Communicating with Clients

1
Communicating with Clients Families
Interviewing Skills

• Emily Eckley MS, RD
• eeast1_at_utk.edu
• Celebrating Diversity Conference
• April 28, 2006

2
Objectives

• Describe the steps to take when preparing to
  interview a client their family.
• List the skills needed to conduct culturally
  appropriate interviews.
• Ask culturally appropriate questions when working
  with a client families from another culture.
• Describe the cultural influences on verbal and
  non verbal communication.

3
Plan

• Define culture
• Discuss components of a culturally appropriate
  interview
• Before the interview
• During the interview
• After the interview
• Skill Building Case Study

4
Culture

• Integrated pattern of human behavior that
  includes
• Thoughts, communications, languages
• Practices, beliefs, values, customs
• Courtesies, rituals, manners of interacting and
  roles,
• Relationships expected behaviors
• Of racial, ethnic, religious or social group
• The ability to transmit the above to succeeding
  generations

National Center for Cultural Competence, 2006.
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An Iceberg Concept of Culture
Dress Age Race/Ethnicity Gender
Language
Eye behavior Facial expressions
Body language Sense of self
Notions of modesty
Adapted by the NCCC
Concept of cleanliness Emotional response
patterns Rules for social interaction Child
rearing practices Decision-making
processes
Approaches to problem solving Concept of justice
Value individual vs. group Perceptions of
mental health, illness, disability Patterns of
superior and subordinate role in relation to
status by age, gender, class And much more
National Center for Cultural Competence, 2006
6
An Iceberg Concept of Culture
The iceberg concept of culture is widely used and
available in the public domain, for example see
Culture Matters www.peacecorps.gov
Or www.genderandpeacekeeping.org
National Center for Cultural Competence, 2006
7
Culturally Sensitive Interviewing

• Before the Session
• Develop self-awareness
• Increase knowledge of commonly held cultural
  beliefs interacting styles of patients/clients
• During the Session
• Complete an assessment by conducting a cultural
  interview
• After the Session
• Make a plan to negotiate between the culture of
  the patient/client the medical culture

Pachter Harwood, 1996
8
The First Step Increase Your Own Awareness

• Know Thyself
• Beliefs
• Values
• Lifestyles
• Practices
• Complete Cultural Self-Assessment
• National Center for Cultural Competence
• http//gucchd.georgetown.edu/nccc/

Campinha-Bacote, 2003. Pederson, 2002.
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Ways to Increase Self Awareness

• Recognize communication styles
• Learn about cultural linguistic differences
• Develop interest in other cultures
• Become sensitive to myths and stereotypes
• Be able to discuss your own culture
• Explore your own values
• Learn about relationships

Pederson, 2002.
10
Preparing for the Interview

• Seek to increase Cultural Knowledge
• Process of learning about basic world views of
  different cultures
• World view is
• The set of explanations used by a group of people
  to explain lifes events
• Includes explanations about nature of
• reality
• knowledge
• reason or logic
• relationships

Boyle Andrews, 1995.
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What Knowledge Is Needed?

• History of culture
• Roles of
• Education
• Money
• Values
• Attitudes
• Behaviors
• Communication styles
• Language slang
• Resources for teaching learning
• How culture is perceived
• Other information

Pederson, 2002.
12
How To Prepare

• Read
• Ask
• Engage
• Observe
• Analyze

Meaningful Exchange, 2005.
13
During the Session

• Develop utilize culturally appropriate
  interviewing skills
• Conduct a cultural interview
• Client centered interviewing
• Understanding a clients social situation
• Navigate the complexities of communicating across
  cultures

14
Cultural Interviewing Skills

• Awareness
• Solid knowledge foundation
• Clear communication
• Sense of humor
• Honesty genuineness
• Innovation
• Flexibility
• Empathy
• Respect, value , care, trust

Bauer Sokolik, 2002
15
Utilizing the Skills

• Listen respectfully
• Use the teaching learning techniques of other
  cultures
• Establish empathic rapport with persons from
  other cultures
• Analyze feedback accurately
• Develop new ideas
• Make it fun!

Pederson, 2002
16
Conducting Cultural Assessments

• EVERY client should have a cultural interview
• Information from the interview should be used to
  form a culturally relevant treatment plan

Campinha-Bacote, 2003
17
Client Centered Interviewing Model

• Focuses on client experiences
• 4 dimensions of this experience
• Ideas about what is wrong
• Feelings, especially fears, about being ill
• Impact of problems on own functioning
• Expectations about what should be done

Stewart, 1995
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Questions for Client Centered Interviewing

• What do you call the problem?
• What do you think caused the problem?
• How bad is it?
• Why do you think it started when it did?
• How does it affect your life?

Kleinman, 1978
19
Questions for Client Centered Interviewing

• What kind of treatment do you think will work?
• What do you fear most about the problem?
• How can I be of most help to you?
• What other remedies or treatments for your
  problem have you used?

