Reflective Essay on Cross-Cultural Communication

Cross-Cultural Communication: Tools for working with families and children

Owing to the increase in global migration, nurses are caring for patients in extensive cultural and linguistic settings. The surge in the occurrence of immigration and diversification of cultural groups has given birth to the notion of intercultural communication which entails the interaction between patients and healthcare professionals from different cultural backgrounds.

According to Yakar, H. K., & Alpar, S. E. (2018), intercultural communication competence needs to be improved so that cultural differences of interacted individuals from different cultures can be recognized, respected, handled with toleration, and effective communication in diverse cultural settings may be established.

In this review, we explore the intricacies of cultural nuances including non-verbal cues, ‘high context’ communication style, the role of silence and social stances in a particular culture. Several models of service care delivery have emerged in the healthcare industry to provide optimal care to our multiethnic world as per Ladha, T., Zubairi, M., Hunter, A., Audcent, T., & Johnstone, J. (2018).

We will discuss one of the strategies, the LEARN model, Berlin, E. A., & Fowkes Jr, W. C. (1983), which outlines strategies to battle the challenges of cultural differences between patients and healthcare professionals.

According to Berlin, E. A., & Fowkes Jr, W. C. (1983), LEARN model is an aid to effective history taking. The difference in focus is between a patient’s factual subjective report of onset and duration and characteristics of symptoms and a patient’s theoretical explanations and reasons for the problem.

Listen: The first step in communication is to gauge the conceptualizations of the patient about the illness. This step raises questions like, ‘What do you feel is wrong with you?’ and ‘What do you think would help?’. It builds a credible relationship of trust and understanding.

Explain: The next step is to offer your own perception of the disease, the recommended plan of care and possible mitigation of the disease. To convey the knowledge skillfully, one should be considerate about the cultural beliefs, literacy, and socioeconomic status of the patient and elucidate the problem in the simplest words.

Acknowledge: Be respectful of the patient’s point of view. Through mutual understanding, the physician and patient should recognize similarities and eliminate differences in plan of care.

Recommend: Within the confines of patient comfort, draft a plan which maximizes recovery and minimizes conflicts.

Negotiate: The finalized proposal should be an amalgamation of patient centered course of action and professional knowledge.

To apply and incorporate this model in daily interactions at an interpersonal level, we explore the multiple nuances in which it can be effective.

According to Bowen, S. (2001), “language barriers have been demonstrated to have adverse effects on access to health care, quality of care, rights of patients, patient and provider satisfaction, and most importantly, on patient health outcomes.”

Immigrant patients who are not fluent in the official language are likely to face misinterpreted information exchange. Nurses mostly rely on relatives for translation which is detrimental to communication as they often omit the information. In circumvention of this challenge, accredited interpreters are appointed who facilitate history taking by being forthright, clear and unambiguous in their construal.

According to Hanssen, I., & Alpers, L. M. (2010). “As the interpreter is the only person in the setting who understands both languages (and cultures), he/she may find him/herself in a position of power. It is imperative that the interpreter has the skill, knowledge and moral backbone to handle this power in a beneficial way for the interlocutors.”

Referring back to the LEARN model, it is recommended to visit the same interpreter and schedule longer meetings in order to forge a trustworthy relationship among all three parties.

It is crucial to be well aware of the different communication styles depending on the different cultural backgrounds and ethnicities. Broad diversity can exist among cultural groups and hence cultural generalizations and stereotyping should be discouraged to prevent formation of misjudged assumptions. According to Bradby, H. (2001), “Communication requires the interpretation of speech, tone, facial expressions, body language, gestures and assumptions shared between the communicants about the context and purpose of the exchange.”

Observing western order, they adapt a low context style which requires little interpretation and is usually forthcoming. However, many other ethnic groups rely heavily on background, non-verbal cues, body language, and tone of voice to convey meaning. These cues may include aversion of eyes, silence, shaking of head and expressions of contempt or apprehension. The patients and their families may not be able to explicitly voice their concerns but upon close acuity their subtle reluctance could be evident, suggested by Ladha, T., Zubairi, M., Hunter, A., Audcent, T., & Johnstone, J. (2018). Physicians must be careful not to mistake non-verbal communication like silence as an assertion, but a misunderstanding of the question asked, invasion of privacy, mistrust, or disagreement.

In light of the LEARN model – which helps health practitioners in devising a satisfactory and reconciliatory treatment plan for culturally diverse patients – the strategies outlined, helps in addressing various challenges which present themselves when it comes to medical decision making and aid in reaching a culturally appropriate negotiation, the strategies also stress upon alleviating family stress by adopting a curious and modest approach and also prepares health practitioners in sharing perceptions of the illness, treatment and self-management plan based on the information gained regarding background, experience, literacy, expectations and concerns.

References:

Berlin, E. A., & Fowkes Jr, W. C. (1983). A teaching framework for cross-cultural health care—application in family practice. Western Journal of Medicine, 139(6), 934.

Bradby, H. (2001). Communication, interpretation, and translation. Chapter 6 in Cully, L.; Dyson, S.(eds.): Ethnicity and Nursing Practice.

Bowen, S. (2001). Language barriers in access to health care. Ottawa: Health Canada.

