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Intercultural Communication Strategies for Hospice Staff

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Title: 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
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