Kleinman, 1978
20
Learning More About the Client
How Environment has Changed
Control Over Environment
Social Stressors Support Networks
Literacy Language
21
How to Learn about Clients Social Experience

• Where are you from?
• Why did you decide to come to this country?
• When did you come?

How Environment has Changed
Source Carrillo, 1999
22
How to Learn about Clients Social Experience

• How much of a problem is money in your life?
• Are you ever short of food or clothing?
• How do you keep track of appointments?

Control Over Environment
Carrillo, 1999
23
How to Learn about Clients Social Experience

• What is causing the most stress in your life?
• How do you deal with the stress?
• Do you have family or friends that you can call
  on for help?

Social Stressors Support Networks
Carrillo, 1999
24
How to Learn about Clients Social Experience

• What trouble do you have reading your medication
  bottles or appointment slips?
• What language do you speak at home?
• Do you have a hard time communicating what you
  want to say to your healthcare providers?

Literacy Language
Carrillo, 1999
25
Navigating the Complexities of Communication

• Most people assume that the most important aspect
  of communication is verbal
• Much of our meaning is communicated nonverbally
• Interpreting nonverbal communication can be
  challenging when interacting with someone of a
  different culture

Mutha, 2002
26
Verbal Communication

• Language
• Spoken
• Written
• Degree of directness
• Loudness/Pitch
• Appropriate subjects for conversation
• Emotional expressiveness

Randall-David, 1989
27
Nonverbal Communication

• Facial expressions
• Gestures
• Eye contact
• Distance
• Touch
• Silence
• Body movements

Randall-David, 1989
28
Ways to Become Actively Involved in the
Communication Process

• Learn proper forms of addressing in the clients
  language
• Learn basic words sentences in the clients
  language
• Work effectively with interpreter
• Use a positive tone of voice
• Repeat important information more than once
• Reinforce verbal instructions with written
  materials
• Watch the clients non verbal communication

Randall-David, 1989
29
After the Interview

• Debrief analyze
• What went right?
• What went wrong?
• How can I improve?
• Seek additional information
• Put together ALL the information
• Form a plan

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Forming a Plan

• Goal Negotiate between the culture of the client
  the medical culture
• Tailor the treatment/intervention to meet the
  client familys needs
• Make the client family feel comfortable part
  of the process

31
Wrap Up

• We live work in very culturally diverse
  environments
• Through preparation directed use of skills, we
  can work effectively cross-culturally
• This is a continual process

32
Skill BuildingCase Study
33
Questions???
34
References

• Auger S, Colindres M. Latino Cultural
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  North Carolinas Womens Preventive Health
  Branch, Division of Maternal Child Health,
  North Carolina Department of Environment, Health,
  Natural Resources 1994.
• Bauer K, Sokolik C. Basic Nutrition Counseling
  Skill Development. Belmont, CA
  Wadsworth/Thompson Learning 2002.
• Boyle J, Andrews M. Transcultural Concepts in
  Nursing. Boston Scott Foresman 1995.
• Campinha-Bacote J. The Process of Cultural
  Competence in the Delivery of Healthcare
  Services A Culturally Competent Model of Care.
  4th ed. Cincinnati, OH Transcultural C.A.R.E.
  Associates 2003.
• Carrillo JE, Green AR, Betancourt JR.
  Cross-cultural primary care a patient-based
  approach. Ann of Intern Med. 1999 130 829-34.
  
• Eckley EE, Haughton B. Meaningful Exchange
  Enhancing Cultural Competence of Public Health
  Personnel. Knoxville, TN Department of
  Nutrition, the University of Tennessee 2005.
• Georgetown University. National Center for
  Cultural Competence. Available at
  http//gucchd.georgetown.edu/nccc/. Accessed
  February 20, 2006.
• Kleinman A, Eisenber L, Good B. Culture, illness,
  care clinical lessons from anthropologic
  cross-cultural research. Ann Intern Med. 1978
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• Mutha S, Allen C, Welch M. Towards Culturally
  Competent Care A Toolbox for Teaching
  Communication Strategies. San Francisco Center
  for the Health Professions University of
  California 2002.
• Pachter LM, and Harwood RL. Culture and child
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  Behav Pediatr. 1996 17 191-198.
• Pederson PB, et. al. Counseling Across Cultures.
  5th ed, Thousand Oaks, CA Sage Publications,
  Inc. 2002.
• Randall-David E. Strategies for Working with
  Culturally Diverse Communities Clients.
  Bethesda, MD Association for the Care of
  Childrens Health 1989.
• Stewart M, Brown JB, Weston WW, McWilliam CL,
  Freeman TR. Patient-Centered Medicine
  Transforming the Clinical Method. Thousand Oaks,
  CA Sage Publications 1995.