Intercultural Communication Strategies for Hospice Staff

1
Intercultural Communication Strategiesfor
Hospice Staff

• Gail Henson, Ph. D.
• Hospice Institute
• December 14, 2004

2
Human beings draw close to one another by their
common nature, but habits and customs keep them
apart.

• Confucius

3
Objectives

• Identify 2 attitudes, behaviors that indicate
  intercultural communication competence
• Identify 2 barriers and challenges to
  intercultural communication with Hospice patients
  and families
• Verbalize an understanding of reasons for
  barriers and challenges to effective
  intercultural communication

4
Objectives, continued

• Describe 3 strategies for effective intercultural
  communication to enhance intercultural work in
  hospice role
• Demonstrate behaviors that indicate intercultural
  communication competence.

5
Intercultural contact occurs

• Where?
• Client base
• Staffing in nursing homes, hospitals
• Home setting
• Where else?
• What experiences can you share?

Objective 1
6
Why is there an increasing amount of
intercultural contact?

• Immigration refugee patterns
• International interactione.g. through business,
  media
• Social contactagain through business, internet,
  media

Objective 1
7
Who are Hospices culturally diverse clients?
Vietnamese
Bosnians
Indians
Cubans
Somali Bantu
Objective 1
Iraquis
Mexicans
8
Definition of intercultural communication

• Circumstance in which people from diverse
  cultural backgrounds interact with one another
• Crucial element-culture and its impact on
  cultural behavior

Objective 1
9
Definition of Intercultural Communication
Competence

• Communication behavior that is appropriate and
  effective in a given context.
• From Samovar Porter
• Communication between Cultures, 5th Ed

1
Objective 1

10
Indicators of intercultural communication
competence

• Motivation
• Knowledgecultures, communication, language
• Attitudesself-awareness, clients attitudes
• Skillslistening, speaking, empathy

From Samovar Porter Communication between
Cultures, 5th Ed
Objective 1
11
What are some barriers challenges to in the
Hospice setting?

• Language
• Gender roles, family structure
• History of the culture, e.g. tribal warfare,
  ethnic cleansing
• Views of causes of illness
• Experience with medical systems
• Understanding, acceptance of treatment
• Ethnocentrism, prejudice, stereotyping
• Nonverbal communication patterns

Objective 2
12
Barriers challenges may arise at any point
during interaction reasons

• Motivations, goals and plans
• Contradictory goals when needs conflict
• Cognitive skills inadequate
• Goals change if theres a history of failure

• Perception
• Low level of accuracy, discrimination
• Inaccurate stereotypes
• Errors of attributiontoo much, too little
• Halo effectsperceiving people as consistently
  good, bad

From Transcultural Communication and Health Care
Practice RCN.

Objective 3
13
Barriers arise because..

• Translation
• Technical language
• Idioms, slang
• Dialect
• Limited English Proficiency
• No linguistic equivalent

• Feedback
• Lack of skill
• Withholding
• Unrealistic or falsified
• Perception errors

From Transcultural Communication and Health Care
Practice RCN.
Objective 3
14
Barriers may arise due to culture shock

• Client/family may experience anxiety that results
  from losing familiar signs and symbols
• We all feel more comfortable with the familiar
• Stages of culture shock honeymoon phase,
  culture shock, recovery, adjustment

Objective 3
15
The chief barrier to effective intercultural
communication is ethnocentrism

• Notion that ones culture is superior to any
  other.
• Ethnocentrism helps members of the culture
  associate and identify with cultures ideas,
  ethics, pride, sense of personal worth
• Consequences of ethnocentrismnegative or
  derogatory evaluations of anything thats
  different. Political, moral, religious---

From Samovar Porter Communication between
Cultures, 5th Ed
Objective 3
16
So what do we need to do to develop intercultural
communication skills?

• Develop knowledge of other cultures and their
  understandings of illness, life and death, and
  their communication styles.
• Develop attitudes open to others and to
  understanding them.
• Develop skills.

Objective 4
17
Develop knowledge of other cultures views of
illness, life, death

• Cultures differ in the way they explain, treat,
  and prevent illness,
• suffering, death, dying,
• life itself

• Categories of systems
• biomedical
• personalistic
• naturalistic

Objective 4
18
Knowledge of causes of illness

• Biomedical-terms
• Spirits-personalistic
• Naturalisticimbalance of humors, yin and yang
• Disharmony with nature

From Samovar Porter Communication between
Cultures, 5th Ed
Objective 4--handout
19
Knowledge of Treatments

• Medicine
• Alternative medicines

• Acupuncture

Shamans
Cupping
Objective 4
20
Know the values that cause conflict majority,
minority culture

• Future orientation
• Informality
• Direct, open, honest
• Practical, efficiency
• Materialism

• Past, present orientation
• Formality
• Indirect, face, ritual
• Idealism
• Spiritualism, detachment

From Samovar Porter Communication between
Cultures, 5th Ed
Objective 4
21
Knowledge that culturally determined family roles
affect communication

• Dominance patterns
• Modesty
• Female purity
• Pregnancy
• Childbirth
• End of life

From Samovar Porter Communication between
Cultures, 5th Ed

Objective 4
22
Knowledge of Prevention

• Immunizations
• Healthy living
• Avoid violating cultural taboos
• Astrology
• Fatalism
• Charms and amulets

From Samovar Porter Communication between
Cultures, 5th Ed
Objective 4
23
Knowledge of interplay of religion, spirituality
healthcare

• Very strong
• Biomedical modellimited
• Has profound effect on outcomes
• How does the client answer the question, Which
  is more important, the body or the soul?