Hanssen, I., & Alpers, L. M. (2010). Interpreters in intercultural health care settings: Health professionals’ and professional interpreters’ cultural knowledge, and their reciprocal perception and collaboration. Journal of intercultural communication, (23).

Ladha, T., Zubairi, M., Hunter, A., Audcent, T., & Johnstone, J. (2018). Cross-cultural communication: Tools for working with families and children. Paediatrics & child health, 23(1), 66-69.

Yakar, H. K., & Alpar, S. E. (2018). Intercultural communication competence of nurses providing care for patients from different cultures. International Journal of Caring Sciences, 11(3), 1743-1755.

Delivering Health Care for Aboriginal People in a Person-centred Way:

Person‐centered care as per Brummel‐Smith, K., Butler, D., Frieder, M., Gibbs, N., Henry, M., … & Saliba, D. (2016), means that in a health care system patients’ values and preferences are first assessed and then guide all the aspects of their health care. It is achieved through a dynamic relationship among individuals, others who are important to them, and all relevant providers. This collaboration supports decision‐making to the extent that the individual desires.

This approach addresses involvement and empowerment of general patients in care, and since it also takes into account the patient’s cultural and individual needs, preferences, beliefs, values as well as their comfort and surroundings thus, it appropriates taking into account its relevance to cross cultural contexts including delivering health care to Aboriginal patients. This approach is likely to guide health practitioners in improving Aboriginal patient’s experience and health outcomes.

The panel discussion by TRACS WA addresses health issues experienced by Aboriginal people, and discuss the strategies that help health care providers to navigate and make informed decisions about good health care practicing in disparate cultural settings.

Considering the historical, cultural and socioeconomic background, it can be inferred that the health of many Aboriginal people is already compromised on a daily basis due to the fact that they are living in socioeconomically disadvantaged and remote communities where burden of disease exists due to lack of access to illness management services. The issues discussed include health perspectives, communication barriers and effective engagement with the patients.

For Aboriginal people, family, community, land and traditions are more important than health which means individual health sometimes is not a priority and they see health holistically rather than biomedically. As per Duff, D., Jesudason, S., Howell, M., & Hughes, J. T. (2018), it encompasses the physical, social, emotional, spiritual and cultural well-being of the individual and of the whole community and thus, it is imperative to respect all aspects of culture in the patient’s clinical care to ensure their holistic health an individual needs are met. Aboriginal people associate hospitals with death and dying instead of a place of healing so it is crucial for health care practitioners to employ strategies that make it easier for them to seek medical help rather than struggle with the processes and either leave without help or don’t communicate what matters to them at all. The strategies to address these issues include:

• having the respect for culture and community,
• tracking Aboriginal patient’s journey – before they come to the hospital to when they are under clinical care and after they are discharged,
• building rapport through effective consultation and communication,
• developing trust by taking consent and boundaries into consideration,
• recognizing the social, emotional and environmental determinants of health,
• engaging patients in a way that informs, consults, involves, collaborates and empowers them,
• creating a culturally safe hospital environment where they are navigated with respect and have control over themselves.

A close understanding of the presented strategies suggest that they very well address cultural competence which is discursively operationalized as an important aspect of health professions’ curricula and practices of care on the basis that it contributes to reducing ethnic disparities in health care, Jowsey, T. (2019).

As per Nguyen, H. T. (2008), cultural safety and cultural competence are key concepts that have practical meaning for Aboriginal people. They form the basis for effective patient-centred care and the professional advocacy role of the general practitioner. Culturally safe care is characterized by a collaboration between patient and health practitioner in which power is shared, the life experiences, views and cultural beliefs of the patient are respected, and Aboriginal histories and associated social impacts are acknowledged. Cultural safety is consistent with the principles of patient centered care. According Jowsey, T. (2019), the premises of cultural safety are participation, protection, and partnership which are addressed in the suggested strategies and thus these can be applied to different cultural contexts with amendments in execution depending on different cultural requirements.

The panel discussion outlined some of the good strategies like how health practitioners can build rapport with Aboriginal patients by striking a conversation about their land and origin, talking about their community and identifying common grounds that can enhance the bond and close the gap. If we ponder over how does a good health system look like to an Aboriginal patient, we can certainly create an environment where they can easily seek help and make it look less daunting and foreign and also help them in self-management when they are discharged.

References:

American Geriatrics Society Expert Panel on Person‐Centered Care, Brummel‐Smith, K., Butler, D., Frieder, M., Gibbs, N., Henry, M., … & Saliba, D. (2016). Person‐centered care: A definition and essential elements. Journal of the American Geriatrics Society, 64(1), 15-18.

Duff, D., Jesudason, S., Howell, M., & Hughes, J. T. (2018). A partnership approach to engage Aboriginal and Torres Strait Islander peoples with clinical guideline development for chronic kidney disease. Renal Society of Australasia Journal, 14(3), 84.

Jowsey, T. (2019). Three zones of cultural competency: surface competency, bias twilight, and the confronting midnight zone. BMC medical education, 19(1), 306.

Nguyen, H. T. (2008). Patient centred care: cultural safety in indigenous health. Australian family physician, 37(12), 990.