strangers.
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Discuss your culture’s use of eye contact. Include information regarding practices between family members, friends, strangers, and persons of different age groups.
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Explore the meaning of gestures and facial expressions in your culture. Do specific gestures or facial expressions have special meanings? How are emotions displayed?
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Are there acceptable ways of standing and greeting people in your culture?
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Discuss the prevailing temporal relation of your culture. Is the culture’s worldview past, present, or future oriented?
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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.
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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?
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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?
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Who in your family had the most influence in teaching you cultural values and practices? Mother, father, or grandparent?
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How do you want to be addressed? First name or last name with a title?
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How do you address older people in your culture? First name or last name with a title?
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What activities have you done to increase your cultural competence?
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Given that everyone is ethnocentric to some degree, what do you do to become less ethnocentric?
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How do you distinguish a stereotype from a generalization?
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How have your variant characteristics of culture changed over time?
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What ethnic and racial groups do you encounter on a regular basis? Do you see any racism or discrimination among these groups?
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What does your organization do to increase diversity and cultural competence?
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What barriers do you see to culturally competent care in your organization? School, work, etc.
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How many languages are spoken in your community?
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Do different languages pose barriers to healthcare, including health literacy? What affordability concerns for healthcare do you see in your community?
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What complementary/alternative healthcare practices do you use?
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What complementary/alternative healthcare practices are available in your community?
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Is public transportation readily available to healthcare services in your community? What might be done to improve them?
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What do you do when you cannot understand the language of your patient?
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In what languages are healthcare instructions provided in your organization?
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Does your organization offer both interpreter and translation services?
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Given the heritage and diversity of the population in your community, what cultural, social, and material issues do you consider important?
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Purnell, L. (2018). Cross Cultural Communication: Verbal and Non-Verbal Communication, Interpretation and Translation. In: Douglas, M., Pacquiao, D., Purnell, L. (eds) Global Applications of Culturally Competent Health Care: Guidelines for Practice. Springer, Cham. https://doi.org/10.1007/978-3-319-69332-3_14
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