From Samovar Porter Communication between
Cultures, 5th Ed
Objective 4
24
Healthcare practices must accommodate cultural
diversity

• Attitudes from culture, religion
• Attitudes to pain
• Belief systems

Objective 4 handout
25
Develop strategies for effective intercultural
communication with Hospice clients and families.
Step 1

• Recognize ones reactions to differences
• Consider the origins of these reactions
• Consider how might the specific communication
  barriers, challenges affect the ability to
  provide services
• Consider how the clients/families might perceive
  ones behavior.

Objective 4
From Samovar Porter Communication between
Cultures, 5th Ed
26
We can all change

• The brain is an open system
• We have free choice to respond
• Our communication behavior influences other
  people.

Objective 4
27
Ward off potential problems

• Reasons for communication problems vary
• Seek similarities
• Reduce uncertainty
• Address withdrawal interpersonal, intercultural,
  international

• Check stereotyping
• Confront prejudice
• Confront racism
• Power

Objective 4
28
Recognize diversity

• medical systems
• treatment
• ethnocentrism

Objective 4
29
Effective strategies

• Develop strategies that are
• Culture specificknowing client base
• Context specificto Hospice
• Culture general-common across all cultures
• Learn the culture-specific norms for nonverbal
  communication
• Understand the communication style
• Ask questions

From Samovar Porter Communication between
Cultures, 5th Ed
Objective 4
30
Improving intercultural effectiveness

• Know yourself
• Know your culture
• Know your personal attitudes
• Know your communication style
• Monitor yourself
• Consider the physical and human settings
• Timing, physical setting, customs

From Samovar Porter Communication between
Cultures, 5th Ed
Objective 4
31
Know your communication style in intercultural
settings

• Do I seem tense or at ease?
• Do I smile often?
• Do I repeatedly interrupt?
• Do I show sympathy when theres a crisis or
  problem?

• What does my tone of voice suggest?
• How do I react to being touched by a client?
• How do I handle silence?
• In this setting, do you appear rushed?

Communication style involves vocal, verbal, non
verbal
Objective 4
From Samovar Porter Communication between
Cultures, 5th Ed
32
Effective strategies

• Understand the communication style
• Direct or indirect
• Collectivistgroup members weigh in on decisions
  or Individualistic
• Appropriateness of language for expressing pain,
  emotion, dealing with ambiguity
• Amount of conversationhigh context, low context

Objective 4
33
Improving intercultural effectiveness

• Seek to understand diverse message systems
• Learn different languages
• Understand cultural variations in language use
• Remember words are culture bound
• Idioms
• Ambiguity
• Expressions
• Subcodes
• Nonverbal codes

Objective 4
34
Improving intercultural effectiveness

• Achieving clarity
• State your information clearly and precisely
• Adjust to listeners level of understanding
  without being demeaning
• Explain jargon
• Use idioms carefully
• Slow down speaking
• Speak in smaller units
• Repeat key points
• Encourage listener to ask questions
• Check for understanding

Objective 4
35
Develop empathy

• Empathy is the bedrock of effective intercultural
  communication
• (Calloway-Thomas, Cooper, Blake)

Objective 4
36
Effective strategies

• Learn the culture-specific norms for nonverbal
  communication
• Body behaviorattire, gestures, posture, facial
  expressions, eye contact, touch, smell,
  vocalizations (qualifiers), volume, noises,
  laughing, accents, dialects
• Space distance
• Timing
• Silence

From Samovar Porter Communication between
Cultures, 5th Ed
Objective 4
37
Strategies for effective intercultural
communication Ask questions

• What do you call the problem?
• What do you think has caused the problem?
• Why do you think it started when it did?
• What does the illness do? How does it work?
• What kind of treatment should the patient
  receive? What are the most important results you
  hope the patient receives from the treatment?
• What are the chief problems the sickness has
  caused?
• What do you fear most about the sickness?

Arthur Kleinman, Patients and Healers in the
Context of Culture. Berkeley, Univ of California
Press, 1980.
Objective 4
38
Practice strategies

• Which is more important to your client, the body
  or the soul?
• Case studies

Objective 5
39
Values of majority, minority cultures

• Master over nature
• Personal control over environment
• Doing/ activity
• Time dominates
• Human equality
• Youth valued
• Competition

• Harmony with nature
• Fate determines ones destiny
• Being orientation
• Personal relationships
• Group welfare
• Elders valued
• Cooperation

40
Values of majority, minority culture

• Future orientation
• Informality
• Direct, open, honest
• Practical, efficiency
• Materialism

• Past, present orientation
• Formality
• Indirect, face, ritual
• Idealism
• Spiritualism, detachment

Objective 4
41
Intercultural Communication Strategiesfor
Hospice Staff

• Gail Henson, Ph. D.
• Hospice Institute
• December 4, 2004